Benefits of Centralized Scheduling in a Post- Acute Residential Rehabilitation Program for people with acquired brain lesions. A Pilot Study

Publication date: Available online 18 December 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Alec Vestri, Silvia Pizzighello, Sara Piccoli, Andrea Martinuzzi
ObjectiveTo verify if the use of a designated staff person to coordinate and schedule therapy services in a post acute residential rehabilitation program for people with acquired brain lesions results in a higher intensity treatment allowing the reaching of clinical outcome in a reduced length of stay. Cost saving and perceived satisfaction were explored.DesignThis nonrandomized retrospective study uses data collected relative to two different methods of scheduling: Self Planning in which each single team member makes appointments which are then displayed on a shared board, and Managed Planning in which appointments were made by a designated staff person.SettingThe study was conducted in a residential centre for people with post acute acquired brain lesions between 2009 and 2012.Participantsand main outcome measure: Patients of Managed Planning group (N=10) were balanced with patients of Self Planning group (N=10) on the basis of clinical and demographical characteristics. The sample of 20 patients was analysed using organizational measures (length of stay in rehabilitation, number of treatment hours and the total cost of rehabilitation), clinical outcome scales (Disability Rating Scale, Functional Independence Measure and Functioning and Barthel Index), perceived quality of treatment by patients (Questionnaire) and perceived satisfaction of team members (Job Descriptive Index).InterventionsNot applicableResultsAll patients improved on all clinical rating scales at the moment of discharge (all effect size are large). In the Managed Planning, number of treatment hours increased (Cohen's d = 2.15) resulting in reduced length of stay (Cohen's d = 0.95) and cost of rehabilitation (Cohen's d = 1.22); the quality of treatment perceived by the patients and their families increased while team member satisfaction did not change.ConclusionThe use of a designated staff person to manage therapy services improve efficiency and efficacy of a patient centered health care system. The proposed scheduling system results in a remarkable cost saving for the National Health System.



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Resilience and function in adults with physical disabilities: an observational study

Publication date: Available online 18 December 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Samuel L. Battalio, Arielle M. Silverman, Dawn M. Ehde, Dagmar Amtmann, Karlyn A. Edwards, Mark P. Jensen
ObjectiveTo determine if resilience is uniquely associated with functional outcomes (satisfaction with social roles, physical functioning, and quality of life) in individuals with physical disabilities, after controlling for measures of psychological health (depression and anxiety) and symptom severity (pain, fatigue, sleep disturbance). We also examined the potential moderating effect of gender, age, and diagnosis on the hypothesized associations between resilience and function.DesignCross-sectional survey study.SettingSurveys were mailed (81% response rate) to a community sample of 1949 individuals multiple sclerosis, muscular dystrophy, post poliomyelitis syndrome, or spinal cord injury. Participants were recruited through web or print advertisement (28%), a registry of previous research participants who indicated interest in future studies (21%), a departmental registry of individuals interested in research (19%), disability specific registries (18%), by word of mouth (10%), or other sources (3%).ParticipantsA convenience sample of community-dwelling adults aging with physical disabilities (N=1574) with a mean Connor-Davidson Resilience Scale (CD-RISC10) score of 29.InterventionsNot applicable.Main Outcome MeasuresPatient Reported Outcomes Measurement Information System (PROMIS) measures of Satisfaction with Social Roles and Activities and Physical Functioning, the World Health Organization's Older People's Quality of Life Questionnaire (OPQOL-brief), and the Connor-Davidson Resilience Scale (CD-RISC10).ResultsAfter controlling for age, age², gender, diagnosis, psychological health, and symptom severity, resilience was significantly and positively associated with satisfaction with social roles (β = .17, p < .001) and quality of life (β = .39, p < .001), but not physical function (β = .04, p > .05). For every 1 point increase in scores of resilience, there was an increase of .5 in the quality of life score and .2 in the satisfaction with social roles score. Gender also moderated the association between resilience and satisfaction with social roles, F(1, 1453) = 4.09, p = .043.ConclusionsThe findings extend past research, providing further evidence indicating that resilience plays a unique role in non-physical functional outcomes among individuals with physical disabilities.



