Enhanced green remediation and refinement disposal of electrolytic manganese residue using air-jet milling and horizontal-shaking leaching

The reclamation and reuse of electrolytic manganese residue (EMR) as a bulk hazard solid waste are limited by its residual ammonia nitrogen (NH4+-N) and manganese (Mn2+). This work adopts a co-processing strategy comprising air-jet milling (AJM) and horizontal-shaking leaching (HSL) for refining and leaching disposal of NH4+-N and Mn2+ in EMR. Results indicate that the co-use of AJM and HSL could significantly enhance the leaching of NH4+-N and Mn2+ in EMR. Under optimal milling conditions (50 Hz frequency, 10 min milling time, 12 h oscillation time, 400 rpm rate, 30 ℃ temperature, and solid-to-liquid ratio of 1:30), NH4+-N and Mn2+ leaching efficiencies were optimized to 96.73% and 97.35%, respectively, while the fineness of EMR was refined to 1.78 µm. The leaching efficiencies of NH4+-N and Mn2+ were 58.83% and 46.96% higher than those attained without AJM processing. The AJM used strong airflow to give necessary kinetic energy to EMR particles, which then collided and sifted to become refined particles. The AJM disposal converted kinetic energy into heat energy upon particle collisions, causing EMR phase transformation, and particularly hydrated sulfate dehydration. The work provides a fire-new and high-efficiency method for significantly and simply leaching NH4+-N and Mn2+ from EMR.

Innovative co-treatment technology for effective disposal of electrolytic manganese residue

Electrolytic manganese residue (EMR) stockpiles contain significant amounts of Mn2+ and NH4+-N which pose a risk of environmental pollution. For EMR safe disposal, an innovative approach is proposed that involves direct sodium silicate-sodium hydroxide (Na2SiO3-NaOH) collaborative technology. This approach utilises Na2SiO3 and NaOH as the solidifying agent and activator, respectively, to treat EMR without hazardous effects. The study also provides insights into the kinetics of Mn2+ leaching under the effect of Na2SiO3-NaOH. Leaching efficiency was determined by varying parameters such as stirring rate, reaction temperature, pH of the initial solution, Na2SiO3 concentration, and reaction time to investigate the efficacy of this method. The study indicates that the co-treatment technology of Na2SiO3-NaOH can achieve maximum solidification efficiencies of 99.7% and 98.2% for Mn2+ and NH4+-N, respectively. The process can successfully solidify Mn2+ by synthesising Mn(OH)2 and MnSiO3 in an alkaline environment under optimal conditions including stirring rate of 450 rpm, initial solution pH of 8, test temperature of 40 °C, test time of 420 min, and Na2SiO3 content of 5%. The findings of this study have confirmed that surface chemistry plays a vital role in regulating the test rate and the proposed equation accurately describes Mn2+ leaching kinetics. Overall, the co-treatment technology involving Na2SiO3-NaOH is a viable solution for EMR resource utilisation without compromising environmental safety. This method has the potential to be implemented for other waste streams with comparable compositions, ultimately promoting the sustainable management of waste.

[The association between Helicobacter pylori virulence factor genotypes and gastroduodenal diseases in children]

