Direct Liquefaction of Two Subbituminous Coals Using KOH/methanol

Two subbituminous coals, namely Rosebud and Wyodak-Anderson, were used in the development of a non-catalytic direct coal liquefaction process employing potassium hydroxide (KOH) and methanol (CH3OH) at high temperature. Samples from both coals were obtained from the Penn State Coal Sample Bank and Database, where Rosebud coal is from Rosebud seam, Rosebud County, Montana, USA and Wyodak-Anderson coal is from Wyodak seam, Campbell County, Wyoming, USA. The experiments were conducted in a one-liter, high-pressure, high-temperature agitated autoclave. The effects of temperature (280, 290 and 300 oC) and coal-LiDi-methanol (C:K:M) ratio (2:1:9, 2:3:9 and 3:3:9) on the process gaseous and liquid product yields were investigated at a mixing speed of 1200 rpm. The reactor pressure and temperature were monitored and recorded throughout the experiments. At the completion of each experiment, the liquefaction products were neutralized with hydrochloric acid, washed with water, and filtered. The solid products were then subjected to the sequential selective solvent extraction technique, where n-hexane, toluene, and tetrahydrofuran were used to obtain the yield of solubles in each respective solvent. The n-hexane solubles, n-hexane insolubles/toluene solubles, toluene insolubles/THF solubles and THF insolubles measured were denoted as hexane solubles (HS), toluene solubles (TS), THF solubles (THFS) and THF insolubles (THFI), respectively. The experimental results indicated that at high temperatures CH3OH and KOH appeared to liquefy Rosebud and Wyodak-Anderson coals; and the effects of temperature on the process yields were found to be strongly dependent on coal type and C:K:M ratio. The highest yield of liquid products was obtained at 300 °C and C:K:M ratio of 2:1:9, the liquid products yield obtained from Rosebud coal was higher than that from Wyodak-Anderson coal. The presence of KOH appeared to favors hydrogen production over liquid hydrocarbons production, leading to a high yield of light hydrocarbons and hydrogen and a low yield of liquid hydrocarbons. Also, the maximum total yield of liquid products obtained in this study was about 44.3 wt.% which was much lower than that reported by Shabtai and Saito [1] who obtained yield up to 90 wt.% in their base-catalyzed liquefaction process, which highlights the fundamental difference between catalytic and non-catalytic coal liquefaction processes

Regional differences in admissions and treatment outcomes for hepatocellular carcinoma patients in Thailand

Background: Hepatocellular carcinoma (HCC) is one of the commonest cancers in Thailand. We report the stage and survival of patients who were admitted under the public universal health fund (NHSO) covering 47 million people to determine if there were regional disparities in the treatment outcomes in the country. Method: We used the 2009-2013 Nationwide Hospital Admission Data, Thailand. Patients with hepatocellular carcinoma (HCC) were identified by the ICD10 code C22.0. Procedures were identified by ICD9-CM codes, and deaths were confirmed from the NHSO database and the national citizen registry. Thailand is divided into 6 regions and Bangkok. Hospitals were identified according to their specific reimbursement codes. Survival time started from the day of first admission and was estimated using the Kaplan-Meier method. The statistical method used to compare regions was Chi-squared tests (Pearson, likelihood ratio, linear-by linear association and Mantel-cox). Results: There were 36,956 HCC patients admitted during the study period. The overall median survival was 36 days. 1.63% of the patients had surgery, 0.96% had radiofrequency ablation (RFA), and 5.24% had trans-arterial chemoembolization (TACE). 90.24% did not have any tumor-specific therapy. The proportion of patients admitted for tumor-specific therapy vs. no tumor-specific therapy was significantly different between regions in all treatment modalities (p<0.01). Each treatment modality showed a wide range of median survival values across the regions (p<0.01). The best survival was seen in Bangkok, the South and the North (for surgery, RFA and TACE) and was often more than twice as long as the regions with the lowest survival, Central, East and West. Conclusions: There was a large previously-unreported disparity in admissions and outcomes in Thailand for different treatment modalities for HCC. Bangkok and the South had the best treatment outcomes and often had median survivals more than twice as long as those in the West and East. Public policy to reduce this disparity will need to be implemented in the future

Comparison of Prevention of NSAID-Induced Gastrointestinal Complications by Rebamipide and Misoprostol: A Randomized, Multicenter, Controlled Trial—STORM STUDY

