Lanthanum Cerate Microspheres for Efficient Fluoride Removal from Wastewater

The performance of lanthanum cerate microspheres (LCM) at removing fluoride was analyzed in batch experiments after they were synthesized via the hydrothermal strategy. The ball-shaped microsphere morphology of LCM is confirmed by SEM and TEM. The synthesized LCM adsorbent showed excellent adsorption capacity in the pH range 3.0-7.0, with the optimal pH range being 3.5-4.5. The Langmuir adsorption model was more appropriate than the Freundlich model for describing the adsorption isotherm. The LCM adsorbent exhibited a significantly higher Langmuir adsorption capacity of 104.83 mg/g at pH 4.0, surpassing that of any other reported adsorbent. We investigated the adsorption of fluoride under a variety of conditions, including the presence of distinct anions. Furthermore, testing the adsorbent in actual groundwater demonstrated its high effectiveness in removing fluoride. Different useful analytical techniques were used for measurements and to learn and deduce the adsorption mechanism.

Synthesis and characterization of PANI-ZrWPO4 nanocomposite: adsorption-reduction efficiency and regeneration potential for Cr(VI) removal

A novel polyaniline zirconium tungstophosphate (PANI-ZrWPO4) nanocomposite was successfully synthesized through an in situ oxidative polymerization reaction followed by a microwave irradiation process. The synthesized nanocomposite was characterized by using FESEM, EDX, TEM, XRD, FTIR, Raman, TGA-DTA, XPS, and N2 adsorption-desorption analysis and chemical analysis to know about the formation of material. The results of the FTIR and Raman spectra confirmed that the conducting PANI polymer interacted with ZrWPO4 to form the PANI-ZrWPO4 nanocomposite. The XRD data showed that the composite had a crystalline nature. The TEM and FESEM images revealed that polyaniline had formed on the exterior of the PANI-ZrWPO4 nanocomposite. Further investigation was done on the efficiency of the PANI-ZrWPO4 nanocomposite as an adsorbent for Cr(VI) removal through batch adsorption experiments. The maximum Langmuir adsorption capacity of PANI-ZrWPO4 was found to be 71.4 mg g-1. The removal of Cr(VI) was optimized with the six variables namely adsorbent dose, initial concentration, Time, pH, Temperature, and stirring rate using the Box-Behnken design (BBD) model. The XPS spectra confirmed simultaneously adsorption reduction occurs Cr(VI) to Cr(III) through in situ chemical reduction. Moreover, the regeneration efficiency of PANI-ZrWPO4 was studied, and it was found to be able to remove around 80% of Cr(VI) even after five cycles, demonstrating its potential as an effective and reusable adsorbent.

A pilot study for development of a pulmonary function test induction jacket to automate effort in performing the forced vital capacity manoeuvre

The pulmonary function test (PFT) induction jacket was invented to make the process of performing the forced vital capacity (FVC) manoeuvre with a computerized spirometer effortless and productive for both the patient and the medical practitioner. The jacket is composed of three layers of PVC material sealed together to form a single jacket with two chambers. The inner chamber is formed between the inner layer and the middle layer, in which cold water at a temperature of 10 °C is circulated using a connected water unit when triggered. Similarly, the outer chamber is formed between the middle layer and the outer layer, in which air is pressurized using a connected air unit. Thirty volunteers performed the FVC manoeuvre with and without wearing the jacket. There was no difference between the results in spirometry parameters in the participants without a jacket and those with a jacket. However, use of the jacket significantly reduced the number of trials the participants had to undergo to perform spirometry. The jacket automated the FVC manoeuvre by triggering a physiological inspiratory gasp using cold water and circumscribing pressurized air for expiration. Additionally, subsequent advancements in the jacket have been suggested.

Prognostic implications of clinical phenotype and severity of cardiac involvement in patients presenting with immunoglobulin light chain amyloidosis

Background

Patients with systemic immunoglobulin light chain (AL) amyloidosis may present with a wide array of signs and symptoms due to the multi-systemic organ involved. The presence of cardiac involvement is the key determinant of survival. Cardiac magnetic resonance (CMR) has the unique ability to measure the continuum of cardiac amyloidosis (CA) infiltration providing a deep characterisation from early CA involvement to severe degree of CA burden.

Purpose

The aim of this study was to characterise the clinical profiles and the severity of organ involvement in patients presenting with AL amyloidosis and to investigate implications for long-term outcome.

Methods

Patients newly diagnosed with AL amyloidosis at the National Amyloidosis Centre underwent comprehensive clinical, laboratory and instrumental work up, including CMR imaging with left ventricular (LV) mass, late gadolinium enhancement (LGE) and extracellular volume (ECV). The clinical phenotypes were classified in cardiac, renal and other according to the symptoms at presentation. The degree of CA was investigated by CMR: 0= no features of CA (normal LV mass, no LGE and normal ECV); 1=early cardiac amyloid infiltration (normal LV mass, raised ECV no LGE); 2= characteristic of CA with normal mass (diffuse subendocardial or transmural LGE, altered gadolinium kinetics and raised ECV); 3= characteristic of CA with elevated mass (diffuse subendocardial or transmural LGE and raised ECV). The study outcome was all-cause mortality.

Results

The study population included 241 AL patients presenting with cardiac and renal (22.8%, n=55), cardiac (28.2%, n=68), renal (33.2%, n=80) and other (15.8% n=38) phenotypes. During a median follow up of 33 (IQR 7–52) months, cardiac phenotype either in isolation or in combination with renal phenotype was associated with a higher rate of all-cause mortality compared to the others (p<0.001) (Figure). On CMR imaging, 43.2% of patients without cardiac phenotype (49%, n=118/241) had characteristic scans of CA (CMR grade 2 and 3) whilst 13.8% of patients with cardiac phenotype (51%, n=123/241) had no features of CA on CMR images (CMR grade 0) in (p<0.001). With Kaplan Meier analysis, the risk of all-cause death increased in patients with characteristic features of CA on CMR scan (Figure 1) and in patients with cardiac phenotype and features of CA on CMR scans compared to the others (both p<0.001) (Figure). At multivariable analysis, age at diagnosis (hazard ratio [HR] 1.03, p=0.009), clinical phenotype at presentation (HR 1.35, p=0.014) and ECV measured by CMR (HR 56, p<0.001) emerged as independent prognostic parameters.

Conclusions

Patients with newly diagnosed AL amyloidosis present most frequently with renal and cardiac phenotypes. CMR detects CA in >40% of patients with non-cardiac phenotype. ECV is an independent predictor of all-cause mortality across the full clinical spectrum of AL amyloidosis.

Funding Acknowledgement

Type of funding sources: None.

