The adsorption process was spontaneous and exothermic, be well fitted by the apparent second-order kinetic model and dominated by chemical interaction. Pd/SiO2@GO-1.0 had a good solvent elution regeneration performance.The novel sulfomethylated lignin-grafted-polyacrylic acid (SL-g-PAA) hydrogel was fabricated in this work via a facile and green synthetic strategy for the efficient removal of heavy metal ions from wastewater, and then successively reused for chemiluminescence (CL). The sulfomethylation of lignin was first performed to improve its water solubility and introduce numerous active sites for adsorption of heavy metal ions. The as-synthesized SL-g-PAA hydrogel with high content of lignin exhibited the highly efficient and rapid removal of various metal ions from simulated wastewater. More importantly, the spent hydrogel (M2+@SL-g-PAA) after adsorption was reused for the first time to develop a new CL system by an ingenious strategy, in which these metal ions adsorbed on M2+@SL-g-PAA act as heterogeneous catalytic sites to catalyze the CL reaction between N-(4-aminobutyl)-N-ethylisoluminol (ABEI) and H2O2. The resultant CL system displayed high CL intensity and long duration time, which could be observed by naked eye in the dark and lasted for > 24 h. The combination of facile fabrication process, renewable raw materials, and ingenious strategy for successive application in adsorption and CL endows this lignin-based composite hydrogel with a great potential for application in wastewater treatment, biological imaging and cold light sources.The particulate matter (PM) in livestock houses, one of the primary sources of atmospheric PM, is not only detrimental to the respiratory health of animals and farmworkers but also poses a threat to the public environment and public health and warrants increased attention. In this study, we investigated the variation in the pulmonary microbiome and metabolome in broiler chickens exposed to PM collected from a broiler house. We examined the pulmonary microbiome and metabolome in broilers, observing that PM induced a visible change in α and β diversity. A total of 66 differential genera, including unclassified_f_Ruminococcaceae and Campylobacter, were associated with pulmonary inflammation. Untargeted metabolomics was utilised to identify 63 differential metabolites induced by PM and correlated with differential bacteria. We observed that PM resulted in injury of the broiler lung and disruption of the microbial community, as well as causing changes in the observed metabolites. These results imply that perturbations to the microbiome and metabolome may play pivotal roles in the mechanism underlying PM-induced broiler lung damage.Pollution emitted from power plants, including a considerable amount of fly ash (FA) and carbon dioxide (CO2), annually increases and is challenging from an environmentally friendly and sustainable point of view. To date, laboratory-scaled approaches cannot efficiently replace the FA-landfilling and mitigate the stress from CO2 emission. Here, a practically operatable fundamental work by combining carbonated FA (C-FA)-immobilizing CO2 in FA-and polypropylene (PP) matrix is reported and reveals abnormal mechanical and thermal features clarified by calculating van der Waals (vdW) interaction from an atomic scale. This is the first study wherein the interaction between instantaneous dipole moment-induced PP and fillers is simulated and examined. The vdW interactions at the (hetero)interfaces are -59.66, -82.30, and -224.39 kJ mol-1 Å-2 for PP, calcium oxide (CaO; before carbonation), and calcium carbonate (CaCO3; after carbonation), respectively, which provides concrete theoretical support for interesting findings such as the independence of tensile strength on filler loadings and „well-grown” interface-induced higher conductivity characteristics of the composites. Therefore, this work can offer practical solutions to mitigate pollution, provide a new perspective on fundamental physical interactions, and guide the development of practical next-generation composite materials.Inherently safer design is the most proactive approach to manage risk, as referred by scientists and experts. Researchers have adopted various methods in evaluating inherent safety indices like parameter-based indexing, risk-based indexing, consequence-based indexing, etc. However, the existing approaches have their limitations. The present paper focuses on establishing an inherent system safety index (ISSI) to evaluate inherently safer design during the concept development stage. The analysis starts by identifying a non-harmful system’s inherent safety characteristics and related parameters. Four subindexes, determined from the non-harmful system’s characteristics, are established using their relevant parameters. The safety of the chemical process system, the health of workers, and the environment’s safety can be assured by selecting relevant parameters. Parameters are scored based on their deviation from the non-harmful condition. The sum of the deviations of the parameters gives the value of the inherent safety index. The case study looks at various routes of Methyl Methacrylate (MMA). According to the present case study, MMA production followed by Tertiary butyl alcohol is the safest route given health, safety, and environmental perspective. This approach helps overcome the limitation of parameter-based indexing, which arises from selecting predefined fixed parameters that become invalid in case of system variation or significant modification of the system. Besides, it considers the complexity and vulnerability that arises from the interaction of various factors|, which increase predetermined risk calculated at the design stage when the system is in operation. The subindices can be used individually if a focus is needed in a definite section of a system with a particular application or a smaller portion. This method is helpful for the industry in designing a safer plant considering the health, safety, and environmental perspective at the concept development stage.The co-management of different wastewater matrices can lead to synergistic effects in terms of pollutants removal. Here, the co-treatment of real municipal wastewater (MWW) and acid mine drainage (AMD) is comprehensively examined. Under the identified optimum co-treatment condition, i.e., 15 min contact time, 17 AMD to MWW liquid-to-liquid ratio, and ambient temperature and pH, the metal content of AMD (e.g., Al, Fe, Mn, Zn) was grossly (~95%) reduced along with sulphate (~92%), while MWW’s phosphate content was practically removed (≥99%). The PHREEQC geochemical model predicted the formation of (oxy)-hydroxides, (oxy)-hydro-sulphates, metals hydroxides, and other mineral phases in the produced sludge, which were confirmed using state-of-the-art analytical techniques such as FE-SEM-EDS and XRD. The key mechanisms governing pollutants removal include dilution, precipitation, co-precipitation, adsorption, and crystallization. Beneficiation and valorisation of the produced sludge and co-treated effluent could promote resource recovery paradigms in wastewater management. Overall, the co-treatment of AMD and MWW appear to be feasible, yet not practical due to the excessive volume of MWW that is required to attain the desired treatment quality. Future research could focus on chemical addition for the control of the pH and the use of (photo)-Fenton for enhancing treatment efficiency.Bio-heavy oil (BHO) is a renewable fuel, but its efficient use is problematic because its combustion may emit hazardous air pollutants (e.g., polycyclic aromatic hydrocarbon (PAH) compounds, NOx, and SOx). Herein, catalytic fast pyrolysis over HZSM-5 zeolite was applied to upgrading BHO to drop-in fuel-range hydrocarbons with reduced contents of hazardous species such as PAH compounds and N- and S-containing species (NOx and SOx precursors). The effects of HZSM-5 desilication and linear low-density polyethylene (LLDPE) addition to the feedstock on hydrocarbon production were explored. The apparent activation energy for the thermal decomposition of BHO was up to 37.5% lowered by desilicated HZSM-5 (DeHZSM-5) compared with HZSM-5. Co-pyrolyzing LLDPE with BHO increased the content of drop-in fuel-range hydrocarbons and decreased the content of PAH compounds. The DeHZSM-5 was effective in producing drop-in fuel-range hydrocarbons from a mixture of BHO and LLDPE and suppressing the formation of N- and S-containing species and PAH compounds. The DeHZSM-5 enhanced the hydrocarbon production by up to 58.5% because of its enhanced porosity and high acid site density compared to its parent HZSM-5. This study experimentally validated that BHO can be upgraded to less hazardous fuel via catalytic fast co-pyrolysis with LLDPE over DeHZSM-5.

