Rapid Sequence Induction is Superior to Morphine for Intubation of Preterm Infants: A Randomized Controlled Trial.

OBJECTIVES: To compare rapid sequence intubation (RSI) premedication with morphine for intubation of preterm infants. STUDY DESIGN: Preterm infants needing semi-urgent intubation were enrolled to either RSI (glycopyrrolate, thiopental, suxamethonium, and remifentanil, n = 17) or atropine and morphine (n = 17) in a randomized trial. The main outcome was "good intubation conditions" (score ≤10 assessed with intubation scoring), and secondary outcomes were procedural duration, physiological and biochemical variables, amplitude-integrated electroencephalogram, and pain scores. RESULTS: Infants receiving RSI had superior intubation conditions (16/17 versus 1/17, P < .001), the median (IQR) intubation score was 5 (5-6) compared with 12 (10.0-13.5, P < .001), and a shorter procedure duration of 45 seconds (35-154) compared with 97 seconds (49-365, P = .031). The morphine group had prolonged heart rate decrease (area under the curve, P < .009) and mean arterial blood pressure increase (area under the curve, P < .005 and %change: mean ± SD 21% ± 23% versus -2% ± 22%, P < .007) during the intubation, and a subsequent lower mean arterial blood pressure 3 hours after the intubation compared with baseline (P = .033), concomitant with neurophysiologic depression (P < .001) for 6 hours after. Plasma cortisol and stress/pain scores were similar. CONCLUSION: RSI with the drugs used can be implemented as medication for semi-urgent intubation in preterm infants. Because of circulatory changes and neurophysiological depression found during and after the intubation in infants given morphine, premedication with morphine should be avoided

Quantitative determination of estrone by liquid chromatography-tandem mass spectrometry in subcutaneous adipose tissue from the breast in postmenopausal women

Estrone is the most abundant estrogen after the menopause. We developed a liquid chromatography-tandem mass spectrometric method (LC-MS/MS) for determination of estrone in adipose tissue. Subcutaneous adipose tissue from the breast was collected during elective surgery in postmenopausal women undergoing mastectomy for treatment of breast cancer (n = 13) or reduction mammoplasty (controls, n = 11). Homogenized adipose tissue was extracted with organic solvents and the estrone fraction was purified by LH-20 column chromatography from the excess of lipids. The concentration of estrone was analyzed by LC-MS/MS. The method was accurate with an intra-assay variation of 8% and an interassay variation of 10%. The median concentration of estrone in subcutaneous adipose tissue from the breast did not differ between breast cancer and control women, 920 pmol/kg and 890 pmol/kg, respectively. In breast cancer patients but not in the controls, breast adipose tissue estrone levels correlated positively with the serum estrone concentration. In conclusion, the new method provides a reliable means to measure estrone concentrations in adipose tissue in postmenopausal women. (C) 2015 Elsevier Ltd. All rights reserved.Peer reviewe

Estrogen biosynthesis in breast adipose tissue during menstrual cycle in women with and without breast cancer

Circulating estrogens fluctuate during the menstrual cycle but it is not known whether this fluctuation is related to local hormone levels in adipose tissue. We analyzed estrogen concentrations and gene expression of estrogen-regulating enzymes in breast subcutaneous adipose tissue in premenopausal women with (n = 11) and without (n = 17) estrogen receptor-positive breast cancer. Estrone (E-1) was the predominant estrogen in premenopausal breast adipose tissue, and E-1 and mRNA expression of CYP19A1 in adipose tissue correlated positively with BMI. Adipose tissue estradiol (E-2) concentrations fluctuated during the menstrual cycle, similarly to the serum concentrations. In women with breast cancer median adipose tissue E-1 (1519 vs. 3244, p <.05) and E-2 (404 vs. 889 pmol/kg, p <.05) levels were lower in the follicular than in the luteal phase whereas in control women no significant differences were observed. In the follicular phase, mRNA expressions of HSD17B1 (median 0.06; interquartile range 0.05-0.07 vs. 0.17; 0.03-0.2, p = .010) and CYP19A1 (0.08; 0.07-0.14 vs. 0.22; 0.09-0.54, p = .025) were lower in women with breast cancer than in controls. In conclusion, the changes in adipose tissue E-1 and E-2 concentrations and the estrogen-regulating CYP19A1 and HSD17B1 during the menstrual cycle may be related to dysfunctional local estrogen metabolism in women with breast cancer.Peer reviewe

