Pretreatment Variables Research Articles

803. Risk factors associated with Clostridioides difficile infection in hospitalized patients with community-acquired pneumonia

BackgroundPatients with community-acquired pneumonia (CAP) who are hospitalized and treated with antibiotics may carry an increased risk for developing Clostridioides difficile infection (CDI). Accurate risk estimation tools are needed to guide monitoring and CDI mitigation efforts. We aimed to identify patient-specific risk factors associated with CDI among hospitalized patients with CAP.MethodsDesign: retrospective case-control study of hospitalized patients who received CAP-directed antibiotic therapy between 1/1/2014 and 5/29/2018. Cases were hospitalized CAP patients who developed CDI post-admission. Control patients did not develop CDI and were selected at random from CAP patients hospitalized during this period. Variables: comorbidities, laboratory results, vital signs, severity of illness, prior hospitalization, and past antibiotic use. Propensity-score weights: identified via structural decomposition analysis of pre-treatment variables. Analysis: weighted classification tree models that predicted any CDI, hospital-onset CDI, and any healthcare-associated CDI according to CAP antibiotic treatment. Performance: percent accuracy in classification (PAC) and weighted positive (PPV) and negative predictive values (NPV). Modeling: completed using the ODA package (v1.0.1.3) for R (v3.5.1).ResultsA total of 32 cases and 232 controls were identified. Sixty pre-treatment variables were screened. Structural decomposition analysis, completed in two stages, identified prior hospitalization (OR 6.56, 95% CI: 3.01-14.31; PAC: 80.3%) and BUN greater than 29 mg/dL (OR 11.67, 95% CI: 2.41-56.5; PAC: 80.8%) as propensity-score weights. With respect to CDI, receipt of broad-spectrum anti-pseudomonal antibiotics was significantly (all P’s< 0.05) associated with any CDI (NPV: 90.29%, PPV: 27.94%), hospital-onset CDI (NPV: 97.53%, PPV: 26.86%), and healthcare-associated CDI (NPV: 92.89%, PPV: 27.94%).ConclusionWe identified risk factors available at hospital admission and empiric use of broad-spectrum Gram-negative antibiotics as being associated with the development of CDI. Model PPVs were over two-fold greater than our sample base rate. Increased monitoring and avoidance of overly broad antibiotic use in high-risk patients appears warranted.Disclosures All Authors: No reported disclosures

Predicting the chances of live birth for couples undergoing IVF-ICSI: a novel instrument to advise patients and physicians before treatment

Background: The prevalence of infertility ranges from 3.5% to 16.7% in more developed countries. For this reason, the number of In Vitro Fertilization(IVF) technique and Intracytoplasmic Sperm Injection (ICSI) treatments has been significantly increasing. Several factors affect the success rate of in vitro treatments, which can be used to calculate the probability of success for each couple. As these treatments are complicated, expensive and with a variable probability of success, the most common question asked by IVF patients is “What are my chances of conceiving before starting an IVF/ICSI treatment?”. The main aim of this study is to develop a validated model that estimates the chance of a live birth before the start of an IVF/ICSI non-donor cycle. Methods: A logistic regression model was developed based on the retrospective study of 737 IVF/ICSI cycles. Overall 14 pre-treatment variables were evaluated (woman’s and man’s age, duration of infertility, cause of infertility, woman’s and man’s Body Mass Index (BMI), Anti-Müllerian Hormone (AMH), Antral Follicle Count (AFC), woman’s and man’s ethnicity, woman’s and man’s smoking status and woman’s and man’s previous live children) and the outcome of the treatment was discriminated as "live birth" or "no live birth". Results: From the 14 variables acquired before starting the IVF/ICSI procedures, only male factor, man’s BMI, man's mixed ethnicity and level of AMH were statistically significant. The interactions between infertility duration and woman’s age, infertility duration and man’s BMI, AFC and AMH, AFC and woman’s age, AFC and woman’s BMI, and AFC and disovulation were also statistically significant. The Area Under the Receiver Operating Characteristic (AUROC) curve test for the discriminatory ability of the final prediction model was 0.700 (95% Confidence Interval (CI) 0.660–0.741). Conclusions: This model might result in a new validated decision support system to help physicians to manage couples’ pre-treatment expectations.

