Vascular complications after peripheral veno-arterial extracorporeal life support cannulation in cardiogenic shock.

Background: Extra Corporeal Life Support (ECLS) is an evolving therapy in therapy-resistant cardiogenic shock (CS). Vascular cannulation in emergency situations can be accomplished through puncture of the femoral vessels by specialised teams. Since lower limb ischemia constitutes one of the major complications following cannulation, a distal perfusion cannula (DPC) has emerged as standard of care. We here aimed to analyse the impact of the DPC on limb perfusion and 6-month survival rate. Methods: In a retrospective study from January 2012 to December 2018, 98 patients with cardiogenic shock and peripheral (v-a) ECLS implantation with documented limb perfusion status were identified and analysed. Demographic data, laboratory parameters, cause of CS, comorbidities, limb perfusion complications and complication management were analysed. Results: 53 patients (54%) received ECLS therapy in referral centers by our mobile ECLS team, while in 45 patients (46%) the cannulation occured in our center. 71 patients (72%) received a DPC (group A) at the time of ECLS implantation, whereas 27 (28%) (group B) did not or received later (14 patients owing to limb ischemia). 44 patients (45%) developed limb ischemia as a complication of ECLS therapy (31% in group A and 81% in group B- p < 0.001). The 6-month survival rate was 28% in our study cohort (30% in group A and 22% in group B- p = 0.469). Conclusion: Lower limb ischemia remains a serious complication after peripheral ECLS cannulation in CS, especially when a DPC is absent. Standardised DPC implementation may reduce the rate of severe limb complications in peripheral ECLS.

Neuroprotection of retinal ganglion cells in vivo using the activation of the endogenous cannabinoid signaling system in mammalian eyes.

Cannabinoid and glutamatergic signaling systems in the human retina coexist and greatly influence one another. Under glaucomatous conditions, excess levels of glutamate accrete in the retinal ganglion cell (RGC) layer. The present study tests the putative neuroprotective effect mediated by cannabinoids at the CB1 and CB2 receptors. In the first experiment, mice were given intravitreal injections of 160 nmol N-methyl-d-aspartic acid (NMDA) in one eye and saline in the paired eye. In the second experiment, both eyes were given NMDA, while one of the two was additionally given the cannabinoid agonist WIN 55,212-2. Ten days later, animals were perfused and the retinae were dissected as wholemounts and stained with Cresyl Violet. Quantitative analysis revealed that 70% of the neurons in the retinal ganglion cell (RGC) layer exposed to NMDA underwent cell death. The addition of the cannabinoid CB1/CB2 agonist doubled the number of neurons surviving the NMDA treatment. These data provide evidence that cannabinoids, either exogenous or endogenous, may be harnessed to provide protection from neurodegenerative diseases, including glaucoma, and from glutamate-induced, and potentially other forms of neurotoxicity, under chronic or acute conditions.

Occurrence and hazard assessment of natural radioactivity in drinking water in South Lebanon.

This study is intended to assess the natural radioactivity in the drinking water in the southern region of Lebanon and to determine its suitability for human consumption. In this context, activity concentrations for gross alpha, gross beta, 238U, 234U, and radon from selected drinking water sources, wells, and springs and the corresponding tap water, in the area under investigation, were determined during both the wet and the dry seasons. The maximum recorded activities of gross alpha, gross beta, and radon measured using liquid scintillation counter were found to be 374.6 ± 11.5 mBq L-1 for gross alpha, 418 ± 12 mBq L-1 for gross beta, and 42,900 ± 370 mBq L-1 for radon. Whereas, alpha spectroscopy analysis for uranium content showed maximum activities of 53.7 ± 2.1 mBq L-1 for 238U and 55.9 ± 2.3 mBq L-1 for 234U. Significant seasonal activity variation between wet and dry season was noticed only in gross alpha concentrations. In addition, significant variation between sources and tap water was recorded only in radon concentrations. Whereas, no significant variation was noted in radioactivity concentrations in waters from springs and those from wells. In contrast to all sampled locations, the annual effective dose of only one sampled well (Aitaroun) exceeded the WHO individual dose criterion (IDC) level of 100 µSv year-1 and recorded an annual effective dose of 170 µSv year-1, 103 µSv year-1, and 127 µSv year-1 for infants, children, and adults, respectively.