Objective: To investigate the association between Helicobacter pylori (Hp) virulence factor genotypes and the degree and activity of gastric mucosa pathological changes in pediatric gastroduodenal diseases. Methods: This retrospective cohort study was conducted from May 2020 to October 2020. The frozen strains of Hp, which were cultured with the gastric mucosa of 68 children with gastroscopy confirmed gastroduodenal diseases who visited the children's hospital of Zhejiang University School of Medicine from April 2012 to December 2014, were resuscitated. After extracting DNA from these Hp strains, PCR amplification and agarose gel electrophoresis were performed to determine the detection rate of cytotoxin-associated protein A (cagA),vacuolating cytotoxin A (vacA)(s1a、s1b/s2,m1/m2), outer inflammatory protein A (oipA),blood group antigen binding adhesin (babA),duodenal ulcer promoting protein A (dupA) genes; oipA genes were sequenced to determine the gene status. The patients were divided into different groups according to the findings of gastroscopy and gastric mucosa pathology. The detection rates of various virulence factor genotypes among different groups were compared using χ2 tests or Fisher's exact tests. Results: The 68 Hp strains all completed genetic testing. According to the diagnostic findings of gastroscopy, the 68 cases were divided into 47 cases of superficial gastritis and 21 cases of peptic ulcer. Regarding the pathological changes of gastric mucosa, 8 cases were mild, and 60 cases were moderate and severe according to the degree of inflammation; 61 cases were active and 7 cases inactive according to the activity of inflammation. The overall detection rates of cagA, vacA, vacA s1/m2, functional oipA, babA2, and dupA virulence factor genes were 100% (68/68), 100% (68/68), 94% (64/68), 99% (67/68), 82% (56/68), and 71% (48/68), respectively. In the superficial gastritis group, their detection rates were 100% (47/47), 100% (47/47), 96% (45/47), 98% (46/47), 81% (38/47), and 70% (33/47), respectively; in the peptic ulcer group, their detection rates were 100% (21/21), 100% (21/21), 90% (19/21), 100% (21/21), 86% (18/21), and 71% (15/21), respectively. There was no statistically significant difference between the two groups (all P>0.05). In the mild gastric mucosa inflammation group, the detection rates of the above six genotypes were 8/8, 8/8, 8/8, 7/8, 7/8, and 5/8, respectively; and in the moderate to severe inflammation groups, the detection rates were 100% (60/60), 100% (60/60), 93% (56/60), 100% (60/60), 82% (49/60), and 72% (43/60), respectively, with no statistically significant difference between the two groups (all P>0.05). In the active inflammation group, the detection rate of six genotypes were 100% (61/61), 100% (61/61), 93% (57/61), 98% (60/61), 82% (50/61), and 72% (44/61), respectively; and in the inactive inflammation group, they were 7/7, 7/7, 7/7, 7/7, 6/7, and 4/7, respectively. Again, there was no statistically significant difference between the two groups (all P>0.05). There was no statistically significant difference in the detection rate of combinations of 4 or 5 virulence factor genes among the different groups (all P>0.05). Conclusions: CagA, vacA, vacA s1/m2, functional oipA, babA2, and dupA genes are not associated with superficial gastritis and peptic ulcer in children, or with the degree and activity of gastric mucosa pathological inflammation. Different gene combinations of cagA, vacA, oipA, babA2, and dupA have no significant effects on predicting the clinical outcome of Hp infection in children.

[The relationship between genetic polymorphism of CYP2C19 and the efficacy of Helicobacter pylori eradication therapy in children]

Objective: To investigate the relationship between genetic polymorphisms of cytochrome P450 2C19 (CYP2C19) and the efficacy of Helicobacter pylori (Hp) eradication therapy in children. Methods: The retrospective cohort study was conducted on 125 children with gastroscopy and positive rapid urease test (RUT) from September 2016 to December 2018 who presented to the Children's Hospital of Zhejiang University School of Medicine due to gastrointestinal symptoms including nausea, vomiting, abdominal pain, bloating, acid reflux, heartburn, chest pain, vomiting blood and melena. Hp culture and drug susceptibility test were carried out with gastric antrum mucosa before treatment. All the patients completed 2 weeks of standardized Hp eradication therapy and had ¹³C urea breath test 1 month after that, which was used to evaluate the curative effect. The DNA of gastric mucosa after RUT was analyzed and CYP2C19 gene polymorphism was detected. Children were grouped according to metabolic type. Combined with the results of Hp culture and drug susceptibility, the relationship between CYP2C19 gene polymorphism and the efficacy of Hp eradicative treatment was analyzed in children. Chi square test was used for row and column variables, and Fisher exact test was used for comparison between groups. Results: One hundred and twenty five children were enrolled in the study, of whom 76 were males and 49 females. The genetic polymorphism of CYP2C19 in these children found poor metabolizer (PM) of 30.4% (38/125), intermediate metabolizer (IM) of 20.8% (26/125), normal metabolizer (NM) of 47.2% (59/125), rapid metabolizer (RM) of 1.6% (2/125), and ultrarapid metabolizer (UM) of 0. There were statistically significant in positive rate of Hp culture among these groups (χ²=124.00, P<0.001). In addition, the successful rates of Hp eradication in PM, IM, NM and RM genotypes were 84.2% (32/38), 53.8% (14/26), 67.8% (40/59), and 0, respectively, with significant differences (χ²=11.35, P=0.010); those in IM genotype was significantly lower than that in PM genotype (P=0.011). With the same standard triple Hp eradicative regimen, the successful rate of Hp eradication for IM type was 8/19, which was lower than that of PM (80.0%, 24/30) and NM type (77.3%, 34/44) (P=0.007 and 0.007, respectively). There was a significant difference in the efficacy of Hp eradication treatment among different genotypes (χ²=9.72, P=0.008). According to the clarithromycin susceptibility result, the successful rate of Hp eradication treatment for IM genotype was 4/15 in the sensitive group and 4/4 in the drug-resistant group (χ²=6.97, P=0.018). Conclusions: The genetic polymorphism of CYP2C19 in children is closely related to the efficacy of Hp eradication treatment. PM has a higher successful rate of eradication treatment than the other genotypes.

