Effects of intensive blood pressure lowering on cerebral ischaemia in thrombolysed patients: insights from the ENCHANTED trial.

Background: Intensive blood pressure lowering may adversely affect evolving cerebral ischaemia. We aimed to determine whether intensive blood pressure lowering altered the size of cerebral infarction in the 2196 patients who participated in the Enhanced Control of Hypertension and Thrombolysis Stroke Study, an international randomised controlled trial of intensive (systolic target 130-140 mm Hg within 1 h; maintained for 72 h) or guideline-recommended (systolic target <180 mm Hg) blood pressure management in patients with hypertension (systolic blood pressure >150 mm Hg) after thrombolysis treatment for acute ischaemic stroke between March 3, 2012 and April 30, 2018. Methods: All available brain imaging were analysed centrally by expert readers. Log-linear regression was used to determine the effects of intensive blood pressure lowering on the size of cerebral infarction, with adjustment for potential confounders. The primary analysis pertained to follow-up computerised tomography (CT) scans done between 24 and 36 h. Sensitivity analysis were undertaken in patients with only a follow-up magnetic resonance imaging (MRI) and either MRI or CT at 24-36 h, and in patients with any brain imaging done at any time during follow-up. This trial is registered with ClinicalTrials.gov, number NCT01422616. Findings: There were 1477 (67.3%) patients (mean age 67.7 [12.1] y; male 60%, Asian 65%) with available follow-up brain imaging for analysis, including 635 patients with a CT done at 24-36 h. Mean achieved systolic blood pressures over 1-24 h were 141 mm Hg and 149 mm Hg in the intensive group and guideline group, respectively. There was no effect of intensive blood pressure lowering on the median size (ml) of cerebral infarction on follow-up CT at 24-36 h (0.3 [IQR 0.0-16.6] in the intensive group and 0.9 [0.0-12.5] in the guideline group; log Δmean -0.17, 95% CI -0.78 to 0.43). The results were consistent in sensitivity and subgroup analyses. Interpretation: Intensive blood pressure lowering treatment to a systolic target <140 mm Hg within several hours after the onset of symptoms may not increase the size of cerebral infarction in patients who receive thrombolysis treatment for acute ischaemic stroke of mild to moderate neurological severity. Funding: National Health and Medical Research Council of Australia; UK Stroke Association; UK Dementia Research Institute; Ministry of Health and the National Council for Scientific and Technological Development of Brazil; Ministry for Health, Welfare, and Family Affairs of South Korea; Takeda.

High incidence of NMDAR encephalitis among Austronesians: A population-based study in Sabah, Malaysia.

NMDAR encephalitis may be more common among non-Caucasians. A population-based study was conducted to estimate its incidence in Sabah, Malaysia, where the population consists predominantly of Austronesians (84%), and with a Chinese minority. Registries of NMDAR encephalitis at neurology referral centers were reviewed for case ascertainment. The annual incidence was 2.29/million (Austronesians: 2.56/million, Chinese: 1.31/million). Among pediatric population, the incidence was: Austronesians: 3.63/million, Chinese: 2.59/million. Our study demonstrated a higher incidence of NMDAR encephalitis among Austronesians than the predominantly Caucasian populations in Europe (0.5-0.9/million; pediatric: 0.7-1.5/million). Racial and genetic factors may contribute to risks of developing NMDAR encephalitis.

Isotherm, Kinetics and Thermodynamics of Cu(II) and Pb(II) Adsorption on Groundwater Treatment Sludge-Derived Manganese Dioxide for Wastewater Treatment Applications.

The ubiquitous occurrence of heavy metals in the aquatic environment remains a serious environmental and health issue. The recovery of metals from wastes and their use for the abatement of toxic heavy metals from contaminated waters appear to be practical approaches. In this study, manganese was recovered from groundwater treatment sludge via reductive acid leaching and converted into spherical aggregates of high-purity MnO2. The as-synthesized MnO2 was used to adsorb Cu(II) and Pb(II) from single-component metal solutions. High metal uptake of 119.90 mg g-1 for Cu(II) and 177.89 mg g-1 for Pb(II) was attained at initial metal ion concentration, solution pH, and temperature of 200 mg L-1, 5.0, and 25 °C, respectively. The Langmuir isotherm model best described the equilibrium metal adsorption, indicating that a single layer of Cu(II) or Pb(II) was formed on the surface of the MnO2 adsorbent. The pseudo-second-order model adequately fit the Cu(II) and Pb(II) kinetic data confirming that chemisorption was the rate-limiting step. Thermodynamic studies revealed that Cu(II) or Pb(II) adsorption onto MnO2 was spontaneous, endothermic, and had increased randomness. Overall, the use of MnO2 prepared from groundwater treatment sludge is an effective, economical, and environmentally sustainable substitute to expensive reagents for toxic metal ion removal from water matrices.

Optimization, isotherm, and kinetic studies of diclofenac removal from aqueous solutions by Fe-Mn binary oxide adsorbents.

