Enzyme-assisted extraction of carotenoids from Bulgarian tomato peels

Enzyme-assisted extraction of carotenoids from tomato peels of the Bulgarian cultivar “Stela”, one of the most widely used cultivars by the canning industry, was examined in this study. The carotenoid content in raw tomato peels was established by HPLC analysis. A two-step protocol was followed: the tomato peels were first treated with enzymes and then extracted by the use of acetone as a solvent for 30 min at 20±1 °C and solid/liquid ratio of 1:30. The total carotenoid, lycopene, and β-carotene extraction yields were increased by the use of pectinase, cellulase, endo-xylanase, and proteinase enzymes in comparison with the non-enzyme-treated samples. The increase in the extraction yield was affected by the enzymes used, the enzyme concentration, the pretreatment time and temperature. Maximum total carotenoid (55.15 mg/100 g d.w.), β-carotene (35.85 mg/100 g d.w.), and lycopene (15.44 mg/100 g d.w.) extraction yields were obtained in peels pretreated with mixed cellulase (100 U g−1) and endo-xylanase (400 U g−1) for 4 h at 50 °C. Carotenoid recovery by mixed cellulolytic and hemi-cellulolytic enzyme pretreatment of tomato peels is a good approach, which can be used for waste utilization

Achievement motivation and attitude of medical laboratory assistants to continuing education

Introduction. The problem of improving competence by means of continuing education of health specialists is not sufficiently discussed and studied, especially in terms of medical laboratory assistants. The emphasis of the present study is on the ability to update achievement motivation of laboratory assistants through new opportunities and forms of continuing professional education. Their interest in continuing education indicates an aspiration for improving their professional competence with respect to innovative professional practices including dynamically changing methods, technologies and devices facilitating health examinations that reflect the highly significant results of their work for the health and life of their patients. The aim of the present research is to study the achievement motivation of students and medical laboratory technicians and its influence on the main variables and descriptors of the attitude towards continuous learning. Materials and research methods. The studied persons represent three target groups involved in continuing professional education - in-service medical laboratory assistants, heads of medical laboratories and students enrolled in the programme of Medical Laboratory Assistant at Bulgarian medical colleges. The methodological tools comprise standardised psychological tests, as well as questionnaires developed for the purposes of the specific study. Results and scientific novelty. The main results support the thesis that motivation for achievement is updated in activities and situations where professional success is subjectively important and there are clear criteria of success or failure. The interest in continuing education depends on the motivation for achievement as a tendency in various individuals. The higher achievement motivation determines a stronger need to improve professional competences, aspiration to acquire a graduate degree in their professional field, preferences to specialisations as a form of continuing learning and understanding of continuing education as a manifestation of the desire for new knowledge. The results from the study may enrich the existing research data on the application of achievement motivation theory as an explanatory model of life-long learning behaviour, which may become an effective way to tackle the rapidly ageing and half-life of knowledge in medicine and technology. Practical significance. The applicability of the results is very clearly visible in the formulated thesis of the necessary change in the educational policy in the country through new forms of continuous education of medical laboratory assistants which would update their achievement motivation and would result in increase in the efficiency of their professional functioning.Введение. Проблема повышения компетентности путем непрерывного обучения специалистов здравоохранения, в частности медицинских лаборантов, недостаточно изучена. Основное внимание в настоящем исследовании уделяется возможности актуализировать мотивацию достижений лаборантов посредством новых методов и форм непрерывного профессионального образования. Интерес лаборантов к непрерывному обучению является индикатором стремления к повышению их профессиональной компетентности в условиях инновативности профессии с ее динамически меняющимися методами, технологиями и аппаратурой для медицинских исследований и при высокой значимости результатов их работы для здоровья и жизни людей. Цель работы - исследовать мотивацию достижений у студентов и медицинских лаборантов и ее влияние на основные переменные и дескрипторы отношения к непрерывному обучению. Материалы и методы. Респонденты являются представителями трех целевых групп, имеющих отношение к непрерывному обучению в профессии: практикующие медицинские лаборанты, руководители медицинских лабораторий и студенты специальности «Медицинский лаборант» в болгарских медицинских колледжах. Методический инструментарий включает в себя стандартизированные психологические тесты, а также вопросники, разработанные для целей конкретного исследования. Результаты и научная новизна. Основные результаты работы обосновывают тезис о том, что мотивация достижений становится актуальной в действиях и ситуациях, когда успех в профессии субъективно значим и существуют четкие критерии успеха или неудачи. Готовность к непрерывному обучению зависит от мотивации достижений как личностной тенденции. Более высокая мотивация достижений обуславливает более сильную потребность в повышении профессиональных компетенций, стремление получить ученую степень в своей профессиональной области, предпочтение специализации как формы непрерывного обучения и понимание непрерывного образования как проявление стремления к новым знаниям. Результаты исследования могут обогатить существующие данные по применению теории мотивации достижений в качестве объяснительной модели поведения при непрерывном обучении, что может стать эффективным способом решения проблемы быстрого старения и периода полураспада знаний в медицине и технологиях. Практическая значимость. Применимость результатов выражается особенно четко в сформулированном тезисе о необходимом изменении образовательной политики страны посредством новых форм непрерывного обучения для медицинских лаборантов, которые смогут актуализировать свою мотивацию достижений и в результате повысить эффективность их функционирования в профессии.The article is supported by the Medical College of the Trakia University, Stara Zagora, Bulgaria.Статья выполнена при поддержке Медицинского колледжа Тра-кийского университета - Стара Загора, Болгария