Antibacterial activity of chitosan nano-composites and carbon nanotubes: A review.

Bacteriological contamination of water sources is a major challenge that has a detrimental impact on both the environment and human health. This imposes the search for the most efficient disinfectant. Despite their antibacterial efficiency, traditional methods can often form disinfection byproducts through their reaction with organic and inorganic compounds. Substitutes for conventional bacterial inactivation methods should not produce harmful byproducts and must also be cost effective. Nanotechnology is an attractive option that is suited for surface reactions as nanostructures offer large surface to volume ratios. Technologies using chitosan-modified nanocomposites and carbon nanotubes have proven to offer promising alternatives for bacterial inactivation. To enhance their antibacterial efficiency, such technologies have been modified chemically and physically and have as well been associated with other treatment techniques. However, despite their high bacterial disinfection efficacy and lack of treatment byproducts, the vagueness in bacterial inactivation mechanisms and complexity in materials preparation have often obscured their wide scale application. The aim of this manuscript is to review the recent advances in bacterial disinfection using nanomaterials, in the form of chitosan and carbon nanotubes. The rapid rate of research and the notable progress in this area dictate the frequent compilation and dissemination of recent introductions to this field. Existing gaps in the literature are thus also highlighted and reported discrepancies are pinpointed so that roadmaps for future studies may be figured.

[Laser surgery on varicose veins]. / Visszérmutét lézerrel.

INTRODUCTION: With the development of medicine, technical inventions have been intoduced into the therapy of varicose veins, such as ultrasound examination and laser treatment. PATIENTS AND METHODS: Over 11 years 1729 laser surgery were performed on varicose veins. Junctions of saphenous veins, saphenous stems and perforator veins were treated with lasers, but reticular and spider veins were treated with other methods. The most important elements of laser surgery are the introduction of the laser fibre into the lumen of the vein and delivering the laser energy. All of this is performed without incisions under ultrasound guidance. Laser crossectomy is an innovation in our technique. This procedure is performed under a combination of local and intravenous anaesthesia. RESULTS: After 1 year 58% of operated legs (998) were checked (mean 3.3 years) and recurrent varicosity was found in 114 legs (11.4%). Recurrences were found mainly in those cases which would have been excluded from other studies, but in everyday practice they occur in a high percentage, such as being overweight, after delivery and previously operated cases. In selected cases, the recurrence rate is only 6.0%. Complications after laser surgery are less frequent than following classic varicose vein surgery. CONCLUSIONS: According to international guidelines and this study, endovascular interventions can be recommended instead of classic varicose vein surgery because they are less demanding, and cause fewer complications. Using laser crossectomy, the number of early recurrences decreases. All stem varicosities are suitable for laser surgery.

The fate of selected pharmaceuticals in solar stills: Transfer, thermal degradation or photolysis?

