Processed electroencephalography: impact of patient age and surgical position on intraoperative processed electroencephalogram monitoring of burst-suppression.

We previously reported that processed EEG underestimated the amount of burst suppression compared to off-line visual analysis. We performed a follow-up study to evaluate the reasons for the discordance. Forty-five patients were monitored intraoperatively with processed EEG. A computer algorithm was used to convert the SedLine® (machine)-generated burst suppression ratio into a raw duration of burst suppression. The reference standard was a precise off-line measurement by two neurologists. We measured other potential variables that may affect machine accuracy such as age, surgery position, and EEG artifacts. Overall, the median duration of bust suppression for all study subjects was 15.4 min (Inter-quartile Range [IQR] = 1.0-20.1) for the machine vs. 16.1 min (IQR = 0.3-19.7) for the neurologists' assessment; the 95% limits of agreement fall within - 4.86 to 5.04 s for individual 30-s epochs. EEG artifacts did not affect the concordance between the two methods. For patients in prone surgical position, the machine estimates had significantly lower overall sensitivity (0.86 vs. 0.97; p = 0.038) and significantly wider limits of agreement ([- 4.24, 3.82] seconds vs. [- 1.36, 1.13] seconds, p = 0.001) than patients in supine position. Machine readings for younger patients (age < 65 years) had higher sensitivity (0.96 vs 0.92; p = 0.021) and specificity (0.99 vs 0.88; p = 0.007) for older patients. The duration of burst suppression estimated by the machine generally had good agreement compared with neurologists' estimation using a more precise off-line measurement. Factors that affected the concordance included patient age and position during surgery, but not EEG artifacts.

Mitigation of algal organic matter released from Chaetoceros affinis and Hymenomonas by in situ generated ferrate.

This study demonstrates the application of in situ ferrate (Fe(VI)) for the efficient removal of dissolved algal organic matter (AOM) from seawater. Sodium hypochlorite (NaOCl) and ferric (Fe(III)) were used to produce in situ Fe(VI) by wet chemical oxidation. First, the removal efficiencies of two model AOM compounds, humic acid (HA) and sodium alginate (SA), were evaluated in the presence of sodium chloride with an initial influent dissolved organic carbon (DOC) concentration of 5.0 mg C L-1 at different pH levels to establish the optimal doses for in situ Fe(VI) generation. The concentration of Fe(VI) was determined by the 2,2-Azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) ultraviolet-visible spectrophotometry method. In the case of HA, 72% DOC removal was recorded when applied with 1.5 mg L-1 of Fe(III) and 1.5 mg L-1 of NaOCl (in situ Fe(VI) concentration of 1.46 mg L-1) while 42% DOC removal was observed for SA. Subsequently, the removal of AOM extracted from two bloom-forming algal species, Chaetoceros affinis (CA) and Hymenomonas (Hym), cultivated in seawater from the Red Sea, were tested with in situ generated Fe(VI) at the established optimum condition. In situ Fe(VI) recorded superior performance in removing AOM extracted from CA and Hym, showing 83% and 92% DOC removal when the influent DOC concentrations were 2.48 and 2.63 mg L-1, respectively. A detailed AOM characterization was conducted using liquid chromatography-organic carbon detection.

Bioactive chemical compounds in Eremurus persicus (Joub. & Spach) Boiss. essential oil and their health implications.

The genus Eremurus is native to Eastern Europe and temperate Asia. Particularly, Eremurus persicus (Joub. & Spach) Boiss. is highly valued in traditional foods and medicine. Scientific knowledge about E. persicus chemical composition and bioactivity is required. Therefore, the present study is aimed to determine the volatile composition of E. persicus essential oil (EO) by means of gas chromatography coupled to flame ionization/mass spectrometry detection. Moreover, the antioxidant, antimicrobial, anticancer, and acetylcholinesterase inhibitory activities of the EO were tested. Interestingly, the anti-dermatophyte potency was close to that of the drug griseofulvin, with minimum fungicidal concentration ranging between 0.7 and 4.5% depending on the fungi strain. The EO was also effective against hepatocellular carcinoma (Hep-G2) and breast adenocarcinoma (MCF-7) human cancer cell lines in a concentration (200-1500 ng/mL)-dependent manner, with a decrease of the cell viability up to 65% and 52%, respectively. The E. persicus EO was rich in terpenes and oxygenated terpene derivatives. Individually, limonene (16.25%), geranylgeraniol (15.23%), n-nonanal (9.48%), geranyl acetone (9.12%), benzene acetaldehyde (8.51%), linalool (7.93%), α-pinene (6.89%), and 1,8-cineol (5.22%) were the most abundant volatile compounds and could be chosen as analytical markers of this essential oil. In conclusion, our results suggested that this EO possesses a wide range of bioactive properties that could be useful in nutraceutical, functional foods and cosmeceutical formulations.