Nasal myiasis is a nasal infestation caused by house fly larvae (maggot). It’s a rare condition with only a few reported cases and no treatment consensus.

A 54-year-old woman was admitted to the emergency unit with a complaint of larvae found in the left nasal cavity and bloody nasal discharge for 2days. Anterior rhinoscopy found some living larvae in a narrowed left nasal cavity. Patient’s management included larvae removal manually with forceps, nasal saline irrigation, a systemic broad-spectrum antibiotic, and insulin to controlled blood sugar.

Removal of larvae in the nasal cavity using irrigation saline and systemic broad-spectrum antibiotics is effective in the absence of bone destruction.

manual extraction combined with nasal saline irrigation and systemic broad-spectrum antibiotic was effective to manage nasal myiasis.

manual extraction combined with nasal saline irrigation and systemic broad-spectrum antibiotic was effective to manage nasal myiasis.

Rectal gastrointestinal stromal tumors (GISTs) are rare, and preserving anorectal function can be challenging. We report the case of a patient with rectal GIST with external anal sphincter invasion, treated via the laparoscopic and transanal approaches.

A 61-year-old man with locally advanced GIST in the right anterolateral wall of the lower rectum was examined. Lower endoscopy revealed a 50-mm submucosal tumor located 4cm from the anal verge. On immunohistochemistry, the biopsy specimen tested positive for CD34 and C-KIT, and the patient was diagnosed with GIST. Abdominal magnetic resonance imaging (MRI) revealed external anal sphincter infiltration. Because of the large tumor size and proximity to the anal verge, preserving the anus was challenging, and colorectal resection was avoided. Instead, neoadjuvant therapy with imatinib was administered to facilitate local resection of the tumor. Post-treatment MRI showed a reduction in tumor size (30×20×30mm), and surgery was performed. We identified an appropriate resection line for diplomatic sphincter resection of the infiltrated area by laparoscopy alone. Thus, we performed a hybrid surgery using the laparoscopic and transanal approaches. The patient had an unremarkable postoperative course and was discharged on postoperative day 23.

No study has reported cases of rectal GIST with external anal sphincter invasion wherein anal function was preserved. Here, imatinib was administered preoperatively, and hybrid surgery was performed using the transanal and laparoscopic approaches.

Preoperative treatment and surgery preserved anorectal function in a patient with a massive rectal GIST.

Preoperative treatment and surgery preserved anorectal function in a patient with a massive rectal GIST.

Thoracic endovascular aortic repair (TEVAR) is the first treatment option for many thoracic aortic pathologies. Especially after aortic dissections, it is possible to have progression during follow-up with appearance of new lesions on arterial wall. Herein, we report a case of Penetrating Aortic Ulcer (PAU) post release of Thoracic endoprosthesis.

A 67-years-old male with hypertension and diabetes mellitus was followed at our hospital after an emergency procedure for Type B aortic dissection (TBAD) complicated by symptomatic large infrarenal AAA and treated with a proximal TEVAR plus chimney for left subclavian artery and PETTICOAT with EVAR for abdominal aortic disease. Follow up at 15months showed a deep PAU with partial crush of stent in Left Subclavian Artery. Thus, we performed a left carotid-subclavian bypass and subsequently a TEVAR procedure with release of Bolton Relay endoprosthesis (Terumo Aortic, Sunrise, Florida, United States).

