Sequential Use Research Articles

BS SO04 - Intragastric Balloons - are they for the long term?

Abstract Background Intragastric balloons are a bridging therapy to bariatric metabolic surgery. When sufficient weight loss to facilitate surgery is not achieved, a second balloon may be considered. Traditionally, balloons were used for 6 months prior to removal. The COVID-19 pandemic limited patient interactions and treatment duration was doubled. We assessed outcomes (weight loss trends and safety) in patients with severe obesity undergoing sequential balloon treatment. The study period accounts for changes in balloon protocol instigated during the pandemic, addressing a current literature gap. Method Consecutive patients who underwent balloon treatment between May 2014 and February 2023 were identified. Only patients deemed fit enough for potential adjuvant bariatric surgery at presentation were included in the study. Outcomes recorded included: weight and BMI at 3-monthly intervals until balloon removal, progression to surgery and morbidity. Results 45 patients were identified. Median BMI on balloon insertion was 62kg/m2. Median weight loss with the first balloon was 15.2kg (8.8% weight loss). 11 patients (24.4%) had a second balloon, with median weight loss of 3.3kg (1.9%). 22 patients (48.8%) met criteria for surgery, only one had multiple balloons. Weight loss was observed during the first three quartiles of balloon treatment, however median 2kg was gained during months 9-12. 16 (35.6%) first balloon patients had complications. 2 (18.2%) second balloon patients had complications. Median time from insertion to complication was 14 days. Conclusion The present study concludes that, although not associated with increased complication risk, sequential IGB use as a bridging treatment to definitive bariatric surgery does not significantly contribute to weight loss in super obese patients. Optimal treatment is achieved with a single IGB, although weight loss is not uniform across a 12 month treatment period and weight gain can result after 9 months.

The role of hydrogen in the synthesis of High-entropy alloys and their hydrides

The aim of this work is to present the new technique processes of formation of stable hydrides of High-entropy alloys (HEAs) with high hydrogen content. The essence of the proposed method is the sequential use of self-propagating high-temperature synthesis (SHS) method for producing the metal hydrides, followed by the formation of alloys in the hydride cycle (HC) method. Preliminary, the hydrides of three compositions of metal mixtures were synthesized in SHS: 0.2TiH2+0.2ZrH2+0.2HfH2+0.2VH2+0.2NbH2, 0.3TiH2+0.15ZrH2+0.15HfH2+0.2VH2+0.2NbH2 and 0.3TiH2+0.1ZrH2+0.1HfH2+0.2VH2+0.2NbH2+0.1MgH2. From the synthesized mixtures of metal hydrides, the HEAs were produced in HC. The resultant hard alloys Ti0.2Zr0.2Hf0.2V0.2Nb0.2, Ti0.3Zr0.15Hf0.15V0.2Nb0.2 and Ti0.3Zr0.15Hf0.15V0.2Nb0.2Mg0.1 without crushing combusted in Н2 at РH2 = 5-30atm. in SHS mode. As a result, the hydrides of HEAs (Ti0.2Zr0.2Hf0.2V0.2Nb0.2)Н2.05, (Ti0.3Zr0.15Hf0.15V0.2Nb0.2)H2.05 and (Ti0.3Zr0.1Hf0.1V0.2Nb0.2 Mg0.1)H182 were synthesized with H2 content between 2.17-2.42wt.% and H/Me = 1.82-2.05. The repeating the hydrogenation-dehydrogenation processes for 1-3 times confirmed the exceptional cyclic stability of hydrides and the reversible high hydrogen storage capacity of the alloys. The regularities and the mechanism of formation of HEAs and their hydrides were elucidated. The applicability of combination of SHS and HC methods for synthesis of solid solutions of BCC structure HEAs and of their hydrogen-rich hydrides was demonstrated. The remarkable advantages of the developed efficient, low-energy consuming, waste-free and safe method for the synthesis of HEAs and their hydrides can be of commercial interest and attractive to industry, given the current needs for the development of renewable energy, in particular, the solid hydrogen storage facilities.