Performance of titanium salts compared to conventional FeCl3 for the removal of algal organic matter (AOM) in synthetic seawater: Coagulation performance, organic fraction removal and floc characteristics.

During algal bloom periods, operation of seawater reverse osmosis (SWRO) pretreatment processes (e.g. ultrafiltration (UF)) has been hindered due to the high concentration of algal cells and algal organic matter (AOM). The present study evaluated for the first time the performance of titanium salts (i.e. titanium tetrachloride (TiCl4) and polytitanium tetrachloride (PTC)) for the removal of AOM in seawater and results were compared with the conventional FeCl3 coagulant. Previous studies already demonstrated that titanium salts not only provide a cost-effective alternative to conventional coagulants by producing a valuable by-product but also minimise the environmental impact of sludge production. Results from this study showed that both TiCl4 and PTC achieved better performance than FeCl3 in terms of turbidity, UV254 and dissolved organic carbon (DOC) removal at similar coagulant dose. Liquid chromatography - organic carbon detection (LC-OCD) was used to determine the removal of AOM compounds based on their molecular weight (MW). This investigation revealed that both humic substances and low MW organics were preferentially removed (i.e. up to 93% removal) while all three coagulants showed poorer performance for the removal of high MW biopolymers (i.e. less than 50% removal). The detailed characterization of flocs indicated that both titanium coagulants can grow faster, reach larger size and present a more compact structure, which is highly advantageous for the design of smaller and more compact mixing and sedimentation tanks. Both titanium coagulants also presented a higher ability to withstand shear force, which was related to the higher amount of DOC adsorbed with the aggregated flocs. Finally, TiCl4 had a better recovery after breakage suggesting that charge neutralization may be the dominant mechanism for this coagulant, while the lower recovery of both PTC and FeCl3 indicated that sweep flocculation is also a contributing mechanism for the coagulation of AOM.

High flux and antifouling properties of negatively charged membrane for dyeing wastewater treatment by membrane distillation.

This study investigated the applicability of membrane distillation (MD) to treat dyeing wastewater discharged by the textile industry. Four different dyes containing methylene blue (MB), crystal violet (CV), acid red 18 (AR18), and acid yellow 36 (AY36) were tested. Two types of hydrophobic membranes made of polytetrafluoroethylene (PTFE) and polyvinylidene fluoride (PVDF) were used. The membranes were characterized by testing against each dye (foulant-foulant) and the membrane-dye (membrane-foulant) interfacial interactions and their mechanisms were identified. The MD membranes possessed negative charges, which facilitated the treatment of acid and azo dyes of the same charge and showed higher fluxes. In addition, PTFE membrane reduced the wettability with higher hydrophobicity of the membrane surface. The PTFE membrane evidenced especially its resistant to dye absorption, as its strong negative charge and chemical structure caused a flake-like (loose) dye-dye structure to form on the membrane surface rather than in the membrane pores. This also enabled the recovery of flux and membrane properties by water flushing (WF), thereby direct-contact MD with PTFE membrane treating 100 mg/L of dye mixtures showed stable flux and superior color removal during five days operation. Thus, MD shows a potential for stable long-term operation in conjunction with a simple membrane cleaning process, and its suitability in dyeing wastewater treatment.

Effect of coagulation on fouling potential and removal of algal organic matter in ultrafiltration pretreatment to seawater reverse osmosis.