Myocardial ischaemia in cardiac amyloidosis: a change of perspective

Introduction

Cardiac involvement is the main driver of clinical outcomes in systemic amyloidosis; however many clinical observations are not explained by the concept of replacement of the interstitium by amyloid material. Preliminary studies support the hypothesis that myocardial ischaemia contributes to cellular damage.

Purpose

This study assesses the presence and mechanisms of myocardial ischaemia using cardiovascular magnetic resonance (CMR) with multiparametric mapping and histopathological assessment.

Methods

Ninety-two patients with cardiac amyloidosis (CA) (AL = 41, ATTR = 51) and 97 without CA (3-vessel coronary disease (3VD) = 47, unobstructed coronary arteries = 26, healthy volunteers (HV) = 24) underwent quantitative stress perfusion CMR with myocardial blood flow (MBF) mapping. Twenty-six myocardial biopsies and 3 explanted hearts with CA were analysed histopathologically.

Results

Stress MBF was severely reduced in patients with CA with lower values than patients with 3VD, unobstructed coronary arteries and HV (CA = 1.03±0.51 ml/min/g, 3VD = 1.35±0.50 ml/min/g, Unobstructed coronaries = 2.92±0.52 ml/min/g, HV = 3.14±0.69 ml/min/g; CA vs 3VD p=0.008, CA vs Unobstructed coronaries p<0.001, CA vs HV p<0.001). After adjustment for intracellular volume the MBF in patients with CA remained significantly lower than in HV (stress MBF/ICV: AL = 2.24±1.12, ATTR = 2.22±0.93, HV = 4.38±1.06; AL vs. ATTR p=1.000, AL vs HV p<0.001, ATTR vs. HV p<0.001). Myocardial perfusion reserve (MPR) was severely reduced in CA patients, compared to HV and patients with unobstructed coronary arteries, with the degree of reduction being comparable only to patients with 3VD (CA = 1.55±0.60, 3VD = 1.54±0.51, unobstructed coronaries = 2.78±0.70, HV = 4.08±0.86; CA vs 3VD p=1.000, CA vs unobstructed coronary arteries p<0.001, CA vs. HV p<0.001). Myocardial perfusion abnormalities correlated with amyloid burden, systolic and diastolic function, structural parameters and blood biomarkers (p<0.05). Biopsies demonstrated diffuse hypoxia with abnormal VEGF staining in cardiomyocytes and endothelial cells. Amyloid infiltration in intramural arteries was associated with severe lumen reduction in 20% of vessels, and severe reduction in capillary density.

Conclusion

CA is associated with severe myocardial ischaemia demonstrable by histology and CMR stress perfusion mapping. Histological evaluation indicates a complex pathophysiology, where systolic and diastolic dysfunction, amyloid infiltration of the epicardial arteries and disruption and rarefaction of the capillaries play a role in contributing to myocardial ischaemia.

Funding Acknowledgement

Type of funding sources: None.

Changes in referral pathway and phenotypic status of patients diagnosed with ATTR cardiac amyloidosis during the past 20 years

Background

Diagnostic and therapeutic advances have led to much increased awareness of transthyretin (ATTR) cardiac amyloidosis (CA).

Purpose

We sought to characterise the impact of this on referral practice, cardiac phenotype at diagnosis and specifically to determine whether patients are now being diagnosed at an earlier stage in their disease process.

Methods

We studied 1845 patients diagnosed with ATTR-CA at the National Amyloidosis Centre (NAC) from 2002–2021, all of whom underwent deep clinical phenotyping and follow-up.

Results

Analysis by 5-year quartiles revealed a substantial incremental increase in patients diagnosed with ATTR-CA (35 vs 260 vs 704 vs 846), which was associated with greater proportions of patients referred following advanced cardiac imaging (referrals following cardiac magnetic resonance and bone scintigraphy: 3% vs 44% vs 67% vs 76%; P<0.001). Over time, median duration of symptoms prior to diagnosis diminished from 36-months between 2002–2006 to 12-months between 2017–2021 (P<0.001) and a greater proportion of patients presented with milder disease across the 5-yearly quartiles (NAC stage 1: 40% vs 43% vs 44% vs 57%; P<0.001). The latter was associated with more favourable echocardiographic parameters of structure and function, including an incremental reduction in maximal left ventricular wall thickness (18.26mm vs 17.41mm vs 17.09mm vs 16.68mm; P=0.017). This was associated with improved survival in the overall population (2007–2011 vs 2012–2016: HR=1.65, 95% CI [1.33–2.06]; P<0.001 and 2012–2016 vs 2017–2021: HR =1.83, 95% CI [1.45–2.31]; P<0.001) and in each genotype (wtATTR, T60A and V122I). Despite a significant increase in the proportion of patients enrolled into clinical trials (0.0% vs 0.0% vs 2.6% vs 23.9%; P<0.001) and prescribed disease modifying therapy (5.7% vs 0.4% vs 4.8% vs 13.5%; P<0.001); the improved survival remained significant even after adjusting for clinical trials and disease modifying therapy (2012–2016 vs. 2017–2021: HR=1.65 95% CI [1.29–2.11], P<0.001).

Conclusion

Increased awareness and advances in cardiac imaging have been associated with a substantial increase in the diagnosis of ATTR-CA and at a progressively earlier stage of the disease, which has contributed to improved survival in recent years. These changes may have important implications for initiation and outcome of therapy. Given that ATTR-CA is now being diagnosed earlier, more data are needed to guide decisions on in whom and when to initiate treatment, and which treatments should be used at each disease stage. Furthermore, the changes in ATTR-CA phenotype at diagnosis urgently need to be factored into clinical trial design, given that pre-determined end-points based on trials performed in the past may no longer be appropriate, or at least sufficiently powered, or of adequate duration to evaluate efficacy of novel agents.

Funding Acknowledgement

Type of funding sources: None.

Multi-imaging characterisation of cardiac phenotype in different types of amyloidosis

Background

Bone scintigraphy is extremely valuable when assessing patients with suspected cardiac amyloidosis (CA), but the clinical significance and associated phenotype of different degrees of myocardial tracer uptake across different types of amyloidosis is yet to be defined.

Purpose

We sought to define the phenotypes of patients with varying degrees of cardiac uptake on bone scintigraphy, across multiple types of systemic amyloidosis using extensive characterisation comprising of biomarkers, echocardiographic and cardiac magnetic resonance (CMR) imaging.

Methods

A total of 296 patients (117 immunoglobulin light-chain [AL] amyloidosis, 165 transthyretin [ATTR] amyloidosis, 7 apolipoprotein-A1-amyloidosis [AApoAI],and 7 apolipoprotein-A4-amyloidosis [AApoA4]) underwent deep characterisation of their cardiac phenotype.