Sustainability Assessment of Chemical Processes: Evaluation of Three Synthesis Routes of DMC

This paper suggested multicriteria based evaluation tool to assess the sustainability of three different reaction routes to dimethyl carbonate: direct synthesis from carbon dioxide and methanol, transesterification of methanol and propylene carbonate, and oxidative carbonylation of methanol. The first two routes are CO 2 -based and in a research and development phase, whereas the last one is a commercial process. The set of environmental, social, and economic indicators selected were renewability of feedstock, energy intensity, waste generation, CO 2 balance, yield, feedstock price, process costs, health and safety issues of feedstock, process conditions, and innovation potential. The performance in these indicators was evaluated with the normalized scores from 0 to +1; 0 for detrimental and 1 for favorable impacts. The assessment showed that the transesterification route had the best potential toward sustainability, although there is still much development needed to improve yield. Further, the assessment gave clear understanding of the main benefits of each reaction route, as well as the major challenges to sustainability, which can further aid in orienting development efforts to key issues that need improvement. Finally, it was concluded that a multicriteria analysis such as the one presented in this paper was a viable method to be used in the process design stage

Liquorice ingestion attenuates vasodilatation via exogenous nitric oxide donor but not via β2-adrenoceptor stimulation

We examined the effect of liquorice ingestion on haemodynamic responses to exogenous nitric oxide donor (nitroglycerin) and β2-adrenoceptor agonist (salbutamol), and 11β-hydroxysteroid dehydrogenase activity, in 21 volunteers and 21 reference subjects. Haemodynamic data was captured before and after sublingual nitroglycerin (0.25 mg) and inhaled salbutamol (400 μg) during orthostatic challenge utilising radial pulse wave analysis and whole-body impedance cardiography. The recordings were performed at baseline and following two weeks of liquorice intake (290–370 mg/d glycyrrhizin). Urinary cortisone and cortisol metabolites were examined. Liquorice intake elevated aortic systolic and diastolic blood pressure and systemic vascular resistance when compared with the reference group. Following research drug administration the liquorice-induced increase in systemic vascular resistance was observed in the presence of nitroglycerin (pPeer reviewe

Direct synthesis of dimethyl carbonate from methanol and carbon dioxide: a thermodynamic and experimental study

The direct synthesis of dimethyl carbonate (DMC) from carbon dioxide and methanol is an atom economic, green and promising process. The present work focuses on this process using calcined hydrotalcite (CHT) supported on hexagonal mesoporous silica (HMS) as a catalyst and phosphonium based ionic liquid (IL) as a promoter. Phosphonium based ionic liquids are good solvents for carbon dioxide and are better alkali promoters. Different modified Keggin type cesium modified heteropoly acids (HPA) supported on HMS were also used as catalysts, which give good comparison between dual site catalysts with altered acidity or/and basicity. The conversion and selectivity were measured as a function of concentration of reactants, catalyst and temperature. The experimental results were compared with the thermodynamic calculations and simulated results. Kinetic model was developed by proposing a reaction mechanism. Sustainability of the process was justified by using a heterogeneous catalyst and by avoiding the use of harmful organic solvents in the presence of an ionic liquid with supercritical CO<SUB>2</SUB>

Direct synthesis of formic acid from carbon dioxide and hydrogen: a thermodynamic and experimental study using poly-urea encapsulated catalysts

The present work is concerned with direct hydrogenation of CO2 to formic acid which takes into account thermodynamic feasibility and experimental studies. Poly-urea encapsulated catalysts were explored and the effect of ionic liquids under supercritical conditions was examined. The monometallic and bimetallic catalysts were prepared, characterized, screened for the hydrogenation of CO2 and also compared with a commercially available poly-urea–Pd catalyst. The effect of reaction temperature, type of the catalyst, promoter, pressure and molar ratio of the feed (H2/CO2) on the yield of formic acid has been studied and discussed in order to maximize the formation of formic acid. The highest yield of formic acid obtained in terms of turn-over frequency (TOF) was 11,900 h−1 at a total pressure of 144 bar, temperature of 70 °C, mole ratio (H2/CO2) of 1, catalyst (poly urea encapsulated Ru) loading of 0.04 g/cm3 and 3.12 × 10−5 mol/cm3 of ionic liquid (trihexyl (tetradecyl) phosphonium chloride)