Renal replacement therapy in Europe : A summary of the 2011 ERA-EDTA Registry Annual Report

BackgroundThis article provides a summary of the 2011 ERA-EDTA Registry Annual Report (available at www.era-edta-reg.org).MethodsData on renal replacement therapy (RRT) for end-stage renal disease (ESRD) from national and regional renal registries in 30 countries in Europe and bordering the Mediterranean Sea were used. From 27 registries, individual patient data were received, whereas 17 registries contributed data in aggregated form. We present the incidence and prevalence of RRT, and renal transplant rates in 2011. In addition, survival probabilities and expected remaining lifetimes were calculated for those registries providing individual patient data.ResultsThe overall unadjusted incidence rate of RRT in 2011 among all registries reporting to the ERA-EDTA Registry was 117 per million population (pmp) (n = 71.631). Incidence rates varied from 24 pmp in Ukraine to 238 pmp in Turkey. The overall unadjusted prevalence of RRT for ESRD on 31 December 2011 was 692 pmp (n = 425 824). The highest prevalence was reported by Portugal (1662 pmp) and the lowest by Ukraine (131 pmp). Among all registries, a total of 22 814 renal transplantations were performed (37 pmp). The highest overall transplant rate was reported from Spain, Cantabria (81 pmp), whereas the highest rate of living donor transplants was reported from Turkey (39 pmp). For patients who started RRT between 2002 and 2006, the unadjusted 5-year patient survival on RRT was 46.8% [95% confidence interval (CI) 46.6-47.0], and on dialysis 39.3% (95% CI 39.2-39.4). The unadjusted 5-year patient survival after the first renal transplantation performed between 2002 and 2006 was 86.7% (95% CI 86.2-87.2) for kidneys from deceased donors and 94.3% (95% CI 93.6-95.0) for kidneys from living donors.publishersversionPeer reviewe

Long-term chimney/snorkel endovascular aortic aneurysm repair experience for complex abdominal aortic pathologies within the PERICLES registry