Predicting drug-induced liver injury from anti-tuberculous medications by early monitoring of liver tests

Tuberculosis Drug Induced Liver Injury (TB-DILI) is a common and potentially severe complication associated with anti-tuberculous treatment (ATT). Optimal liver test monitoring for standard TB medication has not been established. We describe the predictive value of pre-treatment liver tests (LTs) and at 2-weeks after initiation of ATT for the detection of TB-DILI. Patients initiating ATT were monitored with routine LTs pre-treatment and after 2-weeks. Logistic regression models were constructed to retrospectively identify pre-treatment variables associated with 'late' TB-DILI (>2 weeks after treatment initiation) and whether pre-treatment and 2-week alanine aminotransferase (ALT) levels could predict late TB-DILI. 1247 patients with active tuberculosis managed at 5 sites across north west London between January 2015 and December 2018 were monitored with routine LTs. 103 cases (8.3%) of ATT-associated DILI were diagnosed. 60 cases (58.3%) of TB-DILI occurred later than 2-weeks. The risk of late TB-DILI was 2.2-fold greater for every 30 U/L increment in ALT pre-treatment (OR 2.16, 95% CI 1.38-3.29 p<0.001) and 2.1-fold greater for every 30 U/L increment in ALT gradient at 2-weeks (OR 2.06, 95% CI 1.52-2.76 p<0.001). Routine 2-week LTs capture early TB-DILI and may be valuable in predicting late TB-DILI in patients on ATT.

Early Initiation of Treatment with Rivipansel for Acute Vaso-Occlusive Crisis in Sickle Cell Disease (SCD) Achieves Earlier Discontinuation of IV Opioids and Shorter Hospital Stay: Reset Clinical Trial Analysis

Early Initiation of Treatment with Rivipansel for Acute Vaso-Occlusive Crisis in Sickle Cell Disease (SCD) Achieves Earlier Discontinuation of IV Opioids and Shorter Hospital Stay: Reset Clinical Trial Analysis

Steroid Use, Advanced Stage Disease and ≥3 Lines of Prior Chemotherapy Are Associated with a Higher Risk of Infection Following CD19 CAR T-Cell Therapy for B-NHL: Real World Data from a Large UK Center

Steroid Use, Advanced Stage Disease and ≥3 Lines of Prior Chemotherapy Are Associated with a Higher Risk of Infection Following CD19 CAR T-Cell Therapy for B-NHL: Real World Data from a Large UK Center

The efficacy of Theraband versus general active exercise in improving postural kyphosis

BackgroundThoracic kyphotic posture is accompanying increased biomechanical load of the backbone which is possibly problematic. ObjectiveThe current study aimed to examine the effects of general active exercise versus Theraband exercise on female kyphotic posture. MethodsAn experimental study was conducted at the biomechanical lab. in Physical Therapy College, Cairo University. Fourteen female volunteers with kyphotic posture aged from 18 to 30 years were selected and equally distributed into two groups; 1st group received Theraband exercises (neck retraction exercise, scapular retraction exercise, and resistive shoulder blade squeeze) and 2nd group received general active exercises (Thoracic stretching exercise, thoracic extension exercises, and extension in lying with cervical retraction exercises). Each exercise was conducted properly for 60 min in 3 sessions per week for 4 weeks (total of 12 sessions per week). The Index of kyphosis (IK) was calculated before and after treatment. Moreover, the percentage of back disability index questionnaire (PBDI) and pain score were also detected. ResultsMultivariate analysis of covariance (MANCOVA) was used to compare the post-treatment's means between the first and second groups and control the pre-treatment variables. No significant differences were found post-treatment (P > 0.05). Moreover, IK measures showed a statistically significant difference post-treatment (P < 0.05). The paired sample t-test showed statistically significant differences (P < 0.05) in all variables within the first and second groups. ConclusionThe current study demonstrated the positive effect of both techniques in reducing the IK, percentage of back disability index, and pain score with a more positive effect of Theraband in reducing the IK measures post-treatment.