Adipose tissue estrogen production and metabolism in premenopausal women

Objective: Although the ovaries produce the majority of estrogens in women before menopause, estrogen is also synthesized in peripheral tissues such as adipose tissue (AT). The typical female AT distribution, concentrated in subcutaneous and femoro-gluteal regions, is estrogen-mediated, but the significance of estrogen synthesis in AT of premenopausal women is poorly understood. Design and Methods: Serum and subcutaneous and visceral AT homogenates from 28 premenopausal women undergoing non-malignant surgery were analyzed for estrone, estradiol, and serum estrone sulfate (E1S) concentrations with liquid chromatography-tandem mass spectrometry. Isotopic precursors were used to measure enzyme activities of estrone-producing steroid sulfatase and estradiol-producing 17?-hydroxysteroid dehydrogenases (17?-HSD). Messenger RNA (mRNA) expression levels of genes for estrogen-metabolizing enzymes were analyzed using real-time reverse transcription quantitative polymerase chain reaction. Results: While estradiol was the predominant circulating active estrogen, estrone dominated in AT, with a higher concentration in visceral than subcutaneous AT (median, 2657 vs 1459 pmol/kg; P = 0.002). Both AT depots converted circulating E1S to estrone, and estrone to estradiol. Median levels of estrone were five to ten times higher in subcutaneous and visceral AT than in serum (P <0.001) and the estradiol level in visceral AT was 1.3 times higher than in serum (P <0.005). The local estrone concentration in visceral AT correlated positively with mRNA expression of estrone-producing enzyme aromatase (r = 0.65, P = 0.003). Waist circumference correlated positively with increased estradiol production in subcutaneous AT (r = 0.60, P = 0.039). Conclusions: Premenopausal AT demonstrated high estrogenic enzyme activity and considerable local estrogen concentrations. This may be a factor promoting female-typical AT distribution in premenopausal women.Peer reviewe

Investigating errors in medical imaging:medical malpractice cases in Finland

Abstract Objective: The objectives of the study were to survey patient injury claims concerning medical imaging in Finland in 1991–2017, and to investigate the nature of the incidents, the number of claims, the reasons for the claims, and the decisions made concerning the claims. Materials and methods: The research material consisted of patient claims concerning imaging, sent to the Finnish Patient Insurance Centre (PVK). The data contained information on injury dates, the examination code, the decision code, the description of the injury, and the medical grounds for decisions. Results: The number of claims included in the study was 1054, and the average number per year was 87. The most common cause was delayed diagnosis (404 claims, 38.3%). Most of the claims concerned mammography (314, 29.8%), radiography (170, 16.1%), and MRI (162, 15.4%). According to the decisions made by the PVK, there were no delays in 54.6% of the examinations for which claims were made. About 30% of all patient claims received compensation, the most typical reason being medical malpractice (27.7%), followed by excessive injuries and injuries caused by infections, accidents and equipment (2.7%). Conclusion: Patient injury in imaging examinations and interventions cannot be completely prevented. However, injury data are an important source of information for health care. By analysing claims, we can prevent harm, increase the quality of care, and improve patient safety in medical imaging

Substitution potential of rare earth catalysts in ethanol steam reforming

Abstract This study suggests the possibility of substituting rare earths containing catalysts in ethanol steam reforming by means of sustainability assessment. Four Ni-catalysts are assessed; two of the Ni-catalysts are rare earths containing catalysts Ni/Al₂O₃-CeO₂and Ni/La₂O₃ while the other two are non-rare earths containing catalysts Ni/Al₂O₃ and Ni/ZnO. The sustainability assessment tool used covers environmental, health and safety and economic indicators in conjunction with a linear scale transformation (Max) normalization technique and an analytical hierarchy method to evaluate the sustainability performance of the catalysts. The sustainability assessment results obtained demonstrated that Ni/Al₂O₃ is the best performing catalysts in terms of the overall sustainability of the ethanol steam reforming reaction. The rare earths containing catalyst supports, i.e. cerium and lanthanum oxides can be successfully substituted with aluminum oxide catalyst support whilst still maintaining the overall sustainability performance of the reaction