Results

AL-amyloidosis patients with grade 0 myocardial radiotracer uptake spanned the spectrum of CMR findings from no evidence of CA to characteristic features of CA, while AL-amyloidosis patients with grade 1–3 always produced characteristic CMR features. In ATTR-amyloidosis the CA burden strongly correlated with myocardial tracer uptake (correlation between bone scintigraphy cardiac uptake and CMR derived extracellular volume: R=0.88, 95% CI [0.84–0.91], P<0.001), except in patients with the Ser77Tyr variant. AApoAI-amyloidosis presented with grade 0–1 myocardial tracer uptake, and unique features of disproportionate right sided involvement such as disproportionate right ventricular (RV) and right atrial uptake on bone scintigraphy, RV free wall thickening, and tricuspid valve thickening and dysfunction. Within our cohort, AApoAIV-amyloidosis always presented with grade 0 myocardial tracer uptake, and characteristic features of CA on CMR. All AL-amyloidosis patients with grade 1 myocardial tracer uptake had characteristic CMR features of CA (n=48, 100%), while only ATTR-amyloidosis grade 1 patients with the Ser77Tyr variant had characteristic features of CA on CMR (n=5, 11.4%). Following the exclusion of Ser77Tyr and AApoAI, a CMR showing characteristic features of CA or an extracellular volume >0.40 in a patient with grade 1 myocardial tracer uptake had a sensitivity and specificity of 100% for diagnosing AL-amyloidosis.

Conclusion

Deep characterisation of the cardiac phenotype in different types of amyloidosis, across a range of bone scintigraphy cardiac uptake grades has identified clear differences between each amyloidosis type. The distinctive characteristics in each cohort has allowed the development of a diagnostic pathway to help define the diagnostic differentials and the clinical phenotype in each individual patient, following comprehensive assessment with bone scintigraphy and CMR.

Funding Acknowledgement

Type of funding sources: None.

Mechanistic insight into the adsorption of mercury (II) on the surface of red mud supported nanoscale zero-valent iron composite

Recently, nanoscale zero-valent iron (nZVI) particles have been efficiently used in the remediation of many heavy metals, yet potential agglomeration and loss of nZVI remain a critical area of research. In this study, we used red mud as a stable supporting medium to develop red mud modified nZVI to form (RM-nZVI) composite. We assessed its sorptive/reductive removal of mercury (Hg²⁺) from aqueous solutions. The RM-nZVI was synthesized through the reduction of ferric iron by sodium borohydride (NaBH₄) in the presence of red mud. Morphological characterization of RM-nZVI confirmed its diffusion state with lesser aggregation. The RM-nZVI has the BET surface area, pore diameter, and pore volume as 111.59 m²g^-1, 3.82 nm, and 0.49 cm³g^-1, respectively. Adsorption of mercury (Hg²⁺) by RM-nZVI exhibits pH-dependent behavior with increased removal of Hg²⁺ with the increase in pH up to 5, and the removal rate decreased gradually as the pH increased from 5 to 10. Extensive characterization of RM-nZVI corroborated the evidence that the removal of Hg²⁺ was initially by rapid physical adsorption, followed by a reduction of Hg²⁺ to Hg⁰. The adsorption data were best fitted with Langmuir isotherm with R² (correlation coefficient) > 0.99 with high uptake capacity of 94.58 (mg g^-1). The novel RM-nZVI composite with enhanced sorptive and reductive capacity is an ideal alternative for removing Hg²⁺ from contaminated water.

Visible light active Zr- and N-doped TiO2 coupled g-C3N4 heterojunction nanosheets as a photocatalyst for the degradation of bromoxynil and Rh B along with the H2 evolution process

Herein, we drastically increased the l ight-harvesting abilities of TiO₂ by creating a defect level with doping using zirconium (Zr) and nitrogen (N). Titanium was substantially replaced by Zr from its lattice point, and N was bound on the surface as (NO)_x. The doped system comes with a reduced band edge of 2.8 eV compared to pure TiO₂ (3.2 eV), and the doping was accompanied by a higher rate of recombination of photogenerated electron-hole pairs. A heterostructure was fabricated between the modified titania and g-C₃N₄ to efficiently separate the carriers. An easy and cost-effective sol-gel process followed by a co-calcination technique was used to synthesize the nanostructured composite. The optimum dopant concentration and the extent of doping were investigated via XRD, Raman, XPS, TEM, and PL analyses, followed by a photocatalytic study. The impact of the band positions was investigated via UV-DRS and EIS. The dynamic nature of the band alignment at the depletion region of the heterojunction increased the carrier mobility from the bulk to active sites. The photogenerated electrons and holes retained their characteristic redox abilities to generate both OH˙ and O₂ ^-˙ through a z-scheme mechanism. The photocatalytic activity resulted in superior photocatalytic H₂ evolution along with the defragmentation of bromoxynil, a persistent herbicide. The active catalyst exhibited 97% degradation efficiency towards pollutants along with 0.86% apparent quantum efficiency during the H₂ evolution reaction.

Investigating the selectivity and interference behavior for detoxification of Cr(VI) using lanthanum phosphate polyaniline nanocomposite via adsorption-reduction mechanism

A novel Lanthanum phosphate polyaniline (LaPO₄-PANI) nanocomposite was synthesized by the simple sol-gel technique. The nanocomposite prepared at 1:1 ratio provided the highest ion exchange capacity and selective adsorption of Cr(VI). The phase composition and particle morphology of the as-prepared material was evaluated by XRD, FESEM and TEM analyses. The FTIR, Raman, and TGA data inferred the definite chemical interaction between the organic and inorganic counterparts in the formation of LaPO₄-PANI. The selective adsorption of Cr(VI) was estimated by evaluating the distribution coefficient, electrical double layer theory as well as valency and Pauling's ionic radii of interfering ions (phosphate, iodide, sulfate, chloride, sulfide). The high tolerance capability of LaPO₄-PANI against the interfering ions made it appropriate for selective and efficient removal of Cr(VI) ions from solutions. The nanocomposite showed the highest removal percentage of 98.6% towards Cr(VI) in a wide pH range of 2-6 at room temperature, as compared to sole lanthanum phosphate (56%) and polyaniline (75%). The XPS analysis revealed the adsorption mechanism due to the combined effect of both adsorption and reduction. Cr(VI) is adsorbed through electrostatic interactions while the = N-/-NH- group facilitated the in situ chemical reduction. The procured results make the LaPO₄-PANI nanocomposite a promising adsorbent for the removal of Cr(VI).

