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Interleukin-18 and fibroblast growth factor 2 in combination is a useful diagnostic biomarker to distinguish adult-onset Still's disease from sepsis
Get PDFObjective: To identify potential biomarkers to distinguish adult-onset Still's disease (AOSD) from sepsis. Method: We recruited 70 patients diagnosed with AOSD according to the Yamaguchi criteria, 22 patients with sepsis, and 118 age-matched controls. Serum levels of 40 cytokines were analyzed using multi-suspension cytokine array. We performed a cluster analysis of each cytokine in the AOSD and sepsis groups in order to identify specific molecular networks. Further, multivariate classification (random forest analysis) and logistic regression analysis were used to rank the cytokines by their importance and determine specific biomarkers for distinguishing AOSD from sepsis. Results: Seventeen of the 40 cytokines were found to be suitable for further analyses. The serum levels of eleven were significantly higher in patients with AOSD than healthy controls. Levels of serum fibroblast growth factor 2 (FGF-2), vascular endothelial growth factor (VEGF), granulocyte colony-stimulating factor (G-CSF), and interleukin (IL)-18 were significantly elevated in patients with AOSD compared with those with sepsis, and cytokine clustering patterns differed between these two groups. Multivariate classification followed by logistic regression analysis revealed that measurement of both FGF-2 and IL-18 could distinguish AOSD from sepsis with high accuracy (cutoff value for FGF-2 = 36 pg/mL; IL-18 = 543 pg/mL, sensitivity 100%, specificity 72.2%, accuracy 93.8%). Conclusion: Determination of FGF-2 and IL-18 levels in combination may represent a biomarker for the differential diagnosis of AOSD from sepsis, based on the measurement of multiple cytokines
Study on prevention of hypercapnia by Nasal High Flow in patients with endoscopic submucosal dissection during intravenous anesthesia
Get PDFBACKGROUND: For relatively invasive upper gastrointestinal endoscopy procedures, such as an endoscopic submucosal dissection (ESD), intravenous anesthesia is routinely used to reduce patient anxiety. However, with the use of intravenous sedation, even at mild to moderate depth of anesthesia, there is always a risk of upper airway obstruction due to a relaxation of the upper airway muscles.With the advent of Nasal High Flow (NHF) devices that allow humidified high flow air through the nasal cavity, can be used as a respiratory management method in the context of anesthesia. AIRVO is commonly used for patients with obstructive sleep apnea and other respiratory disorders. This device uses a mild positive pressure load (several cmH2O) that improves carbon dioxide (CO2) washout and reduces rebreathing to improve respiratory function and therefore is widely used to prevent hypoxemia and hypercapnia.This study aims to maintain upper airway patency by applying NHF with air (AIRVO) as a respiratory management method during intravenous anesthesia for patients undergoing an ESD. In addition, this study investigates whether the use of an NHF device in this context can prevent intraoperative hypercapnia and hypoxemia. METHODS/DESIGN: This study design employed 2 groups of subjects. Both received intravenous anesthesia while undergoing an ESD, and 1 group also used a concurrent nasal cannula NHF device. Here we examine if the use of an NHF device during intravenous anesthesia can prevent hypoxemia and hypercapnia, which could translate to improved anesthesia management.Efficacy endpoints were assessed using a transcutaneous CO2 monitor. This device measured the changes in CO2 concentration during treatment. Transcutaneous CO2 (PtcCO2) concentrations of 60 mmHg or more (PaCO2 > 55 mmHg) were considered marked hypercapnia. PtcCO2 concentrations of 50 to 60 mmHg or more (equivalent to PaCO2 > 45 mmHg) were considered moderate hypercapnia.Furthermore, the incidence of hypoxemia with a transcutaneous oxygen saturation value of 90% or less, and whether the use of NHF was effective in preventing this adverse clinical event were evaluated. DISCUSSION: The purpose of this study was to obtain evidence for the utility of NHF as a potential therapeutic device for patients undergoing an ESD under anesthesia, assessed by determining if the incidence rates of hypercapnia and hypoxemia decreased in the NHF device group, compared to the control group that did not use of this device. TRIAL REGISTRATION: The study was registered the jRCTs 072190022.URLhttps://jrct.niph.go.jp/en-latest-detail/jRCTs072190022
Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur, Nepal
Get PDFBackground: The emergence of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing uropathogens has
]complicated the treatment of urinary tract infections (UTI). Paediatric UTI is a common illness, which if not treated properly,
may lead to acute and long-term complications, such as renal abscess, septicaemia, and renal scarring. This study aimed to determine the prevalence of MDR and ESBL-producing uropathogens among children. Methods: During the study period (April 2017-April 2018), midstream urine samples were collected following aseptic procedures from children < 16 years in Siddhi Memorial Hospital. Standard culture and biochemical tests were performed to identify uropathogens and antimicrobial susceptibility test was done by modified Kirby-Bauer disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL-producing uropathogens were screened by ceftazidime (30 μg) and cefotaxime (30 μg) discs, and confirmed by the combination disc tests: ceftazidime + clavulanic acid (30/10 μg) or cefotaxime + clavulanic acid (30/10 μg) as recommended by CLSI. Results: We processed 5545 non-repeated urine samples from the children with symptoms of UTI. A significant growth of uropathogens was observed in 203 samples (3.7%). The median age of the children was 24 months (interquartile range (IQR), 12-53 months). Escherichia coli
(n = 158, 77.8%) and Klebsiella pneumoniae (n = 30, 14.8%) were common among the uropathogens. Among them, 80.3% were resistant to amoxycillin and 51.2% were resistant to cotrimoxazole. Most of them were susceptible to amikacin,nitrofurantoin,
and ofloxacin. MDR was detected in 34.5% (n = 70/203) and ESBL producers in 24.6% (n = 50/203) of them. The proportion of
MDR isolates was higher in children < 5 years (n = 59/153, 38.6%) than children ≥ 5 years (n = 11/50, 22%) (P = 0.03). Conclusions:Nitrofurantoin, ofloxacin, and amikacin can be used for the empirical treatment for UTI in children in Bhaktapur, Nepal.MDR and ESBL-producing uropathogens are prevalent; this warrants a continuous surveillance of antimicrobial resistance
Switching from originator infliximab to biosimilar infliximab in Japanese patients with rheumatoid arthritis achieving clinical remission (the IFX-SIRIUS study I)
Get PDFBACKGROUND: The introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) into clinical practice has
dramatically improve the clinical outcomes of individuals with rheumatoid arthritis (RA). However, bDMARDs are associated
with high costs, which has resulted in restricted treatment access and a burden on medical insurance finances. Although biosimilars offer cost-saving, their effectiveness and safety must be established in Post-Marketing Surveillance (PMS). Infliximab (IFX), a chimeric monoclonal antibody to TNF-alpha, is the first bDMARD; its biosimilar, CT-P13, is the first biosimilar DMARD approved for RA treatment in Japan. We will evaluate whether switching from originator IFX to CT-P13 is not inferior for maintaining non-clinical relapse to continued treatment with originator IFX in RA patients achieving clinical remission. METHODS/DESIGN: This study is an interventional, multicenter, open-label, single-arm against historical control and noninferiority clinical trial with a 24-week follow-up. Eighty RA patients who are treated by originator IFX for ≥24 weeks and are achieving clinical remission will be included. Patients will be switched
to CT-P13 with the unchanged dosing regimen. We will evaluate disease activity by measuring clinical disease activity
indices and by using musculoskeletal ultrasound (MSUS). The primary endpoint is the ratio of patients who experience
a nonclinical relapse during the study period. Important secondary endpoints are the changes from the baseline of the MSUS scores. We will also comprehensively analyze the serum levels of many biomarkers such as cytokines and chemokines.DISCUSSION: The study results are expected to show the noninferiority of switching to CT-P13 over the continuation of originator IFX. The strength of this study is its prospective evaluation of therapeutic efficacy using not
only clinical disease activity indices but also MSUS to accurately and objectively evaluate disease activity at the joint level among patients drawn from multiple centers with a standardized evaluation by MSUS.