Deep insight into green remediation and hazard-free disposal of electrolytic manganese residue-based cementitious material

This work presents an innovative approach to developing a low-carbon and hazard-free cementitious material (EGC) by activating ground granulated blast-furnace slag (GGBS) with electrolytic manganese residue (EMR), which has an excellent heavy metal solidified capacity. Herein, the multi-step leaching was creatively conducted to investigate the solidified morphology of heavy metals in hazardous EMR. CO₂ emission per unit strength factor was calculated to quantitatively analyze the low-carbon degree. The results show that the added hazardous EMR rich in sulfate and the dilution effect caused by the decrease in GGBS lessen the final setting time and fluidity. Low-temperature calcination (200 °C) alters the dissolution rate of ettringite and AFm-like phases by changing the sulfate crystal. Excessive acidic EMR consumes more calcium hydroxide and lowers the pH of the EGC system, resulting in weakened GGBS activity. The formation of jouravskite, thaumasite, and henritermierite are AFm-like hydrated lamellated structures, which provides evidence for the immobilization of Mn²⁺ in EMR. Vast Mn²⁺ are embedded in the main interlayer of [Ca₂Al(OH)₆]⁺ by substituting Al to form AFm-like phase. The lowest 60d unit compressive strength carbon emission of the EGC system containing 20 % calcinated EMR is 0.78 kg∙MPa^-1∙m^-3, meaning the substitution barrier is better addressed by adding calcined EMR. This work provides an innovative solution for high value-added and hazard-free utilization for EMR and carbon reduction in the cement industry.

Feasibility of low-carbon electrolytic manganese residue-based supplementary cementitious materials

In this work, the electrolytic manganese residues (EMR) were used as sulfate activators for fly ash and granulated blast-furnace slag to fabricate highly reactive supplementary cementitious materials (SCMs). The findings promote the implementation of a win-win strategy for carbon reduction and waste resource utilisation. The effects of EMR dosing on the mechanical properties, microstructure and CO₂ emission of the EMR-doped cementitious materials are investigated. The results show that low dosing EMR (5 %) produced more ettringite, fostering early strength development. The fly ash-doped mortar strength increases and then decreases with the addition of EMR from 0 to 5 % to 5-20 %. It was found that blast furnace slag contributes less to strength than fly ash. Moreover, the sulfate activation and the micro-aggregate effect compensate for the EMR-induced dilution effect. The significant increase in strength contribution factor and direct strength ratio at each age verifies the sulfate activation of EMR. The lowest EIF₉₀ value of 5.4 kg∙MPa^-1∙m³ was achieved for the fly ash-doped mortar with 5 % EMR, suggesting the synergistic effect between fly ash and EMR optimised the mechanical properties while maintaining lower CO₂ emissions.

The Mechanical Characteristics of High-Strength Self-Compacting Concrete with Toughening Materials Based on Digital Image Correlation Technology

Brittle fracture is a typical mechanical characteristic of high-strength self-compacting concrete, and the research on its toughening modification remains the highlight in the engineering field. To understand the effect of toughening materials (including polymer latex powders, rubber particles, and polyethylene fibers) on the mechanical behavior of C80 high-strength self-compacting concrete under static loading, the failure mode, mechanical strength, strain field, and crack opening displacement (COD) of prepared high-strength self-compacting concrete under compressive, splitting, and flexural loads were studied based on digital image technology (DIC). The corresponding mechanism is also discussed. The results show that the hybrid of polymer latex powders, rubber particles, and polyethylene fibers can increase the crack path and inhibit the development of macrocracks in concrete, thus turning the fracture behavior of concrete from brittle to ductile. The addition of toughening materials reduced the compressive and flexural strengths of high-strength self-compacting concrete, but it increased the splitting strength. DIC showed that the incorporation of toughening materials promoted the redistribution of strain and reduced the degree of strain concentration in high-strength self-compacting concrete. The evolution of COD in high-strength self-compacting concrete can be divided into two stages, including the linear growth stage and the plastic yield stage. The linear growth stage can be extended by incorporating toughening materials. The COD and energy absorption capacity of concrete were enhanced with the addition of toughening materials, and the best enhancement was observed with the hybrid of polymer latex powders, rubber particles, and polyethylene fibers. Overall, this research provides a reference for exploring effective technical measures to improve the toughness of high-strength self-compacting concrete.