Facile synthesis of poly o-toluidine modified lanthanum phosphate nanocomposite as a superior adsorbent for selective fluoride removal: A mechanistic and kinetic study

This work reports the synthesis of a new adsorbent material (LaP-POT), synthesised by sol-gel polymerisation method from lanthanum phosphate (LaP) and poly o-toluidine (POT). The sustainability and selectivity of the material as a potential adsorbent is evaluated for the removal of fluoride from aqueous as well as real water samples using batch experimental techniques. FESEM and TEM images showed the successful incorporation of rod-shaped lanthanum phosphate into the poly o-toluidine polymer matrix. The increased degradation temperature of LaP-POT from TGA curve inferred a definite interaction between two. XPS study revealed the successful binding of fluoride onto LaP-POT. The selectivity of fluoride ion onto LaP-POT material was ascertained by the distribution coefficient value. The co-anions showed little effect on fluoride removal. Kinetic study suggested that intraparticle diffusion is not the only rate controlling step; the external mass transfer or chemical interaction also impacts the fluoride adsorption. The maximum adsorption was observed at room temperature with a maximum Langmuir uptake capacity of 10.94 mg g^-1. The reusability of the material is tested up to 5 successive cycles for a workable commercial application purpose. The results showed that LaP-POT provides more active sites, thus making it a promising adsorbent for the removal of fluoride.

Kendu (Diospyros melanoxylon Roxb) fruit peel activated carbon-an efficient bioadsorbent for methylene blue dye: equilibrium, kinetic, and thermodynamic study

In this work, activated carbon was synthesized by the carbonization of kendu fruit peel followed by chemical activation using ammonium carbonate as an activating agent to get modified kendu fruit peel (MKFP). The SEM and FESEM images of the biomaterial illustrated a highly porous honeycomb-like structure, further supported by the N₂ sorption isotherm analysis. The FTIR spectra specified the presence of oxygen-containing functional groups such as carboxyl, carbonyl, and hydroxyl on the adsorbent surface. Batch experiments were performed for the optimization of methylene blue (MB) dye removal. The adsorption process followed pseudo-second-order kinetic model and Langmuir isotherm model with a maximum adsorption capacity of 144.9 mg g^-1. No desorption was found because the adsorbent surface was bonded with the chromophoric group of the MB dye by means of strong chemical interaction evident from the high adsorption energy (E = 10.42 kJ mol^-1) and enthalpy change (∆H = 42.7 kJ mol^-1). Hence, the MKFP has the potential to act as an efficient bioadsorbent for MB dye removal. Graphical abstract.

0816 Sleep Correlates Of Nightmares Among Veterans

Introduction

There is an increased prevalence of Nightmare disorder (ND) among patients with obstructive sleep apnea (OSA). A further investigation of objectively measured sleep parameters among patients with and without ND could inform on potential comorbidities. We hypothesize ND correlates with Epworth sleepiness scale (ESS), apnea hypopnea index (AHI), Trough 02% (Sp02 nadir), and periodic limb movement (PLM) index.

Methods

Data presented herein are interim results from an IRB approved study to determine correlates and sequelae of nightmares. A cohort of all patients with ND visiting James A Haley Veterans Hospital between 2007 and 2011 was defined along with a random cohort of control patients. Demographic and outpatient visit data between January 2006 and April 2016 was pulled from VISTA for both the ND and control cohorts, and patients who had undergone a sleep study were identified. To date, sleep summary data has been individually extracted for 111 ND patients and 835 control patients. Logistic regression (SAS 9.4) was used to compare ESS, AHI, Sp02 nadir, and PLM Index.

Results

Mean age for ND was significantly lower at 49.7 ± 14, compared to 58.4 ± 12 for controls. Other demographic measures were similar including gender, race, and marital status. PLM index was significantly lower in ND compared to controls, however this relationship disappeared after adjusting for age. There were neither significant differences between other polysomnographic (PSG) variables, specifically AHI and Sp02 nadir, nor did OSA severity significantly different between ND and controls.

Conclusion

Among veterans undergoing a PSG, there were no significant differences between measured sleep parameters. Our results contradict our hypothesis that ND correlates with ESS, AHI, Sp02 nadir, and PLM index.

Support

This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.

Interactive Fe2O3/porous SiO2 nanospheres for photocatalytic degradation of organic pollutants: Kinetic and mechanistic approach

A uniformly distributed mesoporous silica nanospheres has been successfully synthesized. Silica nanospheres have been loaded with different content of Fe₂O₃ nanoparticles synthesized by the sol-gel process followed by calcination to form the Fe₂O₃ supported on silica nanospheres composite. The as-synthesized photocatalyst has been characterized for crystal structure, morphology, stability, surface area and also surface composition was determined. The photocatalytic oxidation ability of the composite photocatalyst was evaluated by degrading aqueous solutions of Methylene Blue and Congo red dyes under visible light having intense absorption in the wavelength range between 550 and 560 nm. The prime significance of silica is to act as catalyst support for uniform distribution of hematite particles for enhanced catalytic reactivity. Highest degradation has been achieved with 20 wt % loading of hematite nanoparticles indicating the less agglomeration and availability of more catalytic sites. Furthermore, colorless organic pollutants 2-chlorophenol and 2, 4-dichlorophenol have been degraded with high efficiency in the presence of H₂O₂ oxidizer. The scavenger experiments confirmed that hydroxyl radicals are the majorly participating species in this catalytic system. The composite system also shows good recyclability of the materials and advocates the promising nature of the designed system for multiple hazardous environmental contaminants.

Evaluation of variation of interfraction doses to organs at risk during brachytherapy of cervical cancer

Background

Two-dimensional treatment planning using radiographs or simulator films was the standard in planning brachytherapy for patients with cervical cancer. Three-dimensional (3D) treatment planning has improved treatment efficacy. This retrospective study compares conventional and 3D treatment planning of brachytherapy in patients with cervical cancer and interfraction dose variation to bladder and rectum (D2cc).

Methods

The mean doses to bladder and rectum (D2cc) were computed by computed tomography (CT)-based planning during 100 sessions of intracavitary brachytherapy for carcinoma cervix with the same source configuration as generated for conventional planning, and these estimates were compared with the doses at International Commission on Radiation Units and measurements (ICRU) rectal, bladder points and point A. Interfraction variation of doses to bladder and rectum during various sessions was also analysed.

Result

The mean ICRU bladder dose and D2cc of the bladder for all patients was 3.7 Gy and 7.4 Gy, respectively (p < 0.001). The mean ICRU rectal dose from conventional plan was 4.3Gy and with CT planning, 4.45 Gy (p = 0.04). Interfraction dose variations for D2cc of the bladder were min -5.3 Gy and max 4.8 Gy and those of the rectum were min -1.8 Gy and max 1.72Gy.

Conclusion

Dosimetric evaluation of conventional and 3D CT-based treatment planning for the same brachytherapy sessions demonstrated underestimation of ICRU bladder dose points (p < 0.001) and the rectal ICRU point dose and D2cc (p=0.04). The doses to organs at risk did not show a statistically significant variation between the fractions. However, large variation was noted between the interfractional maximum and minimum doses to bladder and rectum.