We will explore whether parameters at baseline can predict a nonclinical relapse after switching from originator IFX
to CT-P13 by integrating multilateral assessments, i.e., clinical disease activity indices, MSUS findings, and serum biomarkers. TRIAL REGISTRATION: This study was registered in the Japan Registry of Clinical Trials (https://jrct.niph.go.jp) on October 11, 2019 as jRCTs071190030
Influence of Inlet Boundary Conditions on Multi-blades Centrifugal Fan to Unsteady Flow Simuation
Get PDFThe flow simulation is effective and useful method for fan design and analysis. Though it is difficult to use it for the sound source analysis. It needs a lot of simulation time and data to analyze the fluctuating characteristics of whole fan flow. We proposed the one pitch unsteady simulation for the turbulent noise characteristics of the multi-blades fan. It is used the circumferential variation to inlet boundary condition that is obtained from the results of steady state analysis of fan. In this report, it was investigated the influence of the inlet boundary condition of one pitch blade simulation on the unsteady flow characteristics that the three types of inlet boundary conditions are examined, (1) constant inflow velocity with time, (2) variation of inflow velocity with time but the constant velocity with circumference and (3) variation of inflow velocity with time and circumference. It makes clear that condition (1) is difficult to simulate the unsteady flow around blade, but the condition (2) and (3) is almost same and simulate the unsteady flow well. The flow separation at the leading edge is occurred in all conditions, but the flow after the separation is different in condition (1) compared to (2) and (3). The pressure fluctuations on the blade surface in condition (2) and (3) is well indicated the characteristics of the sound sources that the main location of the broad band noise is located to the end of scroll
Effect of Stirring Using Wind Power Toward Photocatalyzed Oxidation Reaction Rate with Titanium(IV) Oxide Nanoparticles
Get PDFPhotocatalyzed oxidation reaction of organic compound (methylene blue; MB) by using titanium(IV) oxide (TiO2) nanoparticles and wind power
to stir the solution with uses a hand-made propeller was carried out. As a first, to check the degree of reaction rate, MB was added
to the aqueous solution with TiO2 nanoparticles and UV (ultraviolet rays) irradiation that changes its color of MB gradually resulted
in proceeding the oxidation reaction by O2 in air. After that, calibration curve was made using UV-vis spectrometer which was used
to determine the concentration of MB in the solution measuring its absorbance. Then the UV condition was changed with and without UV.
As a result, it was revealed that with UV condition, the reaction rates of oxidation of MB were faster than without UV. The wind condition
to stir the solution was also revealed with unexpected result; i.e., “Weak-power” wind to stir the solution accelerated the reaction
rather than “Middle-power” one. The reason stirring by middle-power wind couldn't accelerate the reaction so far is supposed that
hand-made propeller used to stir the solution is not strong enough to convey the power under the condition
Do memories of the Ebola virus disease outbreak influence post-Ebola health seeking behaviour in Guéckédou district (epicentre) in Guinea? A cross-sectional study of children with febrile illness
Get PDFBACKGROUND: The 2013-2015 Ebola Virus Disease (EVD) outbreak in Guinea resulted in community mistrust that influenced health
care service utilization. This study aimed to assess whether EVD-related memories affect post-outbreak health-seeking behaviours for children under 5 years of age with febrile illnesses in Guéckédou district, Guinea. METHODS: This cross-sectional study was conducted by surveying caregivers of children under 5 years of age in the sub-district most affected by the EVD outbreak(Guèndembou) and the least affected sub-district (Bolodou) in Guéckédou district. Memories of the outbreak were referred to as EVD-related fears in the post-EVD period, which was based on a series of questions regarding current feelings.