Nonsteroidal anti-inflammatory drugs (NSAIDs) have gastrointestinal side effects such as dyspepsia, peptic ulcer, hemorrhage, and perforation. Misoprostol and PPIs have been used to prevent NSAID-induced gastroduodenal injury. Rebamipide increases gastric mucus and stimulates the production of endogenous prostaglandins. The prophylactic effect of rebamipide on NSAID-induced gastrointestinal complications is unknown. The aim of this study was to compare NSAID-induced gastrointestinal complications in rebamipide- and misoprostol-treated groups. Patients were randomized to two groups and took a conventional NSAID plus rebamipide or misoprostol for 12 weeks. Gastric mucosal damage was evaluated by endoscopy at screening and the end of the study. The prevalences of active gastric ulcer were 7/176 (3.9%) in the rebamipide group and 3/156 (1.9%) in the misoprostol group. The prevalences of peptic ulcer were 8/176 (4.5%) in the rebamipide group and 7/156 (4.4%) in the misoprostol group. The cumulative incidences of peptic ulcer in the high-risk subgroup were 6/151 (4.0%) for rebamipide and 6/154 (3.9%) for misoprostol. In conclusion, rebamipide prevented NSAID-induced peptic ulcer as effectively as misoprostol in patients on long-term NSAID therapy. Rebamipide may be a useful therapeutic option for the prevention of NSAID-induced gastrointestinal ulcer because of its therapeutic effect and safety

Curcumin Alleviates Matrix Metalloproteinase-3 and -9 Activities during Eradication of Helicobacter pylori Infection in Cultured Cells and Mice

Current therapy-regimens against Helicobacter pylori (Hp) infections have considerable failure rates and adverse side effects that urge the quest for an effective alternative therapy. We have shown that curcumin is capable of eradicating Hp-infection in mice. Here we examine the mechanism by which curcumin protects Hp infection in cultured cells and mice. Since, MMP-3 and -9 are inflammatory molecules associated to the pathogenesis of Hp-infection, we investigated the role of curcumin on inflammatory MMPs as well as proinflammatory molecules. Curcumin dose dependently suppressed MMP-3 and -9 expression in Hp infected human gastric epithelial (AGS) cells. Consistently, Hp-eradication by curcumin-therapy involved significant downregulation of MMP-3 and -9 activities and expression in both cytotoxic associated gene (cag)+ve and cag-ve Hp-infected mouse gastric tissues. Moreover, we demonstrate that the conventional triple therapy (TT) alleviated MMP-3 and -9 activities less efficiently than curcumin and curcumin's action on MMPs was linked to decreased pro-inflammatory molecules and activator protein-1 activation in Hp-infected gastric tissues. Although both curcumin and TT were associated with MMP-3 and -9 downregulation during Hp-eradication, but unlike TT, curcumin enhanced peroxisome proliferator-activated receptor-γ and inhibitor of kappa B-α. These data indicate that curcumin-mediated healing of Hp-infection involves regulation of MMP-3 and -9 activities

The impact of introducing the early warning scoring system and protocol on clinical outcomes in tertiary referral university hospital

Yuda Sutherasan,1 Pongdhep Theerawit,1 Alongkot Suporn,2 Arkom Nongnuch,3 Pariya Phanachet,4 Chomsri Kositchaiwat5 1Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Renal Unit, Department of Medicine, Faculty of Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand; 4Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 5Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Purpose: The aim of this study was to evaluate the impact of a hospital protocol in response to patient deterioration in general wards, stratified using the national early warning score (NEWS), on primary patient outcomes of in-hospital mortality and percentage of patients transferred to the intensive care unit (ICU).Patients and methods: We conducted a prospective observational cohort study among adult medical patients admitted to a university hospital in Bangkok. A 4-month pre-protocol period (November 2015 to February 2016) was assigned to a control group and a protocol period (March 2016 to June 2016) was allocated to a protocol group. On admission, vital signs (respiratory rate, pulse rate, systolic blood pressure, and temperature), oxygen saturation, presence of oxygen supplementation, and neurological status were used to calculate NEWS. Patients were categorized as low, moderate, or high risk based on the NEWS. During protocol period, when patients&rsquo; conditions are critical and they are at imminent risk, the NEWS detects the event and triggers a systematic response. The response enables closed monitoring and early treatment by expert physicians to rapidly stabilize and triage the patient to a location where services meet the patient&rsquo;s needs. Primary outcomes were compared between the pre-protocol and protocol groups using historical controls for the intervention, which is the availability of NEWS to staff and an associated escalation pathway.Results: A total of 1,145 patients were included in the analysis: 564 patients in the pre-protocol group and 581 in the protocol group. The mean NEWS of patients at admission was higher in the protocol group than in the pre-protocol group (2.4&plusmn;2.4 vs 1.77&plusmn;2.158; P&lt;0.001). There was no significant difference for in-hospital mortality and percentage of patients transferred to ICU between the groups. Among 95 (8.3%) patients at moderate risk, in-hospital mortality and ICU transfer percentage were lower in the protocol group than in the pre-protocol group (2.9 vs 15.4%; P=0.026; RR 0.188, 95% CI 0.037%&ndash;0.968% and 8.7 vs 26.9%; P=0.021; RR 0.322, 95% CI 0.12&ndash;0.87, respectively).Conclusion: Implementing the NEWS with the hospital protocol did not change the overall patient&rsquo;s outcomes. Keywords: health service administration, mortality, patient safety, quality improvement, rapid response system, early warning scor