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Percutaneous needle tenotomy for the treatment of muscle and tendon contractures in adults with brain damage: results and complications

Publication date: Available online 18 December 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Flavia Coroian, Claire Jourdan, Jérome Froger, Claire Anquetil, Olivier Choquet, Bertand Coulet, Isabelle Laffont
ObjectiveTo study the results and complications of percutaneous needle tenotomy (PNT) of superficial retracted tendons in brain damaged patients. Muscle and tendon contractures are common in this population and can lead to severe functional impairment. Care management is commonly based on open surgical tenotomy. PNT is a mini-invasive surgical procedure suspected to be safer among frail patients.DesignProspective observational studySettingUniversity Hospital Physical Medicine and Rehabilitation (PM&R) and Orthopedic Surgery Departments.ParticipantsThirty-eight patients with severe brain damage (60.7 years [24-93]; 21 women) requiring surgical management of contractures and eligible for PNT were enrolled between February 2015 and February 2016.InterventionsThe PNT gesture was performed by a PM&R physician trained by an orthopedic surgeon, under local or loco-regional anesthesia. Treated tendons varied among patients.Main Outcome MeasuresAll patients were evaluated at 1, 3 and 6 months to assess surgical outcomes (joint range of motion [ROM], pain, and functional improvement) while screening for complications.ResultsImprovements on ROM (37/38) and contractures-related pain (12/12) were satisfactory. Functional results were satisfactory (Goal Attainment Scale≥0) for most patients (37/38): nursing (12), putting shoes on (8), getting in bed or sitting on a chair (6), verticalization (7), transfers and gait (8), grip (2).Five patients had complications related to the surgical gesture: 2 cast-related complications, 2 hand hematoma and one cutaneous necrosis of the Achilles tendon in a patient with previous obliterative arteriopathy of the lower limbs.ConclusionPNT yields good results in the management of selected superficial muscle and tendon contractures. The complications rate is very low and this treatment can be an alternative to conventional surgery in frail neurological patients.



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Myofascial Induction Effects on Neck-Shoulder Pain in Breast Cancer Survivors: Randomized, Single-Blind, Placebo-Controlled Cross-Over Design

Publication date: Available online 18 December 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Eduardo Castro-Martín, Lucía Ortiz-Comino, Tania Gallart-Aragón, Bernabé Esteban-Moreno, Manuel Arroyo-Morales, Noelia Galiano-Castillo
ObjectivesTo investigate the immediate effects of myofascial induction (MI) with placebo electrotherapy as control on perceived pain, cervical/shoulder range of motion (ROM) and mood state in breast cancer survivors (BCSs) with shoulder/arm morbidity. Our secondary objective was to examine the relationships between pain modifications and cervical/shoulder ROM on the side affected by breast cancer.DesignRandomized, single-blind, placebo-controlled cross-over study.SettingPhysical therapy laboratory.ParticipantsTwenty-one BCSs who had a diagnosis of stage I-IIIA breast cancer and had completed adjuvant therapy (except hormonal treatment).InterventionDuring each session, the BCSs received either an MI (fascial unwinding) intervention focused on the upper limb area following the Pilat approach or placebo pulsed shortwave therapy (control group). Each session lasted 30 minutes, and an adequate wash-out period of 4 weeks between sessions was established.Main Outcome MeasuresThe Visual Analogue Scale (VAS) for pain and anxiety, shoulder-cervical goniometry for ROM, the Profile of Mood States (POMS) for psychological distress and the Attitudes Towards Massage (ATOM) Scale were used.ResultsAn analysis of covariance (ANCOVA) revealed significant time x group interactions for VAS affected arm (P=0.031) but not for VAS cervical (P=0.332), VAS non-affected arm (P=0.698) or VAS anxiety (P=0.266). The ANCOVA also revealed significant interactions for affected shoulder flexion (P<0.001), abduction (P<0.001), external rotation (P=0.004) and internal rotation (P=0.001). Significant interactions for affected cervical rotation (P=0.022) and affected cervical lateral flexion (P=0.038) were also found. A significant negative correlation was found between changes in VAS affected arm and shoulder/arm internal rotation ROM (r=-0.46; P=0.03).ConclusionsA single MI session decreases pain intensity and improves neck-shoulder ROM to a greater degree than placebo electrotherapy for BCSs experiencing pain.