The increase in demand for, and disposal of, pharmaceuticals, positively correlated with the growing human population, has led to the emergence of contaminants with high environmental and health impacts. Several developing countries that endure problems related to water sufficiency and/or quality resort to the use solar stills as an affordable water treatment method. This research is aimed at investigating the fate of five chemically distinct pharmaceuticals that might pervade solar stills; ibuprofen (IBU), diclofenac (DCF), carbamazepine (CBZ), ampicillin (AMP) and naproxen (NPX). The experiments were conducted under three conditions. The first condition studied the combined effect of temperature and light in simulated field-test-scale solar stills. The effect of temperature as a sole variable was investigated in the second while the third condition studied the effect of light only via concentrated solar power (CSP). Results show that distillates from solar stills did not contain the parent compounds for four out of the five pharmaceuticals. IBU was the only pharmaceutical that showed a transfer via vapor into the distillate with the highest recorded transfer percentage of 2.1% at 50°C when subjected to temperature alone and 0.6% under the combined effect of temperature and light. In the case of NPX and DCF, the parent compounds did not undergo transfer into the distillate phase; however their degradation by-products did. In addition, the results also showed that in the case of NPX, IBU and CBZ both high temperatures and sunlight combined were required to attain noticeable degradation. CSP accelerated the degradation of DCF, NPX and IBU with a three-minutes-degradation percentage of 44%, 13% and 2% respectively.

Coagulation of highly turbid suspensions using magnesium hydroxide: effects of slow mixing conditions.

Laboratory experiments were carried out to study the effects of slow mixing conditions on magnesium hydroxide floc size and strength and to determine the turbidity and total suspended solid (TSS) removal efficiencies during coagulation of highly turbid suspensions. A highly turbid kaolin clay suspension (1,213 ± 36 nephelometric turbidity units (NTU)) was alkalized to pH 10.5 using a 5 M NaOH solution; liquid bittern (LB) equivalent to 536 mg/L of Mg(2+) was added as a coagulant, and the suspension was then subjected to previously optimized fast mixing conditions of 100 rpm and 60 s. Slow mixing speed (20, 30, 40, and 50 rpm) and time (10, 20, and 30 min) were then varied, while the temperature was maintained at 20.7 ± 1 °C. The standard practice for coagulation-flocculation jar test ASTM D2035-13 (2013) was followed in all experiments. Relative floc size was monitored using an optical measuring device, photometric dispersion analyzer (PDA 2000). Larger and more shear resistant flocs were obtained at 20 rpm for both 20- and 30-min slow mixing times; however, given the shorter duration for the former, the 20-min slow mixing time was considered to be more energy efficient. For slow mixing camp number (Gt) values in the range of 8,400-90,000, it was found that the mixing speed affected floc size and strength more than the time. Higher-turbidity removal efficiencies were achieved at 20 and 30 rpm, while TSS removal efficiency was higher for the 50-rpm slow mixing speed. Extended slow mixing time of 30 min yielded better turbidity and TSS removal efficiencies at the slower speeds.

Precipitation softening: a pretreatment process for seawater desalination.

Reduction of membrane fouling in reverse osmosis systems and elimination of scaling of heat transfer surfaces in thermal plants are a major challenge in the desalination of seawater. Precipitation softening has the potential of eliminating the major fouling and scaling species in seawater desalination plants, thus allowing thermal plants to operate at higher top brine temperatures and membrane plants to operate at a reduced risk of fouling, leading to lower desalinated water costs. This work evaluated the use of precipitation softening as a pretreatment step for seawater desalination. The effectiveness of the process in removing several scale-inducing materials such as calcium, magnesium, silica, and boron was investigated under variable conditions of temperature and pH. The treatment process was also applied to seawater spiked with other known fouling species such as iron and bacteria to determine the efficiency of removal. The results of this work show that precipitation softening at a pH of 11 leads to complete elimination of calcium, silica, and bacteria; to very high removal efficiencies of magnesium and iron (99.6 and 99.2 %, respectively); and to a reasonably good removal efficiency of boron (61 %).

Do biological-based strategies hold promise to biofouling control in MBRs?

