Mining minerals and critical raw materials from bittern: Understanding metal ions fate in saltwork ponds.

Seawater represents a potential resource for raw materials extraction. Although NaCl is the most representative mineral extracted other valuable compounds such as Mg, Li, Sr, Rb and B and elements at trace level (Cs, Co, In, Sc, Ga and Ge) are also contained in this "liquid mine". Most of them are considered as Critical Raw Materials by the European Union. Solar saltworks, providing concentration factors of up-to 20 to 40, offer a perfect platform for the development of minerals and metal recovery schemes taking benefit of the concentration and purification achieved along the evaporation saltwork ponds. However, the geochemistry of these elements in this environment has not been yet thoroughly evaluated. Their knowledge could enable the deployment of technologies capable to achieve the recovery of valuable minerals. The high ionic strengths expected (0.5-7 mol/kg) and the chemical complexity of the solutions imply that only numerical geochemical codes, as PHREEQC, and the use of Pitzer model to estimate the activity coefficients of the different species in solution can be adopted to provide valuable description of the systems. In the present work, for the first time, PHREEQC Pitzer code database was extended to include the target minor and trace elements using Trapani saltworks (Sicily, Italy) as a case study system. The model was able to predict: i) the purity in halite and the major impurities contained, mainly Ca, Mg and sulphate species; ii) the fate of minor components as B, Sr, Cs, Co, Ge and Ga along the evaporation ponds. The results obtained pose a fundamental step in critical raw materials mining from seawater brine, for process intensification and combination with desalination.

The effect of inactivated Lactobacillus LB fermented culture medium on symptom severity: observational investigation in 297 patients with diarrhea-predominant irritable bowel syndrome.

INTRODUCTION: Little is known about the intensity of symptoms of diarrhea-predominant IBS (IBS-D) or the consequences of the disease on patients' health-related quality of life (HRQOL). This observational investigation assessed the symptoms (abdominal pain, bloating, number of stools per day, and stool consistency), impact on HRQOL, and consequence on anal continence in 297 patients with IBS-D before and after 1 month of probiotic treatment with Lacteol (inactivated Lactobacillus LB plus fermented culture medium). METHODS: Functional assessment using a standardized visual analogue scale in order to quantify abdominal pain, bloating, and quality of life before and after 1 month of treatment with 2 capsules/day of Lacteol. The number of symptomatic days per week, number of stools, consistency of stools, secondary fecal incontinence rate, and potential trigger effect of food were quantified. A χ2 test was used to compare qualitative data and the variance of quantitative criteria was analyzed. RESULTS: The pain score decreased from 4.46±0.15 on a scale of 0-10 before treatment to 2.8±0.14 after treatment (p<0.0001). Bloating decreased from 4.49±0.18 to 2.5±0.15 on a scale of 0-10 (p<0.0001). The HRQOL score, which is inversely correlated with quality of life, decreased from 5.99±0.14 to 3.92±0.16 (p<0.0001). In this cohort study, the fecal incontinence rate secondary to diarrhea was clearly higher than that of the general population: 18% versus a prevalence of 9-10%, according to different studies. The mean number of stools per week decreased from 17.59 to 12.83 after treatment (p<0.0001). Before treatment, 54% of patients had watery stools and 46% had smooth stools; at the end of treatment, only 18.5% of patients still had watery stools, and 34% had normal stools. 52% of patients attributed their symptoms to their diet: 34% to vegetables, 29% to fruit, 15% to milk, 15% to fat, 6% to peppers and spices, and 4% to sugar. CONCLUSION: This observational investigation shed new light on patients with IBS-D, the HRQOL of which is altered by a fecal incontinence rate twice as high as that of the general population. Correlation with diet is confirmed by 1 out of 2 patients reporting poor tolerance of fiber and dairy products. Nutritional management should thus be part of these patients' treatment. Inactivated Lactobacillus LB plus fermented culture medium is a probiotic drug that has been used by physicians for a long time to treat patients with diarrhea. Strongly concentrated, it has no side effects and seems to help these patients. Due to a strong placebo effect in patients with this pathology, however, a controlled study is necessary to confirm this result.