RESULTS: While the majority of caregivers sought care for their children with febrile illness in both districts, a statistically
significantly higher proportion of caregivers in Guèndembou sought care, compared to caregivers in Bolodou..
More caregivers in Guèndembou (19.9%; n = 39) reported the death of family members or friends due to EVD compared to Bolodou
(6.9%; n = 14; P < 0.001). The mean EVD fear score of caregivers was significantly higher in Guèndembou (3.0; SD: 3.0) than
in Bolodou (2.0; SD: 1.1) (p < 0.001). Caregivers with a fear score above the median were 1.68 times more likely to seek care than those whose fear score was equal to or below the median; however, this difference was not statistically significant. Caregivers who reported family members' or friends' death due to EVD were also more likely to seek care (AOR = 2.12; 95%CI: 0.91-4.91), however, with no statistical significance. Only residing in the EVD-most
affected sub-district of Guèndembou (AOR = 1.74; 95%CI: 1·09-2.79) was positively associated with seeking care. CONCLUSIONS: This study reveals that community members in the rural district of Guéckédou still live with fear related to EVD nearly 2 years after the outbreak. It calls for more efforts in the health domain to preserve communities' key values
and address the psychosocial effect of EVD in rural Guinea
Controlling biofouling and disinfection by-product formation during reverse osmosis treatment for seawater desalination
No full textControlling membrane fouling and disinfection by-products (DBPs) is an ongoing challenge in achieving sustainable membrane-based seawater desalination. This study assessed the efficacy of a new disinfectant, stabilized hypobromite, for controlling biofouling and DBP formation during reverse osmosis (RO) membrane treatment of seawater. Accelerated chemical exposure tests revealed that stabilized hypobromite did not degrade a commercial polyamide RO membrane; thus, unlike other powerful oxidants, it is able to remain as a residual chemical on membrane surfaces. In our experiments, stabilized hypobromite also effectively inactivated bacteria in seawater and reduced potential organic foulants (e.g., humic acid-like and protein-like substances). Disinfection at a stabilized hypobromite dose of 5 mg-Cl2/L resulted in the formation of trihalomethanes (THMs), haloacetic acids (HAAs), and bromate at 55, 29, and <10 μg/L, respectively. Chlorine treatment resulted in higher formations of THMs, HAAs, and bromate (80, 74, and 50 μg/L, respectively), indicating stabilized hypobromite is superior to chlorine in this respect. Pilot-scale validation demonstrated that pre-disinfection with stabilized hypobromite enabled the RO membrane treatment to operate for half a year without significant fouling. The findings in this study indicate the great potential of stabilized hypobromite for controlling DBP formation and biofouling in seawater desalination
Single-incision laparoscopic total colectomy using an organ retractor: A case report
Get PDFIntroduction: Single-incision laparoscopic surgery (SILS) has benefits, including less postoperative pain, a shorter incision, and improved cosmesis. However, SILS is technically difficult because of the limited movement. An organ retractor is an instrument that has the potential to overcome these limitations. Presentation of case: An 85-year-old woman with hematochezia was referred to our hospital. Emergency endoscopy showed diverticulosis of the entire colon and active bleeding from the ascending colon. Despite endoscopic clipping, the bleeding continued. SILS total colectomy using an organ retractor was performed due to uncontrollable diverticular bleeding. A 3-cm incision was placed in the umbilicus, and three conventional ports were inserted into the single umbilical incision. An organ retractor was used for hepatocolic ligament transection, transection of the ileocolic vessels, and transection of the mesentery of the sigmoid colon. For each transection, the tension was adjusted to provide a good operative view. The patient's postoperative course was uneventful. Conclusion: An organ retractor was effective for SILS total colectomy to maintain an adequate operative view, which enabled safe dissection