Properties and Microstructural Characteristics of Manganese Tailing Sand Concrete

In this work, manganese tailing sand concrete (MTSC) was prepared using manganese tailing sand (MTS) in replacement of river sand (RS) to alleviate the shortage of RS resources and achieve clean treatment and high-value resource utilization of manganese tailing stone. The effects of MTS content on the slump, mechanical strength, air void characteristics, hydration products and micromorphology of MTSC were studied experimentally. The leaching risk of harmful substances in MTSC was also explored by testing the concentration of Mn²⁺. The results show that the utilization of MTS reduces the slump of MTSC to a certain extent. When the MTS content is lower than 40%, the gypsum introduced by MTS and C₃A in cement undergoes a hydration reaction to form ettringite, which decreases the number of pores with a diameter less than 0.1 mm and promotes strength development in MTSC. Additionally, when the MTS content exceeds 40%, the large amount of gypsum reacts to form more ettringite. The expansive stress generated by the ettringite severely damages the pore structure, which is not conducive to the mechanical properties of MTSC. In addition, the leaching of hazardous substances in MTSC is insignificant, and the incorporation of cement can effectively reduce the risk of leaching hazardous substances in MTSC. In summary, it is completely feasible to use MTS to replace RS for concrete preparation when the substitution rate of MTS is less than 40%, with no risk of environmental pollution. The results and adaptation in the concrete industry can reduce the carbon footprint, which is in line with the current trend in civil and materials engineering.

AB1426 PREDICTORS OF RHEUMATIC TOXICITIES OF IMMUNE CHECKPOINT INHIBITORS AND CANCER OUTCOMES IN PATIENTS WITH ADVANCED MELANOMA

Background

Immune checkpoint inhibitors (ICIs) including monoclonal antibodies to PD-1 and CTLA-4 have activity across various cancers. Dedicated cohort studies have examined the epidemiology and clinical course of rheumatic toxicities (1–3) and the effect of pre-existing autoimmune disease has been explored (4), with limited assessment of the effect of non-immune mediated rheumatic disease (3). A positive association between ICI-induced rheumatic disease and favourable cancer outcomes has been suggested (1,2), although derived from heterogenous cancer populations.

Objectives

To identify risk factors for the development of ICI-induced rheumatic disease and predictors of cancer outcomes in patients with advanced melanoma.

Methods

A single-centre observational study of patients with stage III or IV melanoma receiving all available ICI therapies, who completed a for-purpose questionnaire to capture rheumatic symptoms and risk factors upon recruitment and at 12-months. Symptom severity was assessed according to patient reported measures such as visual analogue scale (VAS) scores for pain. Clinical details were extracted from patients’ medical records. Predictors of rheumatic toxicities and cancer outcomes were identified through regression analysis.

Results

Amongst 147 eligible patients, the prevalence of new or worsening rheumatic symptoms was 32.5% at recruitment and 21% at 12 months. The incidence of documented arthralgia, inflammatory arthritis and PMR-like syndrome was 39.5%, 5.4% and 3.4% respectively. Binary logistic regression identified pre-existing symptomatic rheumatic disease, including non-immune mediated rheumatic disease, as the primary risk factor for developing rheumatic toxicities (OR 3.161). Continuation of ICI therapy (OR 16.52), followed by rheumatic toxicities (OR = 4.368) were predictors of favourable tumour response.

Conclusion

Rheumatic toxicities of ICI therapy commonly affect patients with melanoma and are more likely to occur in patients with pre-existing autoimmune and non-immune mediated rheumatic disease. Continuation of ICI therapy improves cancer outcomes and can be facilitated by early detection of rheumatic symptoms using patient reported outcome measures.

Table 1.

Bivariate logistic regression of predictors of patient-reported rheumatic toxicity. Sig., Significance; OR, Odds ratio; CI, confidence interval; BRAF/MEK, BRAF and MEK inhibitors; PD-1, Programmed Cell Death protein – 1; CTLA-4, Cytotoxic T-lymphocyte-associated protein.

Figure 1.

A) Receiver-operator curve for accuracy of binary logistic regression model clinician-recorded rheumatic disease. (B) Area under receiver-operator curve. Test result variable(s): predicted probability. AUROC, Area Under Receiver-Operator Curve; Std. Error, Standard Error; Sig., Significance.

(a) Under the nonparametric assumption

(b) Null hypothesis: true area = 0.5

References

[1]Kostine M, Rouxel L, Barnetche T, Veillon R, Martin F, Dutriaux C, et al. Rheumatic disorders associated with immune checkpoint inhibitors in patients with cancer-clinical aspects and relationship with tumour response: a single-centre prospective cohort study. Ann Rheum Dis. 2018;77(3):393–8.

[2]Braaten TJ, Brahmer JR, Forde PM, Le D, Lipson EJ, Naidoo J, et al. Immune checkpoint inhibitor-induced inflammatory arthritis persists after immunotherapy cessation. Ann Rheum Dis. 2019;332–8.

