British Journal of Biomedical Science in 2020. What have we learned?

Each year the British Journal of Biomedical Science publishes a 'What have we learned' editorial designed to introduce readers within the major disciplines of laboratory medicine to developments outside their immediate area. In addition it is designed to inform a wider readership of the advances in the diagnosis and treatment of disease. To this end, in 2020 the journal published 39 articles covering the disciplines within Biomedical Science in the 4 issues comprising volume 77. These included a review of COVID-19 in this issue, 27 original articles, 6 Biomedical Science 'In Brief' and 4 case histories. 27 of the articles involved molecular techniques, with one of these comparing results with a mass spectrometry based method. The preponderance of molecular genetic studies gives us a good idea of the likely future direction of the disciplines.

Toxicology in clinical laboratories: challenging times.

In recent years, there have been a number of significant developments in toxicology within clinical laboratories, both with the available instrumentation and in the range of compounds abused by the drug using communities. There have also been developments in the regulation of forensic science in the UK which may in time impact clinical toxicology. This review is designed to provide an update of these changes within toxicology to the more general pathology laboratory audience. For detailed information in specific areas, the reader is referred to the references in the text. In the preparation of this review, the references held by the author as part of his practice of an analytical toxicologist in the NHS were supplemented by a full literature search in Medline and Embase and a review of pertinent UK and European Governments and regulatory agency websites for recent documentation.

Disinfection of water by adsorption combined with electrochemical treatment.

The disinfection performance of a unique process of adsorption combined with electrochemical treatment is evaluated. A flake graphite intercalation compound adsorbent was used, which is effective for the removal of organic contaminants and is amenable to anodic electrochemical regeneration. Adsorption of Escherichia coli on the graphite flake was followed by electrochemical treatment under a range of experimental conditions in a sequential batch reactor. The adsorption of E. coli cells was found to be a fast process and was capable of removing >99.98% of cells from solution after 5 min with a ca. 6.5-log10 reduction in E. coli concentration after 10 min. With electrochemical treatment the adsorbent could be reused, with no decrease in E. coli adsorption observed over five cycles. In the presence of chloride, >8.5-log10 reduction of E. coli concentration was achieved. Disinfection was found to be less effective in the absence of chloride. However, selection of appropriate operating conditions enabled effective disinfection in a chloride free system, reducing the potential for formation of disinfection by-products. The energy consumption required to achieve >8.5-log10 disinfection was 2-7 kWh m(-3).

Combining adsorption with anodic oxidation as an innovative technique for removal and destruction of organics.

Coupling of adsorption with electrochemical oxidation is a novel approach to the treatment of aqueous organics that has demonstrated a number of key benefits over the individual application of these processes. This is based on a highly conducting adsorbent material, developed under the trade name Nyex™, that is able to rapidly adsorb the organics and anodically oxidise them within a single treatment unit. Successful scale up of the process (in both continuous and batch operation) has been achieved for the polishing of two separate groundwaters (one containing relatively simple petrol, diesel and their degradation products and the other with a range of more complex organics). Treatment showed that low discharge consents can be achieved, including the removal of more complex and difficult to treat compounds to below the limits of detection. Energy consumption for electrochemical regeneration was relatively low (down to 0.5 kWh/m(3)) suggesting that the process could be a practical alternative approach for effluent polishing.

Removal of mercaptans from a gas stream using continuous adsorption-regeneration.

The removal of the mercaptan, 1-methyl-1-propanethiol, from aqueous solutions using a non-porous, electrically conducting carbon-based adsorbent (Nyex 1000) was investigated. The adsorption process was found to be rapid (equilibrium capacity achieved within 5 minutes) with low adsorptive capacity (of the order of 0.4 mg g(-1)) when compared with activated carbon. Electrochemical regeneration of the Nyex 1000 in a simple divided electrochemical cell within a sequential batch treatment unit restored 100% of the adsorbent's adsorptive capacity using treatment times as low as 20 minutes by passing a current of 0.5 A. The sorptive characteristics of a Nyex-water slurry were also modelled and investigated both in a bubble column and in a continuous adsorption-regeneration treatment system. It was demonstrated that the continuous removal-destruction system could achieve a step reduction in challenge gas concentration of approximately 75% for a period of 35 minutes with a current of 5 Amps. This was attributed to mass transfer enhanced by a combination of adsorption and chemical reaction with free chlorine species generated in the electrochemical process.

Continuous water treatment by adsorption and electrochemical regeneration.

This study describes a process for water treatment by continuous adsorption and electrochemical regeneration using an air-lift reactor. The process is based on the adsorption of dissolved organic pollutants onto an adsorbent material (a graphite intercalation compound, Nyex(®)1000) and subsequent electrochemical regeneration of the adsorbent leading to oxidation of the adsorbed pollutant. Batch experiments were carried out to determine the adsorption kinetics and equilibrium isotherm for adsorption of a sample contaminant, the organic dye Acid Violet 17. The adsorbent circulation rate, the residence time distribution (RTD) of the reactor, and treatment by continuous adsorption and electrochemical regeneration were studied to investigate the process performance. The RTD behaviour could be approximated as a continuously stirred tank. It was found that greater than 98% removal could be achieved for continuous treatment by adsorption and electrochemical regeneration for feed concentrations of up to 300 mg L(-1). A steady state model has been developed for the process performance, assuming full regeneration of the adsorbent in the electrochemical cell. Experimental data and modelled predictions (using parameters for the adsorbent circulation rate, adsorption kinetics and isotherm obtained experimentally) of the dye removal achieved were found to be in good agreement.

Mycophenolic acid trough level monitoring: relevance in acute and chronic graft versus host disease and its relation with albumin.

