Ischaemic monomelic neuropathy of the lower limb.

Background: Ischaemic mononeuropathy (IMN) is a rarely reported type of peripheral neuropathy secondary to an ischaemic injury, due to a complication of haemodialysis access. Although underreported, this phenomenon typically occurs in diabetic patients and may reflect the predisposition to neuropathic injury on a background of chronic deleterious changes in the microvasculature in diabetes. It is characterised by mononeuropathic features such as paraesthesia, pain and motor weakness and usually is reported as a rare complication of brachiocephalic fistula. We report a case of IMN which occurred in a patient with end-stage diabetic nephropathy following polytetrafluoroethylene (PTFE) graft placement in the groin as vascular access for haemodialysis.

Outcome of laparotomy and conservative treatment of patients with acute mesenteric venous ischemia with viable bowel.

BACKGROUND: Acute mesenteric ischemia (AMI) is one of the most serious abdominal emergencies. Predicting the onset of bowel necrosis that warrants surgical intervention is of paramount importance in AMI. The present study aimed to investigate the outcome of patients with AMI secondary to mesenteric venous occlusion (MVO) and the consequence of non-therapeutic exploratory laparotomy. METHODS: The records of 132 patients with AMI were retrospectively reviewed. The outcome of patients with acute mesenteric venous ischemia (AMVI) and viable bowel was analyzed based on the method of treatment: conservative versus surgical. The impact of non-therapeutic laparotomy on the outcome of patients with AMVI in terms of morbidity, readmission, and mortality was analyzed. RESULTS: Forty-seven patients (34 male) with AMVI had viable bowel. Of the 47 patients with viable bowel, 8 (17%) had an exploratory non-therapeutic laparotomy, whereas 39 patients were treated conservatively. Patients who had non-therapeutic laparotomy had significantly higher complication (50 vs 5.1%, p = 0.005) and readmission rates (37.5 vs 5.1%, p = 0.03) and longer hospital stay (8.5 vs 7 days, p = 0.02) than those treated conservatively. Patients with bowel necrosis who had a therapeutic laparotomy had slightly lower rates of morbidity and mortality as compared to patients with viable bowel who underwent a non-therapeutic laparotomy. CONCLUSION: Careful assessment and informed decision-making in patients with AMVI are crucial to avoid unnecessary surgical intervention that can result in higher rates of complications and readmission and extended hospital stay.

Structure-Activity Relationship of Carbon Nitride Dots in Inhibiting Tau Aggregation.

Due to the numerous failed clinical trials of anti-amyloid drugs, microtubule associated protein tau (MAPT) now stands out as one of the most promising targets for AD therapy. In this study, we report for the first time the structure-dependent MAPT aggregation inhibition of carbon nitride dots (CNDs). CNDs have exhibited great promise as a potential treatment of Alzheimer's disease (AD) by inhibiting the aggregation of MAPT. In order to elucidate its structure-activity relationship, CNDs were separated via column chromatography and five fractions with different structures were obtained that were characterized by multiple spectroscopy methods. The increase of surface hydrophilic functional groups is consistent with the increase of polarity from fraction 1 to 5. Particle sizes (1-2 nm) and zeta potentials (~-20 mV) are similar among five fractions. With the increase of polarity from fraction 1 to 5, their MAPT aggregation inhibition capacity was weakened. This suggests hydrophobic interactions between CNDs and MAPT, validated via molecular dynamics simulations. With a zebrafish blood-brain barrier (BBB) model, CNDs were observed to cross the BBB through passive diffusion. CNDs were also found to inhibit the generation of multiple reactive oxygen species, which is an important contributor to AD pathogenesis.

Gel-like carbon dots: A high-performance future photocatalyst.

To protect water resources, halt waterborne diseases, and prevent future water crises, photocatalytic degradation of water pollutants arouse worldwide interest. However, considering the low degradation efficiency and risk of secondary pollution displayed by most metal-based photocatalysts, highly efficient and environmentally friendly photocatalysts with appropriate band gap, such as carbon dots (CDs), are in urgent demand. In this study, the photocatalytic activity of gel-like CDs (G-CDs) was studied using diverse water pollution models for photocatalytic degradation. The degradation rate constants demonstrated a remarkably enhanced photocatalytic activity of G-CDs compared with most known CD species and comparability to graphitic carbon nitride (g-C3N4). In addition, the rate constant was further improved by 1.4 times through the embedment of g-C3N4 in G-CDs to obtain CD-C3N4. Significantly, the rate constant was also higher than that of g-C3N4 alone, revealing a synergistic effect. Moreover, the use of diverse radical scavengers suggested that the main contributors to the photocatalytic degradation with G-CDs alone were superoxide radicals (O2-) and holes that were, however, substituted by O2- and hydroxyl radicals (OH) due to the addition of g-C3N4. Furthermore, the photocatalytic stabilities of G-CDs and CD-C3N4 turned out to be excellent after four cycles of dye degradation were performed continuously. Eventually, the nontoxicity and environmental friendliness of G-CDs and CD-C3N4 were displayed with sea urchin cytotoxicity tests. Hence, through various characterizations, photocatalytic degradation and cytotoxicity tests, G-CDs proved to be an environmentally friendly and highly efficient future photocatalyst.