Diclofenac (DCF), a widely used non-steroidal anti-inflammatory drug, has been detected in effluents of conventional wastewater treatment plants worldwide. The presence of this compound in various water resources even at very low concentrations poses a big threat both to human health and aquatic ecosystems. In this study, the removal of diclofenac from aqueous solution using Fe-Mn binary oxide (FMBO) adsorbents was investigated. FMBO adsorbents were prepared at varying Fe/Mn molar ratios (1:0, 3:1, and 1:1) through simultaneous oxidation and co-precipitation methods. Batch adsorption experiments were conducted to evaluate the effects of important parameters, such as initial DCF concentration, FMBO dosage, solution pH, and Fe/Mn molar ratio, on DCF removal. Acidic to neutral pH conditions were more favorable for DCF adsorption, while increasing initial DCF concentration and adsorbent dosage resulted in higher DCF removal efficiencies for the three oxides. Lower Fe/Mn molar ratio during FBMO synthesis favored higher DCF removals of up to 99% within a wide pH range. Optimization of operating parameters (initial DCF concentration, FMBO dosage, and solution pH) by Box-Behnken design resulted in up to 28.84 mg g-1 DCF removal for 3:1 FMBO. Freundlich isotherm best described the experimental data, indicating that adsorption occurred on heterogeneous adsorbent surface. Chemisorption was the rate-limiting step of the DCF removal, as best described by the pseudo-second-order kinetic model.

Manganese and iron recovery from groundwater treatment sludge by reductive acid leaching and hydroxide precipitation.

In this study, the recovery of manganese (Mn) and iron (Fe) from groundwater treatment sludge through reductive acid leaching and hydroxide precipitation was investigated. Maximum leached Mn (100%) was obtained using sulfuric acid and hydrogen peroxide at 25 °C. Leached Mn and Fe decreased with the increase in the solid-liquid ratio. Leaching time had minimal effect on Mn and Fe leaching beyond 5 min, while agitation rate had minimal effect beyond 150 rpm. At 25 °C, the rate-limiting step of Mn leaching was diffusion through inert solid components of the sludge, composed mainly of insoluble sand particles. Fe leaching was governed by diffusion through the insoluble components of the sludge, including the unreacted manganese dioxide (MnO2). Maximum precipitation of Fe and separation from Mn in the leachate through addition of potassium hydroxide occurred at pH 4.0. The results demonstrated that reductive acid leaching and hydroxide precipitation is an effective means of recovering Mn and Fe from groundwater treatment sludge. The applicability of the recovered Mn for nickel ion removal from aqueous solution was also explored in the study. Highest nickel ion uptake by the MnO2 synthesized from the recovered Mn was at 111.67 mg g-1, even exceeding the adsorption capacities of previously studied nickel adsorbents.

Clinicopathological Features of Telbivudine-Associated Myopathy.

Telbivudine, a thymidine nucleoside analog, is a common therapeutic option for chronic hepatitis B infection. While raised serum creatine kinase is common, myopathy associated with telbivudine is rare. Reports on its myopathological features are few and immunohistochemical analyses of inflammatory cell infiltrates have not been previously described. We describe the clinical, myopathological and immunohistochemical features of four patients who developed myopathy after telbivudine therapy for chronic hepatitis B infection. All four patients presented with progressive proximal muscle weakness, elevation of serum creatine kinase and myopathic changes on electromyography. Muscle biopsies showed myofiber degeneration/necrosis, regeneration, and fibers with cytoplasmic bodies and cytochrome c oxidase deficiency. There was minimal inflammation associated with strong sarcolemmal overexpression of class I major histocompatibility complex (MHC class I). Upon withdrawal of telbivudine, muscle weakness improved in all patients and eventually completely resolved in three. In our series, telbivudine-associated myopathy is characterized by necrotizing myopathy which improved on drug withdrawal. Although the occasional loss of cytochrome c oxidase is consistent with mitochondrial toxicity, the overexpression of MHC class I in all patients could suggest an underlying immune-mediated mechanism which may warrant further investigation.

Feasibility studies on arsenic removal from aqueous solutions by electrodialysis.

The effectiveness of electrodialysis (ED) in removing inorganic arsenic (As) from aqueous solution was investigated. A tailor-made ED stack was used to perform current-voltage and optimization experiments in a recirculating batch mode. Samples were pre-oxidized with NaClO using 1:2 sample to oxidant weight ratio (RS:O) to transform 100% of As(III) to As(V) in 180 seconds. A high feed water conductivity of 1500 µS/cm and a low feed water conductivity of 800µS/cm had limiting currents of 595 mA and 525 mA, respectively. Optimum experimental conditions that provided maximum As separation were applied potential (E) of 12 V, feed flow rate (Q) of 0.033 L/s, feed concentration (C) of 662.0 µg L(-1), and operating time (t) of 45 min, the most significant ones were applied potential, feed concentration and operating time. Model confirmation experiments showed a good agreement with experimental results with only 0.031% error. The total As in the diluate stream was 4.0 µg L(-1), consisting of an average of 3.0 µg L(-1) As(V) and 1.0 µg L(-1) As(III).