Biofouling in membrane bioreactors (MBRs) remains a primary challenge for their wider application, despite the growing acceptance of MBRs worldwide. Research studies on membrane fouling are extensive in the literature, with more than 200 publications on MBR fouling in the last 3 years; yet, improvements in practice on biofouling control and management have been remarkably slow. Commonly applied cleaning methods are only partially effective and membrane replacement often becomes frequent. The reason for the slow advancement in successful control of biofouling is largely attributed to the complex interactions of involved biological compounds and the lack of representative-for-practice experimental approaches to evaluate potential effective control strategies. Biofouling is driven by microorganisms and their associated extra-cellular polymeric substances (EPS) and microbial products. Microorganisms and their products convene together to form matrices that are commonly treated as a black box in conventional control approaches. Biological-based antifouling strategies seem to be a promising constituent of an effective integrated control approach since they target the essence of biofouling problems. However, biological-based strategies are in their developmental phase and several questions should be addressed to set a roadmap for translating existing and new information into sustainable and effective control techniques. This paper investigates membrane biofouling in MBRs from the microbiological perspective to evaluate the potential of biological-based strategies in offering viable control alternatives. Limitations of available control methods highlight the importance of an integrated anti-fouling approach including biological strategies. Successful development of these strategies requires detailed characterization of microorganisms and EPS through the proper selection of analytical tools and assembly of results. Existing microbiological/EPS studies reveal a number of implications as well as knowledge gaps, warranting future targeted research. Systematic and representative microbiological studies, complementary utilization of molecular and biofilm characterization tools, standardized experimental methods and validation of successful biological-based antifouling strategies for MBR applications are needed. Specifically, in addition, linking these studies to relevant operational conditions in MBRs is an essential step to ultimately develop a better understanding and more effective and directed control strategy for biofouling.

Hollow-fiber membrane bioreactor for the treatment of high-strength landfill leachate.

Performance assessment of membrane bioreactor (MBR) technology for the treatability of high-strength landfill leachate is relatively limited or lacking. This study examines the feasibility of treating high-strength landfill leachate using a hollow-fiber MBR. For this purpose, a laboratory-scale MBR was constructed and operated to treat leachate with a chemical oxygen demand (COD) of 9000-11,000 mg/l, a 5-day biochemical oxygen demand (BOD5) of 4000-6,000 mg/l, volatile suspended solids (VSS) of 300-500 mg/l, total nitrogen (TN) of 2000-6000 mg/l, and an ammonia-nitrogen (NH3-N) of 1800-4000 mg/l. VSS was used with the BOD and COD data to simulate the biological activity in the activated sludge. Removal efficiencies > 95-99% for BOD5, VSS, TN and NH3-N were attained. The coupled experimental and simulation results contribute in filling a gap in managing high-strength landfill leachate and providing guidelines for corresponding MBR application.

[5-year experience with varicose vein laser surgery]. / Lézeres visszérmutéttel szerzett ötéves tapasztalatok.

INTRODUCTION: The incidence of varicose veins in the lower limb is relatively frequent in Europe including Hungary. AIM: Authors report their 5-year experience in varicose vein laser surgery focusing with regards to recurrence and complication rates. PATIENTS AND METHODS: Surgery was performed on 647 lower limbs in 546 patients with an age between 17 and 80 years. They were overweight in 4.6 % of cases. The diameter of treated saphenous veins was between 4 and 31 mm. Indications for surgery were recurrence in 9.1% of cases and crural ulcer in 4.0% of cases. Laser fibre was introduced into the varicose saphenous stems and then 980 nm, later 1470 nm wavelength laser was delivered while the fibre was step-by-step pulled-out. Following the learning period laser energy was raised from a mean of 28 J/cm to 164 J/cm because of high recurrence rate. RESULTS: During the learning period the recurrence rate was 13.8% while it was 1.9% thereafter. Pulmonary embolism occurred in two cases, which could have been avoidable. Further minor complications were also noted. CONCLUSIONS: Varicose vein laser surgery can be recommended because the recurrence rate is very low, major complications can be avoided and minor complications are temporary.

5-HT(1A)-like receptor activation inhibits abstinence-induced methamphetamine withdrawal in planarians.