Early neurological deterioration following thrombolysis for minor stroke with isolated internal carotid artery occlusion

Better understanding the incidence, predictors and mechanisms of early neurological deterioration (END) following intravenous thrombolysis (IVT) for acute stroke with mild symptoms and isolated internal carotid artery occlusion (iICAo) may inform therapeutic decisions. From a multicenter retrospective database, we extracted all patients with both National Institutes of Health Stroke Scale (NIHSS) score <6 and iICAo (i.e. not involving the Willis circle) on admission imaging, intended for IVT alone. END was defined as ≥4 NIHSS points increase within 24h. END and no-END patients were compared for (i) pre-treatment clinical and imaging variables and (ii) occurrence of intracranial occlusion, carotid recanalization and parenchymal hemorrhage on follow-up imaging. Seventy-four patients were included, amongst whom 22 (30%) patients experienced END. Amongst pre-treatment variables, suprabulbar carotid occlusion was the only admission predictor of END following stepwise variable selection (odds ratio=4.0, 95% confidence interval: 1.3-12.2; P=0.015). On follow-up imaging, there was no instance of parenchymal hemorrhage, but an intracranial occlusion was now present in 76% vs. 0% of END and no-END patients, respectively (P<0.001), and there was a trend toward higher carotid recanalization rate in END patients (29% vs. 9%, P=0.07). As compared to no-END, END was strongly associated with a poor 3-month outcome. Early neurological deterioration is a frequent and highly deleterious event after IVT for minor stroke with iICAo, and is of thromboembolic origin in three out of four patients. The strong association with iICAo site-largely a function of underlying stroke etiology-may point to a different response of the thrombus to IVT. These findings suggest END may be preventable in this setting.

Carotid stent occlusion after emergent stenting in acute ischemic stroke: Incidence, predictors and clinical relevance

Background and aimsEmergent stent placement may be required during neurothrombectomy. Our aim was to investigate the incidence, predictors and clinical relevance of early extracranial carotid stent occlusion following neurothrombectomy. MethodsWe retrospectively analyzed a cohort of 761 consecutive neurothrombectomies performed at our center between May 2010 and August 2018, from whom a total of 106 patients had acute internal carotid artery occlusions. Early stent occlusion was defined as complete vessel occlusion within 24 h of neurothrombectomy. Clinical outcome was evaluated at day 90 with the modified Rankin Score scale (mRS). Pretreatment, procedural and outcome variables were recorded and analyzed using logistic regression. ResultsCarotid stenting was performed in 99 (13%) patients. Of those, 22 (22%) had early stent occlusion at follow-up. Stent occlusion was associated with a lower use of post-stenting angioplasty [adjusted OR (aOR) = 11.2, 95%CI = 2.49–50.78, p = 0.002)], increased residual intrastent stenosis (aOR = 2.1, 95%CI = 1.38–3.06, p < 0.001) and unsuccesful intracranial recanalization (modified TICI score 0-2a) (aOR = 13.5, 95%CI = 1.97–92.24, p = 0.008). Stent occlusion was associated with poor clinical outcome at day 90 (poorer mRS shift, aOR = 3.9, 95%CI = 1.3–11.3, p = 0.014; mRS>2, aOR = 6.3, 95%CI = 1.8–22.7, p = 0.005), and with an increased rate of symptomatic intracranial hemorrhage at 24 h (14% versus 1%, p = 0.033). ConclusionsEarly carotid stent occlusion occurred in one out of five neurothrombectomies and was associated with periprocedural factors that included increased residual intrastent stenosis, a lower use of post-stenting angioplasty and unsuccessful intracranial recanalization. Further investigation is warranted for the evaluation of strategies aimed to prevent carotid stent occlusion.