Mycophenolate mofetil (MMF) is used to treat acute and chronic graft versus host disease (GvHD). There is scant evidence in the literature about mycophenolic acid (MPA) trough level monitoring in GvHD. We therefore reviewed 32 patients treated with MMF for acute (n = 19) or chronic GvHD (n = 13). Twelve (63%) of 19 patients with acute GvHD and nine (69%) of 13 with chronic GvHD showed a good response. In all 21 patients who responded to MMF, their mean total MPA levels were therapeutic (1-3.5 mg/L), whereas five of 11 patients who did not respond had sub-therapeutic mean MPA levels (p = 0.002). Sixteen (66%) of 24 steroid refractory or dependent patients responded to MMF. Associations between the mean total MPA level for each patient and the corresponding mean serum albumin concentration showed therapeutic mean total MPA levels for all 23 patients with mean albumin ≥ 31 g/L but sub-therapeutic mean total MPA levels in five of nine patients with mean albumin <31 g/L (p = 0.0006). In conclusion, MMF is efficacious in steroid refractory and dependent acute or chronic GvHD with statistically significant correlation between therapeutic plasma total MPA trough levels and clinical response. Serum albumin levels should be taken into account when considering MMF dose adjustments.

Atrazine removal using adsorption and electrochemical regeneration.

This paper demonstrates the removal of atrazine using a novel carbon-based adsorbent to below 1.0 microg l(-1) and its subsequent electrochemical regeneration in a simple electrochemical cell. Effective electrochemical regeneration can be achieved with a treatment time as low as 20 min over a number of adsorption/regeneration cycles using laboratory-prepared solutions. The results suggest that electrochemical modification of the particulate surface on electrochemical regeneration can result in adsorptive capacities three times greater than originally achieved.

Treatment of dyehouse effluents with a carbon-based adsorbent using anodic oxidation regeneration.

Adsorption is an attractive route for the removal of coloured, toxic and non-biodegradable organics from wastewater as very low discharge standards can be achieved. This paper reports on the use of a novel carbon-based material, Nyex100, as an adsorbent material for the treatment of dyehouse effluent. The adsorbent has low porosity and high electrical conductivity and these factors have allowed the adsorbent to be electrochemically regenerated. This work has demonstrated that the adsorbent can be cycled through the process of adsorption and regeneration a number of times with little drop in adsorptive capacity. However regeneration appears to modify the preference for organic species adsorption. Electrochemical regeneration can be rapidly achieved (15-20 minutes) using low current densities (< 20 mA cm(-2)). However, the low adsorptive capacity of the adsorbent, because of its small surface area, means that large quantities of adsorbent would need to be cycled within the process to treat the effluent volume generated in even small dyehouses. Thus, it is believed that operating the process in this mode limits the practical application of this technology.

Anaesthetic considerations in a parturient with varicella presenting for Caesarean section.

A parturient with varicella (chickenpox) presented for an elective Caesarean section and spinal anaesthesia was employed for surgery. A review of the literature is presented and the anaesthetic issues are discussed.

Evidence for long-term pancreatic damage caused by laxative abuse in subjects recovered from anorexia nervosa.

OBJECTIVE: This study examined whether a prior history of laxative abuse results in long-term changes in gastrointestinal function. METHOD: The functioning of the enteroinsular axis was examined by measuring the insulin response to a standard meal. The study involved 18 subjects who had fully recovered from anorexia nervosa (AN) and an age and weight-matched control group. In the recovered group, 10 of 18 subjects had a history of laxative abuse. RESULTS: Subjects with a prior history of laxative abuse show a more gradual increase and decrease in insulin secretion, but no differences in glucose response or hunger ratings. DISCUSSION: Because there are no differences in the glucose response to the meal, it is hypothesized that the difference in insulin response is due to changes in the enteroinsular axis. These data indicate that chronic laxative abuse induces long-term changes in gastrointestinal function.

Anorexia nervosa visited and revisited: weight is the issue.

Anorexia nervosa is known as a psychiatric disorder. Many practitioners seem unaware that a patient in a starvation state is cognitively impaired and thus a poor candidate for psychotherapy. Weight restoration is a prerequisite to other treatment modalities. Many practitioners and all patients fail to recognize this illness because of a prevailing cultural idealization of thinness. Since these patients initially seem so compliant in treatment, valuable time is lost by those who fail to understand the patient's deceptiveness and the life-threatening potential of the disease.

Comparison of described empathic and nominated empathic individuals.

A composite profile of "empathic individuals" was developed from adjectives checked on Gough and Heilbrun's Adjective Check List by 43 undergraduate students enrolled in a course on counseling. Individuals were nominated as empathic by the students who also completed the checklist. The composite profile was consistent with the Rogerian definition of empathy and Factor 3 (Sociability) of the check list. The profiles for the nominated sample and for the students did not differ significantly on 36 of the 37 scales but both differed significantly from the composite profile on 34 scales.

Medical consequences of eating disorders.

While much has appeared in the recent literature about various psychotherapeutic techniques used to treat eating disorders, little attention has been paid to the medical complications. Prominent among these are heart damage, failure of the endocrine system, infarction and perforation of the stomach after acute dilatation, multiple suicide attempts, aspiration, injury or rupture of the esophagus, severe bleeding per rectum causing anemia due to laxative abuse, hypokalemic nephropathy, depressive disorders due to starvation, and severe erosion of the enamel of the teeth resulting in extensive loss of teeth. I decry the sudden trend of nonmedically trained personnel rushing into the treatment of eating disorders, particularly anorexia nervosa and bulimia, because they know little about the possibly fatal consequences of their failure to attend to some of these medical phenomena. I also note with grave concern the identification of the medical profession with the "thin is better" mentality of our culture, which blinds them to the serious medical consequences of eating disorders.