Synthesis and characterization of magnetic bio-adsorbent developed from Aegle marmelos leaves for removal of As(V) from aqueous solutions

A novel magnetic bio-adsorbent was prepared from the leaves of Aegle marmelos tree (Indian bael) and Fe₂O₃ nanoparticles. The AMP@Fe₂O₃ nanocomposite (Aegle marmelos leaf powder) was synthesized by pyrolysis process and applied for As(V) removal through batch adsorption process. The synthesized AMP@Fe₂O₃ nanocomposite was analyzed by several instrumental techniques like XRD, FESEM, TEM, HRTEM, FTIR, BET, and VSM studies. Maximum amount of As(V) was removed at pH 3, contact time of 250 min, adsorbent dose of 0.1 g/L, and initial concentration of 0.5 mg/L at room temperature. The model study revealed that the pseudo-second-order kinetics and Langmuir isotherm models were best fitted with the experimental data. The nanocomposite showed a maximum adsorption capacity of 69.65 mg/g. The endothermic nature of the adsorption process was ascertained from the thermodynamics studies. The zeta potential and FTIR analysis before and after adsorption demonstrated two types of adsorption mechanism. The first one was the electrostatic attraction between negatively charged As(V) ions (H₂AsO₄^-) and protonated -OH group present on the Fe₂O₃ surface and the second one was ligand exchange between the surface hydroxyl groups and As(V) ions. The AMP@Fe₂O₃ nanocomposite was desorbed with 0.5 M NaOH solutions and also used up to four cycles without any major decrease in removal efficiency. Thus, AMP@Fe₂O₃ nanocomposite can be applied as a potential adsorbent for As(V) removal from wastewater.

The perils of inhibiting deficient factors

Essentials Anticoagulation in patients with factor X deficiency is an evidence-poor area. A patient with factor X deficiency was anticoagulated with warfarin followed by rivaroxaban. Warfarin may be a safer anticoagulant option than rivaroxaban in hereditary factor X deficiency. A baseline coagulation screen should be performed prior to commencement of anticoagulation.

SUMMARY

We report a case of a previously undiagnosed factor X deficiency in an 83-year-old man who had no previous bleeding history despite multiple hemostatic challenges. He was anticoagulated with warfarin for atrial fibrillation without bleeding complications; however, major hemorrhage occurred soon after a switch to rivaroxaban.

A novel approach in red mud neutralization using cow dung

In this study, cow dung was identified as a neutralizing agent for red mud (RM). Present research estimated a significant reduction in pH value of red mud (10 g) from 10.28 to 8.15 and reduction in alkalinity of ~148 mg/L from ~488 mg/L by adding 80 g of cow dung in 40 days of anaerobic condition. XRD results exhibit a high intensity of quartz and found new compound, the calcium carbide. The acid neutralizing capacity (ANC) of NRM reduces to ~0.87 from ~1.506 mol H⁺/kg. Based on the resultant research, present study proposes cow dung as an efficient neutralizing agent for reducing the pH and alkalinity in the red mud.

Synthesis of thorium–ethanolamine nanocomposite by the co-precipitation method and its application for Cr(vi) removal

Studies on the adsorption of Cr(vi) from water by a thorium ethanolamine nanocomposite.

Correction: Adsorption of safranin-O dye on CO2 neutralized activated red mud waste: process modelling, analysis and optimization using statistical design

Correction for ‘Adsorption of safranin-O dye on CO₂ neutralized activated red mud waste: process modelling, analysis and optimization using statistical design’ by Manoj Kumar Sahu et al., RSC Adv., 2015, 5, 42294–42304.

Correction: Removal of safranin-O dye from aqueous solution using modified red mud: kinetics and equilibrium studies

Correction for ‘Removal of safranin-O dye from aqueous solution using modified red mud: kinetics and equilibrium studies’ by Manoj Kumar Sahu et al., RSC Adv., 2015, 5, 78491–78501.

Perineal hernia formation following extralevator abdominoperineal excision

AIM

Extralevator abdominoperineal excision (ELAPE) has become increasingly used because of some evidence of improved oncological outcome. It is, however, thought to be associated with a higher incidence of perineal hernia formation, although the exact incidence is not known. The aim of this study was to identify the incidence of perineal hernia after ELAPE.

METHOD

The case notes of patients over a 54-month period were reviewed. The perineal closure technique, perineal complications and management plan were recorded.

RESULTS

During the study period, 56 patients underwent ELAPE, of whom 24 (44%) developed a perineal wound complication. Primary perineal closure was performed with (eight patients) and without (32 patients) insertion of a biological mesh or myocutaneous flap. Perineal hernia was the commonest complication (26%) and occurred in nine (45%) of 20 patients who had a laparoscopic ELAPE.

CONCLUSION

Perineal hernia formation was the commonest perineal complication of ELAPE and occurred in nearly half of patients having a laparoscopic ELAPE.

Fluoride removal from aqueous solutions using cerium loaded mesoporous zirconium phosphate

Adsorption of fluoride on cerium modified mesoporous zirconium phosphate.

Adsorption of safranin-O dye on CO2neutralized activated red mud waste: process modelling, analysis and optimization using statistical design

Neutralization of red mud using CO₂and activated by calcined at 500 °C.

Removal of safranin-O dye from aqueous solution using modified red mud: kinetics and equilibrium studies

Adsorption of safranin-O dye on SDS modified red mud at different pH.

Adsorption studies of chromium (VI) removal from water by lanthanum diethanolamine hybrid material

In the present research work, lanthanum diethanolamine hybrid material is synthesized by co-precipitation method and used for the removal of Cr(VI) from synthetic dichromate solution and hand pump water sample. The sorption experiments were carried out in batch mode to optimize various influencing parameters such as adsorbent dose, contact time, pH, competitive anions and temperature. The characterization of the material and mechanism of Cr(VI) adsorption on the material was studied by using scanning electron microscope, Fourier transform infrared, X-ray diffraction, Brunauer-Emmett-Teller and thermogravimetric analysis-differential thermal analysis. Adsorption kinetics studies reveal that the adsorption process followed first-order kinetics and intraparticle diffusion model with correlation coefficients (R2) of 0.96 and 0.97, respectively. The adsorption data were best fitted to linearly transformed Langmuir isotherm with correlation coefficient (R2) of 0.997. The maximum removal of Cr(VI) is found to be 99.31% at optimal condition: pH = 5.6 of the solution, adsorbent dose of 8 g L(-1) with initial concentration of 10mgL(-1) of Cr(VI) solution and an equilibrium time of 50 min. The maximum adsorption capacity of the material is 357.1 mg g(-1). Thermodynamic parameters were evaluated to study the effect of temperature on the removal process. The study shows that the adsorption process is feasible and endothermic in nature. The value of E (260.6 kJ mol(-1)) indicates the chemisorption nature of the adsorption process. The material is difficult to be regenerated. The above studies indicate that the hybrid material is capable of removing Cr(VI) from water.