Objective: The early and short-term efficacy of the snorkel/chimney technique for endovascular aortic aneurysm repair (ch-EVAR) have been previously reported. However, long-term ch-EVAR performance, vessel patency, and patient survival remain unknown. Our study evaluated the late outcomes to identify possible predictors of failure within the PERICLES (performance of the chimney technique for the treatment of complex aortic pathologies) registry. Methods: Clinical and radiographic data from patients who had undergone ch-EVAR from 2008 to 2014 in the PERICLES registry were updated with an extension of the follow-up. Regression models were used to evaluate the relevant anatomic and operative characteristics as factors influencing the late results. We focused on patients with ≥30 months of follow-up (mean, 46.6 months; range, 30-120 months). Results: A total of 517 patients from the initial PERICLES registry were included in the present analysis, from which the mean follow-up was updated from 17.1 months to 28.2 months (range, 1-120 months). All-cause mortality at the latest follow-up was 25.5% (n = 132), with an estimated patient survival of 87.6%, 74.4%, and 66.1% at 1, 3, and 5 years, respectively. A subgroup of 244 patients with 387 chimney grafts placed (335 renal arteries, 42 superior mesenteric arteries, 10 celiac arteries) and follow-up for ≥30 months was used to analyze specific anatomic and device predictors of adverse events. In the subgroup, the technical success was 88.9%, and the primary patency was 94%, 92.8%, 92%, and 90.5% at 2.5, 3, 4, and 5 years, respectively. The mean aneurysm sac regression was 7.8 ± 11.4 mm (P <.0001). Chimney graft occlusion had occurred in 24 target vessels (6.2%). Late open conversion was required in 5 patients for endograft infection in 2, persistent type Ia endoleak in 2, and endotension in 1 patient. The absence of an infrarenal neck (odds ratio, 2.86; 95% confidence interval, 1.32-6.19; P =.007) was significantly associated with long-term device-related complications. A sealing zone diameter >30 mm was significantly associated with persistent or late type Ia endoleak (odds ratio, 4.86; 95% confidence interval, 1.42-16.59; P =.012). Conclusions: The present analysis of the PERICLES registry has provided the missing long-term experience for the ch-EVAR technique, showing favorable results with more than one half of the patients surviving for >5 years and a chimney graft branch vessel patency of 92%. The absence of an infrarenal neck and treatment with a sealing zone diameter >30 mm were the main anatomic long-term limits of the technique, requiring adequate preoperative planning and determination of the appropriate indication

Use of stainless-steel, balloon-expandable chimney grafts is durable though caution is required when lining angulated renal arteries

Purpose: To analyze the overall performance of flexible nitinol stents used to line chimney grafts (CGs) during chimney endovascular aneurysm repair (chEVAR) of pararenal pathologies. Materials and Methods: A retrospective review was conducted of all 116 elective patients (mean age 74.3±7.2 years; 103 men) who underwent chEVAR with balloon-expandable Advanta V12/iCAST CGs in combination with the Endurant stent-graft between January 2009 and December 2017 at a single center. CG lining with a nitinol stent was electively performed in 43 target vessels of 32 patients. The Kaplan-Meier method was used to estimate the primary outcomes of CG patency and freedom from reintervention (FFR) at the patient level and according to the use of a stent to line the CG. Estimates are reported with the 95% confidence interval (CI). Adjusted odds ratios (ORs) were calculated to identify any confounding effect between the presence/absence of a stent lining or according to the number of CGs. Results: The mean radiological follow-up was 27.3 months (range 22.1–32.6). During this time, 8 CGs (4.7%) became occluded, 6 of them were lined with stents. Restoration of patency was possible in 3 of the 4 occluded stents that were associated with symptoms. First-year primary patency estimates were 96.9% (95% CI 92.5% to 100%) for the unlined group vs 77.1% (95% CI 58% to 95.3%; p=0.001) for the lined group, while FFR was 87.6% (95% CI 79.9% to 95.2%) vs 83.4% (95% CI 68.1% to 98.6%; p=0.82), respectively. Lining represented an independent risk factor for CG occlusion (OR 9.9, p=0.006). Conclusion: CG lining performed mainly in angulated renal arteries during chEVAR was significantly associated with CG occlusion. These findings highlight the importance of not having the distal part of the CG impinge on the angulated segment of the target vessel

Use of Rotational Atherectomy-Assisted Balloon Angioplasty in the Treatment of Isolated Below-the-Knee Atherosclerotic Lesions in Patients with Chronic Limb-Threatening Ischemia