This paper investigated the effect of coagulation on fouling potential and removal of algal organic matter (AOM) in seawater ultrafiltration (UF) systems. AOM harvested from a strain of bloom forming marine diatom, Chaetoceros affinis, was coagulated with ferric chloride under different coagulation modes and conditions. The effect of coagulation on fouling potential was determined with the Modified Fouling Index-Ultrafiltration (MFI-UF). Removal of AOM was studied for three different modes of coagulation, namely, coagulation followed by sedimentation, coagulation followed by sedimentation and filtration through 0.45 µm, and inline coagulation followed by filtration through 150 kDa UF membranes. Liquid chromatography - organic carbon detection was used to determine the removal of AOM with particular emphasis on biopolymers. AOM (as biopolymers) had a high fouling potential as measured by MFI-UF, which strongly depended on filtration flux. Moreover, the developed cake/gel layer on the membrane was fairly compressible during filtration; manifested as higher fouling potential at higher filtration flux and non-linear development of pressure in filtration tests. Coagulation substantially reduced fouling potential and compressibility of the AOM cake/gel layer. The impact of coagulation was particularly significant at coagulant doses >1 mg Fe/L. Coagulation also substantially reduced the flux-dependency of AOM fouling potential, resulting in linear development of pressure in filtration tests at constant flux. This was attributed to adsorption of biopolymers on precipitated iron hydroxide and formation of Fe-biopolymer aggregates, such that the fouling characteristics of iron hydroxide precipitates prevailed and AOM fouling characteristics diminished. At low coagulant dose, inline coagulation/UF was more effective in removing AOM than the other two coagulation modes tested. At high coagulant dose where sweep floc conditions prevailed, AOM removal was considerably higher and controlled by coagulant dose rather than coagulation mode.

Six hours of resting platelet concentrates stored at 22-24 ºC for 48 hours in permeable bags preserved pH, swirling and lactate dehydrogenase better and caused less platelet activation.

BACKGROUND: During transportation, platelet concentrates (PC) usually undergo a long period without agitation. Whether this interruption improves quality and viability or, contrariwise, has deleterious effects on PC stored for 48 hours (h) is unknown. The aim of this study was to investigate the effects of metabolic resting (6 h of interruption of agitation) vs continue agitation of PC stored for 48 h in the blood bank of Tehran. MATERIALS AND METHODS: PC were prepared from platelet-rich plasma and stored in permeable bags in a shaker/incubator for 42 h at room temperature (20-24 ºC). Then, simply by stopping the agitator, the PC remained stationary ("resting") without agitation for 6 h (WCA6h), prior to transfusion. In vitro measurements of platelet quality were carried out just after completion of the resting period and the results were compared with those of PC continuously agitated in the same day (designated as the control group, CA6h). The in vitro variables measured were swirling, ristocetin-induced aggregation (GPIb-related function), lactate dehydrogenase (LDH) concentration, platelet factor 4 (PF4) release and P-selectin expression (activation markers). RESULTS: The mean platelet counts of the control group (CA6h) and rested (WCA6h) PC were not statistically different (P =0.548). Likewise, the mean pH values were not significantly different: WCA6h (7.16 ± 0.08) and CA6h (7.22 ± 0.16) (P =0.300). Although ristocetin-induced aggregation did not differ significantly between CA6h (79.2 ± 4.4) and WCA6h (66.65 ± 28.55) (P =0.186), WCA6h showed significantly less PFA release (P =0.015) and lower P-selectin expression (P =0.006). CONCLUSIONS: We observed that PC stored under agitation for 42 h at 22-24 ºC in permeable bags and then rested for 6 h had better preserved pH, swirling and LDH and less platelet activation then PC kept under continuous agitation for the whole 48 h storage period.

Nutritional status in a sample of the Afghan immigrant children within Iran.

Anthropometric studies in Afghan immigrants in Iran have not been yet performed; therefore the aim of the present study is to identify Body Mass Index (BMI) in a sample of Afghan immigrant children in Iran during the year 2005. In this cross-sectional study 606 Afghan children aged between 6-14 years have been randomly selected within Shahriar County of Tehran Province of Iran and their weight and height have been measured. Then, using BMI formula BMI = Weight (kg)/Height (m2) their BMI was calculated and based on CDC (Centers for Disease and Prevention Control) indices, children were categorized as: under weight, normal and obese. Results of this study showed that 97 cases (16%) had low weight whereas, 429 cases (81.2%) had normal weight and 17 cases (2.8%) had over weight. More percentage of girls had lower weight than the boys (15.2 versus 16.9%), Afghan children who were born in Iran had also lower weight (17.3%) than those who were born in Afghanistan (15.2%) and third and upper birth order children had lower weight compared to first and second birth order (17 versus 15.3%). However, none of these differences were statistically significant. The researchers suggest that due to high incidence of malnutrition in Afghan immigrant children in Iran interventional and educational programs are needed in order to improve their level of health and nutritional status.

