An Update on the Efficacy and Safety Profile of Clazosentan in Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis.

OBJECTIVE: The present meta-analysis was conducted to provide an update on the efficacy and safety profile of clazosentan with different doses in aneurysmal subarachnoid hemorrhage (aSAH). METHODS: We performed a comprehensive and electronic search updated to September 2018 of The Cochrane Library, Embase, and PubMed to identify relevant clinical trials. Trials of the effectiveness of clazosentan in treating cerebral vasospasm after aSAH were studied. The main outcomes included new cerebral infarction (NCI), delayed ischemic neurologic deficit (DIND), vasospasm associated with morbidity/mortality, angiographic vasospasm, rescue therapy, and adverse events. We applied RevMan 5.3 software for this meta-analysis to analyze the combined pooled odds ratios (ORs) with 95% confidence intervals (CIs) using a fixed- or random-effects model on the basis of heterogeneity. RESULTS: A total of 5 randomized placebo-controlled trials were included in this meta-analysis. Beneficial outcome was found in patients who received higher doses of clazosentan (>5 mg/h) after aSAH based on decreased incidence of DINDs (OR, 1.76; 95% CI, 1.16-2.69; P = 0.008), NCIs (OR, 2.31; 95% CI, 1.34-3.95; P = 0.002), and angiographic vasospasms (OR, 1.85; 95% CI, 1.19-2.89; P = 0.007). Meanwhile, other parameters, such as vasospasm-related morbidity/mortality, rescue therapy, and adverse events, showed no statistical significance (P > 0.05) between high and low doses of clazosentan. CONCLUSIONS: The significant beneficial outcomes of high-dose clazosentan have been proven in preventing cerebral vasospasm and subsequent cerebral infarction compared with low-dose clazosentan, with a manageable safety profile. However, high doses of clazosentan had no significant effect on rescue therapy and vasospasm-related morbidity/mortality.

[Start-up and Operation of Biofilter Coupled Nitrification and CANON for the Removal of Iron, Manganese and Ammonia Nitrogen].

A pilot-scale bio-filter coupled nitrification and CANON was started up to remove iron, manganese and ammonia nitrogen from groundwater in a plant, and the main removal route of ammonia nitrogen was analyzed. The experiment showed that the bio-filter could be started up successfully and achieved stable operation after 164 days of culture development. The value of △NH4+-N/△NO3--N was 1.49, and the oxidation and removal of Fe(Ⅱ), Mn(Ⅱ), and NH4+-N were (9.87±1.17), (2.25±0.06), and (1.51±0.06) mg·L-1, respectively. The calculation based on the quantitative relationship between nitrogen conservation and dissolved oxygen (DO) measurement indicated that the contribution of CANON to NH4+-N removal was 33.48%-38.87%, and the average ratio of ammonia nitrogen removal amount to DO was 1:3.79-1:3.94. The removal ratio of ammonia nitrogen was lower with lower temperature.

[Effect of Organic Carbon Source on Start-up and Operation of the CANON Granular Sludge Process].

The effect of organic carbon on the start-up and operation of the CANON granular sludge process was investigated in two SBR reactors with different strategies:gradually increased organic carbon concentration (R1) and without organic carbon (R2). The results showed that adding 50 mg·L-1 organic carbon accelerated the start-up of the CANON granular sludge process. R1 and R2 were started up in 23 d and 32 d, respectively. Moreover, the appropriate organic carbon enhanced the activity of AOB, AnAOB, and denitrification, increasing the ammonia removal rates and total nitrogen (TN) removal rates. The maximum ammonia removal rates and total nitrogen removal rates of R1 were 92% and 88%, respectively. The maximum ammonia removal rates and total nitrogen removal rates of R2 were 89% and 80%, respectively. Further tests showed that excessive organic carbon concentration decreased the activity of AOB and AnAOB and reduced the removal efficiency of ammonia and total nitrogen. Adding organic carbon promoted denitrification activity and increased nitrogen removal efficiency.

[Arsenic(â ¤) Removal by Granular Adsorbents Made from Backwashing Residuals from Biofilters for Iron and Manganese Removal].

Granular adsorbents for arsenic removal (GA) made from the backwashing residuals from iron and manganese removal biofilters for groundwater were characterized and examined as an arsenate sorbent. The GA were characterized by SEM-EDS microscopy, X-ray diffraction (XRD), and BET surface area measurement. The results showed that the GA had rough surfaces, developed pores, and were mainly amorphous, with small fractions of crystalline quartz and hematite. The surface area of the GA, which consists of many mesopores, was 43.8 m2·g-1. The kinetic studies revealed that arsenate adsorption on the GA was described by a pseudo-second-order kinetic equation, and the Freundlich isotherm equation fit the arsenate adsorption well (R2=0.994). The maximum adsorption capacity calculated by the Langmuir isotherm equation for As(Ⅴ) was 5.05 mg·g-1. Further studies showed that the GA operated well for As(Ⅴ) removal over a broad range in pH from 1.1 to 9.5. The coexistence of HCO3- and SO42- had no great influence on arsenic adsorption, while the H2PO4- and SiO32- showed negative effects. The GA can be regenerated well, and 82% of the original adsorption capacity was maintained after three regeneration cycles.

[Research advance on clinical blood transfusion and tumor therapy].

Clinical blood transfusion is one of the most important supportive therapy for patients with tumor. The blood transfusion has dual effects for patients with tumor. First, blood transfusion can rectify anemia and improve oxygen saturation, accelerate oxidation and necrosis for tumor cells; the second, blood transfusion can induce immunosuppression, tumor recurrence and postoperative infection for tumor patients. Filtering white blood cells (WBC) before blood transfusion can decrease the incidence of the adverse reactions. The rational perioperative autotransfusion for patients with tumors is focus to which the world medical sciences pay close attention. In this article, the support effect of blood transfusion for treatment of tumor patients, blood transfusion and immunosuppression, blood transfusion and postoperative infection and relapse of tumor patients, depleted leukocyte blood transfusion and autologous transfusion of tumor patients are reviewed.