Delayed Complication Secondary to Unsuccessful Deployment of the StarClose Device.

The introduction of vascular closure devices (VCD) such as the StarClose device, has been an innovative step in interventional procedures. Earlier post-procedure ambulation, reduced hematoma formation, the time to hemostasis and the need for blood transfusion have been achievable.1 Few case reports describe complications following deployment of the StarClose device, resulting in acute ischemia. Here we present a unique case of unsuccessful deployment of the StarClose device in a patient following an elective right superficial femoral artery angioplasty, resulting in delayed deterioration of the patient's symptoms, necessitating surgery months after the initial intervention.

Development and validation of risk prediction score for incisional surgical site infection after appendectomy.

Surgical site infection (SSI) is a challenging and resource-consuming healthcare problem. Predicting the onset of SSI beforehand can help prevent or minimize its incidence. The present study aimed to determine the independent predictors of incisional SSI after open appendectomy using a multivariate analysis and to establish a predictive risk score of SSI after appendectomy. Records of eligible patients who underwent open appendectomy were reviewed. The characteristics and treatment outcomes of patients were collected and analyzed. Significant association between different variables and SSI after appendectomy was examined by univariate analysis. Then, variables with a significant association with SSI were entered into a multivariate binary logistic regression analysis to determine the significant independent predictors of SSI. The study included 343 patients (51.3% female). Incisional SSI was recorded in 44 (12.8%) patients. Univariate analysis revealed five parameters with a significant association with SSI, including BMI > 30 kg/m2 (p < 0.0001), diabetes mellitus (DM) (p = 0.0001), total leukocyte count (p = 0.04), free intraperitoneal fluid (p < 0.0001), and perforated/gangrenous appendicitis (p < 0.0001). After identifying four significant independent predictors of incisional SSI by binary logistic regression analysis, a predictive risk score was developed. The independent predictors of SSI were DM (OR = 6.05, p = 0.005), free intraperitoneal fluid (OR = 6.94, p = 0.0001), obesity (OR = 8.94, p = 0.0001), and perforated/gangrenous appendicitis (OR = 24.64, p = 0.0001). Four independent predictors of incisional SSI after open appendectomy were found after multivariate analysis. A predictive risk score of SSI was developed and included obesity, DM, free intraperitoneal fluid, and perforated/gangrenous appendicitis as predictors of SSI.

A review into the management of May-Thurner syndrome in adolescents.

OBJECTIVE: To investigate the presentation, etiology, management and outcomes of May-Thurner syndrome (MTS) in adolescents aged under 18. METHODS: We searched electronic bibliographic databases to identify published reports of MTS in patients under 18 years of age. We conducted our review according to the PRISMA statement standards. RESULTS: Ten studies encompassing 22 patients treated for MTS in adolescent cases were identified. The mean age of patients was 15 years (range, 10-18 years). Of the 22 patients, 12 (55%) were confirmed to have proximal deep vein thrombosis as the primary indication for intervention. Treatment methods included catheter-directed thrombolysis and iliac vein stenting (41%), pharmacomechanical thrombolysis and iliac vein stenting (18%), iliac vein stenting alone (27%), open surgery (14%), catheter-directed thrombolysis (5%), and anticoagulation alone (5%). Complications were infrequent. All studies reported subjective improvements in clinical symptoms with only two studies using validate outcome measures. In total, 9 of 22 patients (41%) had addition risk factors that may precipitate thrombosis. CONCLUSIONS: As in adults, the most common form of treatment seen in the literature is a combination of catheter direct thrombolysis, followed by iliac vein stenting with subsequent anticoagulation. Complications from interventions were low. It is unclear how these interventions affect symptomology and the long-term sequalae associated endovascular surgery and stenting in adolescents. Further research is needed in well-designed studies with adequate follow-up.

Thromboangiitis obliterans: Aggressive angioplasty provides a potential solution (randomized pilot study).

BACKGROUND: Thromboangiitis obliterans is an inflammatory disease affecting both medium- and small-sized vessels. Vasodilators, antiplatelets were proposed for treatment but the effect was minimal. OBJECTIVE: This study was conducted to investigate the effect of balloon angioplasty on patients with Buerger's disease compared to medical treatment. METHODS: Between January 2006 and December 2016, 82 patients with Buerger's disease were enrolled in the study, of whom 52 were randomized to the aggressive endovascular intervention and 30 were randomized medically by cilostazol and aspirin as a control group. In all, 23% of the patients presented with severe claudication, 50% with ischemic rest pain and 27% with ischemic ulcers. Randomization was done using the opaque envelope method. Allocation concealment was maintained to ensure no selection bias. Patient groups were compared for the duration of ulcer healing, ankle-brachial index, peak systolic velocity changes and transcutaneous oximetry (TcPO2) level for 30 months. RESULTS: No major procedural complications occurred in the endovascular group. Angiographic success was achieved in 100% of supragenicular lesions but in 90% of infrapopliteal lesions. The endovascular group showed a statistically significant improvement in the ulcer healing size and duration at 6 months after the procedure with a mean time of 3 ± 0.9 months compared to 5.8 ± 1.69 months for the medical treatment group (p < 0.001), the mean TcPO2 from 27.23 ± 16.75 mm Hg (range: 0-56 mm Hg) before the procedure to 71.32 ± 12.94 mm Hg (range: 52-92 mm Hg) following revascularization (p < 0.01). The mean ankle-brachial index significantly improved from 0.54 ± 0.14 preoperatively to 0.82 ± 0.08 at final follow-up (p < 0.01). CONCLUSION: The endovascular therapy should be considered as an effective, safe, minimally invasive method in the light of the promising results after a modification of the standard technique.