Simultaneous analysis and quantification of markers of manjisthadi churna using high performance thin layer chromatography

Manjisthadi churna has been traditionally used in the Ayurvedic system of medicine and by traditional medical practices of India to treat hyperlipidemia. A rapid, simple and accurate method with high performance thin layer chromatography has been developed to standardised Manjisthadi churna using rubiadin, sennoside and ellagic acid as markers. Methanol extract of Manjisthadi churna were used for high performance thin layer chromatography on silica gel plates. The Rf of rubiadin, sennoside-A and ellagic acid were found to 0.48, 0.23 and 0.72, respectively with densitometric scanning at 280 nm and the calibration plot were linear in the range of 100-600 ng of markers. The correlation coefficients were higher than 0.99 were indicative of good linear dependence of peaks area on concentration. The rubiadin, sennoside-A and ellagic acid contents in Manjisthadi churna were found to be 0.014, 0.038 and 0.534% w/w, respectively. This method permits reliable quantification of rubiadin, sennoside-A and ellagic acid with good resolution and separation of the same from other constitutes of the extract of Manjisthadi churna. Recovery value from 95.66-102.33% showed the reliability and reproducibility of the method. The proposed high performance thin layer chromatography method for simultaneous quantification of markers in Manjisthadi churna can be used for routine quality testing.

Removal efficiency of fluoride by novel Mg-Cr-Cl layered double hydroxide by batch process from water

The fluoride ion removal from aqueous solution using synthesized Mg-Cr-Cl layered double hydroxide has been reported. Mg-Cr-Cl was characterized by X-ray powder diffraction, Fourier-transform infrared, thermo-gravimetric analysis, differential thermal analysis, and scanning electron microscope. Adsorption experiments were carried out in batch mode as a function of adsorption dosages, contact time, pH, and initial fluoride concentration to get optimum adsorption capacity. The adsorption kinetic study showed that the adsorption process followed first order kinetics. The fluoride removal was 88.5% and 77.4% at pH 7 with an adsorbent dose of 0.6 g/100 mL solution and initial fluoride concentration of 10 mg/L and 100 mg/L, respectively. The equilibrium was established at 40 min. Adsorption experiment data were fitted well with Langmuir isotherm with R2 = 0.9924. Thermodynamic constants were also measured and concluded that the adsorption process was spontaneous and endothermic in nature. The removal percentage decreased slowly with increasing pH. This process is suitable for industrial effluents. The regeneration of the material is not possible.

Biosorption of arsenic (III) from aqueous solution by living cells of Bacillus cereus

In this work, removal of arsenic (III) from aqueous solution by living cells (Bacillus cereus), biosorption mechanism, and characterization studies have been reported. B. cereus cell surface was characterized using SEM-EDX and FTIR. Dependence of biosorption on pH of the solution, biosorbent dose, initial arsenic (III) concentration, contact time, and temperature had been studied to achieve optimum condition. The maximum biosorption capacity of living cells of B. cereus for arsenic (III) was found to be 32.42 mg/g at pH 7.5, at optimum conditions of contact time of 30 min, biomass dosage of 6 g/L, and temperature of 30 ± 2 °C. Biosorption data of arsenic (III) are fitted to linearly transformed Langmuir isotherm with R (2) (correlation coefficient) >0.99. The pseudo-second-order model description of the kinetics of arsenic (III) is successfully applied to predict the rate constant of biosorption. Thermodynamic parameters reveal the endothermic, spontaneous, and feasible nature of sorption process of arsenic (III) onto B. cereus biomass. The arsenic (III) ions are desorbed from B. cereus using both 1 M HCl and 1 M HNO(3).

Women's views on and adherence to low-molecular-weight heparin therapy during pregnancy and the puerperium

BACKGROUND

Non-adherence to prescribed medication represents a significant factor associated with treatment failure. Pregnant women identified at risk of venous thromboembolism are increasingly being prescribed low-molecular-weight heparin (LMWH) during pregnancy and the puerperium. It is important to understand women's views on and adherence to LMWH during pregnancy and the puerperium, so that women gain maximum benefit from the treatment.

OBJECTIVES

To monitor women's adherence to enoxaparin, when prescribed during pregnancy and the puerperium, and explore their beliefs about the enoxaparin therapy prescribed.

PATIENTS/METHODS

A prospective cohort study involving 95 nullparous and multiparous women prescribed enoxaparin for recognized antenatal indications. Adherence to enoxaparin was assessed through self-completion of a diary, additionally verified through laboratory tests. An adapted beliefs about medication questionnaire was administered to women during their pregnancy.

RESULTS

Women were highly adherent to enoxaparin: antenatally, mean percentage adherence 97.92%; postnatally, mean percentage adherence 93.37% (paired t-test, P = 0.000). In the cohort of women we followed, their perceived necessity for enoxaparin therapy outweighed any concerns they had regarding enoxaparin antenatally, necessity-concerns differential 2.20. In some women, however, this perceived necessity does decrease postnatally.

CONCLUSIONS

Our results suggest that most women prescribed enoxaparin are highly adherent to their therapy during the antenatal period and that women's antenatal beliefs about enoxaparin are able to predict a decrease in postnatal adherence. Our results have important clinical implications, particularly when women are initiated on LMWH just during the postnatal period.

Hydrogeochemical processes controlling the high fluoride concentration in groundwater: a case study at the Boden block area, Orissa, India

The present investigation reports the assessment of hydrochemical/geochemical processes controlling the concentration of fluoride in groundwater of a village in India (Boden block, Orissa). Boden block is one of the severely affected fluoride-contaminated areas in the state of Orissa (India). The sampling and subsequent analysis of water samples of the study area was carried out following standard prescribed methods. The results of the analysis indicate that 36.60% groundwater F(-) concentration exceeds the limit prescribed by the World Health Organization for drinking water. The rock interaction with groundwater containing high concentration of HCO(3)(-) and Na(+) at a higher pH value of the medium could be one of the important reasons for the release of F(-) from the aquatic matrix into groundwater. Geochemical classification of groundwater based on Chadha rectangular diagram shows that most of the groundwater samples having fluoride concentration more than 1.5 mg L(-1) belongs to the Na-K-HCO(3) type. The saturation index values evaluated for the groundwater of the study area indicated that it is oversaturated with respect to calcite, whereas the same is undersaturated with respect to fluorite content. The deficiency of calcium ion concentration in the groundwater from calcite precipitation favors fluorite dissolution leading to excess of fluoride concentration. The risk index was calculated as a function of fluoride level in drinking water and morbidity of fluorosis categorizes high risk for villages of Amera and Karlakote panchayat of Boden block.