In literature there are few studeis that focus on migration after TEVAR during follow-up. Elongation, changes of tortuosity on thoracic aorta after TEVAR, can help to determine a migration of prosthesis. In this case Bolton Relay endoprosthesis (Terumo Aortic, Sunrise, Florida, United States) has permitted to improve precision and quality of procedure.

In literature there are few studies reporting complications of TEVAR post prosthesis migration. In this case, Bolton Relay endoprosthesis was useful and safe.

In literature there are few studies reporting complications of TEVAR post prosthesis migration. In this case, Bolton Relay endoprosthesis was useful and safe.

The concurrent existence of Omphalocele and Meckel’s diverticulum is not unheard of but is relatively uncommon. A few cases of their coexistence have been reported. Due to the uncommon dual presentation, it is easy to delay or even miss the diagnosis, delaying management. Meckel’s diverticulum should be considered if there is a bowel opening on an omphalocele.

Herein we present a newborn male baby who was referred to us presenting with an omphalocele that was leaking faeces. The baby also had a cleft lip and palate. He was born at term to a 30-year-old mother whose pregnancy was otherwise normal. The fistulated omphalocele was surgically repaired, and the child continued to do well.

Omphalocele and Meckel’s diverticulum are both relatively rare congenital malformations that are uncommonly present together. Other congenital malformations can be associated; hence thorough investigations should be carried out when resources are available. The search for associated malformation should not delay the management of the pathology as it can have serious consequences on the health and outcome of the child.

Fistulation of Meckel’s diverticulum on an Omphalocele is rare. Treatment involves surgical resection and repair. Though other co-morbidities should be investigated, investigation for cause and other co-morbidities should not delay surgery.

Fistulation of Meckel’s diverticulum on an Omphalocele is rare. Treatment involves surgical resection and repair. Though other co-morbidities should be investigated, investigation for cause and other co-morbidities should not delay surgery.

Carotid artery stenting (CAS) has been indicated as an alternative to carotid endarterectomy in high risk patients. Sometimes, an aortic arch can be anatomically unfavourable for CAS. Herein we report our experience in a case of CAS with transcervical approach.

A 77-year-old male was referred to our hospital for severe subtotal occlusion of the left internal carotid artery. He had a past medical history of radiation to the head and neck for laryngeal cancer. Previous CT-angiography had shown a type III aortic with bovine arch. CAS via transcervical approach was performed with transitory reversal flow during the placement of RX Spider Filter 6 Fr (Medtronic, Minneapolis, MN). After release of 7×30mm RX Xact carotid stent (Abbott Vascular, Chicago, IL) and ballooning with a 5.5×30mm Rx Submarine balloon catheter (Medtronic Minneapolis, MN), angiography check showed a good result.

The transcervical approach is an innovative technique where usually a shunt is created, either between the common carotid artery and the internal jugular vein or between the common carotid artery and the common femoral vein. This flow reversal reduces the risk of periprocedural embolic events. In our experience a short proximal clamping with transitory reversal flow, reduces the invasiveness of procedure with good outcomes.

Transcervical carotid access with transitory reversal flow is a valid alternative in complicated patient with anatomy unfit for CAS.

Transcervical carotid access with transitory reversal flow is a valid alternative in complicated patient with anatomy unfit for CAS.

The Clinical Care Classification (CCC) system is one of the standard nursing terminologies recognized by the American Nurses Association, developed to describe nursing care through electronic documentation in different healthcare settings. The translation of the CCC system into languages other than English is useful to promote its widespread use in different countries and to provide the standard nursing data necessary for interoperable health information exchange. The aim of this study was to translate the CCC system from English to Italian and to test its clinical validity.

A translation with cross-cultural adaptation was performed in four phases forward-translation, back-translation, review, and dissemination. Subsequently a pilot cross-mapping study between nursing activities in free-text nursing documentation and the CCC interventions was conducted.

All elements of the CCC system were translated into Italian. Semantic and conceptual equivalences were achieved. Altogether 77.8% of the nursing activities were mapped into CCC interventions.

The CCC system, and its integration into electronic health records, has the potential to support Italian nurses in describing and providing outcomes and costs of their care in different healthcare settings. Future studies are needed to strengthen the impact of the CCC system on clinical practice.

The CCC system, and its integration into electronic health records, has the potential to support Italian nurses in describing and providing outcomes and costs of their care in different healthcare settings. Future studies are needed to strengthen the impact of the CCC system on clinical practice.

Replication of prediction modeling using electronic health records (EHR) is challenging because of the necessity to compute phenotypes including study cohort, outcomes, and covariates. However, some phenotypes may not be easily replicated across EHR data sources due to a variety of reasons such as the lack of gold standard definitions and documentation variations across systems, which may lead to measurement error and potential bias. Methicillin-resistant Staphylococcus aureus (MRSA) infections are responsible for high mortality worldwide. With limited treatment options for the infection, the ability to predict MRSA outcome is of interest. However, replicating these MRSA outcome prediction models using EHR data is problematic due to the lack of well-defined computable phenotypes for many of the predictors as well as study inclusion and outcome criteria.

In this study, we aimed to evaluate a prediction model for 30-day mortality after MRSA bacteremia infection diagnosis with reduced vancomycin susceptibilinging, often due to the limited availability of validated computable phenotypes. On the other hand, it is often possible to derive proxy computable phenotypes that can be further validated and calibrated.