Development of machine learning-based clinical decision support system for hepatocellular carcinoma

There is a significant discrepancy between the actual choice for initial treatment option for hepatocellular carcinoma (HCC) and recommendations from the currently used BCLC staging system. We develop a machine learning-based clinical decision support system (CDSS) for recommending initial treatment option in HCC and predicting overall survival (OS). From hospital records of 1,021 consecutive patients with HCC treated at a single centre in Korea between January 2010 and October 2010, we collected information on 61 pretreatment variables, initial treatment, and survival status. Twenty pretreatment key variables were finally selected. We developed the CDSS from the derivation set (N = 813) using random forest method and validated it in the validation set (N = 208). Among the 1,021 patients (mean age: 56.9 years), 81.8% were male and 77.0% had positive hepatitis B BCLC stages 0, A, B, C, and D were observed in 13.4%, 26.0%, 18.0%, 36.6%, and 6.3% of patients, respectively. The six multi-step classifier model was developed for treatment decision in a hierarchical manner, and showed good performance with 81.0% of accuracy for radiofrequency ablation (RFA) or resection versus not, 88.4% for RFA versus resection, and 76.8% for TACE or not. We also developed seven survival prediction models for each treatment option. Our newly developed HCC-CDSS model showed good performance in terms of treatment recommendation and OS prediction and may be used as a guidance in deciding the initial treatment option for HCC.

Attrition and attendance in group therapy for university students: An examination of predictors across time.

There exists a dearth of research focused explicitly on predictors of attrition, particularly in the area of group therapy, where both attrition and attendance becomes of primary concern. The present study examined both pretreatment and treatment-specific variables in the prospective prediction of attendance and attrition in group therapy. Fifty-two participants were randomized to one of two 12-week group treatments. Participants completed baseline interviews and questionnaires, as well as weekly assessments of treatment-specific factors. No pretreatment factors predicted attendance or drop out, although men attended a larger amount of sessions and were less likely to drop out. Cross-lagged panel analyses supported bidirectional, causal relationships both treatment-specific predictors (therapeutic alliance and number of therapeutic techniques) and attendance. Successful retention in group therapy may be less predictable from pretreatment factors and instead lie in increasing alliance and fostering the practice of therapeutic strategies.

Invasive versus non-invasive management of older patients with non-ST elevation myocardial infarction (SENIOR-NSTEMI): a cohort study based on routine clinical data

SummaryBackgroundPrevious trials suggest lower long-term risk of mortality after invasive rather than non-invasive management of patients with non-ST elevation myocardial infarction (NSTEMI), but the trials excluded very elderly patients. We aimed to estimate the effect of invasive versus non-invasive management within 3 days of peak troponin concentration on the survival of patients aged 80 years or older with NSTEMI.MethodsRoutine clinical data for this study were obtained from five collaborating hospitals hosting NIHR Biomedical Research Centres in the UK (all tertiary centres with emergency departments). Eligible patients were 80 years old or older when they underwent troponin measurements and were diagnosed with NSTEMI between 2010 (2008 for University College Hospital) and 2017. Propensity scores (patients' estimated probability of receiving invasive management) based on pretreatment variables were derived using logistic regression; patients with high probabilities of non-invasive or invasive management were excluded. Patients who died within 3 days of peak troponin concentration without receiving invasive management were assigned to the invasive or non-invasive management groups based on their propensity scores, to mitigate immortal time bias. We estimated mortality hazard ratios comparing invasive with non-invasive management, and compared the rate of hospital admissions for heart failure.FindingsOf the 1976 patients with NSTEMI, 101 died within 3 days of their peak troponin concentration and 375 were excluded because of extreme propensity scores. The remaining 1500 patients had a median age of 86 (IQR 82–89) years of whom (845 [56%] received non-invasive management. During median follow-up of 3·0 (IQR 1·2–4·8) years, 613 (41%) patients died. The adjusted cumulative 5-year mortality was 36% in the invasive management group and 55% in the non-invasive management group (adjusted hazard ratio 0·68, 95% CI 0·55–0·84). Invasive management was associated with lower incidence of hospital admissions for heart failure (adjusted rate ratio compared with non-invasive management 0·67, 95% CI 0·48–0·93).InterpretationThe survival advantage of invasive compared with non-invasive management appears to extend to patients with NSTEMI who are aged 80 years or older.FundingNIHR Imperial Biomedical Research Centre, as part of the NIHR Health Informatics Collaborative.