Bmim[OAc]-Cu2O/g-C3N4 as a multi-function catalyst for sonophotocatalytic degradation of methylene blue.

In this study, ionic liquid, 1-butyl-3-methylimidazolium acetate (Bmim[OAc]) modified cuprous oxide immobilized over graphitic carbon nitride (Bmim[OAc]-Cu2O/g-C3N4) as an efficient heterogeneous catalyst was successfully prepared by depositing Bmim[OAc]-Cu2O over the surface of g-C3N4. The deposition of cuprous oxide over the surface of g-C3N4 leads to the formation of a heterojunction that promotes the charge separation. Cu2O enhances the degradation capability owing to its dual function where it acts as a photocatalyst and Fenton like catalyst. Bmim[OAc] plays a vital role in trapping the photogenerated electrons, which in turn reduce the chances of electron-hole pairs recombination. Sonophotocatalytic degradation of methylene blue (MB) was investigated using the prepared Bmim[OAc]-Cu2O/g-C3N4 at room temperature and pH = 7 in presence of ultraviolet (UV, 6 W, λ = 254 nm) and ultrasonic (US, 20 kHz) as a dual irradiation system and H2O2 as an oxidant. Only 30 min of dual irradiation was enough for Bmim[OAc]-Cu2O/g-C3N4 (0.1 gL-1) to achieve a complete degradation using 10 mM H2O2 at 25 °C and pH = 7. The value of band gap of tested catalyst plays a vital role in boosting the degradation capability of the sonophotocatalytic system through the generated reactive radicals especially the hydroxyl radicals and superoxide radicals, which play a major role in the system. The kinetics of the reaction was investigated and the activation energy was calculated from the slope of the Arrhenius plot and found to be 19.77 kJ/mol.

Sequential Extended Thoracoscopic Sympathicotomy for Palmo-Axillo-Plantar Hyperhidrosis.

BACKGROUND: Palmo-axillo-plantar hyperhidrosis (HH) exists in approximately 70% to 100% of patients complaining of HH. Many studies have documented variable effects of thoracoscopic sympathicotomy (TS) on plantar sweating. The present trial evaluated sequential extended thoracoscopic sympathicotomy for the treatment of palmo-axillo-plantar HH regarding its feasibility and outcome on each domain of HH, particularly the plantar domain METHODS: Forty-two patients with severe palmo-axillo-plantar HH underwent sequential extended (T3 to T12) thoracoscopic sympathicotomy. Improvement in HH was assessed using visual analog scale and iodine-starch test, and quality of life was evaluated using the Keller quality of life questionnaire preoperatively and 2 years postoperatively. RESULTS: Included were 16 men and 26 women with a mean age of 24.3 ± 5.3 years. The average preoperative VAS for the palmar, axillary, and plantar HH was 9 ± 0.66, which declined significantly (p < 0.0001) at 24 months of follow-up to a mean of 0.74 ± 0.4 for the palmar and axillary domains and to 1.26 ± 0.7 for plantar HH. Improvement in quality of life was observed in all patients at 24 months of follow-up as the overall median score decreased from 120.5 to 3.5. CONCLUSIONS: Sequential extended thoracoscopic sympathicotomy proved to be an effective method for the treatment of combined HH because it achieved satisfactory and sustained improvement of palmar, axillary, and plantar sweating. Although the benefits of sequential extended thoracoscopic sympathicotomy outweigh its drawbacks and technical difficulties, further prospective studies are required to ascertain the effectiveness of this new technique.

Suppression of pancreatic cancer by sulfated non-anticoagulant low molecular weight heparin.

Sulfated non-anticoagulant heparins (S-NACHs) might be preferred for potential clinical use in cancer patients without affecting hemostasis as compared to low molecular weight heparins (LMWHs). We investigated anti-tumor effects, anti-angiogenesis effects, and mechanisms of S-NACH in a mouse model of pancreatic cancer as compared to the LMWH tinzaparin. S-NACH or tinzaparin with or without gemcitabine were administered, and tumor luminescent signal intensity, tumor weight, and histopathology were assessed at the termination of the study. S-NACH and LMWH efficiently inhibited tumor growth and metastasis, without any observed bleeding events with S-NACH as compared to tinzaparin. S-NACH distinctly increased tumor necrosis and enhanced gemcitabine response in the mouse pancreatic cancer models. These data suggest the potential implication of S-NACH as a neoadjuvant in pancreatic cancer.