Despite the rich information in EHR data, replication of prediction models involving complex predictors is still challenging, often due to the limited availability of validated computable phenotypes. On the other hand, it is often possible to derive proxy computable phenotypes that can be further validated and calibrated.

Prior to COVID-19, levels of adoption of telehealth were low in the U.S., though they exploded during the pandemic. Following the pandemic, it will be critical to identify the characteristics that were associated with adoption of telehealth prior to the pandemic as key drivers of adoption and outside of a public health emergency.

We examined three data sources The American Telemedicine Association’s 2019 state telehealth analysis, the American Hospital Association’s 2018 annual survey of acute care hospitals and its Information Technology Supplement. Telehealth adoption was measured through five telehealth categories. Independent variables included seven hospital characteristics and five reimbursement policies. After bivariate comparisons, we developed a multivariable model using logistic regression to assess characteristics associated with telehealth adoption.

Among 2923 US hospitals, 73% had at least one telehealth capability. More than half of these hospitals invested in telehealth consultation servi drive adoption, and promote equity.

Clinicians rely on pharmacologic knowledge bases to answer medication questions and avoid potential adverse drug events. In late 2018, an artificial intelligence-based conversational agent, Watson Assistant (WA), was made available to online subscribers to the pharmacologic knowledge base, Micromedex®. WA allows users to ask medication-related questions in natural language. This study evaluated search method-dependent differences in the frequency of information accessed by traditional methods (keyword search and heading navigation) vs conversational agent search.

We compared the proportion of information types accessed through the conversational agent to the proportion of analogous information types accessed by traditional methods during the first 6months of 2020.

Addition of the conversational agent allowed early adopters to access 22 different information types contained in the 'quick answers’ portion of the knowledge base. These information types were accessed 117,550 times with WA during the study period, compared to 33,649,651 times using traditional search methods. The distribution across information types differed by method employed (c

test, P<.0001). Single drug/dosing, FDA/non-FDA uses, adverse effects, and drug administration emerged as 4 of the top 5 information types accessed by either method. Intravenous compatibility was accessed more frequently using the conversational agent (7.7% vs. 0.6% for traditional methods), whereas dose adjustments were accessed more frequently via traditional methods (4.8% vs. 1.4% for WA).

In a widely used pharmacologic knowledge base, information accessed through conversational agents versus traditional methods differed. User-centered studies are needed to understand these differences.

In a widely used pharmacologic knowledge base, information accessed through conversational agents versus traditional methods differed. User-centered studies are needed to understand these differences.

Splenic artery pseudoaneurysms (PSA) are relatively rare but associated with high mortality/morbidity when presenting acutely. Embolization has emerged as the treatment of choice. We aim to evaluate the outcomes of embolization for the treatment of splenic artery PSAs.

From 2007 to 2019, all patients that underwent embolization for splenic artery PSAs were included in this IRB-approved review. Evaluated outcomes included complications, morbidity/mortality rates, and 30-day white blood cell count. Student t-tests were performed to compare laboratory values before and after embolization. 5-year survival rates were estimated using Kaplan Meier methodology.

A retrospective analysis of 24 patients (14 males, mean age 51±19years) who underwent splenic artery PSA embolization was performed. Fifteen PSA embolizations were performed in an emergent setting. There was technical success in 23/24 patients. Etiologies included trauma (10), pancreatitis (9), post-surgical (3), and malignancy (2). Post-embolization patients had a mean length of stay of 19days and within 30days, 9 patients developed leukocytosis (median of 14,800/μl). The 5-year survival rate of these patients was 89% [95% CI 75% – 100%]. Post-procedure, 4 patients developed grade 2 complications. Grade 3 complications were observed in 5 patients. One (4.2%) splenic abscess was identified. Of the 19 patients with follow-up imaging, 14 patients had splenic infarcts (5 infarcts were >50% of splenic volume).

Splenic artery PSAs are encountered in the emergent setting and are most frequently secondary to trauma or pancreatitis. Embolization can be life-saving in these critically ill patients.

Splenic artery PSAs are encountered in the emergent setting and are most frequently secondary to trauma or pancreatitis. Embolization can be life-saving in these critically ill patients.

To evaluate the incidence of knee bone marrow edema-like signal and its changes before and after running a half marathon running in asymptomatic amateur marathon runners to explore the impact of the half marathon on knee bone marrow edema-like signal.

50 asymptomatic amateur marathon runners (30 males, 20 females) were recruited. T1-weighted imaging (T1WI), fat-suppressed protein density weighted imaging (fs-PDWI) and three-dimensional double-echo steady-state (3D-DESS) sequence on the right knee were performed before and within 3h after a half-marathon running. 20 healthy volunteers were recruited as control. According to the whole-organ magnetic resonance imaging score (WORMS) system, the involvement of bone marrow edema-like signal in 15 regions of knee was graded from 0 to 3. The results were classified and Mann Whitney U test was used for comparison between groups.

The total incidence of bone marrow edema-like signal in amateur marathon group was 62%. Among them, the incidence of grade 1-3 was 48% (24/50), 12% (6/50), 2% (1/50), respectively, which was statistically significant compared with the controls (P=0.007). There was no significant difference between gender before running (P=0.172) and after running (P=0.162). There was no significant difference before and after running (P>0.05). However, 3 subjects showed new lesions, 8 subjects showed progression and 4 subjects showed decreased signal.