Copper-saturated chitosan beads (CuSCBs) for Enhanced phosphate removal

This study investigates the sequential use of non-cross-linked chitosan beads (CBs) for copper and phosphate adsorption, emphasizing copper site saturation and selective phosphate binding. Initially, CBs were loaded with copper until saturation was achieved, where all available sites were occupied by copper at an initial concentration of 100 mg/L. These copper-saturated chitosan beads (CuSCBs) were subsequently applied for phosphate adsorption, achieving a maximum adsorption capacity of 85.89 mg/g at pH 5. X-ray Photoelectron Spectroscopy (XPS) analysis revealed a shift in the Cu2O binding energy to lower values upon phosphate adsorption, indicating that phosphate ions interact primarily with the copper ions intercalated on the CBs rather than the chitosan matrix. Additionally, the nitrogen spectra showed no shift, confirming that the amine groups of chitosan do not participate in phosphate binding. The findings suggest a 1:1 interaction ratio between copper and phosphate ions, with each phosphate ion binding to one copper ion, creating a stable and selective adsorption site. The adsorption data fit the Langmuir isotherm and pseudo-second-order kinetic models, suggesting a homogeneous monolayer adsorption mechanism driven by chemisorption, where each copper site on the chitosan surface selectively binds one phosphate ion. Furthermore, the CuSCBs demonstrated minimal copper leaching and retained 90 % of their phosphate adsorption capacity over multiple adsorption–desorption cycles, highlighting their potential as effective and reusable adsorbents for water treatment applications targeting copper and phosphate removal.

Study of coatings of the Ni–Ti–(SiC, WC, B4C) system applied to the surface of titanium alloy plates using cold gas dynamic spraying and laser processing

The technology of applying composite intermetallic coatings of the Ni–Ti system reinforced with carbides based on powders (SiC, WC, B4C) on the surface of titanium alloy plates with the sequential use of the CGDN method and laser processing is considered. The technological parameters of the laser-thermal processing, ensuring the production of composite coatings of the Ni–Ti–(SiC, WC, B4C) system of high hardness, are determined.

Comparison of GRACE and TIMI risk scores in the prediction of in hospital outcome among NSTEMI patients: a single centre study

Abstract Background Major component of ACS, Non-ST segment elevation myocardial infarction (NSTEMI), has more than twice the incidence compared to ST-segment elevation myocardial infarction (STEMI). GRACE (Global Registry of Acute Coronary Events) and TIMI (Thrombolysis in Myocardial Infarction) risk scores are the two most popular prediction models in ACS due to TIMI’s advantage in its simplicity in clinical application and GRACE’s favorable discriminating power. Nevertheless, limited evidence compared the usefulness of these two major risk scores and their association with in-hospital events. Purpose To compare between the predictive ability of GRACE & TIMI risk scores for In hospital outcomes among the NSTEMI patients . Methods This prospective observational study was carried out from 8th march 2020 to 7th March 2022. Total 2152 acute NSTEMI patients were included. Both GRACE & TIMI risk score were calculated. For GRACE score, patients who scored ≤108 points were low risk,109-139 points were medium risk, ≥140 points were high risk . For TIMI scores patients with 0-2 scores were low risk , 3-4 scores were medium risk and 5-7 score were High risk. In Hospital outcomes were defined as the in hospital composite events which includes acute left ventricular failure, cardiogenic shock, arrhythmia & mortality. Results Among the 2152 patients majority were male (73.5%) with mean age of the study population were 58.33 ± .25 years. Mean Grace score & TIMI score of the study population were 137.81±16.38& 3.29±.97 respectively. Most of the patients were categorized in to Medium risk groups by both GRACE & TIMI risk scores , 70% & 51.3% respectively. However, high risk group percentage were higher in GRACE score group(41.3%) in comparison to TIMI score group(10.3%). GRACE score showed better predictive ability than TIMI score for in-hospital outcomes as evaluated by ROC curve( AUC of GRACE vs TIMI, In hospital ALVF:0.89vs 0.59, P<0.001; Cardiogenic Shock 0.72 vs 0.57, P=0.002; Mortality: 0.75 vs 0.59, P=0.002; arrhythmia 0.72 vs0.63, P=0.003). Conclusion GRACE showed better predictive accuracy than TIMI in NSTEMI patients for in-hospital outcomes. The sequential use of TIMI and GRACE scores provide an easy and promising discriminative tool in predicting outcomes in NSTEMI patients , thus improve the identification of high-risk patients.Pic :ROC curve for prediction of ALVFPic: ROC curve for Mortality prediction

