Chronic Thromboembolic Pulmonary Hypertension

The pulmonary hypertension (PH) and right heart dysfunction that results from chronic thromboembolic involvement of the pulmonary vascular bed is potentially curable with surgical endarterectomy. Over the past several decades, growing clinical experience has brought about increased recognition of this treatable form of PH. Moreover, advances in cardiothoracic surgical techniques have given an increasing number of patients with chronic thromboembolic PH (CTEPH) a surgical remedy with decreasing perioperative morbidity and mortality risks. The availability of pulmonary hypertensive—specific medical therapy for CTEPH patients with surgically inaccessible disease also has been a positive therapeutic advance over the past several years. However, despite this progress, chronic thromboembolic disease as a sequela of acute pulmonary emboli continues to be underappreciated. Furthermore, even if CTEPH has been appropriately diagnosed, misinterpretation of diagnostic information may lead to the inappropriate exclusion of patients from surgical consideration. This may result in the prescription of pulmonary hypertensive medical therapy in CTEPH patients with potentially surgically correctable disease. This difficulty arises from a lack of objective criteria as to what constitutes surgical chronic thromboembolic disease, which primarily is a result of the variability in surgical experience in specialty centers in the United States. Consequently, clinicians must be wary about using pulmonary hypertensive medications in CTEPH patients. Before prescription, it is important to exclude patients from surgical consideration by consulting a specialized center with expertise in this discipline

Phenol oxidation with hydrogen peroxide using Cu/ZSM5 and Cu/Y5 catalysts

In this work, catalytic activity and stability of Cu/Y5 and Cu/ZSM5 zeolites in phenol oxidation with hydrogen peroxide were examined. The catalyst samples were prepared by the ion exchange method of the protonic form of commercial zeolites. The catalysts were characterized by the powder X-ray diffraction (XRD), AAS, while the adsorption techniques were used to measure the specific surface area. The thermal programmed desorption of NH3 (NH3-TPD) was used for measuring the total number of acid sites formed on the surface of zeolites. Catalytic performance of the prepared samples was monitored in terms of phenol, hydrogen peroxide and total organic carbon (TOC) conversion, by-product distribution and a degree of copper leached into the aqueous solution. It was found that the activity of Cu/Y5 catalyst was generally higher than that of Cu/ZSM5 and that unlike Cu/ZSM5, Cu/Y5 catalyzed phenol oxidation more completely

Practical Evaluation and Management of Insomnia in Parkinson's Disease: A Review

ABSTRACT Background Insomnia is one of the most common nonmotor features of Parkinson's disease (PD). However, there are few practical guidelines for providers on how to best evaluate and treat this problem. Methods and Findings This review was developed to provide clinicians with a pragmatic approach to assessing and managing insomnia in PD. Recommendations were based on literature review and expert opinion. We addressed the following topics in this review: prevalence of insomnia in PD, sleep–wake mechanisms, theoretical models of insomnia, risk factors, assessment, pharmacologic and nonpharmacologic treatments. Insomnia treatment choices may be guided by PD severity, comorbidities, and patient preference. However, there is limited evidence supporting pharmacotherapy and nonpharmacologic treatments of insomnia in PD. Conclusions We provide a pragmatic algorithm for evaluating and treating insomnia in PD based on the literature and our clinical experience. We propose personalized insomnia treatment approaches based on age and other issues. Gaps in the existing literature and future directions in the treatment of insomnia in PD are also highlighted