Ribavirin and interferon-alpha combination therapy vs interferon-alpha alone in the retreatment of chronic hepatitis C: a randomized clinical trial.

Interferon-alpha (IFN-alpha) induces sustained remission of chronic hepatitis C in approximately 25% of patients. In patients who are non-responders to the first course of therapy, retreatment with IFN-alpha is of limited efficacy. Ribavirin has also been used to treat chronic hepatitis C, but it induces only a transient response. In this study, we evaluated the efficacy of ribavirin and IFN-alpha combination therapy for IFN-alpha resistant chronic hepatitis C. Twenty-four IFN-alpha non-responders and 24 relapsers were randomized to receive either ribavirin (1000 mg per day) together with IFN-alpha (3-6 million units (MU) thrice weekly) or the same dose of IFN-alpha alone, for 6 months. Both at the end of treatment and 6 months later, normal transaminase levels were more common in the patients receiving combination therapy than in the group receiving IFN-alpha alone: 17 (70.8%) vs seven (29.2%) patients (P = 0.009) and six (25%) vs one (4.2%) patient (P = 0.034), respectively. At the end of treatment and 6 months later, serum HCV RNA was no longer detectable in eight (33.3%) and five (20.8%) patients in the combination therapy group and in six (25%) and one (4.2%) patient in the IFN-alpha therapy group, respectively. Three patients (12.5%) were withdrawn prematurely from combination therapy because of side-effects; ribavirin therapy was ceased or dosage reduced in six other patients (25%), again because of side-effects. In conclusion, this combination treatment was more effective than retreatment with IFN-alpha, alone, in inducing sustained biochemical remission of chronic hepatitis C that was resistant to a previous course of IFN-alpha. The combination treatment, however, was frequently associated with significant side-effects.

Retrograde fibreoptic intubation in a child with Nager's syndrome.

PURPOSE: The authors describe a retrograde fibreoptic technique for tracheal intubation in a micrognathic child with a tracheo-cutaneous fistula. CLINICAL FEATURES: A four-year-old child with Nager's syndrome presented for surgical closure of a tracheocutaneous fistula. A tracheostomy tube had been placed in the neonatal period for management of upper airway obstruction due to severe micrognathia. At 2 1/2 yr of age, after a successful mandibular advancement procedure, the tracheostomy was removed and the child allowed to breathe through the natural airway. Preoperative physical examination revealed an uncooperative child, unable to open her mouth due to limited temporo-mandibular motion. The child was first anaesthetized with ketamine, 70 mg im, then halothane by mask. The authors were unable to open the child's mouth sufficiently to allow rigid laryngoscopy. Attempts at oral and nasal fibreoptic intubation were unsuccessful. Ultimately, the authors were able to intubate nasally by passing an ultrathin Olympus LF-P laryngoscope under direct vision through the tracheocutaneous fistula in a cephalad direction, through the larynx and nasopharynx, then out the nares. An endotracheal tube was then advanced over the fibreoptic scope and positioned distal to the tracheocutaneous fistula. The surgical procedure was successfully accomplished and the trachea was extubated postoperatively without difficulty. CONCLUSION: Retrograde fibreoptic intubation may be an option for airway management of a select group of children who cannot be intubated by traditional techniques.

Nevus cells and special nevomelanocytic lesions in children.

Nevomelanocytic lesions in children represent a wide spectrum of proliferative neurocristopathies, ranging from the common small and benign congenital nevi to the garment-type congenital lesions. Included in this spectrum are some rare entities like neurocutaneous melanocytosis, malignant melanoma simulants, and special variants of congenital pigmented nevi. Here, we analyze some tissue culture characteristics of nevomelanocytic cells from giant and small congenital nevi, neurocutaneous melanocytosis, and a rare variant of nevus named "bulky nevocytoma." Correlations with their histological, immunohistochemical, and ultrastructural features are addressed.

