Catheter intervention for abnormal pulmonary venous drainage

Transcatheter interventions for congenital heart anomalies are constantly improving. Although correction of anomalous pulmonary venous connection is routinely achieved through surgery, there are rare instances where the abnormal pulmonary vein has dual connections to both left atrium and the major systemic veins. Under these circumstances catheter based treatment might become a feasible option. We report a case of dual supply vertical vein connected to left upper pulmonary vein and innominate vein which was successfully obstructed by an occluder device leading to improvements in patient's condition. © 2018 Egyptian Society of Cardiolog

Catheter intervention for abnormal pulmonary venous drainage

Transcatheter interventions for congenital heart anomalies are constantly improving. Although correction of anomalous pulmonary venous connection is routinely achieved through surgery, there are rare instances where the abnormal pulmonary vein has dual connections to both left atrium and the major systemic veins. Under these circumstances catheter based treatment might become a feasible option. We report a case of dual supply vertical vein connected to left upper pulmonary vein and innominate vein which was successfully obstructed by an occluder device leading to improvements in patient's condition. © 2018 Egyptian Society of Cardiolog

Coronary slow flow: Benign or ominous?

Objective: Coronary slow flow phenomenon has been arbitrarily defined as delayed coronary blood flow in the absence of obstructive coronary artery disease. The present study sought to investigate the clinical features, natural history, and outcomes of affected patients. Methods: In this prospective cross-sectional study, 217 consecutive patients who had undergone coronary angiography and showed features of coronary slow flow phenomenon were evaluated for demographic and coronary risk factor profile, as well as clinical outcomes, at baseline and following treatment. Results: The study population consisted of 165 (76) males and 52 (24) females. The mean age of patients was 52.6±10 years. Mean ejection fraction was 48.2±5.4, 39.3 had diabetes, 43.3 had hypertension, 49.8 was a cigarette smoker, 41.9 had dyslipidemia, and 15 had a familial history of cardiac disease. Forty-nine percent was detected to have abnormal hsCRP levels. The most prevalent presenting complaint was atypical chest pain. Fifty-four percent of patients had slow blood flow in all three vessels. Thirty-six people had undergone repeat coronary angiography in a follow-up period of 5-7 years due to persisting or worsening clinical symptoms, of whom 6 (16.6) showed significant coronary artery stenosis. Eight (22.2) had mild CAD, and the rest still showed coronary slow flow without significant stenosis. The most common complaint during follow-up and after initiation of medical therapy was nonanginal chest pain. Conclusion: Patients with coronary slow flow phenomenon are predisposed to atherosclerosis and obstructive coronary artery disease. Therefore, this pathology should not be considered as a totally benign condition. Primary and secondary cardiovasculature preventive measures should be constituted and seem worthwhile in this patient population. © Copyright 2015 by Turkish Society of Cardiology

An investigation into the roles of chlorides and sulphate salts on the performance of low salinity injection in sandstone reservoirs : experimental approach

Numerous studies have been carried out to ascertain the mechanisms of low salinity and smart water flooding technique for improved oil recovery. Focus were often on brine composition and, specifically the cationic content in sandstone reservoirs. Given the importance of the salt composition and concentration, tweaking the active ions which are responsible for the fluids-rock equilibrium will bring into effect numerous mechanisms of displacement which have been extensively debated. This experimental study, however, was carried out to evaluate the extent of the roles of chloride and sulphate-based brines in improved oil recovery. To carry this out, 70,000 ppm sulphates and chloride-based brines were prepared to simulate formation water and 5,000ppm brines of the same species as low salinity displacement fluids. Core flooding process was used to simulate the displacement of oil by using four (4) native sandstones core samples, obtained from Burgan oil field in Kuwait, at operating conditions of 1500 psig and 50oC. The core samples were injected with 70,000 ppm chloride and sulphates and subsequently flooded with the 5,000 ppm counterparts in a forced imbibition process. Separate evaluations of chloride and sulphate-based brines were carried out to investigate the displacement efficiencies of each brine species. The results showed that the in both high and low salinity displacement tests, the SO4 brine presented better recovery of up to 89% of the initial oil saturation (Soi). Several mechanisms of displacement were observed to be responsible for improved recovery during SO4 brine displacement. IFT measurement experiments also confirmed that there was reduction in IFT at test conditions between SO4 brine and oil and visual inspection of the effluent showed a degree emulsification of oil and brines. Changes in pH were observed in the low salinity flooding and negligible changes were noticed in the high salinity floods. These results provide an insight into the roles of chloride and sulphate ions in the design of smart “designer” water and low salinity injection scenarios

Modeling of cu(ii) adsorption from an aqueous solution using an artificial neural network (ann)

