Simultaneous preconcentration of trace metals in environmental samples using amberlite XAD-2010/8-hydroxyquinoline system

A simple and sensitive system for simultaneous preconcentration of Mn(II), Fe(III), Co(II), Ni(II), Cu(II), Zn(II), Pb(II) and Cd(II) at trace level by flame atomic absorption spectrometry (FAAS) is proposed. Amberlite XAD-2010 packed in a column was used as sorbent. Analyte ions were sorbed in the column as their 8-hydroxyquinoline chelates; they could then be eluted by 1 mol L -1 HNO3 in acetone. The analytical conditions including pH, amounts of 8-hydroxyquinoline, sample volume etc. on the quantitative recoveries of the analytes were investigated. The effects of the concomitants ions on the recoveries of the analytes column were also studied. The detection limits, corresponding to three times the standard deviation of the blank, were found to be in the range of 0.10-0.40 μg L-1. The accuracy of the procedure was measured by analyte determinations in certified reference materials (CRM NIES No. 7 Tea Leaves and TMDW-500 Drinking Water). The applications of the presented system were performed by the analysis of some environmental samples including water samples

Improved functionalization of oleic acid-coated iron oxide nanoparticles for biomedical applications

Superparamagnetic iron oxide nanoparticles can providemultiple benefits for biomedical applications in aqueous environments such asmagnetic separation or magnetic resonance imaging. To increase the colloidal stability and allow subsequent reactions, the introduction of hydrophilic functional groups onto the particles’ surface is essential. During this process, the original coating is exchanged by preferably covalently bonded ligands such as trialkoxysilanes. The duration of the silane exchange reaction, which commonly takes more than 24 h, is an important drawback for this approach. In this paper, we present a novel method, which introduces ultrasonication as an energy source to dramatically accelerate this process, resulting in high-quality waterdispersible nanoparticles around 10 nmin size. To prove the generic character, different functional groups were introduced on the surface including polyethylene glycol chains, carboxylic acid, amine, and thiol groups. Their colloidal stability in various aqueous buffer solutions as well as human plasma and serum was investigated to allow implementation in biomedical and sensing applications.status: publishe

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Development of synchronous VHL syndrome tumors reveals contingencies and constraints to tumor evolution

This is an Open Access article distributed under the terms of the Creative Commons Attribution License.-- et al.[Background]: Genomic analysis of multi-focal renal cell carcinomas from an individual with a germline VHL mutation offers a unique opportunity to study tumor evolution. [Results]: We perform whole exome sequencing on four clear cell renal cell carcinomas removed from both kidneys of a patient with a germline VHL mutation. We report that tumors arising in this context are clonally independent and harbour distinct secondary events exemplified by loss of chromosome 3p, despite an identical genetic background and tissue microenvironment. We propose that divergent mutational and copy number anomalies are contingent upon the nature of 3p loss of heterozygosity occurring early in tumorigenesis. However, despite distinct 3p events, genomic, proteomic and immunohistochemical analyses reveal evidence for convergence upon the PI3K-AKT-mTOR signaling pathway. Four germline tumors in this young patient, and in a second, older patient with VHL syndrome demonstrate minimal intra-tumor heterogeneity and mutational burden, and evaluable tumors appear to follow a linear evolutionary route, compared to tumors from patients with sporadic clear cell renal cell carcinoma. [Conclusions]: In tumors developing from a germline VHL mutation, the evolutionary principles of contingency and convergence in tumor development are complementary. In this small set of patients with early stage VHL-associated tumors, there is reduced mutation burden and limited evidence of intra-tumor heterogeneity.RF and JL received funding from EU FP7 (PREDICT project), EB is a Rosetrees Trust fellow, NM received funding from the Rosetrees Trust, MG is funded by the UK Medical Research Council, IV is funded by Spanish Ministerio de Economía y Competitividad subprograma Ramón y Cajal, and CS is a senior Cancer Research UK clinical research fellow and is funded by Cancer Research UK, the Rosetrees Trust, EU FP7 (projects PREDICT and RESPONSIFY, ID:259303), the Prostate Cancer Foundation, and the Breast Cancer Research Foundation. This study was supported by researchers at the National Institute for Health Research Biomedical Research Centres at University College London Hospitals and at the Royal Marsden Hospital.Peer Reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Evaluation of Patients with Delirium in the Emergency Department