Biosorption of As(V) from aqueous solutions by living cells of Bacillus cereus

In this work, the biosorption of As(V) from aqueous solutions by living cells of Bacillus cereus has been reported. The batch biosorption experiments were conducted with respect to biosorbent dosage 0.5 to 15 g/L, pH 2 to 9, contact time 5 to 90 min, initial concentration 1 to 10 mg/L and temperature 10 to 40 °C. The maximum biosorption capacity of B. cereus for As(V) was found to be 30.04 at pH 7.0, at optimum conditions of contact time of 30 min, biomass dosage of 6 g/L, and temperature of 30 ± 2 °C. Biosorption data were fitted to linearly transformed Langmuir isotherms with R(2) (correlation coefficient) >0.99. Bacillus cereus cell surface was characterized using AFM and FTIR. The metal ions were desorbed from B. cereus using both 1 M HCl and 1 M HNO(3). The pseudo-second-order model was successfully applied to predict the rate constant of biosorption.

P3-07-22: Combined Approach for Staging the Axilla in Breast Cancer Patients with Clinically (−)Nodes Versus Sentinel Node Biopsy Alone

Background

Prognostic information and local control for managing the majority of clinically node (−) breast cancer patients may be achieved by sentinel node biopsy (SNB) alone and/or limited axillary dissections (LAD). Currently, 20 - 30% of clinically node (−) patients have unnecessary surgery. This study compares the results from staging the axilla using SNB alone versus using the combined approach shown below.

Methods: Clinically node (−) patients (n=176) were subclassified according to their primary tumor histology, axillary ultrasound (US) data, and US guided Fine Needle Aspiration (US-FNA) results, as follows: Low Risk (LR) for axillary metastasis (n = 62); High Risk (HR) with normal axillary US (n = 17); HR with US suggesting minimal N1a disease (n = 23); HR with US suggesting N1a disease (n = 52); HR with US suggesting N2-3 disease (n = 22). All patients with (+) SNB or (+) US-FNA had Axillary Lymph Node Dissections (ALND). The number of (+) Sentinel Nodes (SN), Non Sentinel Nodes (NSN) and (+) LN after a (+) US-FNA from each patient category was correlated with corresponding preoperative data. HR patients were defined as having grade II tumors ≥ 1.5 cm and grade III tumors &gt; 1.0 cm. US abnormalities in the axilla were interpreted as follows: minimal N1a disease equivalent to cortical defects &lt; 5mm in 1–3 LN; N1a disease, cortical defects &gt; 5mm in 1–3 LN and N2-3 disease, complete nodal replacement in ≥ 1 LN. LAD refers to level I dissections (1-5 LN).

Results: Three subgroups of patients were identified: Group A, patients not requiring ALND (128/176 = 72%); Group B, patients requiring ALND bypassing SNB (22/176 =13%) and Group C, patients requiring LAD (26/176 = 15%). Preoperatively these 3 groups were categorized as follows: Group A included patients at LR for axillary metastasis, HR patients with normal axillary US, HR patients with axillary US suggesting minimal N1a disease and HR patients with axillary US suggesting N1a disease with (−) US-FNA; Group B included HR patients with axillary US suggesting N2-3 disease and (+) US-FNA; Group C included HR patients with axillary US suggesting N1a disease and (+) US-FNA. The post ALND characteristics for these 3 groups are summarized as follows: all Group A patients had N1a disease represented by ≤ 2 (+) LN, 94% (17/18) were SN (+) only, 85% (15/18) with 1 (+) LN and 15% with 2 (+) LN; in Group B, 20 patients had N2-3 disease and 2 patients had N1a disease, all Group B patients had &gt; 2 (+) LN; in group C, 20 patients had N1a disease and 2 patients had N2 disease, and 77% had single (+) node disease.

Conclusion: By following this approach a more patient oriented method for staging the axilla can be implemented as follows: 1. SNB alone for LR patients and for HR patients with axillary US findings suggesting no axillary disease, minimal N1a disease and/or N1a disease with (−) US-FNA; 2. ALND for HR patients with axillary findings suggesting N2-3 disease and a (+) US-FNA; 3. LAD for HR patients with US findings suggesting N1a disease and (+) US-FNA. This approach would result in a 38% (48/176) reduction in the number of SNB and a 30% (22/66) reduction in the number of ALND. This translates in to $200,000 (30-40%) in procedure-associated savings.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-22.

Studies on the removal of arsenic (III) from water by a novel hybrid material

The present work provides a method for removal of the arsenic (III) from water. An ion-exchanger hybrid material zirconium (IV) oxide-ethanolamine (ZrO-EA) is synthesized and characterized which is subsequently used for the removal of selective arsenic (III) from water containing 10,50,100mg/L of arsenic (III) solution. The probable practical application for arsenic removal from water by this material has also been studied. The various parameters affecting the removal process like initial concentration of As (III), adsorbent dose, contact time, temperature, ionic strength, and pH are investigated. From the data of results, it is indicated that, the adsorbent dose of 0.7mg/L, contact time 50min after which the adsorption process comes to equilibrium, temperature (25±2), solution pH (5-7), which are the optimum conditions for adsorption. The typical adsorption isotherms are calculated to know the suitability of the process. The column studies showed 98% recovery of arsenic from water especially at low concentration of arsenic in water samples.

Serum phosphate and outcome at one year after deceased donor renal transplantation

Traditional risk factors do not adequately explain the increased prevalence of cardiovascular disease in renal patients. This study considered a "non-traditional" risk factor, serum phosphate and outcome in renal transplant recipients. Data from 377 patients who received a first deceased donor renal transplant between January 1, 1999, and December 31, 2008, were recorded; 10% (n=38) had diabetes, 16.7% (n=63) were smokers, and 18.8% (n=71) had a history of vascular disease. Three hundred and thirty-three patients were alive at the time of the analysis. Survivors were significantly younger, less likely to be smokers or diabetic, and had a higher estimated glomerular filtration rate at one yr post-transplantation. Serum phosphate was significantly lower in these patients (0.95 ± 0.23 vs. 1.04 ± 0.26, p = 0.031). Analysis of recipient survival, stratified by serum phosphate at one yr post-transplant, revealed that serum phosphate > 1.11 mMol/L was a significant predictor of all-cause mortality (p=0.006). Serum phosphate between 0.9 and 1.11 mMol/L afforded the best outcome. In multivariate analysis, serum phosphate remained a significant predictor of mortality (p=0.016). Serum phosphate at one yr after transplant seems to have a J-shaped relationship with mortality, and this effect is independent of traditional cardiovascular risk factors.