Anesthetic and surgical experience in a case of total vertical craniopagus.

BACKGROUND: A case of craniopagus twins is presented. The twins were attached to each other at the parietal vertex with an interaxis angle of 180 degrees and an interface angle of 90 degrees. To assess the bony, vascular, and nervous system interconnections, the twins underwent computerized tomographic scanning and cerebral angiography under inhalational general anesthesia. CASE DESCRIPTION: To provide adequate skin, tissue expanders were implanted under the scalp at 3 and 7 months of age. Separation became necessary at 1 year of age on an emergency basis, because of respiratory complications in the small twin. Profuse bleeding and hypovolemia led to the death of the healthy big twin. While one would expect that at least one of the twins could have been saved, the small twin also succumbed to air emboli and hypotension hours later. Postmortem examination revealed that the brains were joined at both medial and lateral hemispheric surfaces and shared a common circumferential sinus. CONCLUSION: This case was quite different as regards cerebral anatomy compared to those already reported in the literature.

Synthesis, conformational analysis and antinociceptive activity of 1-[N-methyl-(2-phenylethyl)amino]methyl-1,2,3,4-tetrahydroisoquinoline derivatives.

New derivatives of 1-[N-methyl-(2-phenylethyl)amino]methyl-1,2,3,4-tetrahydroisoquinoline were synthesized. The antinociceptive activity of the compounds, determined by the mouse tail-flick test, showed that the introduction of a hydroxy substituent in position 5 of the isoquinoline nucleus generated compounds 4c and 5c, which were as potent as codeine. Conformational analysis and superimposition of energy minima conformers of the compounds on phenazocine revealed that the main proposed opioid pharmacophores were well matched.

Combined immunoglobulin and azathioprine in multiple sclerosis.

In an attempt to prevent exacerbations of multiple sclerosis, immunoglobulin therapy was combined with azathioprine (AZA). Intravenous immunoglobulin (i.v.IG) 2 g/kg was given in divided doses over 3 consecutive days followed by monthly booster doses (0.2 g/kg) for 3 years to 38 patients with relapsing-remitting multiple sclerosis (MS). In the 34 patients who completed the trial, the relapse rate decreased (from 1.7 relapses per year to 0 during the 3-year trial period). The Kurtzke Expanded Disability Status Scale decreased from 3.4 +/- 0.72 to 3.0 +/- 0.70. The results suggest that combined i.v.IG and AZA suppress the ongoing pathologic process in relapsing-remitting MS.

Involvement of dopamine receptor subtypes in mouse thermoregulation.

The effects of dopamine agonists on core body temperature (BT) were tested in mice. Apomorphine (APO) reduced BT of the mice dose dependently. The response was inhibited by the D-2 antagonist sulpiride, but not by the D-1 antagonist SCH 23390. The D-2 agonist quinpirole also decreased BT and this was prevented by sulpiride pretreatment. Administration of the D-1 agonist SKF 38393 increased BT. This hyperthermia was decreased by SCH 23390 pretreatment. In reserpinized animals, APO caused a dose-related increase in BT. The hyperthermic response of the drug was abolished in animals pretreated with a combination of sulpiride with SCH 23390, but not by single administration of sulpiride or SCH 23390. Quinpirole and SKF 38393 caused hyperthermia in reserpinized mice. The response was decreased in animals pretreated with sulpiride or SCH 23390, respectively. BT of the intact mice was decreased, while that of reserpinized animals was increased by SCH 23390 but not by sulpiride pretreatment. It is concluded that the presynaptic dopamine neurons are involved in hypothermia, while both postsynaptic D-1 and D-2 dopamine receptors may mediated the hyperthermia induced by dopaminergic agents.

Alopecia in dolls!

A case of trichotillomania is presented in which symptoms of pulling out a doll's hair preceded by about one year the self-inflicted alopecia in a child.