Sequential versus concomitant treatment of androgen receptor signaling inhibitors and docetaxel for metastatic hormone-sensitive prostate cancer: an network meta-analysis.

Androgen receptor signaling inhibitors (ARSis), when administered sequentially or in combination with docetaxel and androgen deprivation therapy (ADT), have been shown to enhance overall survival (OS) and progression-free survival (PFS) in patients with metastatic hormone-sensitive prostate cancer (mHSPC). Nonetheless, the optimal sequence for administering chemotherapy and ARSis remains to be determined. To compare the efficacy of ARSis sequential therapy with ARSis combined therapy for mHSPC, and to evaluate the efficacy and safety of different combination regimens. The PubMed, Embase, Cochrane Central, and ClinicalTrials.gov databases were searched from their inception through 14 July 2024, to identify eligible phase III randomized clinical trials (RCTs) evaluating the combination or sequential use of docetaxel + ADT with abiraterone, enzalutamide, apalutamide, or darolutamide. The outcomes of interest included OS, PFS, time to prostate-specific antigen (PSA) progression, grade 3-5 adverse events (AEs), and serious adverse events (SAEs). Five RCTs involving 2836 patients were included in the analysis. When comparing ARSis sequential therapy to ARSis combined therapy, no significant differences were observed in OS (Hazard Ratio (HR): 1.17, 95% Confidence Interval (CI): 0.69-1.96), PFS (HR: 1.03, 95% CI: 0.47-2.22), or time to PSA progression (HR: 0.48, 95% CI: 0.03-7.69). Within the different ARSis combined regimens, the triple therapies involving enzalutamide, abiraterone, and darolutamide demonstrated comparable efficacy and safety profiles in the overall population, and their efficacy in patients with high-volume disease or low-volume disease was also similar. ARSis sequential therapy did not significantly differ from ARSis combined therapy in improving OS and PFS among patients with mHSPC, and thus can be considered as a viable treatment option.

Sequential novel use of Moringa oleifera Lam., biochar, and sand to remove turbidity, E. coli, and heavy metals from drinking water

This research investigates the individual and combined use of Moringa oleifera (MO) Lam., biochar, and sand to remove turbidity, pathogens, and heavy metals from drinking water. Contaminated water was synthetically prepared using kaolin, standard nickel/lead solutions, and Escherichia coli (E. coli). The optimal dose of MO seed protein, extracted in 1 M NaCl solution, was determined using a jar test flocculator. MO treatment reduced water turbidity from 200 to 4 NTU and achieved a 1–2 log reduction in E. coli from an initial count of 1×105 CFU/ml. Nevertheless, no significant reduction in nickel and lead concentrations was noted. Subsequently, the MO-treated water was passed through a biochar column supported on a sand bed, revealing clear water with 1 NTU turbidity and no trace of E. coli counts being detected. The sequential process of using biochar and sand reduced nickel and lead by 97.5 % and 99.3 %, respectively. The physicochemical properties of the treated water met WHO and UK standards for safe drinking water. All experiments were performed in duplicates (n=2; P < 0.05). The scalability and economic feasibility of the project, the mechanism of removal of contaminants by MO and biochar, and the study's limitations are also discussed.

Switching biologics in chronic rhinosinusitis with nasal polyps: A multicenter Canadian experience.