Implementation of a standardized approach to borderline resectable pancreatic cancer in a multisite community oncology program

BackgroundTreatment paradigms for borderline resectable pancreatic cancer are evolving with increasing use of neoadjuvant chemotherapy and neoadjuvant chemoradiation. Variations in the definition of borderline resectable pancreatic cancer and neoadjuvant approaches have made standardizing care for borderline resectable pancreatic cancer difficult. We report an effort to standardize management of borderline resectable pancreatic cancer throughout Sanford Health, a large community oncology network. MethodsStarting in October 2013, cases of pancreatic adenocarcinoma without known metastatic disease were categorized as borderline resectable pancreatic cancer if they met ≥1 of the following criteria: (1) abutment of superior mesenteric, common hepatic, or celiac arteries with <180° involvement, (2) venous involvement deemed potentially suitable for reconstruction, and/or (3) biopsy-proven lymph node involvement. Patients with borderline resectable pancreatic cancer were treated with neoadjuvant chemotherapy followed by reimaging and surgery if venous involvement had improved; if disease remained borderline resectable, patients underwent neoadjuvant chemoradiation and surgical exploration as long as reimaging did not reveal evidence of progressive disease. ResultsForty-three patients from October 2013 to April 2017 were diagnosed with borderline resectable pancreatic cancer. Twelve of 42 (29%) patients proceeded to surgical exploration directly after neoadjuvant chemotherapy; 23 (55%) received neoadjuvant chemoradiation. Overall, 28/43 (65%) underwent exploration with 19 (44%) able to undergo resection. Of those, 14/19 (74%) attained R0 resection and 11/19 (58%) were pathologic N0. No pretreatment or treatment variables were associated with resection rates; resection was the only variable associated with survival. ConclusionThis report demonstrates the feasibility of implementing a standardized approach to borderline resectable pancreatic cancer across multiple sites over a wide geographic area. Adherence to protocol therapies was good and surgical outcomes are similar to many reported series.

Adjusting acidity and porosity of Al‐SBA‐15 catalyst for methanol to dimethyl ether reaction

AbstractThe present study aims to conduct a systematic assessment of Al‐SBA‐15 as the aluminum‐substituted mesoporous catalyst for raw methanol dehydration to dimethyl ether (MTD). The catalysts are synthesized by varying the pretreatment variables (pH of the preparation and Si/Al ratio), the posttreatment variable (steaming time), and by the addition of aluminophosphate as the binder. The experimental design and the analysis of the results, especially the relation of characterization results and reactor performance, are performed by the optimal response surface method in Design‐Expert software. The prepared micro‐mesoporous catalyst exhibits an excellent activity, stability, and DME selectivity; therefore, it can be introduced as an efficient catalyst for raw methanol dehydration.

Clinical response to chemoradiotherapy in esophageal carcinoma is associated with survival and benefit of consolidation chemotherapy.

PurposeFew studies have reported the impact of the clinical response of patients with Esophageal Carcinoma to chemoradiotherapy (CRT). Our study examines the association between clinical response and pretreatment variables, survival, patterns of failure, and benefit of consolidation chemotherapy in subjects with esophageal squamous cell carcinoma (ESCC) patients receiving CRT.MethodsData from ESCC patients treated at Shandong Cancer Hospital between January 2013 and December 2016 were analyzed retrospectively. By definition, we considered a poor response as progressive disease (PD) and stable disease (SD), while complete response (CR) and partial response (PR) were considered as a good response. Multivariate analyses were carried out using Cox proportional hazards models and patient survival was assessed using the Kaplan‐Meier and log‐rank test.ResultsAfter CRT, 136 (48.9%) patients responded well (good response) and 152 (51.1%) patients responded poorly (poor response). Overall survival (OS) and progression‐free survival (PFS) differed significantly between patients responded well and those responded poorly. Patients with an early‐stage or the upper location of the tumor were more likely to achieve a good response. Patients showing poor responses tended to experience local failure. The 3‐year OS and PFS rates of patients showing poor response were 38.9% and 25.5%, respectively, for the CRT with consolidation chemotherapy (CRT + C) group, and 22.7% and 16.7%, respectively, for the CRT group. However, patients with a good response did not benefit from the consolidation chemotherapy. Primary tumor location, T category, N category, and clinical response to chemoradiotherapy were independent factors predicting OS and PFS in ESCC.ConclusionClinical response to CRT substantially improves patient survival and is associated with failure patterns in ESCC. Consolidated chemotherapy may benefit patients with a poor response.