The aim of the study is to evaluate the safety and effectiveness of rotational atherectomy-assisted balloon angioplasty (BTK-RA) for the treatment of isolated below the knee (BTK) atherosclerotic lesions and to compare the outcomes to plain old balloon angioplasty (POBA). Between January 2020 and September 2023, 96 consecutive patients with chronic limb threatening ischemia (CTLI) and isolated BTK-lesions underwent POBA (group A) or BTK-RA (group B). The primary outcome measures were: periprocedural technical success, primary patency, postoperative increase of the ankle branchial index (ABI), target lesion revascularization (TLR), limb salvage, minor amputation and death. Both techniques had similar technical success, operative time, intraprocedural complications and bailout stent implantations, independently of the operator’s experience. Group B had significantly higher primary patency rates (93.5% vs. 72.0%, respectively, p = 0.006), TLR (2.1% vs. 24%, p = 0.057), lower in-hospital stay (2.0–3.0 vs. 4.0–6.0 days, respectively, p p = 0.008), compared to group A. Significant differences (POBA n: 20, 40%, BTK-RA n = 3, 6.5%) were found in minor amputation rates between the two groups (p p = 0.35). The use of BTK-RA for the treatment of BTK-lesions in patients with CTLI showed significant clinical advantages in comparison to POBA

What we have learned from in-vitro studies of the chimney endovascular technique for treatment of complex abdominal aortic aneurysms: A systematic review

Background: A considerable number of patients with abdominal aortic aneurysms (AAA) is not eligible for standard endovascular repair. These complex cases require alternative surgical approaches including the readily available chimney graft endovascular aneurysm repair (Ch-EVAR) or sealing (Ch-EVAS). The optimal configuration for Ch-EVAR or Ch-EVAS is important for success but not yet known. Objective: The aim of the present study was to analyze current data of the outcomes of in-vitro chimney graft treatment in complex AAA. Methods: A systematic review following PRISMA guidelines was conducted including studies reporting on gutter size, main graft compression, and chimney graft compression in in-vitro configurations. Results: The search resulted in 285 articles. 11 studies considering 219 individual tests could be included. Gutter size was comparable between Ch-EVAR and Ch-EVAS configurations. In Ch-EVAR set-ups, the deployed BECG were Advanta V12, VIABAHN®, and BeGraft. One type of SECG was used: VIABAHN®. The four types of main grafts (MG) deployed were: Endurant™ I/II; EXCLUDER Conformable AAA Endoprosthesis and AAA Endoprosthesis, and AFX™ Endovascular AAA Delivery System. In the EVAS-configurations, the Nellix® EVAS system was deployed. In general, SECG presented smaller gutters with higher chimney graft compression. 30% main grafts oversizing seems to give the smallest gutters without high risk of infolding of MG. Oversizing, EndoAnchors, and secondary endobag filling (in Ch-EVAS) reduced gutter sizes. CG ballooning during the entire polymer injection in Ch-EVAS prevented CG compression. Conclusion: In-vitro investigations provide insight in optimal Ch-EVAR and Ch-EVAS configurations for simulated complex AAA repair. The findings above might aid physicians in their planning to potential CG set-ups and can be used in future research to refine the most optimal configuration for chimney graft technique in complex AAA

Current role of the chimney technique in the treatment of complex abdominal aortic pathologies: A position paper from the PERICLES Registry investigators

Historically, chimney/snorkel endovascular aortic repair (Ch-EVAR) emerged as a rescue technique to revascularize and/or preserve inadvertently covered critical branch vessels during infrarenal aortic endografting. Next, in its evolutionary path, Ch-EVAR offered a viable treatment option for complex aortic repair, and particularly in situations where fenestrated/ branched EVAR was not a therapeutic option due to the lack of availability and/or anatomical constraints. In this context, this technique offered distinct advantages such as off-the-shelf availability, straightforward implantation techniques, and lower resource use-intensity enabling performance by a large number of operators managing patients in many centers around the world