[3]Buder-Bakhaya K, Benesova K, Schulz C, Anwar H, Dimitrakopoulou-Strauss A, Weber TF, et al. Characterization of arthralgia induced by PD-1 antibody treatment in patients with metastasized cutaneous malignancies. Cancer Immunol Immunother. 2018;67(2):175–82.

[4]Menzies AM, Johnson DB, Ramanujam S, Atkinson VG, Wong ANM, Park JJ, et al. Anti-PD-1 therapy in patients with advanced melanoma and preexisting autoimmune disorders or major toxicity with ipilimumab. Ann Oncol. 2017;28(2):368–76.

Disclosure of Interests

Alana Bruce: None declared, Alexander Menzies Consultant of: A.M.M. has participated in advisory boards for BMS, MSD, Novartis, Roche, Pierre-Fabre, Georgina Long Consultant of: GVL is consultant advisor for Aduro Biotech Inc, Agenus Inc, Amgen Inc, Array Biopharma inc, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb, Evaxion Biotech A/S, Hexel AG, Highlight Therapeutics S.L., Merck Sharpe & Dohme, Novartis Pharma AG, OncoSec, Pierre Fabre, QBiotics Group Limited, Regeneron Pharmaceuticals Inc, Specialised Therapeutics Australia Pty Ltd., Brian Fernandes: None declared, Fredrick Joshua Consultant of: F.J. has performed clinical trials and participated in advisory boards for Abbvie, Pfizer, Novartis, Sanofi, Eli Lily and Roche

Water treatment sludge conversion to biochar as cementitious material in cement composite

Water treatment sludge was successfully thermally converted to obtain biochar as a stable material with resource potential. This research explored the application of sludge biochar as a supplementary cementitious material. The cement paste samples incorporating different amounts of sludge biochar were prepared, hardened, and analyzed for performance. The results show an improvement in hydration kinetics and mechanical properties of cement paste incorporating biochar, compared to raw sewage sludge. The mineralogical, thermal and microscopic analyses show evidence of pozzolanic activity of the biochar. The samples with 2% and 5% biochar showed higher heat release than the reference material. Specimens with 1%, 2% and 5% biochar showed a slightly higher compressive strength at 28 days compared to the reference material. Sludge conversion to biochar will incur an estimated cost of US$398.23/ton, which is likely to be offset by the substantial benefits from avoiding landfill and saving valuable cementitious materials. Therefore, this research has demonstrated that through conversion to biochar, water treatment sludge can be promoted as a sustainable and alternative cementitious material for cement with minimum environmental impacts, hence contributing to circular economy.

A Comparative Study on the Mechanical Properties and Microstructure of Cement-Based Materials by Direct Electric Curing and Steam Curing

Direct electric curing (EC) is a new green curing method for cement-based materials that improves the early mechanical properties via the uniform high temperature produced by Joule heating. To understand the effects of EC and steam curing (SC) on the mechanical properties and microstructure of cement-based materials, the mortar was cured at different temperature-controlled curing regimes (40 °C, 60 °C, and 80 °C). Meanwhile, the mechanical properties, hydrates and pore structures of the specimens were investigated. The energy consumption of the curing methods was compared. The results showed that the EC specimens had higher and more stable growth of mechanical strength. The hydration degree and products of EC samples were similar to that of SC samples. However, the pore structure of EC specimens was finer than that of SC specimens at different curing ages. Moreover, the energy consumption of EC was much lower than that of SC. This study provides an important technical support for the EC in the production of energy-saving and high early-strength concrete precast components.

A Review on Bubble Stability in Fresh Concrete: Mechanisms and Main Factors

In order to improve the stability of air bubbles in fresh concrete, it is of great significance to have a better understanding of the mechanisms and main influencing factors of bubble stability. In the present review, the formation and collapse process of air bubbles in fresh concrete are essentially detailed; and the advances of major influencing factors of bubble stability are summarized. The results show that the surface tension of air-liquid interface exerts a huge impact on bubble stability by reducing surface free energy and Plateau drainage, as well as increasing the Gibbs surface elasticity. However, surface tension may not be the only determinant of bubble stability. Both the strength of bubble film and the diffusion rate of air through the membrane may also dominate bubble stability. The application of nano-silica is a current trend and plays a key role in ameliorating bubble stability. The foam stability could be increased by 6 times when the mass fraction of nano-particle reached 1.5%.