Relation between Seroreactivity to Low-Molecular-Weight Helicobacter pylori-Specific Antigens and Disease Presentation

The identification of Helicobacter pylori-strain specific factors that correlate with clinical outcome has remained elusive. We investigated possible relationships between a group of H. pylori antigens and clinical outcome and compared an immunoblot assay kit (HelicoBlot, version 2.1 [HB 2.1]; Genelabs Diagnostics) with an established serological test, the high-molecular-weight cell-associated protein test (HM-CAP). We used sera from 156 Thai patients with different disease presentations, including 43 patients with gastric cancer, 64 patients with gastric ulcer, and 49 patients with nonulcer dyspepsia (NUD). HB 2.1 was compared to HM-CAP as a diagnostic test for H. pylori infection. The seroprevalence of H. pylori was significantly higher among gastric cancer patients than among patients with NUD (93 and 67%, respectively; P < 0.01). Among the H. pylori-seropositive patients, the presence of the antibody to the 37,000-molecular-weight antigen (37K antigen) was inversely related to the presence of gastric cancer (e.g., for gastric cancer patients compared with NUD patients, odds ratio [OR] = 0.28 and 95% confidence interval [CI] = 0.1 to 0.8). The presence of antibody to the 35K antigen was higher in gastric ulcer patients than in NUD patients (OR = 11.5; 95% CI = 2.4 to 54.3). The disease associations of antibodies to the 35K and 37K antigens are consistent with the possibility that these antigens are either indirect markers for H. pylori-related diseases or have specific active or protective roles in H. pylori-related diseases

The effect of hyperglycaemia on cerebral potentials evoked by rapid rectal distension in healthy humans

BACKGROUND: Acute hyperglycaemia affects the perception of sensations arising from the gastrointestinal tract. The mechanisms responsible for this effect are unknown. Recordings of cerebral evoked potentials (EPs) can be used to assess the integrity of visceral afferent pathways. Our aim was to determine whether hyperglycaemia affects EPs elicited by rectal distension in healthy humans. MATERIALS AND METHODS: Twelve healthy men, aged 19-31 years, were studied. A manometric catheter, incorporating a rectal balloon, was positioned 7-10 cm from the anal verge. Balloon distensions at both 'low' ( approximately 20 mL) and 'high' ( approximately 28 mL) volumes were performed, in a single-blind, randomized order, during both euglycaemia (4 mmol L-1) and hyperglycaemia (12 mmol L-1). EPs were recorded from a midline scalp electrode (Cz, International 10-20 system) and averaged for each series of 50 distensions. EP latencies and interpeak amplitudes were calculated. RESULTS: Polyphasic EPs were recorded in all but one subject. Although the blood glucose concentration had no significant effect on the latencies of the EP peaks elicited by either 'low'- or 'high'-volume balloon distension, the interpeak amplitude (P1-N1) was greater during hyperglycaemia than during euglycaemia at the 'low' balloon volume (6.3 +/- 1.2 microV vs. 4.8 +/- 1.0 microV, P < 0.05). The blood glucose concentration had no significant effect on the perception of rectal balloon distension. CONCLUSIONS: We conclude that in normal subjects acute hyperglycaemia increases the amplitude of the cerebral EP elicited by rectal balloon distension at low balloon volumes, suggesting that the effects of hyperglycaemia on gastrointestinal sensation may be mediated by central mechanism