The occurrence of knee bone marrow edema-like signal in amateur marathon runners is more common. The lesions of bone marrow edema-like signal will show aggravation or improvement in a certain extent after the half marathon.

The occurrence of knee bone marrow edema-like signal in amateur marathon runners is more common. The lesions of bone marrow edema-like signal will show aggravation or improvement in a certain extent after the half marathon.Patients with multiple sclerosis (MS) who present coronavirus disease 2019 (COVID-19) are of particular interest to neurologists. These patients have a neuroimmune disease and receive immunomodulatory or immunosuppressive therapies in the long-term. We present here data from 73 patients with MS and a confirmed diagnosis of COVID-19 from five Latin American countries. Fifteen patients (20.5%) were hospitalized and two patients died. The use of anti-CD20 therapies was the only risk factor associated to hospitalization and death. Despite the small sample size, this study highlights the awareness regarding therapeutic options for MS during the pandemic.

Biotin may activate the acetyl-CoA-, 3-methylcrotonyl-CoA-, propionyl-CoA-, and pyruvate carboxylases to increase myelin repair and/or synthesis, and may enhance the production of adenosine triphosphate (ATP), which may be essential to prevent neurodegeneration. The purpose of this review was to determine the effectiveness and safety of high-dose biotin (HDB) in multiple sclerosis via a systematic review of randomized controlled trials.

We searched the following electronic databases for relevant articles MEDLINE, CENTRAL, EMBASE, Scopus, and ClinicalTrials.gov website until April 2021. We considered randomized clinical trials (RCTs) that involved adult patients diagnosed with any phenotype of multiple sclerosis that conforms with the McDonald 2010/2017 criteria or the Lublin 2014 criteria. We included studies employing high-dose biotin or „MD1003” administered orally for at least 300 mg/day and given for at least three months. The methodological quality assessment of the included studies was done using th of evidence suggesting an increased incidence of laboratory test interference when HDB is taken.

A moderate certainty of evidence suggests a potential benefit in favor of HDB administered for 12 to 15 months in terms of ITW25 in patients with PMS. However, an important trade-off of this benefit is the high certainty of evidence suggesting an increased incidence of laboratory test interference when HDB is taken.

Therapeutic plasma exchange (TPE) is considered a treatment option for steroid-refractory multiple sclerosis (MS) relapses. Our objective was to assess long-term clinical response to TPE in MS steroid-refractory exacerbations.

Retrospective study of relapsing remitting MS (RRMS) patients presenting intravenous methylprednisolone (IVMPS)-refractory relapses, who underwent TPE. Response to TPE was assessed at 1, 3, 6, 12 and 24-months post-treatment, and compared to a second group of RRMS patients with similar demographic and clinical characteristics presenting, IVMPS-refractory relapses but not treated with TPE. Multivariate regression analysis was used to assess potential predictors of significant clinical response.

Between 2011 to 2020, a total of 23 RRMS patients were treated with TPE. Twenty-one patients not receiving the treatment served as controls. No differences in demographic or clinical characteristics, or predictors of clinical improvement after TPE were detected between groups. Seventy-eight percent of patients treated with TPE presented clinical improvement at 24 months. TPE-treated patients presented lower EDSS scores at 6 and at 24 months. Younger age, presence of gadolinium-enhancing lesions and TPE treatment were associated with better clinical outcomes. No life-threatening side effects were reported.

TPE is a safe and well tolerated procedure that decreases long-term disability in RRMS patients with IVMPS-refractory relapses.

TPE is a safe and well tolerated procedure that decreases long-term disability in RRMS patients with IVMPS-refractory relapses.Background Theory of mind (ToM) is one of the several different concepts in social cognition and is defined as the ability to access the mental states of others or to adopt the point of view of others. Although studies have shown that ToM is impaired in people with multiple sclerosis (MS), the results based on individual ToM tasks are conflicting; some studies have shown deficits only in the 'Reading the Mind in the Eyes’ Test (RMET), while others have reported poor performance in the Faux Pas Test (FPT) as well as RMET. Furthermore, little is known about the relationship between ToM performance and neuroanatomical characteristics in MS. This study investigated ToM impairment and its relationship to regional brain volume or cortical thickness in people with MS. Methods This cross-sectional study included 20 participants with relapse-onset MS and 27 age- and sex-matched volunteers as healthy controls (HC). All the participants underwent neuropsychological (NP) tests as well as ToM tasks, including RMET and FPTicantly associated with the volume of two subcortical structures as well as the thickness of ten cortical areas, suggesting that FPT is an appropriate task to access ToM performance in MS.

The detailed data concerning multiple sclerosis (MS) epidemiology in Poland are based on studies from few and less populated provinces. Therefore, we evaluated MS incidence and prevalence in Poland using electronic administrative health claims (AHCs) from the National Health Fund.

We retrospectively analyzed the AHC financial database collected from 2009 to 2019, encompassing all patients using public health resources. Three different algorithms for identification of MS cases were used based on studies performed in German population (type 1), tested in the United States (type 2), and one created for the purpose of this study (type 3) that required at least 3 AHCs since 2009 with G35 ICD-10 diagnosis in outpatient specialist care, during hospitalization, and/or at rehabilitation service in any combination within maximally 3 years between the first and the last AHC, and provided that at least one AHC was either in neurological outpatient care or during hospitalization at a neurological ward or prescription reported and similar to the numbers shown for central European countries.