Observation of A Raman mode splitting in few layer black phosphorus encapsulated with hexagonal boron nitride

We investigate the impact of encapsulation with hexagonal boron nitride (h-BN) on the Raman spectrum of few layer black phosphorus. The encapsulation results in a significant reduction of the line width of the Raman modes of black phosphorus, due to a reduced phonon scattering rate. We observe a so far elusive peak in the Raman spectra ∼4 cm^-1 above the A mode in trilayer and thicker flakes, which had not been observed experimentally. The newly observed mode originates from the strong black phosphorus inter-layer interaction, which induces a hardening of the surface atom vibration with respect to the corresponding modes of the inner layers. The observation of this mode suggests a significant impact of h-BN encapsulation on the properties of black phosphorus and can serve as an indicator of the quality of its surface.

Paediatric CT dose: a multicentre audit of subspecialty practice in Australia and New Zealand

OBJECTIVES

To evaluate paediatric CT dosimetry in Australia and New Zealand and calculate size-specific dose estimates (SSDEs) for chest and abdominal examinations.

METHODS

Eight hospitals provided data from 12 CT systems for 1462 CTs in children aged 0-15. Imaging data were recorded for eight examinations: head (trauma, shunt), temporal bone, paranasal sinuses, chest (mass) and chest HRCT (high-resolution CT), and abdomen/pelvis (mass/inflammation). Dose data for cranial examinations were categorised by age and SSDEs by lateral dimension. Diagnostic reference ranges (DRRs) were defined by the 25th and 75th percentiles. Centralised image quality assessment was not undertaken.

RESULTS

DRRs for 201 abdominopelvic SSDEs were: 2.8-4.7, 3.6-11.5, 8.5-15.0, 7.6-15, and 10.6-16.2 for the <15 cm, 15-19 cm, 20-24 cm, 25-29 cm and >30 cm groups, respectively. For 147 chest examinations using these body width categories, SSDE DRRs were 2.0-4.4, 3.3-7.9, 4.0-9.4, 4.5-12, and 6.5-12. Kilovoltage peak (kVp), but not AEC or IR, was associated with SSDE (parameter estimate [standard error]: 0.12 (0.03); p < 0.0001).

CONCLUSIONS

Australian and New Zealand paediatric CT DRRs and abdominal SSDEs are comparable to international data. SSDEs for chest examinations are proposed. Dose variations could be reduced by adjusting kVp.

KEY POINTS

• SSDEs can be calculated for all patients, CT systems, and practices • Kilovoltage peak (kVp) has the greatest association with dose in similar-sized patients • Paediatric DRRs for CT are now available for use internationally.

Wearing a crotch strap on a correctly fitted lifejacket improves lifejacket performance

Wearing a lifejacket when immersed in water should support the wearer, maintaining their airway clear of the water. It is proposed that a retention system would improve airway protection by improving retention of the lifejacket around the torso. Study one (n = 10) quantified the performance of lifejackets immediately following a step into water from height when a lifejacket was worn with a crotch strap (two different tightness) and without a crotch strap. Airway freeboard was improved when wearing a crotch strap (P < 0.05) compared with no crotch strap. Study two used a manikin to examine the performance of lifejackets with and without a crotch strap during 3-h exposures to waves. During exposure to waves, the time taken to aspirate the lethal dose of seawater for drowning was doubled when wearing a crotch strap compared with the no-crotch-strap conditions (P < 0.001). Therefore, wearing a crotch strap (functioning retention system) on a correctly fitted lifejacket improves airway protection following accidental immersion and prolonged wave exposure.

Histological and finite element analysis of cell death due to irreversible electroporation

Irreversible electroporation (IRE) has been shown to be an effective method of killing cells locally. In contrast to radiofrequency ablation, the mechanism by which cells are thought to die via IRE is the creation of pores in cell membranes, without substantial increase in tissue temperature. To determine the degree to which cell death is non-thermal, we evaluated IRE in porcine hepatocytes in vivo. Using pulse widths of 10μs, bursts of 3 kV square-wave pulses were applied through a custom probe to the liver of an anesthetized pig. Affected tissue was evaluated histologically via stainings of hematoxylin & eosin (H&E), nitroblue tetrazolium (NBT) to monitor cell respiration and TUNEL to gauge apoptosis. Temperature was measured during the application of electroporation, and heat transfer was modeled via finite element analysis. Cell death was calculated via Arrhenius kinetics. Four distinct zones were observed within the ring return electrode; heat-fixed tissue, coagulation, necrotic, and viable. The Arrhenius damage integral estimated complete cell death only in the first zone, where the temperature exceeded 70°C, and partial or no cell death in the other zones, where maximum temperature was approximately 45°C. Except for a limited area near the electrode tip, cell death in IRE is predominantly due to a non-thermal mechanism.