[Effect of enprostil on the healing and the recurrence of duodenal ulcer. Comparison with ranitidine]. / Effect de l'enprostil sur la cicatrisation et la récidive des ulcéres duodénaux. Comparaison à la ranitidine.

Enprostil, a synthetic prostaglandin E2, has been shown to exert both antisecretory and mucoprotective activity. It is effective in duodenal ulcer healing. OBJECTIVE--This study was performed to compare the frequency and the delay of spontaneous duodenal ulcer relapse during a two-year follow up period after initial healing by enprostil (35 micrograms, twice a day) or ranitidine (300 mg per day). METHODS--This multicentric, double-blind, randomized study included 642 patients (324 in the enprostil group and 318 in the ranitidine group). Patients included in the follow up period were evaluated by an endoscopy at 6 months, one and two years after healing. RESULTS--After a 6 weeks treatment period, healing rate was 85% for ranitidine and 70% for enprostil, respectively (P < 0.001). Adverse effects, especially digestive ones, occurred more often with enprostil than with ranitidine (P < 0.001). After initial healing, there was no significant difference between the 2 groups concerning the cumulative rate of relapse, despite a non significant trend for a milder rate of relapse in the enprostil group (P = 0.08). Twenty-seven % of the patients randomized to treatment (intend-to-treat analysis) in the enprostil group and 29% in the ranitidine group had no ulcer recurrence 6 months after ulcer healing, and respectively 12% and 13% at 2 years (difference not statistically significant). CONCLUSIONS--It is concluded that a) ranitidine is more effective and has less adverse effects than enprostil for duodenal ulcer healing, b) after duodenal ulcer healing by enprostil, there is a non significant trend for a lower rate of relapse than after healing with ranitidine, c) there is the same proportion of patients without ulcer in the 2 groups after 6 months and 2 years.

[Variations of plasma gastrin (basal and postprandial) in ththtreatmentof duodenal ulcer with either enprostil or ranitidine. Correlations with rates of relapse]. / Variations de la gastrine plasmatique (basale et post-prandiale) au cours de traitements de l'ulcère duodénal par l'enprostil ou la ranitidine. Corrélations avec les taux de rechute.

Enprostil, a synthetic E2-prostaglandin efficacious for duodenal ulcer healing, presents both antisecretory and antigastrinic effects. This is at variance with the elevation of plasma gastrin observed with ranitidine. OBJECTIVE--This leads us to compare enprostil and ranitidine on the following points: a) variations of plasma gastrin (basal and postprandial) parameters over a 6-week conventional treatment; b) correlation studies between ulcer relapses (frequency and temporal evolution) after treatment discontinuation and various gastrinic criteria. METHODS--Among a group of 642 patients followed for ulcer relapse, 165 were considered for gastrin (78 of the "Enprostil" group and 87 of the "Ranitidine" group). RESULTS--Initially, both populations were comparable for clinical and plasma gastrin parameters. After 6 weeks of treatment, the increases in the various gastrin parameters (basal, postprandial, peak, integraded) were significantly greater and the absolute values higher (Wilcoxon, P < 0.001) with ranitidine than with enprostil. No correlation was found between relapse occurrence after drug discontinuation and these gastrin parameters. CONCLUSIONS--Ranitidine hypergastrinemia seems directly related to gastric hyposecretion whereas its absence with enprostil is likely more dependent upon a specific antigastrinic activity than on a reduced antisecretory activity. Those differences in mechanism of action have no consequence on the stability of ulcer obtained by either drug.

Expanded full-thickness skin grafts in children: case selection, planning, and management.