Multiple sclerosis incidence and prevalence in Poland are higher than previously reported and similar to the numbers shown for central European countries.

Evidence supports that cannabinoids reduce self-reported spasticity and neuropathic pain in people with MS (PwMS), and legal access to cannabis for medical and recreational use continues to rise. However, there are limited data regarding patterns of cannabis use and perceived benefits of cannabis among PwMS in the US. This study describes the prevalence of cannabis use, routes of administration, perceived benefit of cannabis for MS, and characteristics associated with cannabis use and perception of benefit among a population of PwMS living in two states where cannabis is legal for both medical and recreational use.

A survey about treatments used by PwMS, focusing on complementary and alternative medicine (CAM), was sent to PwMS living in Oregon and Southwest Washington. This survey included questions about current and past cannabis use, route of cannabis administration, and perceived benefits, as well as personal demographics.

Of the 1188 returned surveys, 1000 had at least 75% complete survey responsesy by multiple routes of administration, and most of these people report this being helpful for their MS. People who were younger, had lower household income, had progressive disease, and had more than minimal disability were more likely to use cannabis and report it was beneficial for their MS. People who were not using disease modifying therapies were also more likely to report benefit from cannabis use.Some drugs and medications can precipitate immune system deregulations, which might be confused with recurrent demyelinating diseases, such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMO), exacerbations of an existing disease, neoplastic lesions or other conditions. In this narrative review we describe some of the most relevant drugs and medications associated with iatrogenic demyelination. The anthelminthic agent levamisole is a frequent cocaine adulterant and can precipitate an exacerbated immune response attacking the central nervous system (CNS). High-efficacy multiple sclerosis (MS) drugs might induce a selective CNS immunosuppression, making it susceptible for opportunistic infections that course with demyelination, such as progressive multifocal leukoencephalopathy. Sometimes, the interruption of a high-efficacy drug to treat MS can induce a rapid CNS reentry of lymphocytes, exacerbating demyelinating processes and triggering rebound syndromes. Furthermore, selective cytokines inhibition, such as anti-TNFα agents, might induce an imbalance between cell death and proliferation inducing a paradoxical increase of CNS tumor necrosis factor (TNF), affecting the activity of lymphocytes, microglia and macrophages, triggering aberrant inflammation and demyelination. Immune checkpoint inhibitors are a new class of antineoplastic drugs that enhance the immune response against tumor cells by an upregulation of T-cell activity. However, this hyperactivation of the immune system might be associated with induction of unwanted autoimmune responses. In this paper we review the risk factors, the possible pathological mechanisms and the magnetic resonance imaging (MRI) findings of these drug-related demyelinating syndromes.

There is scarce epidemiological data on Multiple Sclerosis (MS) in Latin America. National epidemiological studies are needed to guide the health policy related to MS.

To determine MS national prevalence in Peru and describe clinical and epidemiological characteristics of the disease.

We conducted a cross-sectional prevalence study in Peru’s four largest regions using two sources. We included adult patients diagnosed with MS by a neurologist using the McDonald criteria. We performed a capture-recapture analysis using the nearly unbiased estimator model, and calculated prevalence as the proportion of the adult Peruvian population in 2016. Additionally, we summarized patients epidemiological and clinical characteristics.

We identified 417 cases 135 from the first source and 282 from the one. We found a point prevalence of 9.12 cases per 100 000 inhabitants (95% CI 5.6 – 12.6). The age range was 35 to 45 years-old, and 51.9% were female. The most common type of MS was relapsing-remitting (79.3%) and the most frequent treatment was subcutaneous IFN-1b (40.7%).

Peru has a medium MS prevalence compared to other Latin American countries. Lima is the region with the highest number of cases, with similar clinical characteristics to other countries in the region.

Peru has a medium MS prevalence compared to other Latin American countries. Lima is the region with the highest number of cases, with similar clinical characteristics to other countries in the region.

This study examined the degree of interruptions experienced by emergency department nurses and related factors.

This study is a descriptive survey using standardized observation tools. A total of 23 nurses working in an emergency department participated in this study. Using a stopwatch over 120h, the degree of interruptions was investigated by measuring start and end times of tasks and interruptions. Factors related to interruptions were classified as communication, telephone calls, medical device alarms, changes in patient condition, and other factors.

The frequency of interruptions in the emergency department was 6.4 times per hour, and its percentage was 9.1%. The time required for actual nursing tasks of „counseling and education,” „safety,” and „patient nursing management and information management” were increased significantly due to interruptions. A primary factor in interruptions was communication with patients, families, and nurses. The longest duration and the highest frequency of interruptions occurred during medication tasks.

Communication with patients, families, and nurses was the highest factor related to interruptions. Nurses may cause interruptions and be subjected to interruptions simultaneously. Therefore, nurses in the emergency department should work with caution not to cause interruptions.

Communication with patients, families, and nurses was the highest factor related to interruptions. Nurses may cause interruptions and be subjected to interruptions simultaneously. Therefore, nurses in the emergency department should work with caution not to cause interruptions.

Cardiopulmonary resuscitation (CPR) skills decline rapidly and rescuers’ physical characteristics could impact on their performance. Our aim was to analyse the effects of deliberate practice using a feedback device (FD) on the CPR performance of nursing students prior to, immediately after, and three months after training, considering their physical characteristics.