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Critical Review: CPAP and Weight Management of Obstructive Sleep Apnea Cardiovascular Co-morbidities

The cardiovascular co-morbidities of obstructive sleep apnea (OSA) are similar to those of obesity. Cardiovascular co-morbidities often are the cause of adverse outcomes in overweight/obese OSA patients. Continuous positive airway pressure (CPAP) therapy resolves the symptoms of OSA, but may, or may not lead to improvement of a given cardiovascular co-morbidity. The impact of CPAP on cardiovascular risk variables, adverse cardiovascular events in overweight/obese OSA patients has been evaluated primarily in prospective, uncontrolled cohort studies.

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Letter to the Editor regarding article by Miranda et.al

The article, "Improved healthcare economic outcomes after liposomal bupivacaine administration" provides a unique perspective on the use of long-acting analgesia in breast surgery and we wish to congratulate the authors [1]. Liposomes are microscopic structures consisting of a phospholipid bilayer encapsulating an aqueous core and confer specific drug release patterns including increased stability and longer duration of drug release [2]. There are increasing reports of liposomal formulations in postoperative analgesia with key advantages proposed as reducing opioid intake and shortening inpatient stay.

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Reply to Letter to the Editor Regarding Article by Miranda et al.

We thank the author for his insightful and well-thought comments on our article, "Improved healthcare economic outcomes after liposomal bupivacaine administration in first-stage breast reconstruction," and the current utilization of liposomal bupivacaine in general1. There have been many advances with the use liposomal bupivacaine for post-operative analgesia both within and outside of plastic surgery2. As mentioned in the letter by Layton, further understanding of the safety profile and efficacy in a novel therapeutic for post-operative analgesia is crucial for its widespread adoption.

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Commentary: The Outcome of the Second Fat Graft is Significantly Better than that of the First Fat Graft for Romberg Syndrome: A Study of Three-Dimensional Volumetric Analysis

The authors use Parry Romberg Syndrome as a model to demonstrate efficacy of serial fat grafting.1 The hallmarks Romberg Syndrome include subcutaneous adipose attrition likely secondary to underlying vascular compromise.2 Three-dimensional scanning photography is used to measure the retention of volume. The surface scans obtained prior to any fat grafting were compared to the scans obtained three months after each round of fat grafting. The authors deemed the volume of surface change per volume of adipose injected as the survival rate.

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Competing causes of death in the head and neck cancer population

Publication date: February 2017
Source:Oral Oncology, Volume 65
Author(s): Sean T. Massa, Nosayaba Osazuwa-Peters, Kara M. Christopher, Lauren D. Arnold, Mario Schootman, Ronald J. Walker, Mark A. Varvares
Purpose/objectivesThe increasing survivorship of head and neck squamous cell carcinoma (HNSCC) comes with a risk of death from other causes, known as competing causes. The demographics of HNSCC are also evolving with increasing incidence of Human Papillomavirus (HPV) associated tumors. This study describes competing causes of death for the HNSCC population compared to the general population and identifies associated risk factors.MethodsAdult patients with first mucosal HNSCC (2004–2011) were identified from the Surveillance, Epidemiology and End Result database. Competing causes of death were compared to reference populations using proportion of deaths and Standardized Mortality Ratios (SMR). A multivariable competing risk survival analysis yielded subdistribution hazard ratios (HR) for competing mortality.ResultsOf 64,598 HNSCC patients, 24,602 (38.1%) were deceased including 7142 deaths (29.0%) from competing causes. The most common were cardiovascular disease, lung cancer, and other cancers. All relative mortality rates were elevated, especially liver disease (SMR 38.7; 95% CI: 29.4–49.3), suicide (SMR 37.1; 95% CI: 26.1–48.6), and subsequent primary cancers (SMR 7.5; 95% CI: 6.78–8.32). Demographic and tumor factors independently increased risk of competing mortality, including age (HR per 5years 1.24; 95% CI: 1.22–1.25), sex (male HR 1.23; 95% CI: 1.16–1.32), race (Black HR 1.17; 95% CI: 1.09–1.26), insurance (uninsured HR 1.28; 95% CI: 1.09–1.50), and marital status (single HR 1.29; 95% CI: 1.21–1.37).ConclusionNearly one in three HNSCC patients died from competing causes. When developing long term survivorship regimens for HNSCC patients, clinicians should be familiar with this population's specific risks.