Objective: Delirium is a neuropsychiatric syndrome characterized by acute onset and a fluctuating course of globally altered mental status. It has been reported that the frequency of delirium among patients hospitalized with any disorder ranges from 2 to 30%. However, in the literature, few studies have evaluated the frequency of delirium in hospitalized patients, including those older than 65 years. According to our knowledge, this is the first study on adult patients in all age groups in an emergency department. We aimed to classify delirium according to its etiological causes and to compare the age groups for frequency and these causes. Material and Methods: Forty-three patients were included in the study; they had been diagnosed with delirium according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV in an emergency department from December 2002 to December 2003. The patients were divided into two groups (group I: age <65 years, group II: age ≥65 years). Following a detailed history, each patient underwent a physical and neurological examination. Additionally, the Mini-Mental State Examination was administered. Radiological and hematological examinations were conducted on all patients who had indications for such testing.Results: Of the patients with delirium, 18 were female and 25 were male. Mean age was 61.18 years (range 18 to 90 years). Of the 43 patients, 21 were in group I and 22 were in group II. The most common causes of delirium were metabolic disorders. There was no significant difference between group I and II for the frequency or etiological causes of delirium. Conclusion: In emergency departments, all patients with delirium should be evaluated for etiological factors, especially metabolic disorders, as treatment of the underlying cause is essential in delirium

Acil servise renal kolik ile başvuran hastaların değerlendirilmesi

Objective: This study aimed to assess some demographical and clinical aspects and laboratory findings of patients presenting with the complaint of renal colic to the emergency department. Material and Methods: The study included a total of 150 adult patients presenting to the emergency department of our University hospital with the complaint of renal colic between January 2009 and January 2010. The data were derived from the patient files of our hospital. Demographical data, time of admission, clinical findings together with laboratory and radiologic findings of patients were assessed. Mean values were calculated as mean value ± standard deviation. Results: Of the patients 91 (68,4 %) were male and the mean age was 38,9±16,5 years. Most of the patients were admitted in October (n= 22, 16,6 %). The most common complaint of the patients was flank pain. The erythrocytes was revealed in 72,2 % of the patients by the urinalysis. Calculus formation was determined in 71 (53,4 %) of the patients. The urinary system ultrasonography (USG) was applied to 39,1 % of the patients and localized renal calculus was detected in 52,0 % of those patients. It was identified that the most common region of localization was the ureter and detected in 29 of the patients (40,9 %). Conclusion: Ultrasonography is considerably a valuable method in identifying renal complications that might lead to dysfunctions in these patients. However, the absence of hematuria does not necessarily rule out the renal colic. We think that emergency physicians should rule out the urinary obstruction in such kind of patients.Amaç: Bu çalışmada acil servise renal kolik ile başvuran hastaların bazı demografik ve klinik özelliklerinin ve laboratuvar bulgularının değerlendirilmesi amaçlandı. Gereç ve Yöntem: Çalışmamız Ocak 2009-Ocak 2010 tarihleri arasında Üniversite hastanesi acil servisine renal kolik nedeniyle başvuran, erişkin, 150 hastayı kapsamaktadır. Veriler, hastanemizin hasta dosyalarından elde edilmiştir. Hastaların demografik özellikleri, başvuru zamanı, klinik bulguları, laboratuvar ve radyolojik verileri değerlendirildi. Ortalama değerler, ortalama ± standart sapma olarak verildi. Bulgular: Hastaların 91’i (% 68,4) erkekti ve yaş ortalamaları 38,9±16,5 yıl idi. En fazla hasta başvurusu ekim ayında oldu (n= 22, % 16,6). Hastaların en sık şikayeti yan ağrısı idi. Yapılan idrar analizinde hastaların % 72,2’ sinde eritrosit tespit edildi. Hastaların 71’inde (% 53,4) taşın lokalizasyonu belirlendi. Üriner sistem ultrasonografi (USG)’si uygulanan hastalarda (n=52, % 39,1) taşın görülme oranı % 52,0 idi. Tespit edilen en sık taş yerleşim yerinin 29 hasta (% 40,9) ile üreter olduğu belirlendi. Sonuç: USG, bu hastalarda böbreğin işlev kaybına sebep olabilecek komplikasyonları saptamak için oldukça değerli bir yöntemdir. Renal kolikli hastalarda mutlak hematüri olmayabilir. Acil hekimlerinin bu tür hastalarda üriner obstrüksiyonu dışlamaları gerektiğini düşünmekteyiz