Since our initial presentation of our experience with tissue expansion as a means of harvesting large full-thickness skin grafts in children in 1987, we have continued to "expand" both the size of full-thickness skin grafts harvested and the range of reconstructive problems to which we have applied the technique. Sixteen expanded full-thickness grafts have been used for immediate reconstruction following giant nevus excision and in postburn reconstruction. Patients ranged in age from 6 months to 15 years, with follow-up ranging from 6 months to 6 1/2 years. Grafts ranging in size from approximately 60 cm2 (excluding the dimensions of one submental graft) to greater than 700 cm2 were harvested from expanded donor sites on unilateral or bilateral groin/lower abdomen, clavicular, and a single submental expansion. Five expanded full-thickness grafts were used in facial reconstruction for single aesthetic unit coverage, multiple unit, and one single-sheet full facial graft. One expanded full-thickness graft was used on the breast. Three grafts were used in dorsal hand and finger coverage, and seven were used on the lower extremity, including an entire plantar surface and toes. Graft loss was confined to a 6.25-cm2 area on one cheek in the full facial expanded full-thickness grafts and a 9-cm2 area on the non-weight-bearing area of the full plantar graft. Donor-site complications were negligible. The anatomic confines of the donor sites and size of the patient may require expander replacement (in situ serial expansion) in order to obtain a large enough graft and accomplish primary donor-site closure. Expander and injection port placement in children for ease of injection and planned expander change must be anticipated. Our protocol from preoperative teaching through graft take is reviewed. Experience has demonstrated that expanded full-thickness grafts maintain all the characteristics of non-expanded full-thickness skin grafts and are an excellent reconstructive option in children.

Anaesthetic management of Miller's syndrome.

Miller's syndrome is a rare congenital disorder with facial features similar to that of Treacher-Collins syndrome. This report details the anaesthetic management of an infant during multiple surgical procedures, beginning with pylormyotomy at one month of age. Airway management was difficult because of severe micrognathia and was accomplished using an awake intubation with a conventional straight blade modified for continuous administration of oxygen ("oxyscope"). Due to recurrent upper airway obstruction and the anticipated need for multiple surgical procedures in the first years of life, a tracheostomy was placed. Because of the multiple airway, orthopaedic, and nutritional difficulties, it is important that a prospective, multidisciplinary approach be used in these patients' care. Consideration should be given to early tracheostomy for airway maintenance.

The role of tissue expansion in pediatric plastic surgery.

The ability to increase available local tissue by controlled soft tissue expansion (TE) has led to a rapid increase in the use of TE in clinical practice. This article reviews some general guidelines when using TE in children and addresses some of the concerns previously expressed regarding the effects of TE on growth in infants and children.

Comparative study of sucralfate versus cimetidine in the treatment of acute gastroduodenal ulcer. Randomized trial with 667 patients.

Six-hundred sixty-seven patients with endoscopically proven peptic ulcer were included in a randomized, multicenter trial to assess the comparative efficacy of sucralfate and cimetidine. One hundred eighty-seven patients with gastric ulcer and 480 patients with duodenal ulcer completed the study. Ulcer healing was evaluated endoscopically at six weeks for duodenal ulcer and at eight weeks for gastric ulcer. Patients with unhealed ulcer at this time were assigned to the other therapy for a second period of six or eight weeks of treatment (crossover). In patients with duodenal gastric ulcer, pain relief and healing were not significantly different in the two groups. Eighty-eight percent of duodenal ulcers and 73 percent of gastric ulcers healed with six weeks of sucralfate treatment. Reported side effects and symptoms, pooled together for duodenal and gastric ulcer, were more significant in the sucralfate group (7.5 percent) than in the cimetidine group (3.7 percent). Constipation was the most frequent symptom recorded. In conclusion, sucralfate and cimetidine are both excellent healing agents for short-term treatment of duodenal and gastric ulcer. Both give rapid relief of symptoms without severe side effects.

[Efficacy and tolerability of enprostil in the treatment of duodenal ulcer. Comparison with cimetidine]. / Efficacité et tolérance de l'enprostil dans le traitement de l'ulcère duodénal. Comparaison à la cimétidine.

