Lipid apheresis: oxidative stress, rheology, and vasodilatation

In the treatment of homozygous and therapy-resistant hypercholesterolemia, lipid apheresis enables not only low density lipoprotein (LDL) cholesterol to be lowered by approximately 60%, but also oxidative stress factors to be influenced and adhesion molecules reduced. This was investigated in a group of 12 patients using the heparin-induced extracorporeal LDL precipitation (H.E.L.P.) procedure

‘‘Generality of mis-fit’’? The real-life difficulty of matching scales in an interconnected world

A clear understanding of processes at multiple scales and levels is of special significance when conceiving strategies for human–environment interactions. However, understanding and application of the scale concept often differ between administrative-political and ecological disciplines. These mirror major differences in potential solutions whether and how scales can, at all, be made congruent. As a result, opportunities of seeking ‘‘goodness-of-fit’’ between different concepts of governance should perhaps be reconsidered in the light of a potential ‘‘generality of mis-fit.’’ This article reviews the interdisciplinary considerations inherent in the concept of scale in its ecological, as well as administrative-political, significance and argues that issues of how to manage ‘‘misfit’’ should be awarded more emphasis in social-ecological research and management practices. These considerations are exemplified by the case of reindeer husbandry in Fennoscandia. Whilst an indigenous small-scale practice, reindeer husbandry involves multi-level ecological and administrative-political complexities—complexities thatwe argue may arise in any multi-level system.</div

Long-Term Trends and Role of Climate in the Population Dynamics of Eurasian Reindeer

Temperature is increasing in Arctic and sub-Arctic regions at a higher rate than anywhere else in the world. The frequency and nature of precipitation events are also predicted to change in the future. These changes in climate are expected, together with increasing human pressures, to have significant impacts on Arctic and sub-Arctic species and ecosystems. Due to the key role that reindeer play in those ecosystems, it is essential to understand how climate will affect the region's most important species. Our study assesses the role of climate on the dynamics of fourteen Eurasian reindeer (Rangifer tarandus) populations, using for the first time data on reindeer abundance collected over a 70-year period, including both wild and semi-domesticated reindeer, and covering more than half of the species' total range. We analyzed trends in population dynamics, investigated synchrony among population growth rates, and assessed the effects of climate on population growth rates. Trends in the population dynamics were remarkably heterogeneous. Synchrony was apparent only among some populations and was not correlated with distance among population ranges. Proxies of climate variability mostly failed to explain population growth rates and synchrony. For both wild and semi-domesticated populations, local weather, biotic pressures, loss of habitat and human disturbances appear to have been more important drivers of reindeer population dynamics than climate. In semi-domesticated populations, management strategies may have masked the effects of climate. Conservation efforts should aim to mitigate human disturbances, which could exacerbate the potentially negative effects of climate change on reindeer populations in the future. Special protection and support should be granted to those semi-domesticated populations that suffered the most because of the collapse of the Soviet Union, in order to protect the livelihood of indigenous peoples that depend on the species, and the multi-faceted role that reindeer exert in Arctic ecosystems

Fully Automatic In-Syringe Magnetic Stirring-Assisted Dispersive Liquid–Liquid Microextraction Hyphenated to High-Temperature Torch Integrated Sample Introduction System-Inductively Coupled Plasma Spectrometer with Direct Injection of the Organic Phase

A proof of concept study involving the online coupling of automatic dispersive liquid–liquid microextraction (DLLME) to inductively coupled plasma optical emission spectrometry (ICP OES) with direct introduction and analysis of the organic extract is herein reported for the first time. The flow-based analyzer features a lab-in-syringe (LIS) setup with an integrated stirring system, a Meinhard nebulizer in combination with a heated single-pass spray chamber, and a rotary injection valve, used as an online interface between the microextraction system and the detection instrument. Air-segmented flow was used for delivery of a fraction of the nonwater miscible extraction phase, 12 μL of xylene, to the nebulizer. All sample preparative steps including magnetic stirring assisted DLLME were carried out inside the syringe void volume as a size-adaptable yet sealed mixing and extraction chamber. Determination of trace level concentrations of cadmium, copper, lead, and silver as model analytes has been demonstrated by microextraction as diethyldithiophosphate (DDTP) complexes. The automatic LIS-DLLME method features quantitative metal extraction, even in troublesome sample matrixes, such as seawater, salt, and fruit juices, with relative recoveries within the range of 94–103%, 93–100%, and 92–99%, respectively. Furthermore, no statistically significant differences at the 0.05 significance level were found between concentration values experimentally obtained and the certified values of two serum standard reference materials.B. Horstkotte acknowledges the financial support by an ERASMUS+ Scholarship No. XIII/3/15-16 and by the Czech Science Foundation (Project No. P206/15/10781S). K. Fikarová is thankful for an Erasmus student scholarship and financial support of the Charles University (Project SVV 260 412/2016). M. Miró acknowledges financial support from the Spanish State Research Agency through Projects CTM2014-56628-C3-3-R (AEI/FEDER, UE) and CTM2014-61553-EXP (AEI/FEDER, UE)