No pharmacological therapy is approved to treat methamphetamine physical dependence, but it has been hypothesized that serotonin (5-HT)-enhancing drugs might limit the severity of withdrawal symptoms. To test this hypothesis, we used a planarian model of physical dependence that quantifies withdrawal as a reduction in planarian movement. Planarians exposed to methamphetamine (10 µM) for 60 min, and then placed (tested) into drug-free water for 5 min, displayed less movement (i.e., withdrawal) than either methamphetamine-naïve planarians tested in water or methamphetamine-exposed planarians tested in methamphetamine. A concentration-related inhibition of withdrawal was observed when methamphetamine-exposed planarians were placed into a solution containing either methamphetamine and 5-HT (0.1-100 µM) or methamphetamine and the 5-HT(1A) receptor agonist 8-hydroxy-N,N-dipropyl-2-aminotetralin (8-OH-DPAT) (10, 20 µM). Planarians with prior methamphetamine exposure displayed enhanced withdrawal when tested in a solution of the 5-HT(1A) receptor antagonist N-[2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl]-N-(2-pyridyl)cyclohexanecarboxamide (WAY 100635) (1 µM). Methamphetamine-induced withdrawal was not affected by the 5-HT(2B/2C) receptor agonist meta-chlorophenylpiperazine (m-CPZ) (0.1-20 µM). These results provide pharmacological evidence that serotonin-enhancing drugs inhibit expression of methamphetamine physical dependence in an invertebrate model of withdrawal, possibly through a 5-HT(1A)-like receptor-dependent mechanism.

Cytotoxic effects of bilberry extract on MCF7-GFP-tubulin breast cancer cells.

Bilberry (European blueberry) has been reported to have many biological effects, including anticancer activity. In this study, we investigated the antiproliferative effects of bilberry extract in relation to its ability to induce apoptosis and affect microtubule assembly and organization in MCF7 human breast cancer cells. We observed that bilberry extract inhibited cell proliferation in a concentration-dependent fashion with a 50% inhibitory concentration of 0.3-0.4 mg/mL, in concert with induction of apoptotic cell death. At these concentrations there was no selective inhibition of mitosis or any other cell cycle stage, nor was there any apparent effect on the microtubule or actin cytoskeletons. However, somewhat higher extract concentrations (0.5-0.9 mg/mL) did cause an increase in the fraction of cells at the G(2)/M phase of the cell cycle, together with destruction of microtubules and formation of punctate tubulin aggregates in the cells. Bilberry extract at 0.3-0.4 mg/mL did not appreciably inhibit microtubule polymerization in vitro, but significant inhibition of polymerization (approximately 30%) did occur at higher extract concentrations (0.5-1 mg/mL). We conclude that bilberry extract as ingested by humans, not just the purified anthocyanins it contains, inhibits proliferation of and induces apoptosis in breast cancer cells at its lowest effective concentrations via a mechanism that does not involve action on microtubules or on mitosis. We further conclude that at somewhat higher concentrations the extract modifies microtubule organization in cells and causes accumulation of cells at mitosis by a direct action on microtubules.

Modeling the formation of trihalomethanes in drinking waters of Lebanon.

The current research aims at developing predictive models for trihalomethane (THM) formation in Lebanon based on field-scale investigations as well as laboratory controlled experimentations. Statistical analysis on field data revealed significant correlations for TTHM with chlorine dose, Specific UV-A, and UV(254) absorbing organics. Simulated distribution system-THM tests showed significant correlations with applied chlorine dose, total organic carbon, bromides, contact time, and temperature. Predictive models, formulated using multiple regression approaches, exhibiting the highest coefficients of determination were quadratic for the directly after chlorination (DAC; r(2) = 0.39, p < 0.036) and network (r(2) = 0.33, p < 0.064) THM databases, and logarithmic for the laboratory simulated THM database (r(2) = 0.70, p < 0.001). Computed r(2) values implied low correlations for the DAC and network THM database, and high correlation for the laboratory simulated THM database. Significance of the models were at the 0.05 level for DAC database, 0.10 level for the network database, and very high (<0.01 level) for the laboratory simulated THM database. It is noteworthy to mention that no previous attempts to assess, monitor, and predict THM concentrations in public drinking water have been reported for the country although a large fraction of the population consumes chlorinated public drinking water.