Enprostil, a synthetic PGE2, has been shown to have an inhibitory effect on gastric acid secretion, a mucoprotective effect and a postprandial lowering effect on gastrin. A double blind randomized study was performed in 80 patients, in order to evaluate the efficacy and safety enprostil (35 mu b.i.d) as compared to cimetidine (400 mg b.i.d) in duodenal ulcer. Healing rates after two, four and six weeks of treatment, as based on endoscopic evaluation, were 35, 72 and 83 p. 100 for enprostil and 45, 73 and 83 p. 100 for cimetidine, respectively. There were no significant differences between treatment groups. The time to relief of nighttime and daytime ulcer pain and antacid consumption were similar in the two groups. The patient's overall subjective assessment was better in the cimetidine group, but this was not confirmed by physicians' opinions. Diarrhea was observed in 7 p. 100 of patients treated by enprostil compared with 5 p. 100 for patients treated by cimetidine. One enprostil treated patient withdrew from the trial prematurely because of abdominal pain. This study demonstrates the efficacy and safety of enprostil in the treatment of active duodenal ulcer at the dosage of 35 micrograms twice daily.

[Scanning electron microscopic study of Campylobacter pylori and associated gastroduodenal lesions]. / Etude en microscopie électronique à balayage de Campylobacter pylori et des lésions gastroduodénales associées.

The detection of Campylobacter pylori was carried out with scanning electron microscopy (SEM) on 4,590 biopsies taken from 1,714 adult patients (1,348 duodenal biopsies, 1,690 antral biopsies and 1,552 fundic biopsies). The mucus was removed and the fragments of mucosa were then fixed with glutaraldehyde, dehydrated, critical point-dried with CO2 or hexamethyldisilazane, mounted, coated with gold, and observed with SEM. Under SEM, C. pylori was characterized by its spiral-shape (long form 2.5 to 6 microns) or by its curved-shape (short form 1.5 microns) and by its relatively constant diameter (0.5 micron). C. pylori was present in 671 patients (40 p. 100) and was found mainly in the fundus and antrum, near the neck of the gastric glands and at the level of the intracellular spaces. It was never present on the surface of enterocytes but was found in the 26 duodenal biopsies in the gastric metaplasia areas and on the surface of adjacent muciparous cells. The main epithelial lesions associated with C. pylori were of an erosive or desquamative type. The high definition observed using SEM allowed C. pylori to be distinguished from other microorganisms observed on the surface of the gastroduodenal mucosa: bacilli and cocci contaminants, Candida albicans, Giardia lamblia, spirochetes and other Campylobacters. SEM is a specific and rapid technique (less than 2 hours) which determines the morphology, localisation of bacteria as well as the associated lesions of the mucous cells.

An approach to excision of congenital giant pigmented nevi in infancy and early childhood.

This paper presents a timely coordinated approach to complete excision of congenital giant pigmented nevi in infancy and early childhood based on a review of 78 patients with giant pigmented nevi of the head and neck, trunk, and/or extremity. Giant pigmented nevi in those selected for review measured from a minimum of 2 percent up to 45 percent total body surface (TBS). Giant nevi of the scalp were treated most effectively using tissue expansion, beginning as early as 3 months of age. Expanded forehead and neck flaps in combination with expanded full-thickness skin grafts were used in early excision of giant pigmented nevi of the face. Giant nevi of the trunk were treated using a combination of abdominoplasty technique, tissue expansion, and split-thickness skin graft, with early "large segment" excision and grafting being the most effective treatment of giant nevi covering the posterior trunk. Giant nevi of the extremities were treated most effectively with excision and graft. Expanded full-thickness skin grafts gave excellent coverage on the hands and feet.

An approach to excision of congenital giant pigmented nevi in infancy and early childhood.

Complete prophylactic excision of "large" and "giant" congenital nevocellular nevi (CNCN) often involves multiple surgical procedures begun in early infancy and not completed until late adolescence. Timely use of combined modalities of excision and reconstruction, beginning in infancy, and recognizing the benefits and limitations of each technique in each body region may allow completion of the excision of even the most extensive lesions in early childhood. In addition to minimizing the risk of malignant transformation, early complete excision may minimize the late psychologic stress caused by the appearance of the lesion and the late decision to attempt total excision. Tissue expansion and extensive excision and grafting in infancy and early childhood may significantly improve the final cosmetic result following treatment of these extensive lesions.