Toxicity and bioaccumulation potential of Cr (VI) and Hg (II) on differential concentration by Eichhornia crassipes in hydroponic culture

In this work, the phytoremediation of Cr (VI) and Hg (II) ion from water by an aquatic plant Eichhornia crassipes has been studied. Plants were cultured in a double distillated water with modified Hoagland's nutrient solution at pH 6.8 supplemented with 0, 0.75, 1.50, 2.50, and 4 mg Cr/L as potassium dichromate (K(2)Cr(2)O(7)) and 0, 5, 10, 15, and 20 mg Hg/L as mercuric chloride (HgCl(2)). They were separately harvested after 3, 6 and 9 days. Plants treated with 4 mg/L of Cr (VI) accumulated the highest concentration of metal in roots (1.22 mg/g, dry weight) and shoots (0.24 mg/g, dry weight) after 9 days; while those treated with 20 mg/L of Hg (II) accumulated the highest concentration of metal in roots (4.22 mg/g, dry weight) and shoots (2.43 mg/g, dry weight) after 9 days. Eichhornia crassipes biomass was characterised using AAS, SEM and FTIR. The accumulation and relative growth of metal ions at different concentrations of chromium and mercury solution significantly increased (P<0.05) with the passage of time. The maximum values of bio-concentration factor (BCF) for Cr (VI) and Hg (II) were found to be 413.33 and 502.40 L/kg respectively.

The effect of estrone on thrombin generation may explain the different thrombotic risk between oral and transdermal hormone replacement therapy

BACKGROUND

The metabolism of estrogen contained within hormone replacement therapy (HRT) is influenced by the route of administration, and this may affect the risk of venous thromboembolism. Thrombin generation, a global coagulation assay, is a marker of hypercoagulability and is of potential use in determining the thrombotic risk associated with particular HRT administration routes.

OBJECTIVES

To determine whether any effect of oral and transdermal HRT on thrombin generation is related to the plasma estrogen profile.

METHODS

We investigated the effects of oral, transdermal and no HRT (controls) in 52, 39 and 52 postmenopausal women, respectively, on thrombin generation, standard markers of thrombophilia, estradiol level and estrone level.

RESULTS

All parameters of thrombin generation were altered in women using oral HRT as compared with controls (P<0.001 for all comparisons). No such differences were found in women using transdermal HRT. Estrone levels correlated with peak thrombin generation (R=0.451, P<0.001) in women using oral HRT, but there was no correlation in women using the transdermal route.

CONCLUSIONS

Thrombin generation is significantly increased in women who use HRT administered by the oral route. This is probably mediated by the hepatic first-pass metabolism of estrone, the main metabolite of oral estradiol, which is avoided by the transdermal route. The effect of estrone on thrombin generation may provide the explanation for the higher thrombotic risk seen in women using oral rather than transdermal HRT.

The use of an exclusion-based risk-assessment model for venous thrombosis improves uptake of appropriate thromboprophylaxis in hospitalized medical patients

BACKGROUND

Venous thromboembolism is a common condition in hospitalized medical patients. Numerous studies have demonstrated that low molecular weight heparin significantly reduces this risk but, despite this, the use of thromboprophylaxis remains poor.

AIM

To evaluate the use of an exclusion based risk-assessment model (RAM) for venous thrombosis in improving the uptake of appropriate thromboprophylaxis in hospitalized medical patients.

DESIGN

A survey with a subsequent audit cycle of three separate audits over 36 months.

METHODS

497 hospitalized patients with acute medical conditions on general medical wards were audited at a secondary care centre in London, UK. The survey and subsequent audits were performed by reviewing the notes and medication charts of medical patients, prior to the launch of the RAM and at 12, 28 and 36 months following its introduction.

RESULTS

Prior to launching the RAM, 49% of hospitalized medical patients received appropriate thromboprophylaxis. This did not change 12 months after the RAM was introduced but increased significantly to 71% following formal education of the health care professionals involved in thromboprophylaxis prescription. This improvement was maintained as demonstrated by a subsequent audit 8 months later (75.9%).

CONCLUSION

The introduction of a simple exclusion-based RAM for venous thrombosis in medical patients significantly improved delivery of thromboprophylaxis. The successful uptake of the RAM appears to have been dependent on direct education of those health carers involved in its use. A similar exclusion-based model used nationally could have a significant impact on the burden of VTE currently experienced in the UK.

Neutralization of red mud using CO2 sequestration cycle

A laboratory study was conducted to investigate the ability of neutralization of red mud (RM) using carbon dioxide gas sequestration cycle at ambient conditions. The neutralized red mud (NRM) was characterized by XRD, SEM, EDX, FT-IR and auto titration method. X-ray diffraction pattern of NRM was revealed that the intensity of gibbsite was increased prominently and formed ilmenite due to dissolution of minerals. EDX analysis was showed that the %(w/w) of Na, C, O, Si were higher in the carbonated filtrate as compared to the RM and NRM. The permanently sequestered CO(2)%(w/w) per 10 g of red mud were approximately 26.33, approximately 58.01, approximately 55.37, and approximately 54.42 in NRM and first, second, third cycles of carbonated filtrate, respectively. The pH of red mud was decreased from approximately 11.8 to approximately 8.45 and alkalinity was decreased from approximately 10,789 to approximately 178 mg/L. The acid neutralizing capacity of NRM was approximately 0.23 mol H(+)/kg of red mud. The specific advantages of these cyclic processes are that, large amount of CO(2) can be captured as compared to single step.

The prevalence of the activating JAK2 tyrosine kinase mutation in chronic porto-splenomesenteric venous thrombosis

BACKGROUND

Occult myeloproliferative disorders (MPD) are present in 25% of patients with chronic portal, splenic and mesenteric venous thrombosis (PSMVT). A somatic mutation of JAK2 (JAK2V617F) can be used to identify patients with latent MPD.

AIM

We evaluated the prevalence and clinical significance of JAK2V617F in patients with chronic PSMVT.

METHODS

Allele-specific polymerase chain reaction was performed to screen for JAK2V617F.

RESULTS

Thirty-five patients were tested for JAK2V617F. The underlying pro-coagulant condition was MPD in seven of 35 (20.0%) patients; other aetiologies included hereditary thrombophilia (n = 5), chronic pancreatitis (n = 2), liver abscess (n = 1) and umbilical vein sepsis (n = 3). The remainder were labelled idiopathic, i.e. 17/35 (48.6%) patients. JAK2V617F was detected in 16/35 (45.7%) patients: seven of seven (100%) with MPD, two of 11 (18.1%) with non-MPD acquired conditions and seven of 17 (41.2%) with 'idiopathic' chronic PSMVT. Mean haemoglobin concentration (P = 0.04), haematocrit (P = 0.04), white cell count (P = 0.002) and platelet count (P = 0.05) were significantly higher in patients with JAK2V617F. None of the seven patients with latent MPD have progressed to overt MPD over median follow-up of 85 months.

CONCLUSION

JAK2V617F occurs in 41% of patients with idiopathic chronic portal, splenic and mesenteric venous thrombosis, confirming the presence of latent myeloproliferative disorders, and should form part of the routine pro-coagulant screen.