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Elevated plasma levels of copeptin linked to diabetic retinopathy in type 2 diabetes

Publication date: 15 February 2017
Source:Molecular and Cellular Endocrinology, Volume 442
Author(s): Qi Zhao, Xiao-Xuan Wu, Jun Zhou, Xiao Wang
BackgroundThe arginine vasopressin (AVP) system has been postulated to play a role in glucose homeostasis, insulin resistance, and diabetes mellitus in human and animal studies. The aim of this study was to evaluate the role of plasma copeptin in Chinese patients with type 2 diabetes mellitus (T2DM) with and without diabetic retinopathy (DR).MethodPlasma copeptin concentrations were determined in 281 patients with T2DM. At baseline, demographic and clinical information including presence of DR and vision-threatening DR (VTDR) was collected. The relationship between copeptin and DR or VTDR was investigated using logistic regression.ResultsT2DM participants with DR or VTDR had significantly higher plasma copeptin concentrations on admission (P < 0.0001). Receiver operating characteristics to predict DR and VDTR demonstrated areas under the curve for copeptin of 0.784 (95% confidence interval [CI] 0.724–0.844) and 0.834 (95% CI 0.781–0.904), respectively, which were superior to those for the homeostasis model assessment of insulin resistance (DR AUC 0.736, 95% CI 0.676–0.797; VTDR AUC 0.754, 95% CI 0.703–0.828; P < 0.01). Multivariate logistic regression analysis adjusted for common DR risk factors showed plasma copeptin concentrations ≥28.6 pmol/L (>3rd quartile) to be an independent marker of DR (OR 3.68, 95% CI 2.04–6.79; P < 0.0001) and VTDR (OR 4.32, 95% CI 2.12–8.14; P < 0.0001).ConclusionsWe found that increased plasma copeptin concentrations were an independent marker of DR and VDTR in Chinese patients with T2DM, suggesting a possible role of copeptin in the pathogenesis of DR complications.



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Phospholipid complex enriched micelles: A novel drug delivery approach for promoting the antidiabetic effect of repaglinide

Publication date: 1 March 2017
Source:European Journal of Pharmaceutical Sciences, Volume 99
Author(s): Ahmed Alaa Kassem, Sameh Hosam Abd El-Alim, Mona Basha, Abeer Salama
To enhance the oral antidiabetic effect of repaglinide (RG), a newly emerging approach, based on the combination of phospholipid complexation and micelle techniques, was employed. Repaglinide-phospholipid complex (RG-PLC) was prepared by the solvent-evaporation method then characterized using Differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FT-IR) and X-ray powder diffraction (XPRD). The results revealed obvious disappearance of the characteristic peaks of the prepared RG-PLCs confirming the formation of drug-phospholipid complex. RG-PLC enriched micelles (RG-PLC-Ms) were prepared by the solvent-evaporation technique employing poloxamer 188 as surfactant. The prepared RG-PLC-Ms showed high drug encapsulation efficiencies (93.81–99.38%), with nanometric particle diameters (500.61–665.32nm) of monodisperse distribution and high stability (Zeta potential < −29.8mV). The in vitro release of RG from RG-PLC-Ms was pH-dependant according to the release media. A higher release pattern was reported in pH=1.2 compared to a more retarded release in pH=6.8 owing to two different kinetics of drug release. Oral antidiabetic effect of two optimized RG-PLC-M formulations was evaluated in an alloxan-induced diabetic rat model for 7-day treatment protocol. The two investigated formulations depicted normal blood glucose, serum malondialdehyde and insulin levels as well as an improved lipid profile, at the end of daily oral treatment, in contrast to RG marketed tablets implying enhanced antidiabetic effect of the drug. Hence, phospholipid-complex enriched micelles approach holds a promising potential for promoting the antidiabetic effect of RG.