Type 2 biologics have been used increasingly for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). However, patterns of biologic switching are understudied, and established guidelines for sequential or simultaneous use do not yet exist. This is a Canadian multicenter retrospective study of real-world patient data. Patients were included if they had recurrent CRSwNP despite maximal medical and surgical management, and received at least one dose of a type 2 biologic. Patients who remained on their initial biologic comprised the continuous group. Patients with sequential or simultaneous use of more than one biologic comprised the switched group. We compared the characteristics of patients who continued and switched biologics. Note that 225 consecutive patients were included. Thirty-six (16%) switched biologics at least once, and six (3%) switched twice. The most common switch was from mepolizumab to dupilumab, with poor control of CRSwNP symptoms being the leading cause for this switch. Lack of efficacy was the main reason for switching off mepolizumab and omalizumab, while adverse events were the leading cause for switching off dupilumab. Additionally, mepolizumab patients were more likely to switch biologics late in their treatment, while dupilumab patients rarely switched after 12 months of therapy (p-value<0.001). Switching biologics for CRSwNP is frequent in Canadian rhinology practices, with 16% of patients switching at least once. The most common switch is from mepolizumab to dupilumab with inadequate CRSwNP control driving this switch. This study may help guide sequential or simultaneous use of biologics in CRSwNP patients.

The Association Between Rheumatic Disease Therapies and Cardiovascular Outcomes in People with HIV-A Retrospective Cohort Study.

Introduction: Inflammation is a significant contributor to cardiovascular disease (CVD) in people with HIV (PWH), who face twice the risk of CVD compared to the general population. The presence of co-existing rheumatic disease (RD) may further exacerbate inflammation and increase the incidence of CVD events in this population. Methods: We conducted a retrospective cohort study using electronic health record (EHR) data from the Veterans Affairs Medical Center in Atlanta, covering the period from 2000 to 2019. A total of 5000 patients aged 20-87 years who were diagnosed with HIV and receiving care at the Atlanta VAMC between 2000 and 2019 were eligible for this analysis. This study included 3930 veterans with HIV and assessed the impact of rheumatic disease therapies (RDTs) on CVD outcomes. The primary outcome was the first occurrence of a CVD event. Results: Rheumatic disease was significantly associated with an increased risk of CVD events (OR = 2.67; p < 0.001). Additionally, exposure to multiple RDTs (aHR = 2.121, p = 0.047), NSAIDs (aHR = 1.694, p = 0.003), glucocorticoids (aHR = 2.332, p < 0.0001), and hypouricemic agents and colchicine (aHR = 3.445, p < 0.0001) were all significantly associated with increased CVD events. Conclusions: The co-existence of HIV infection and rheumatic disease, along with the use of RDTs, may amplify the risk of CVD events in PWH. These findings underscore the need for further investigation into the relationship between RD, RDTs, and CVD risk in larger, controlled studies, given the potential implications for treatment decisions in this patient population. A limitation of our study is that due to its retrospective design, we could not examine the impact of the sequential use of RDT groups and RD severity on CVD events.

Seamless, rapid, and accurate analyses of outbreak genomic data using split k-mer analysis.

Sequence variation observed in populations of pathogens can be used for important public health and evolutionary genomic analyses, especially outbreak analysis and transmission reconstruction. Identifying this variation is typically achieved by aligning sequence reads to a reference genome, but this approach is susceptible to reference biases and requires careful filtering of called genotypes. There is a need for tools that can process this growing volume of bacterial genome data, providing rapid results, but that remain simple so they can be used without highly trained bioinformaticians, expensive data analysis, and long-term storage and processing of large files. Here we describe split k-mer analysis (SKA2), a method that supports both reference-free and reference-based mapping to quickly and accurately genotype populations of bacteria using sequencing reads or genome assemblies. SKA2 is highly accurate for closely related samples, and in outbreak simulations, we show superior variant recall compared with reference-based methods, with no false positives. SKA2 can also accurately map variants to a reference and be used with recombination detection methods to rapidly reconstruct vertical evolutionary history. SKA2 is many times faster than comparable methods and can be used to add new genomes to an existing call set, allowing sequential use without the need to reanalyze entire collections. With an inherent absence of reference bias, high accuracy, and a robust implementation, SKA2 has the potential to become the tool of choice for genotyping bacteria. SKA2 is implemented in Rust and is freely available as open-source software.