CathCam guide wire-directed colonoscopy: first pilot study in patients with a previous incomplete colonoscopy

BACKGROUND AND STUDY AIMS

Conventional colonoscopy as the gold standard for large-bowel diagnostics and therapy may fail in 5 %-20 % of cases, depending on the experience of the examiner. Colonoscopy is regarded as difficult and painful by many patients. In an attempt to overcome the limitations of conventional colonoscopes, a guide wire-directed, thin, flexible diagnostic colonoscope, the CathCam was developed. In this prospective pilot study, we report its use in patients in whom conventional colonoscopy had failed.

PATIENTS AND METHODS

49 patients with a previous or current failure of complete colonoscopy were invited to participate in a trial using the new CathCam system, and 14 (nine men; mean age 59 years) accepted. The CathCam is an 11-mm diameter disposable, multilumen catheter, with visualization by a 3-mm camera with six light-emitting diodes. In the first five patients, the CathCam was inserted over a newly developed 0.024-inch, hinged, lumen-seeking guide wire. Subsequently, a modified combined approach was used: a conventional colonoscope was introduced into the sigmoid or left colon, then the guide wire was advanced as far as possible, followed by CathCam insertion over it. Caecal intubation rate, insertion times and patient discomfort were recorded; patients received low-dose midazolam sedation (2-5 mg).

RESULTS

One patient was excluded during colonoscopy. The caecum could be eventually reached in 12 of 13 patients; in the remaining patient a significant sigmoid stricture could be passed, but further advancement appeared too risky. The mean caecal intubation time was 24 minutes (range 3-105 min). Only two patients experienced pain and discomfort during the procedure (one immediate assessment and one case reported at later telephone interview). No complications occurred, and previously undiagnosed important findings were obtained in 9 cases.

CONCLUSIONS

A combined approach, consisting of guide wire insertion via a partially introduced colonoscope followed by CathCam or colonoscope insertion into the caecum was successful in over 90 % of patients with previous failure of complete colonoscopy. Further improvements may make this system suitable for use as a standard diagnostic colonoscope, either as a single unit (CathCam plus guide wire) or using the guide wire alone with a standard colonoscope in difficult cases.

Right internal carotid pseudoaneurysm mimicking a retropharyngeal abscess in a child

A 7-year-old girl with tonsillar infection with antibiotics. Two weeks later, there was a right sided neck lump. Computed tomography scans demonstrated a predominantly hypodense right retropharyngeal area with peripheral enhancement and mass effect. There was intense enhancement within the postero-superior aspect of the lesion which was continuous with the right internal carotid artery. Ultrasound demonstrated tapering of the right internal carotid artery. Magnetic resonance imaging and magnetic resonance arteriography showed a right internal carotid artery pseudoaneurysm. Surgical exploration confirmed the finding. This case highlights an unusual presentation of an internal carotid pseudoaneurysm and how imaging provided the diagnosis.

Temperature trends in total hip arthroplasty: a retrospective study

The purpose of this study was to define the temporal trend in body temperature of patients during the first 5 days after total hip arthroplasty (THA). The medical records of 98 consecutive THAs were reviewed, 88 clinically uncomplicated cases were included. The average maximum temperature reached during the study period was 38.08 degrees C, a 3.7% (P< or =.01) increase from the preoperative base line of 36.64 degrees C. In this study, 62.5% of patients reached a temperature > or =38.0 degrees C; 19.3% > or = 38.5 degrees C; and 3.4% > or = 39.0 degrees C. No patients had a preoperative temperature of > or =38 degrees C recorded. On the first postoperative day, 39 patients had a temperature > or =38 degrees C. The number of febrile patients progressively decreased until by the fifth postoperative day, only 5 patients had a temperature > or =38 degrees C recorded.

Chloroform: exposure estimation, hazard characterization, and exposure-response analysis