Graphical abstract

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Long-circulating polyhydroxybutyrate-co-hydroxyvalerate nanoparticles for tumor targeted docetaxel delivery: Formulation, optimization and in vitro characterization

Publication date: 1 March 2017
Source:European Journal of Pharmaceutical Sciences, Volume 99
Author(s): Harsh Vardhan, Pooja Mittal, Sandeep Kumar Reddy Adena, Brahmeshwar Mishra
In the present research an attempt was made to develop and optimize docetaxel-loaded polyhydroxybutyrate-co-hydroxyvalerate (PHBV) nanoparticles, using modified emulsification solvent evaporation technique and design of experiment (DOE) methodology. Formulation of docetaxel-loaded PHBV nanoparticles was conducted by factor screening studies with Plackett-Burman design (PBD) followed by Box-Behnken experimental design (BBD) to evaluate the effect of independent variables on responses. Five most important independent variables were screened out, which were obtained from failure mode effect analysis (FMEA) and factor screening studies. The effect of formulation parameters on selected responses was depicted by 2-D and 3-D response surface methodology (RSM). The final optimized batch was evaluated by various in vitro characterizations. The observed particle size, zeta potential and entrapment efficiency of optimized formulation was found to be 283±2.79nm, −17±2.64mV and 44±0.59% respectively. Morphological studies demonstrated the smooth and spherical shape of nanoparticles. In vitro drug release follows the Peppas-Korsmeyer model of drug release kinetics. Cytotoxicity study was assessed using MCF-7 for percentage inhibition of human breast cancer cell line. These results indicate that the PHBV Nanoparticles could be a promising drug delivery system for efficient prolong drug release.

Graphical abstract

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Large mammal biomass predicts the changing distribution of hunter-gatherer settlements in mid-late Holocene Alaska

Publication date: March 2017
Source:Journal of Anthropological Archaeology, Volume 45
Author(s): Andrew H. Tremayne, Bruce Winterhalder
This study provides an ecological explanation for the distribution of Arctic Small Tool tradition (ASTt) settlements in Alaska and the origin of their arctic maritime adaptation. Theoretically grounded in the ideal free distribution (IFD) model, which predicts that higher ranked habitats will be occupied first and most continuously, we contend that the location of large mammals was a major factor influencing human dispersal and settlement decisions in the arctic and subarctic ecosystems of Alaska. We rank habitat suitability based on historic mammal population densities from wildlife ecology reports across predefined ecological zones in Alaska; we multiply densities by average animal weights per species to determine suitability rankings. Coastal habitats in Alaska are higher ranked than adjacent tundra habitats, but the interior boreal forest may have been the highest ranked, considering technological constraints of hunting aquatic species. The ASTt migration into Alaska created population pressure that promoted the colonization of the unoccupied Arctic coast and development of the dual, terrestrial-maritime economy. When pan-Alaska human populations declined around 3200–2500years ago low ranked tundra ecoregions were abandoned. As human populations recovered Alaska coasts became the most densely populated habitats. The adaptive logic entailed in the IFD provides a consistent evolutionary interpretation for settlement patterns documented in this region.

Graphical abstract

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Microchoerus hookeri nov. sp., a new late Eocene European microchoerine (Omomyidae, Primates): New insights on the evolution of the genus Microchoerus