Initial Clinical Experience with PCSK9 Inhibitors to Lower LDL Cholesterol in a University Lipid Clinic Setting

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have demonstrated significant lowering of low-density lipoprotein (LDL) cholesterol in patients with atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia (FH). We retrospectively reviewed data concerning use of PCSK9 inhibitors from patients in our university-based adult lipid clinic. Data collected included clinical pre-treatment variables and pre-and post-treatment non-fasting lipid profiles. Of 165 candidates, 163 were approved for PCSK9 inhibition (90% ASCVD and 10% FH). A majority of patients (72%) had statin intolerance. Treatment was provided and assessed in 141 patients. After three doses of medications, LDL cholesterol fell from 170 + 58 mg/dL to 76 + 45 mg/dL (55%, P&lt;0.001). There were no differences in efficacy according to sex, elevated lipoprotein(a), and the PCS-K9 inhibitor utilized. Continued efficacy was evaluated in 101 patients with LDL decreasing further from initial follow-up to long-term follow-up over an average of 14 months (74 ± 44 mg/dL to 68 ± 41 mg/dL). Permanent discontinuation of PCS-K9 inhibitor because of side effects occurred in 11% of patients. When strict adherence to guidelines was applied, &gt;95% approval rate was obtained, and there was similar efficacy in LDL lowering to what has been previously reported irrespective of statin intolerance.

Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion

Several pretreatment variables such as elevated glucose and hypoperfusion severity are related to brain hemorrhage after endovascular treatment of acute stroke. We evaluated whether elevated glucose and severe hypoperfusion have synergistic effects in the promotion of parenchymal hemorrhage (PH) after mechanical thrombectomy (MT). We included 258 patients MT-treated who had a pretreatment computed tomography perfusion (CTP) and a post-treatment follow-up MRI. Severe hypoperfusion was defined as regions with cerebral blood volume (CBV) values < 2.5% of normal brain [very-low CBV (VLCBV)-regions]. Median baseline glucose levels were 119 (IQR = 105–141) mg/dL. Thirty-nine (15%) patients had pretreatment VLCBV-regions, and 42 (16%) developed a PH after MT. In adjusted models, pretreatment glucose levels interacted significantly with VLCBV on the prediction of PH (p-interaction = 0.011). In patients with VLCBV-regions, higher glucose was significantly associated with PH (adjusted-OR = 3.15; 95% CI = 1.08–9.19, p = 0.036), whereas this association was not significant in patients without VLCBV-regions. CBV values measured at pretreatment CTP in coregistered regions that developed PH or infarct at follow-up were not correlated with pretreatment glucose levels, thus suggesting the existence of alternative deleterious mechanisms other than direct glucose-driven hemodynamic impairments. Overall, these results suggest that both severe hypoperfusion and glucose levels should be considered in the evaluation of adjunctive neuroprotective strategies.

Personalized Psychotherapy for Outpatients with Major Depression and Anxiety Disorders: Transdiagnostic Versus Diagnosis-Specific Group Cognitive Behavioural Therapy

BackgroundOnly about half of all patients with anxiety disorders or major depression respond to cognitive behaviour therapy (CBT), even though this is an evidence-based treatment. Personalized treatment offers an approach to increase the number of patients who respond to therapy. The aim of this study was to examine predictors and moderators of (differential) treatment outcomes in transdiagnostic versus diagnosis-specific group CBT.MethodsA sample of 291 patients from three different mental health clinics in Denmark was randomized to either transdiagnostic or diagnosis-specific group CBT. The study outcome was the regression slope of the individual patient's repeated scores on the WHO-5 Well-being Index. Pre-treatment variables were identified as moderators or predictors through a two-step variable selection approach.ResultsWhile the two-step approach failed to identify any moderators, four predictors were found: level of positive affect, duration of disorder, the detachment personality trait, and the coping strategy of cognitive reappraisal. A prognostic index was constructed, but did not seem to be robust across treatment sites.ConclusionsOur findings give insufficient evidence to support a recommendation of either transdiagnostic or diagnosis-specific CBT for a given patient or to predict the response to the applied group therapies.