Fully Automatic In-Syringe Magnetic Stirring-Assisted Dispersive Liquid–Liquid Microextraction Hyphenated to High-Temperature Torch Integrated Sample Introduction System-Inductively Coupled Plasma Spectrometer with Direct Injection of the Organic Phase

A proof of concept study involving the online coupling of automatic dispersive liquid–liquid microextraction (DLLME) to inductively coupled plasma optical emission spectrometry (ICP OES) with direct introduction and analysis of the organic extract is herein reported for the first time. The flow-based analyzer features a lab-in-syringe (LIS) setup with an integrated stirring system, a Meinhard nebulizer in combination with a heated single-pass spray chamber, and a rotary injection valve, used as an online interface between the microextraction system and the detection instrument. Air-segmented flow was used for delivery of a fraction of the nonwater miscible extraction phase, 12 μL of xylene, to the nebulizer. All sample preparative steps including magnetic stirring assisted DLLME were carried out inside the syringe void volume as a size-adaptable yet sealed mixing and extraction chamber. Determination of trace level concentrations of cadmium, copper, lead, and silver as model analytes has been demonstrated by microextraction as diethyldithiophosphate (DDTP) complexes. The automatic LIS-DLLME method features quantitative metal extraction, even in troublesome sample matrixes, such as seawater, salt, and fruit juices, with relative recoveries within the range of 94–103%, 93–100%, and 92–99%, respectively. Furthermore, no statistically significant differences at the 0.05 significance level were found between concentration values experimentally obtained and the certified values of two serum standard reference materials.B. Horstkotte acknowledges the financial support by an ERASMUS+ Scholarship No. XIII/3/15-16 and by the Czech Science Foundation (Project No. P206/15/10781S). K. Fikarová is thankful for an Erasmus student scholarship and financial support of the Charles University (Project SVV 260 412/2016). M. Miró acknowledges financial support from the Spanish State Research Agency through Projects CTM2014-56628-C3-3-R (AEI/FEDER, UE) and CTM2014-61553-EXP (AEI/FEDER, UE)

Infective endocarditis in intravenous drug abusers: an update

Infective endocarditis despite advances in diagnosis remains a common cause of hospitalization, with high morbidity and mortality rates. Through literature review it is possible to conclude that polymicrobial endocarditis occurs mainly in intravenous drug abusers with predominance in the right side of the heart, often with tricuspid valve involvement. This fact can be associated with the type of drug used by the patients; therefore, knowledge of the patient's history is critical for adjustment of the therapy. It is also important to emphasize that the most common combinations of organisms in polymicrobial infective endocarditis are: Staphylococcus aureus, Streptococcus pneumonia and Pseudomonas aeruginosa, as well as mixed cultures of Candida spp. and bacteria. A better understanding of the epidemiology and associated risk factors are required in order to develop an efficient therapy, although PE studies are difficult to perform due to the rarity of cases and lack of prospective cohorts.This work was supported by Portuguese Foundation for Science and Technology (FCT) through the grants SFRH/BPD/47693/2008, SFRH/BPD/20987/2004 and SFRH/BPD/72632/2010 attributed to Claudia Sousa, Claudia Botelho and Diana Rodrigues, respectively

Evaluation of an electronic warfarin nomogram for anticoagulation of hemodialysis patients

<p>Abstract</p> <p>Background</p> <p>Warfarin nomograms to guide dosing have been shown to improve control of the international normalized ratio (INR) in the general outpatient setting. However, the effectiveness of these nomograms in hemodialysis patients is unknown. We evaluated the effectiveness of anticoagulation using an electronic warfarin nomogram administered by nurses in outpatient hemodialysis patients, compared to physician directed therapy.</p> <p>Methods</p> <p>Hemodialysis patients at any of the six outpatient clinics in Calgary, Alberta, treated with warfarin anticoagulation were included. Two five-month time periods were compared: prior to and post implementation of the nomogram. The primary endpoint was adequacy of anticoagulation (proportion of INR measurements within range ± 0.5 units).</p> <p>Results</p> <p>Overall, 67 patients were included in the pre- and 55 in the post-period (with 40 patients in both periods). Using generalized linear mixed models, the adequacy of INR control was similar in both periods for all range INR levels: in detail, range INR 1.5 to 2.5 (pre 93.6% (95% CI: 88.6% - 96.5%); post 95.6% (95% CI: 89.4% - 98.3%); p = 0.95); INR 2.0 to 3.0 (pre 82.2% (95% CI: 77.9% - 85.8%); post 77.4% (95% CI: 72.0% - 82.0%); p = 0.20); and, INR 2.5 to 3.5 (pre 84.3% (95% CI: 59.4% - 95.1%); post 66.8% (95% CI: 39.9% - 86.0%); p = 0.29). The mean number of INR measurements per patient decreased significantly between the pre- (30.5, 95% CI: 27.0 - 34.0) and post- (22.3, 95% CI: 18.4 - 26.1) (p = 0.003) period. There were 3 bleeding events in each of the periods.</p> <p>Conclusions</p> <p>An electronic warfarin anticoagulation nomogram administered by nurses achieved INR control similar to that of physician directed therapy among hemodialysis patients in an outpatient setting, with a significant reduction in frequency of testing. Future controlled trials are required to confirm the efficacy of this nomogram.</p