Sixty nursing students participated in this randomized clinical trial (control group n=28; training group n=32). Their physical characteristics (weight, height, forced expiratory volume in 1s (FEV1)/forced vital capacity (FVC)% index, handgrip strength, and CPR position strength) were measured before starting the trial. The training group followed a CPR training programme based on deliberate practice, providing feedback on their performance using an FD. All participants were evaluated during two-minute CPR compression/ventilation cycles.

The training group showed an improved ability to perform chest compressions (F

=13.3; p<.001; ω

=0.17) and ventilations (F

=102.1; p<.001; ω

=0.63), improving their overall quality of CPR (F

=40.1; p<.001; ω

=0.40). The physical characteristics of the participants did not affect CPR performance in any study phase.

A structured training programme based on deliberate practice using an FD had a positive effect on the acquisition of CPR skills by participants, while their physical characteristics had no impact on performance.

A structured training programme based on deliberate practice using an FD had a positive effect on the acquisition of CPR skills by participants, while their physical characteristics had no impact on performance.

Emergency departments are faced with a high influx of patients presenting for various complaints. The aim of the present study was to assess the basic characteristics of elderly patients presenting to a rural hospital emergency department in inland Croatia in 2017.

Retrospective data collected from the Hospital Information System and by analysis of medical records on patients presenting to emergency department in 2017 were used in the study.

Study results indicated that a lower proportion of elderly individuals aged 65-74 were hospitalized following emergency department workup. A statistically significantly higher proportion of patients older than 74years was presented to ED due to various discomforts and diseases (ICD-10 group I; χ2=324.85; p<0.01) than due to cardiorespiratory diseases and acute abdomen (χ2=285.04; p<0.01).

Our findings highlight the need for a complex approach in care for elderly people, given that they are a fragile population with multiple comorbidities, chronic diseases, atypical symptoms, and often with cognitive and functional impairments.