Can the Mineralization of Antibiotics from Water Bodies be a Significant Step in the Fight Against Alarming Antimicrobial Resistance?

Introduction: The overuse and improper disposal of antibiotics may add to the continuous rise of antimicrobial resistance (AMR). In this work, we demonstrate a sequential effect of two novel catalytic systems consisting of MIL-100(Fe) MOF (Metal Organic Framework) and MnO2 nanosheets to degrade amoxicillin antibiotic through the destruction of β lactam group. Method: The catalysts exhibit large surface area, excellent porosity, excellent catalytic activity, and insolubility and can be easily separable from the reaction mixture. Results: The sequential use of MIL-100(Fe) MOF and MnO2 nanosheets could showcase 92% degradation of amoxicillin within 1.5 hours under ambient conditions without any significant residual bi-product as confirmed by LCMS studies. Conclusion: Impressively, the antimicrobial susceptibility of degraded residue is lessened by 33% as compared to pure amoxicillin. result: we have successfully developed a two-part method to completely degrade amoxicillin, a commonly used antibiotic. This method utilizes catalysts, MnO2 nanosheets and Fe-MIL 100 MOF, applied sequentially. both catalysts are reusable, non-toxic, and easily separated from the reaction. In just 1.5 hours at normal conditions, this approach achieved 91

The application and interpretation of laboratory biomarkers for the evaluation of vitamin B12 status.

Vitamin B12 (cobalamin; B12) is an essential micronutrient, but deficiency is common. The prompt diagnosis and treatment of B12 deficiency protects against megaloblastic anaemia, neuropathy and neuropsychiatric changes. Biomarkers of B12 status include the measurement of serum B12 (also known as total B12 or serum cobalamin), holotranscobalamin (holoTC or 'active B12'), methylmalonic acid (MMA) and total plasma homocysteine (Hcy). There is no 'gold standard' test for deficiency and the sensitivity and specificity of each biomarker for the evaluation of B12 status is affected by analytical and biological factors that may confer a high degree of diagnostic uncertainty. Limited access to technical and clinical expertise can lead to an over-reliance on the serum B12 test, which is readily available and highly automated. In some cases, the sequential use of different B12 status biomarkers or the calculation of a composite B12 status score, derived from a panel of B12 biomarkers and adjusted for folate status and age, can be used to detect deficient states that may otherwise be overlooked when using a single biomarker approach. This review summarises the utility of B12-related biomarkers and describes approaches to their application and interpretation.

Retinal Vascular Permeability in Diabetic Subjects without Retinopathy Compared to Mild Diabetic Retinopathy and Healthy Controls