Publication date: January 2017
Source:Journal of Human Evolution, Volume 102
Author(s): Raef Minwer-Barakat, Judit Marigó, Joan Femenias-Gual, Loïc Costeur, Soledad De Esteban-Trivigno, Salvador Moyà-Solà
The study of Eocene primates is crucial for understanding the evolutionary steps undergone by the earliest members of our lineage and the relationships between extinct and extant taxa. Recently, the description of new material from Spain has improved knowledge of European Paleogene primates considerably, particularly regarding microchoerines. Here we describe the remains of Microchoerus from Sossís (late Eocene, Northern Spain), consisting of more than 120 specimens and representing the richest sample of Microchoerus from Spain. This primate was first documented in Sossís during the 1960s, on the basis of scarce specimens that were ascribed to Microchoerus erinaceus. However, the studied material clearly differs from M. erinaceus at its type locality, Hordle Cliff, and shows some characters that allow the erection of a new species, Microchoerus hookeri. This new species is characterized by its medium size, moderate enamel wrinkling, generally absent mesoconid and small hypoconulid in the M1 and M2, single paracone in the upper molars and premolars and, particularly, by the lack of mesostyle in most M¹ and M², a trait not observed in any other species of Microchoerus. Some specimens from Eclépens B (late Eocene, Switzerland), determined previously to be Microcherus aff. erinaceus, are also ascribed to M. hookeri. M. hookeri represents the first step of a lineage that differentiated from Necrolemur antiquus and, later, gave rise to several unnamed forms of Microchoerus, such as those from Euzet and Perrière, finally leading to M. erinaceus. This discovery sheds new light on the complex evolutionary scheme of Microchoerus, indicating that it is most probably a paraphyletic group. A detailed revision of the age of the localities containing remains of Microchoerus and the description of the still unpublished material from some European localities, are necessary to clarify the phylogenetic relationships among the members of this microchoerine group.



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Management of fish bone impaction in throat – Our experiences in a tertiary care hospital of eastern India

Publication date: Available online 18 December 2016
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Santosh Kumar Swain, Santosh Kumar Pani, Mahesh Chandra Sahu
ObjectiveTo find out prevalence of accidental ingestion of fish bones and its management in a tertiary care hospital of eastern India.Materials & methodsThis is a prospective observational study. Three hundred thirty patients with complains of fish bone in throat who presented to the out patients department of Otorhinolaryngology and the emergency department of a Medical college between January 2008 to December 2015 were shortlisted for study. Followed by conventional examination, most were subjected to endoscopic examination and removal. The parameters analyzed were age and sex distribution, clinical presentation, duration of symptoms, location of impaction, conventional and endoscopic removal techniques.ResultAmong three hundred thirty patients, no foreign body was found in eighty patients. Patients in age group of 21–30years were affected mostly with almost equal sex distribution. Most patients presented with foreign body sensation in throat of short duration with precise finger point localization. Both conventional and endoscopic methods were employed with successful results but with definite advantage of endoscopic method.ConclusionFish bone in throat is a common occurrence in Otorhinolaryngological practice. Fish bone impaction is a common foreign body in the pharynx. Endoscopic removal is distinctly more helpful than the conventional ones.



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Commentary on “Patients with Small Abdominal Aortic Aneurysms are at Significant Risk of Cardiovascular Events and this Risk is not Addressed Sufficiently”

Publication date: Available online 18 December 2016
Source:European Journal of Vascular and Endovascular Surgery
Author(s): J.-B. Ricco




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Commentary on “Tip Design of Hemodialysis Catheters Influences Thrombotic Events and Replacement Rate”

Publication date: Available online 18 December 2016
Source:European Journal of Vascular and Endovascular Surgery
Author(s): X. Berard, S. Deglise




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Incidence of Stroke Following Thoracic Endovascular Aortic Repair for Descending Aortic Aneurysm: A Systematic Review of the Literature with Meta-analysis