Our findings highlight the need for a complex approach in care for elderly people, given that they are a fragile population with multiple comorbidities, chronic diseases, atypical symptoms, and often with cognitive and functional impairments.Elastic arteries are idealised as being incompressible orthotropic nonlinearly elastic cylinders. They are further idealised as being membranes in order to analyse the effect of the experimentally observed pre-stressing of arterial tissue on inflation. The pre-stress is modelled here using the opening-angle method. It is shown that there can be multiple unloaded states of arterial segments of Fung materials, suggesting the corresponding set of material parameters will not yield reliable predictions of arterial stress in three dimensions as there is no experimental evidence to support this non-uniqueness. It is also shown that the circumferential pre-strain has a simple magnifying scaling effect on the pressure-radial strain relation and on the axial force needed to maintain the membrane length during inflation; the effect of the axial pre-strain is more nuanced.An antibody-drug conjugate (ADC) is a promising therapeutic modality because selective and effective delivery of an anti-cancer drug is achieved by drug-conjugated antibody-targeting cancer antigen. Glypican 1 (GPC1) is highly expressed in malignant tumors, including pancreatic ductal adenocarcinoma (PDAC) and esophageal squamous cell carcinoma (ESCC). Herein, we describe the usefulness of GPC1-targeting ADC. Humanized anti-GPC1 antibody (clone T2) was developed and conjugated with monomethyl auristatin E (MMAE) via maleimidocaproyl-valine-citrulline-p-aminobenzyloxycarbonyl (mc-vc-PABC) linkers (humanized GPC1-ADC[MMAE]). Humanized GPC1-ADC(MMAE) inhibited the growth of GPC1-positive PDAC and ESCC cell lines via inducing cycle arrest in the G2/M phase and apoptosis in vitro. The binding activity of humanized GPC1-ADC(MMAE) with GPC1 was comparable with that of the unconjugated anti-GPC1 antibody. The humanized GPC1-ADC(MMAE) was effective in GPC1-positive BxPC-3 subcutaneously xenografted mice but not in GPC1-negative BxPC-3-GPC1-KO xenografted mice. To assess the bystander killing activity of the humanized GPC1-ADC(MMAE), a mixture of GPC1-positive BxPC-3 and GPC1-negative BxPC-3-GPC1-KO-Luc cells were subcutaneously inoculated, and a heterogenous GPC1-expressing tumor model was developed. The humanized GPC1-ADC(MMAE) inhibited the tumor growth and decreased the luciferase signal, measured with an in vivo imaging system (IVIS), which suggests that the suppression of the BxPC-3-GPC1-KO-Luc population. The humanized GPC1-ADC(MMAE) also inhibited the established liver metastases of BxPC-3 cells and significantly improved the overall survival of the mice. It exhibited a potent antitumor effect on the GPC1-positive PDAC and ESCC patient-derived xenograft (PDX) models. Our preclinical data demonstrate that GPC1 is a promising therapeutic target for ADC.Tremendous population growth and industrialization have increased energy consumption unprecedentedly. The depletion of fossil-based energy supplies necessitates the exploration of solar, geothermal, wind, hydrogen, biodiesel, etc. as a clean and renewable energy source. Most of these energy sources are intermittent, while bioelectricity, biodiesel, and biohydrogen can be produced using abundantly available organic wastes regularly. The production of various energy resources requires materials that are costly and affect the applicability at a large scale. Biomass-derived materials (biochar) are getting attention in the field of bioenergy due to their simple method of synthesis, high surface area, porosity, and availability of functional groups for easy modification. Biochar synthesis using various techniques is discussed and their use as an electrode (anodic/cathodic) in a microbial fuel cell (MFC), catalysts in transesterification, and anaerobic digestion for energy production are reviewed. Renewable energy production using biochar would be a sustainable approach to create an energy secure world.A novel experimental method based on the combination of bio-oil composition inversion and function fitting was purposed and verified for describing the componential evolution curves during the liquefaction of biomass pyrolysis vapors. The evolution curves of representative condensable components were fitted by linear and Slogistic function in the short, middle and long three condensing fields. Linear function exhibited a significant effectiveness for the description and prediction of low-boiling water and furfural and the relative deviations were no more than 5% between actual values in long condenser and predictive values from the elongation of curves in short and middle condensers. For high-boiling phenolic compounds, linear function failed to fit their evolutions in long condenser but Slogistic fitting remained effective despite the relative deviation increasing to about 10%. This investigation provided a unique and effective prediction method for the vapor evolution in industrial shell and tube heat exchanger according to laboratory-scale experiment.Waste activated sludge (WAS) can be treated using anaerobic digestion (AD) for biogas recovery and volume reduction. However, the poor digestibility and hydrolysis of WAS limit AD applications. The current study investigated the feasibility of applying calcium hypochlorite as a WAS pretreatment strategy to improve AD treatment efficiency using laboratory reactors. The results showed that pretreatment with 5 – 20% Ca(ClO)2 (total suspended solids basis) significantly enhanced WAS anaerobic digestibility, and led to significantly enhanced methane production rate and biomethane yield comparing to the AD of raw WAS (P 20%) reduced microbial activities, leading to slow release of dissolved organic compounds and prolonged methane production lag phase. In addition, high Ca(ClO)2 removed 82.7% of the initial phosphate by calcium-phosphate binding, reducing the phosphorus in liquid digestate.A study was designed to isolate cellulolytic bacteria from termite-gut and soil, optimizing their cellulase production to enhance biogas generation, using Lantana camara as a substrate. Out of 57 bacteria screened, two isolates DSB1 and DSB12, showed significant cellulolytic activity. 16S rRNA based methods identified these isolates as Microbacterium sp. and Arthrobacter sp. respectively. Maximum cellulase activity of 1.26 ± 0.044 U/ml and 1.31 ± 0.052 U/ml for DSB1 and DSB12 was observed at pH 7 and 7.2 under 35⁰C and 37⁰C, respectively. The L. camara biomass substrate with cow dung as an inoculum, bioaugmented with DSB1 and DSB12 separately, was tested for biogas production, producing 950 l/kg and 980 l/kg VS biogas with 57% and 60% methane, respectively. DSB1 and DSB12 revealed as potent cellulase producers that can be harnessed in the anaerobic digester for biomass conversion practices for enhanced biogas production.The study aimed to isolate a novel strain with heterotrophic nitrification and aerobic denitrification ability and evaluate the nitrogen removal characteristics. Results showed that Ochrobactrum anthropi HND19 could remove approximately 98.6% of NH4+-N (104.3 mg·L-1) and 97.6% of NO3–N (98.6 mg·L-1), and the removal rates achieved 4.28 and 4.01 mg-N/(L·h) by heterotrophic nitrification and aerobic denitrification. The optimal incubate conditions of strain HND19 were 120 rpm (shaking speed), 5 ‰ (salinity), 30 °C (temperature), 7.5 (C/N ratio) with sodium acetate as carbon resource. And the removal efficiency of the total nitrogen (TN) realized 73.4% under the optimal conditions. Functional genes (hao, napA, nirK, norB, and nosZ) involved in the nitrogen removal processes were successfully amplified from strain HND19. These findings indicate that the strain HND19 possesses great application feasibility in treating wastewater with high-intensity nitrogen.In the Middle East and North Africa, dates are a traditional and economically valuable crop, playing an essential role in people’s daily diets. Date fruit production and related processing industry generate a large quantity of waste; for illustration, the date juicing industry produces roughly 17-28% Date press cake (DPC), which is mainly discarded in open lands and drains. Considering the generation volume and the nutrient content of DPC, this organic by-product stream can be valorized through the production of a wide range of products with a great market appeal, such as volatile fatty acids, activated carbon, organic acids, etc. To provide an insight into the feasibility of the application DPC as a green precursor for various chemical and biological processes, the chemical and nutritional composition of dates and DPC, an overview of the date processing industries, and common practices conducted for DPC valorization addressed and thoroughly discussed, in this review.Effects of succinic acid (SA) in fed-batch feeding mode on astaxanthin and lipids biopoduction of Haematococcus pluvialis against abiotic stresses were explored. By comparison with the control, the initial addition of SA on day 0 increased the production of astaxanthin by 71.61%. More importantly, the maximum values of astaxanthin (35.88 mg g-1) and lipid (54.79%) contents were obtained after supplementation of SA on day 7. Meanwhile, under SA treatment, the chlorophyll, carbohydrate, and protein levels were reduced, but the intracellular levels of SA and reactive oxygen species (ROS), the transcription levels of astaxanthin and fatty acids biosynthesis-, and antioxidant system-related genes were increased. Furthermore, scaling-up cultivation in bioreactor further enhanced the astaxanthin productivity from H. pluvialis. Generally, this study proved the intermittent SA feeding method in fed-batch culture as a potent strategy that facilitated massive astaxanthin and lipids production in algae.