ObjectivesTo investigate retinal vascular permeability mapping as a potential biomarker for diabetic retinopathy in subjects with diabetes with no signs of retinopathy and with mild non-proliferative retinopathy. DesignThis is a case-control study. SubjectsParticipants included seven healthy controls, twenty-two subjects with diabetes mellitus and no clinical signs of retinopathy (DMnoDR), and seven subjects with mild non-proliferative diabetic retinopathy (NPDR). MethodsAll participants underwent routine retinal fluorescein videoangiography (FVA). Each FVA dataset was analyzed with the dynamic tracer kinetic model (DTKM) method to estimate five parameters: extraction fraction, blood flow, arrival time, transit time, and rate constant defined via adiabatic solution. The DTKM method was based on indicator dilution theory, including sequential use of two prominent kinetic models: the plug flow model and the adiabatic approximation to the tissue homogeneity model. Main Outcome MeasuresExtraction fraction (E), i.e., the fluorescein dye leakage measured during one pass through surrounding retinal tissue, is extracted via DTKM method and directly relates to retinal vascular permeability. Thus, E represents the pre-clinical biomarker, retinal vascular permeability. ResultsThe three diagnostic groups were found to have significantly different permeability (p = 0.003). Despite having no clinical signs of retinopathy, the mean rank of average vascular extraction fractions (E) was significantly higher in DMnoDR subjects compared to healthy controls (p = 0.04), as was the mean rank of E for mild NPDR subjects (p = 0.002). The average E for mild NPDR, DMnoDR, and control subjects was 0.1 ± 0.04, 0.07 ± 0.04, and 0.04 ± 0.01, respectively. ConclusionsThe vascular permeability extracted from FVA datasets using the DTKM method is a promising biomarker for detecting preclinical retinal pathology in patients with diabetes. Longitudinal studies are ongoing to explore the ability of this biomarker to distinguish those subjects with diabetes who will progress to clinically apparent retinopathy from those who will not.

First-line zorifertinib for EGFR-mutant non-small cell lung cancer with central nervous system metastases: The phase 3 EVEREST trial.

Zorifertinib (AZD3759), an epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) with high blood-brain barrier penetration capability, demonstrated promising intracranial and systemic antitumor activity in phase 1 and 2 studies in central nervous system (CNS)-metastatic patients. In this phase 3 EVEREST trial (ClinicalTrials.gov: NCT03653546), patients with EGFR-sensitizing mutations, advanced treatment-naive non-small cell lung cancer (NSCLC), and non-irradiated symptomatic or asymptomatic CNS metastases were randomized (1:1) to zorifertinib or first-generation EGFR-TKI (gefitinib or erlotinib; control). The primary endpoint was blinded independent central review (BICR)-assessed progression-free survival (PFS) per RECIST1.1. Overall, 439 patients were randomized (zorifertinib n= 220; control n= 219). Most patients had the EGFR L858R mutation (55%) or >3 CNS lesions (54%). Median PFS was significantly longer with zorifertinib versus control (9.6 versus 6.9months; hazard ratio [HR], 0.719; 95% confidence interval [CI], 0.580-0.893; p= 0.0024). Zorifertinib significantly prolonged intracranial PFS versus control (BICR per modified RECIST1.1: HR, 0.467; 95% CI, 0.352-0.619; investigator per RANO-BM: HR, 0.627; 95% CI, 0.466-0.844). Overall survival (OS) was immature; the estimated median OS was 37.3months with zorifertinib and 31.8months with control (HR, 0.833; 95% CI, 0.524-1.283) in patients subsequently treated with third-generation EGFR-TKIs. Safety profiles were consistent with previously reported data for zorifertinib. Zorifertinib significantly improved systemic and intracranial PFS versus first-generation EGFR-TKIs; adverse events were manageable. Sequential use of zorifertinib and third-generation EGFR-TKIs showed the potential to prolong patients' survival. The results favor zorifertinib as a novel, well-validated first-line option for CNS-metastatic patients with EGFR-mutant NSCLC. This work was funded by Alpha Biopharma (Jiangsu) Co., Ltd., China.

Short-Cycle Autoclave Sterilization of Instruments in Same-Day Ophthalmic Surgeries