Chloroform has been assessed as a Priority Substance under the Canadian Environmental Protection Act. The general population in Canada is exposed to chloroform principally through inhalation of indoor air, particularly during showering, and through ingestion of tap water. Data on concentrations of chloroform in various media were sufficient to serve as the basis for development of deterministic and probabilistic estimates of exposure for the general population in Canada. On the basis of data acquired principally in studies in experimental animals, chloroform causes hepatic and renal tumors in mice and renal tumors in rats. The weight of evidence indicates that chloroform is likely carcinogenic only at concentrations that induce the obligatory precursor lesions of cytotoxicity and proliferative regenerative response. Since this cytotoxicity is primarily related to rates of formation of reactive, oxidative metabolites, dose response has been characterized in the context of rates of formation of reactive metabolites in the target tissue. Results presented here are from a "hybrid" physiologically based pharmacokinetic (PBPK) animal model that was revised to permit its extension to humans. The relevant measure of exposure response, namely, the mean rate of metabolism in humans associated with a 5% increase in tumor risk (TC05), was estimated on the basis of this PBPK model and compared with tissue dose measures resulting from 24-h multimedia exposure scenarios for Canadians based on midpoint and 95th percentiles for concentrations in outdoor air, indoor air, air in the shower compartment, air in the bathroom after showering, tap water, and food. Nonneoplastic effects observed most consistently at lowest concentrations or doses following repeated exposures of rats and mice to chloroform are cytotoxicity and regenerative proliferation. As for cancer, target organs are the liver and kidney. In addition, chloroform has induced nasal lesions in rats and mice exposed by both inhalation and ingestion at lowest concentrations or doses. The mean rate of metabolism associated with a 5% increase in fatty cysts estimated on the basis of the PBPK model was compared with tissue dose measures resulting from the scenarios already described, and lowest concentrations reported to induce cellular proliferation in the nasal cavities of rats and mice were compared directly with midpoint and 95th percentile estimates of concentrations of chloroform in indoor air in Canada. The degree of confidence in the underlying database and uncertainties in estimates of exposure and in characterization of hazard and dose response are delineated.

Volumetric model determination of the tibia based on 2D radiographs using a 2D/3D database

We present a new concept with mathematical background for the construction of a three-dimensional (3D) volumetric model of the human tibia based on two conventional orthogonal two-dimensional (2D) radiographic images. This approach is supported by a computer database containing a collection of 80 2D/3D image data sets of individual cadaveric tibiae. For each of these tibiae, the database contains digitized 2D orthogonal radiographic images in both anterior and lateral views, and the corresponding 3D CT data obtained by computerized tomography. To obtain a 3D model of a tibia for a given patient, shape matching is performed. The computer finds the most similar tibia to the patient's tibia among the 2D radiographic images in the database by applying a matching process. To improve accuracy, a 2D image warping procedure can be applied on the slices of the selected bone prior to 3D reconstruction. The warping process is controlled by the contour data of the two orthogonal views. We found that the 3D model thus achieved was useful for virtual preoperative planning and for simulation of the internal fixation of long bones.

[The significance of nucleotide repeat sequences in FVIII gene for detecting hemophilia A carriers]

OBJECTIVE

To detect the carriers in hemophilia A(HA) families by haplotype analysis of the microsatellite polymorphisms at intron 13 [13(CA)n] and 22[22(GT)n(AG)n] in the factor VIII (FVIII) gene.

METHOD

Multi-PCR amplification of 13(CA)n and 22(GT)n(AG)n combined with silver staining were used.

RESULTS

In 35 HA families, 11 had HA history. There were 21 female members in the 11 HA families and all of them were subjected to molecular study. Fourteen of the 21 females were confirmed to be carriers and approximately 72.7%(8 of 11) of these families were informative.

CONCLUSIONS

Besides the reliable detection of HA carriers, multi-PCR combined with silver staining in HA analysis has the advantages of time saving, simplicity for performing and no radiation contamination.

Antibacterial agents based on the cyclic D,L-alpha-peptide architecture

The rapid emergence of bacterial infections that are resistant to many drugs underscores the need for new therapeutic agents. Here we report that six- and eight-residue cyclic d,l-alpha-peptides act preferentially on Gram-positive and/or Gram-negative bacterial membranes compared to mammalian cells, increase membrane permeability, collapse transmembrane ion potentials, and cause rapid cell death. The effectiveness of this class of materials as selective antibacterial agents is highlighted by the high efficacy observed against lethal methicillin-resistant Staphylococcus aureus infections in mice. Cyclic d,l-alpha-peptides are proteolytically stable, easy to synthesize, and can be derived from a potentially vast membrane-active sequence space. The unique abiotic structure of the cyclic peptides and their quick bactericidal action may also contribute to limit temporal acquirement of drug resistant bacteria. The low molecular weight d,l-alpha-peptides offer an attractive complement to the current arsenal of naturally derived antibiotics, and hold considerable potential in combating a variety of existing and emerging infectious diseases.

Isolated ventricular septal defect secondary to low-velocity blunt chest trauma

Damage to the ventricular septum resulting from low velocity blunt trauma to the anterior chest wall is a rarely reported disorder. We wish to report a case of an isolated large ventricular septal defect secondary to blunt chest trauma requiring urgent surgical repair in an otherWise healthy 19 year old male. The patient endured a long hospital stay complicated by repeated episodes of pulmonary oedema and ARDS but eventually made a good recovery.