A review of the application of carbon-based membranes to hydrogen separation

Hydrogen (H2) is a green clean fuel and chemical feedstock. Its separation and purification from H2-containing mixtures is the key step in the production of H2 with high purity (> 99.99%). Carbon membranes emerged in the 70 s and have provided promising results for applications in processes involving gas separation due to their sieving effects. Particularly, in this review, a general concept route of precursor selection-preparation-modification-performance analysis platform for the carbon membrane has been proposed to promote the development of carbon membrane material for a wide range of application. Several main parts are highlighted which are carbon membrane preparation, precursor selection, precursor pre-treatment covering pyrolysis process, carbonized membrane, pos-treatment and as well as module fabrication in order to improve the separation capability of gas mixtures in respect to permeability and selectivity. The variables of pre-treatment, the parameters of the pyrolysis process and the conditions of the post-treatment are manipulated and implied as a chance to maximize the performance of carbon membrane separation in the coming future. This review will specify an insight into the latest researches, which is expected to offer worthy implications to academicians and industry professionals working in industrial domain for the hydrogen separation. For future perspective, carbon membranes hold significant potential and great promise for further investigation, development and application.

Sex-specific impact of patterns of imageable tumor growth on survival of primary glioblastoma patients

BackgroundSex is recognized as a significant determinant of outcome among glioblastoma patients, but the relative prognostic importance of glioblastoma features has not been thoroughly explored for sex differences.MethodsCombining multi-modal MR images, biomathematical models, and patient clinical information, this investigation assesses which pretreatment variables have a sex-specific impact on the survival of glioblastoma patients (299 males and 195 females).ResultsAmong males, tumor (T1Gd) radius was a predictor of overall survival (HR = 1.027, p = 0.044). Among females, higher tumor cell net invasion rate was a significant detriment to overall survival (HR = 1.011, p < 0.001). Female extreme survivors had significantly smaller tumors (T1Gd) (p = 0.010 t-test), but tumor size was not correlated with female overall survival (p = 0.955 CPH). Both male and female extreme survivors had significantly lower tumor cell net proliferation rates than other patients (M p = 0.004, F p = 0.001, t-test).ConclusionDespite similar distributions of the MR imaging parameters between males and females, there was a sex-specific difference in how these parameters related to outcomes.

Novel two-pot approach ultrasonication and deep eutectic solvent pretreatments for watermelon rind delignification: Parametric screening and optimization via response surface methodology

Sequential delignification of watermelon rind using ultrasonication and deep eutectic solvent (DES) pretreatment methods was demonstrated in this study. The effects of pretreatment factors on delignification were investigated using parametric screening and subsequent optimization of significant factors. Plackett–Burman Design was used for the screening of pretreatment variables, while optimization was performed adopting Central Composite Rotatable Design. For the range of variables considered in the study, the screening experiments revealed that the effects of ultrasonication power, ultrasonication frequency, ultrasonication time, DES reaction temperature and DES reaction time on delignification were significant, while the effects of ultrasonication solid-liquid ratio, ultrasonication temperature, hydrogen bond acceptor/hydrogen bond donor molar ratio, and DES solid-to-liquid ratio were not significant. The significant factors were further investigated and maximum lignin removal of 43.56 % was achieved at ultrasonication power 180 W, ultrasonication frequency 60 kHz, ultrasonication time 40 min, reaction temperature 120°C and reaction time 180 min. Synergistic effect between the two pretreatment methods was observed and it correlated positively with the severity of the ultrasound pretreatment. The SEM and FTIR analyses further established the effectiveness of the sequential combinative pretreatment methods on watermelon rind delignification.