What Is the Issue? The volume of ophthalmic surgeries is increasingly high, with cataract surgery being 1 of the most performed surgeries in Canada. Infections following ophthalmic surgeries, while rare, can cause severe complications that may lead to irreversible vision loss. Reducing postsurgery infections is a high priority in clinical practice. Running a full wrapped, terminal steam sterilization cycle for ophthalmic instruments in autoclaves may be inefficient for ophthalmic surgeries and may cause unnecessary heavy economic and environmental burdens due to high surgical volumes. Using instruments sterilized on a short cycle between sequential same-day ophthalmic surgeries may help improve efficiency and reduce resources used. These instruments are generally processed using autoclaves (i.e., steam sterilizers); the effectiveness of a shorter-cycle method of sterilization is unclear. What Did We Do? To inform decisions regarding the use of autoclaves for short-cycle sterilization for sequential same-day instrument use in ophthalmic surgery, we sought to identify and summarize evidence comparing this method to full-cycle sterilization of wrapped instruments and identify any relevant recommendations. We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2012. One reviewer screened articles for inclusion based on predefined criteria. What Did We Find? In a laboratory setting to simulate sequential same-day procedures, short-cycle sterilization with interrupted dry time for unwrapped ophthalmic instruments is feasibly as effective as full-cycle sterilization for wrapped instruments using the STATIM autoclave. Similarly, short-cycle sterilization with interrupted dry time for contained ophthalmic instruments is feasibly as effective as full-cycle sterilization for contained instruments using the AMSCO autoclave. For sequential same-day ophthalmic procedures, wet instruments sterilized by a short-cycle process with an interrupted dry time can remain sterile for at least 3 minutes if kept in a covered sterilizer containment device. One guideline recommends that wrapped or unwrapped ophthalmic instruments sterilized by a short-cycle process without full drying should be stored in a covered containment device until retrieved by staff wearing sterile gloves and gowns in the operating room for the subsequent surgery after a short delay. Phaco handpieces should be immediately primed with a balanced salt solution and remain wet as they sit on the sterile instrument table. We did not identify any clinical setting evidence from studies or autoclave manufacturers. It is unclear if clinical outcomes differ between patients undergoing sequential same-day ophthalmic surgeries using short-cycle sterilized instruments and those undergoing surgery using full-cycle sterilized instruments. What Does This Mean? Preliminary laboratory evidence and guideline recommendations supporting the use of autoclaves for short-cycle sterilization of instruments for sequential same-day ophthalmic surgeries are available. However, there is no clinical effectiveness evidence available on this process in patient settings. Future research is necessary to understand the clinical safety of using instruments sterilized by short cycles for sequential same-day use for patients undergoing ophthalmic surgeries. In addition to the evidence and recommendations identified, other factors, such as environmental influence, may be useful considerations when making decisions about short-cycle sterilization for sequential same-day instrument use for ophthalmic surgery.

Smear Layer Removing and Pulp Dissolving Ability of Sodium Hypochlorite Mixed with Two Etidronate-Containing Irrigants in Continuous Chelation Technique

The study aimed to assess the effect of two etidronate-containing irrigants and EDTA on the ability of sodium hypochlorite (NaOCl) to remove the smear layer and dissolve organic tissues. This study evaluated the following solutions: distilled water, 3% NaOCl, 3% NaOCl + EDTA, and 3% NaOCl mixed with etidronate powder from two manufacturers [Dual Rinse, (DR); IsraDent, (ID)] to obtain 9%, 15%, and 18% solutions. To assess the proteolytic activity, bovine muscle tissue samples (56.1 ± 5.4 mg; n = 10 per group) were immersed in the tested solutions for 15 min. Absolute weight changes and percentages of weight changes (wt%) were calculated. To assess smear layer removal, the root canals of human wisdom teeth were instrumented, irrigated with the tested solutions (n = 10 per group), and evaluated using SEM. Statistical analysis employed an ANOVA with a post-hoc Tukey test and paired t-test, the Kruskal–Wallis test with a pairwise Wilcoxon rank sum test, and the Friedman test with a pairwise Wilcoxon signed-rank test. The mean weight loss in the NaOCl group comprised 17.3 mg (32 wt%). Sequential use of NaOCl and EDTA resulted in a significant increase in proteolytic activity of the former (57 wt%), while mixing these solutions led to a reduction of proteolytic activity (17 wt%). All NaOCl/DR groups exhibited a significantly greater dissolution activity than that of NaOCl alone, with the mean weight loss ranging from 23.3 mg (40 wt%) to 24 mg (41 wt%). ID9% and ID15% significantly decreased the proteolytic activity of NaOCl. In most groups, the apical thirds of the root canals demonstrated a significantly heavier smear layer compared to the middle and coronal thirds. The most effective smear layer removal was observed after irrigation with NaOCl combined with EDTA or DR (all concentrations); however, in the NaOCl + EDTA and DR18% groups, it was accompanied by moderate to severe erosion. Irrigation with ID did not result in smear layer removal or dentin erosion. In conclusion, the smear layer removal and pulp dissolving effects of continuous chelation using etidronate were manufacturer/composition-dependent. DR9% combined with NaOCl demonstrated the most promising results.