This research optimized the adsorption performance of rice husk char (RHC4) for copper (Cu(II)) from an aqueous solution. Various physicochemical analyses such as Fourier transform infrared spectroscopy (FTIR), field-emission scanning electron microscopy (FESEM), carbon, hydrogen, nitrogen, and sulfur (CHNS) analysis, Brunauer–Emmett–Teller (BET) surface area analysis, bulk density (g/mL), ash content (%), pH, and pHZPC were performed to determine the characteristics of RHC4. The effects of operating variables such as the influences of aqueous pH, contact time, Cu(II) concentration, and doses of RHC4 on adsorption were studied. The maximum adsorption was achieved at 120 min of contact time, pH 6, and at 8 g/L of RHC4 dose. The prediction of percentage Cu(II) adsorption was investigated via an artificial neural network (ANN). The Fletcher–Reeves conjugate gradient backpropagation (BP) algorithm was the best fit among all of the tested algorithms (mean squared error (MSE) of 3.84 and R2 of 0.989). The pseudo-second-order kinetic model fitted well with the experimental data, thus indicating chemical adsorption. The intraparticle analysis showed that the adsorption process proceeded by boundary layer adsorption initially and by intraparticle diffusion at the later stage. The Langmuir and Freundlich isotherm models interpreted well the adsorption capacity and intensity. The thermodynamic parameters indicated that the adsorption of Cu(II) by RHC4 was spontaneous. The RHC4 adsorption capacity is comparable to other agricultural material-based adsorbents, making RHC4 competent for Cu(II) removal from wastewater

Urinary tract infections in children after renal transplantation

Urinary tract infections (UTI) after pediatric kidney transplantation (KTX) are an important clinical problem and occur in 15–33% of patients. Febrile UTI, whether occurring in the transplanted kidney or the native kidney, should be differentiated from afebrile UTI. The latter may cause significant morbidity and is usually associated with acute graft dysfunction. Risk factors for (febrile) UTI include anatomical, functional, and demographic factors as well as baseline immunosuppression and foreign material, such as catheters and stents. Meticulous surveillance, diagnosis, and treatment of UTI is important to minimize acute morbidity and compromise of long-term graft function. In febrile UTI, parenteral antibiotics are usually indicated, although controlled data are not available. As most data concerning UTI have been accumulated retrospectively, future prospective studies have to be performed to clarify pathogenetic mechanisms and risk factors, improve prophylaxis and treatment, and ultimately optimize long-term renal graft survival

Selenium toxicity but not deficient or super-nutritional selenium status vastly alters the transcriptome in rodents

<p>Abstract</p> <p>Background</p> <p>Protein and mRNA levels for several selenoproteins, such as glutathione peroxidase-1 (Gpx1), are down-regulated dramatically by selenium (Se) deficiency. These levels in rats increase sigmoidally with increasing dietary Se and reach defined plateaus at the Se requirement, making them sensitive biomarkers for Se deficiency. These levels, however, do not further increase with super-nutritional or toxic Se status, making them ineffective for detection of high Se status. Biomarkers for high Se status are needed as super-nutritional Se intakes are associated with beneficial as well as adverse health outcomes. To characterize Se regulation of the transcriptome, we conducted 3 microarray experiments in weanling mice and rats fed Se-deficient diets supplemented with up to 5 μg Se/g diet.</p> <p>Results</p> <p>There was no effect of Se status on growth of mice fed 0 to 0.2 μg Se/g diet or rats fed 0 to 2 μg Se/g diet, but rats fed 5 μg Se/g diet showed a 23% decrease in growth and elevated plasma alanine aminotransferase activity, indicating Se toxicity. Rats fed 5 μg Se/g diet had significantly altered expression of 1193 liver transcripts, whereas mice or rats fed ≤ 2 μg Se/g diet had < 10 transcripts significantly altered relative to Se-adequate animals within an experiment. Functional analysis of genes altered by Se toxicity showed enrichment in cell movement/morphogenesis, extracellular matrix, and development/angiogenesis processes. Genes up-regulated by Se deficiency were targets of the stress response transcription factor, Nrf2. Multiple regression analysis of transcripts significantly altered by 2 μg Se/g and Se-deficient diets identified an 11-transcript biomarker panel that accounted for 99% of the variation in liver Se concentration over the full range from 0 to 5 μg Se/g diet.</p> <p>Conclusion</p> <p>This study shows that Se toxicity (5 μg Se/g diet) in rats vastly alters the liver transcriptome whereas Se-deficiency or high but non-toxic Se intake elicits relatively few changes. This is the first evidence that a vastly expanded number of transcriptional changes itself can be a biomarker of Se toxicity, and that identified transcripts can be used to develop molecular biomarker panels that accurately predict super-nutritional and toxic Se status.</p

Benign external hydrocephalus: a review, with emphasis on management

Benign external hydrocephalus in infants, characterized by macrocephaly and typical neuroimaging findings, is considered as a self-limiting condition and is therefore rarely treated. This review concerns all aspects of this condition: etiology, neuroimaging, symptoms and clinical findings, treatment, and outcome, with emphasis on management. The review is based on a systematic search in the Pubmed and Web of Science databases. The search covered various forms of hydrocephalus, extracerebral fluid, and macrocephaly. Studies reporting small children with idiopathic external hydrocephalus were included, mostly focusing on the studies reporting a long-term outcome. A total of 147 studies are included, the majority however with a limited methodological quality. Several theories regarding pathophysiology and various symptoms, signs, and clinical findings underscore the heterogeneity of the condition. Neuroimaging is important in the differentiation between external hydrocephalus and similar conditions. A transient delay of psychomotor development is commonly seen during childhood. A long-term outcome is scarcely reported, and the results are varying. Although most children with external hydrocephalus seem to do well both initially and in the long term, a substantial number of patients show temporary or permanent psychomotor delay. To verify that this truly is a benign condition, we suggest that future research on external hydrocephalus should focus on the long-term effects of surgical treatment as opposed to conservative management