Osteopontin is proinflammatory in experimental autoimmune uveitis.

PURPOSE: Osteopontin (OPN) has been implicated in inflammatory and wound-healing processes. Increased OPN mRNA levels have been reported in experimental autoimmune uveitis (EAU), but the function of OPN in the inflamed eye is unknown. The purpose of this study was to investigate the role of OPN in the pathogenesis of EAU. METHODS: EAU was induced in OPN-null and wild-type (WT) mice by immunization with interphotoreceptor retinoid-binding protein (IRBP). Immunofluorescence experiments were performed to identify OPN-positive cells in WT mice. Disease incidence, serum IRBP antibody levels, vitreous infiltrates, retinal granulomas, and lymphocyte proliferation were assessed in OPN-null and WT mice. To determine whether OPN could induce an EAU-like condition, purified OPN and OPN fragments were injected intraocularly into WT mice and vitreous infiltrates were characterized and quantified. RESULTS: In WT EAU-positive eyes, cell types with increased OPN immunoreactivity were identified as F4/80-positive macrophages/microglia and CD4-positive T cells. OPN-null mice manifested attenuated disease with decreased vitreous infiltrates, fewer granulomas, less lymphocyte proliferation, and lower serum IRBP antibody levels. Exogenous full-length OPN, as well as N- and C-terminal fragments, induced leukocyte infiltration and retinal folding, with some similarities to EAU. CONCLUSIONS: The results demonstrate that OPN is proinflammatory in EAU and may be important for recruitment and activation of leukocytes in retinal inflammation.

Removal of low-concentration phosphorus using a fluidized raw dolomite bed.

Raw dolomite powder, obtained from dolomitic rocks, was evaluated for its efficiency in removing low concentrations of phosphate present in various water and wastewater matrices. A variety of experimental setups and process variables were tested, in an attempt to determine the optimal scheme (fluidized bed) that will be used to accomplish the objectives of the study. Test influents, including distilled water (DW), synthetic groundwater (SGW), tap water (TW), and sodium-hydroxide (NaOH)-alkalized wastewater treated with liquid bittern (STSE-B) and wastewater treated with lime (STSE-L) were used to assess the effect of influent parameters on the quality of the effluent generated. The adsorptive behavior of dolomite was described by fitting data generated from the study into the Freundlich and Langmuir isotherm models. Regeneration of the dolomite was attempted by the use of an acid (hydrochloric acid), DW, and an alkaline (NaOH). Test results indicate remarkable phosphate removal levels for DW and SGW. Removal levels of 100% were attained, for an average of 307 and 314 bed volumes at inflow concentration levels of 0.28 and 0.34 mg phosphate (PO4)/ L, respectively. Relative adsorption capacities were calculated to be 0.06 and 0.072 mg PO4/g of dolomite, respectively. For TW, STSE-L, and STSE-B, 100% removal before the start of the breakthrough was sustained for averages of 205, 94, and 28 bed volumes at phosphate dosages of 0.34, 0.56, and 0.6 mg PO4/L, respectively. The calculated adsorptive capacities were 0.05, 0.051, and 0.025, respectively. Zeta potential measurement resulted in values of -16.0 mV before treatment and +3.0 mV after complete exhaustion of the bed with PO4-jacked SGW influent, indicating an ionic adsorption of ions of opposite charge to that of the particle surface. Although both the Freundlich and Langmuir isotherms were found to fit the sorption curves, the Langmuir seems to better describe the sorption process in dolomite. Among the three attempted dolomite regeneration processes, the use of NaOH has shown to be the most successful.