Sequential use of coagulation and adsorption methods for COD removal from soft drink industry wastewater

Sequential use of coagulation and adsorption methods for COD removal from soft drink industry wastewater

Recovery of carboxylic acids from actual effluent by using sequential cationic-anionic adsorption steps at semi pilot scale

This work presents for the first time an exhaustive experimental assessment at semi-pilot scale for the sequential use of cationic-anionic adsorption columns for recovering carboxylic acids (CAs) from a real fermentation broth. The consecutive steps were dedicated to i) remove cations limiting the CAs interaction with the functional group of the anionic resin, and ii) adsorb CAs onto the anionic resin, respectively. The experimental broth was obtained from anaerobic co-fermentation of urban biowaste (UBW-broth). Breakthrough (BT) tests were firstly performed with the cationic column containing the strong-acid resin Lewatit® S2568H. This allowed both to assess the single process and to prepare 60 L of decationised UBW-broth to be used in the BT-tests with the anionic column (containing the weak-basic resin Lewatit® A365). Both columns were assessed (at 25°C) under packed and expanded bed modes, by feeding at different rates the actual UBW-broth or synthetic solutions. Main study innovative outputs were: 1) 100 % of the CAs occurring in UBW-broth were recovered with the proposed system; 2) best performances were obtained under expanded bed mode of operation, allowing to use 100 % of the installed capacity; 3) the affinity of other organic matter else than CAs resulted weaker than Na+/NH4+ and CAs/PO4x-/Cl- in both cationic and anionic columns, respectively (i.e. low adsorption performances generally reported are due to inorganic cations/anions presence); 4) a very preliminary economic analysis carried out on the basis of the obtained data indicates overall costs ranging 0.58–1.49 EUR/kg of CAs (depending on the process configuration).

Geospatial share of fungicide resistant Botrytis cinerea mutations in the Tokaj and Eger wine regions according to local pest management strategies

AbstractBotrytis cinerea is one of the fungal pathogens with the widest host plant spectrum, causing serious yield losses and significant economic damage in vineyards from year to year. As an ubiquitous, polyphagous fungal pathogen, with both saprophytic and parasitic lifestyle. The sequential use of active substances belonging to the same chemical family to protect vineyards can lead to an increase in fungal chemical resistance, which is reflected in the enrichment of point mutations in the genomic regions coding proteins involved in the mechanism of action of different pesticides. The aim of our studies was to compare the sensitivity to different fungicides of B. cinerea populations in two wine regions with different pest management practices: the Tokaj region, where the presence of B. cinerea is necessary to produce noble rot wines, and the adjacent Eger Region, where a total protection against B. cinerea is desired. Our study is the first Hungarian report of some previously studied resistance mutations in ERG27 and SDHB protein-coding genes. We identified point mutations in ERG27 transmembrane domain that have not been previously described but may affect the emergence of resistance to certain fungicides. Our study shows that the B. cinerea population of the Northern Hungary region is consistently characterized by an increase in fenhexamid resistance.

Hybrid Simulation of Therapeutic Appointment — a New Step in Creating Effective Training for Practical Healthcare

The main difference of the author's educational program "Therapeutic patient at an outpatient appointment" is the introduction of simulation technologies. The course structure includes 5 days of training, during which sequential and joint use of interactive lectures is used, based on international recommendations and treatment protocols of the Republic of Kazakhstan, as well as the development of practical skills on modern simulation equipment.