Publication date: Available online 18 December 2016
Source:European Journal of Vascular and Endovascular Surgery
Author(s): R.S. von Allmen, B. Gahl, J.T. Powell
ObjectiveStroke is an increasingly recognised complication following thoracic endovascular aortic repair (TEVAR). The aim of this study was to systematically synthesise the published data on perioperative stroke incidence during TEVAR for patients with descending thoracic aneurysmal disease and to assess the impact of left subclavian artery (LSA) coverage on stroke incidence.MethodsA systematic review of English and German articles on perioperative (in-hospital or 30 day) stroke incidence following TEVAR for descending aortic aneurysm was performed, including studies with ≥50 cases, using MEDLINE and EMBASE (2005–2015). The pooled prevalence of perioperative stroke with 95% CI was estimated using random effect analysis. Heterogeneity was examined using I² statistic.ResultsOf 215 studies identified, 10 were considered suitable for inclusion. The included studies enrolled a total of 2594 persons (61% male) between 1997 and 2014 with a mean weighted age of 71.8 (95% CI 71.1–73.6) years. The pooled prevalence for stroke was 4.1% (95% CI 2.9–5.5) with moderate heterogeneity between studies (I² = 49.8%, p = .04). Five studies reported stroke incidences stratified by the management of the LSA, that is uncovered versus covered and revascularised versus covered and not-revascularised. In cases where the LSA remained uncovered, the pooled stroke incidence was 3.2% (95% CI 1.0–6.5). There was, however, an indication that stroke incidence increased following LSA coverage, to 5.3% (95% CI 2.6–8.6) in those with a revascularisation and 8.0% (95% CI 4.1–12.9) in those without revascularisation.ConclusionStroke incidence is an important morbidity after TEVAR, and probably increases if the LSA is covered during the procedure, particularly in those without revascularisation.



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The impact of two fluoropolymer manufacturing facilities on downstream contamination of a river and drinking water resources with per- and polyfluoroalkyl substances

Abstract

Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are emerging contaminants that have been detected in the environment, biota, and humans. Drinking water is a route of exposure for populations consuming water contaminated by PFAS discharges. This research study reports environmental measurement concentrations, mass flows, and the fate of dozens of PFASs in a river receiving effluents from two fluoropolymer manufacturing facilities. In addition to quantified levels of PFASs using LC- and GC-MS analytical methods, the total amount of unidentified PFASs and precursors was assessed using two complementary analytical methods, absorbable organic fluorine (AOF) determination and oxidative conversion of perfluoroalkyl carboxylic acid (PFCA) precursors. Several dozen samples were collected in the river (water and sediment) during four sampling campaigns. In addition, samples were collected in two well fields and from the outlet of the drinking water treatment plants after chlorination. We estimated that 4295 kg PFHxA, 1487 kg 6:2FTSA, 965 kg PFNA, 307 kg PFUnDA, and 14 kg PFOA were discharged in the river by the two facilities in 2013. High concentrations (up to 176 ng/g dw) of odd long-chain PFASs (PFUnDA and PFTrDA) were found in sediment samples. PFASs were detected in all 15 wells, with concentrations varying based on the location of the well in the field. Additionally, the presence of previously discharged PFASs was still measurable. Significant discrepancies between PFAS concentration profiles in the wells and in the river suggest an accumulation and transformation of PFCA precursors in the aquifer. Chlorination had no removal efficiency and no unidentified PFASs were detected in the treated water with either complementary analytical method. Although the total PFAS concentrations were high in the treated water, ranging from 86 to 169 ng/L, they did not exceed the currently available guideline values.

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Activated carbon adsorptive removal of azo dye and peroxydisulfate regeneration: from a batch study to continuous column operation

Abstract

The performance of activated carbon (AC) for the adsorption of Acid Orange 7 (AO7) was investigated in both batch and column studies. The optimal conditions for adsorption process in batch study were found to be a stirring speed of 500 rpm, AC dosage of 5 g/L, and initial AO7 concentration of 100 mg/L. The spent AC was then treated with peroxydisulfate (PDS), and the regenerated AC was used again to adsorb AO7. Both pseudo-first-order and pseudo-second-order rate models for adsorption kinetics were investigated, and the results showed that the latter model was more appropriate. The effects of regeneration time, PDS concentration, and stirring speed on AO7-spent AC regeneration were investigated in batch studies, and the optimal conditions were time 2 h, stirring speed 700 rpm, and PDS concentration 10 g/L. Under the same adsorption conditions, 89% AO7 could be decolorized by adsorption using regenerated AC. In the column studies, the effect of flow rate was investigated and the adsorption capacity was nearly the same when the flow rate rose from 7.9 to 11.4 mL/min, but it decreased significantly when the flow rate was increased to 15.2 mL/min. The performance of regenerated AC in the column was also investigated, and a slight increase in the adsorption capacity was observed in the second adsorption cycle. However, the adsorption capacity decreased to some extent in the third cycle due to the consumption of C-OH group on the AC surface during PDS regeneration.

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