Treatment Of Cs Research Articles

High efficiency removal of Cs+ by Fe-Co framework PBAs from radioactive wastewater

The widespread application of nuclear energy has increased the risk of contamination by radionuclide 137Cs. Prussian blue analogues are considered to be excellent materials for the removal of 137Cs from wastewater due to their unique structure. In this work, Cs+ adsorbent for PBAs with Fe-Co framework, potassium iron hexacyanocobaltate (PBAFe), was synthesized by room temperature precipitation method. Systematic structural characterization and performance results of PBAFe showed that it has a specific surface area of 452.8 m2/g and an average pore size of 8.6nm, providing more active sites for Cs+. The adsorption of Cs+ on PBAFe exhibited fast reaction kinetics (within 10min) and high adsorption capacity (82.90mg/g), and the removal rate of Cs+ reached 98.57%. The efficient removal of Cs+ by PBAFe in various real water environments showed its excellent selectivity and potential for practical application. In addition, adsorption mechanism studies showed that the adsorption of Cs+ was achieved by ion exchange with K+ in the PBAFe lattice. PBAFe has the advantages of simple synthesis and good selectivity, and has potential application in the harmless treatment of Cs+ in radioactive wastewater.

Advances in the study of cytokine storm mechanisms in pneumonia: An example of IL-6 and IL-33

In the past decades, pneumonia has been plaguing countries around the world, with great implications for medical and public health. Systems pose a serious challenge. Many pneumonia outbreaks have occurred in local areas and even in the world. Since the end of 2019, the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has once again attracted the world's attention to viral pneumonia. At present, a large number of basic research, drug development and clinical trials are being carried out for SARS-CoV-2 and COVID-19. However, patients are generally given symptomatic and supportive treatment, antiviral therapy, immunotherapy, glucocorticoid therapy and respiratory support. Therefore, finding new and effective treatment methods based on the pathogenic mechanism of SARS-CoV-2 is still the current practical demand and research focus. This review focuses on the occurrence and development of CS and the immunopathological damage caused by CS in viral pneumonia, especially in severe pneumonia, and summarizes the potential means of treating CS through IL-related pathways. Research found that different viruses cause CS, cytokines involved in the type and severity of differences, therefore, should also be targeted in the treatment strategy. In addition, in addition to focusing on the treatment of CS, in order to better study the pathophysiological mechanism of virus-induced CS and screen intervention drugs efficiently, how to safely and effectively establish cell and animal models of CS and improve the scientific evaluation system are also key issues worthy of attention.

Physicochemical and pharmacotechnical characterization of Prussian blue for future Prussian blue oral dosage forms formulation

Ferric hexacyanoferrate, Fe4 [Fe(CN)6]3 · xH2O, known as Prussian blue (PB), has proven its effectiveness as an antidote in cases of accidental poisoning or poisoning caused by radioactive materials such as cesium (Cs) and thallium (Tl); which due to their solubility in water, when absorbed by the human body, cause serious damage to vital organs. The local development of a drug with PB as an active ingredient arises as a response to the civil and military needs established within the Ministry's pharmacy request for national defense. This fact contemplates the circumstances related to public health protection in the nuclear, radiological, biological and chemical (NRBQ) of the emergency institutions in health and national security. In this paper and by using various analytical techniques, the characterization of the locally synthesized PB with pharmaceutical quality has been described, as a first step to predict its behavior in the preparation of a drug that contains it as an active ingredient.The research findings demonstrate that locally synthesized PB is suitable for use in oral dosage forms, enabling the local development of drug formulations incorporating PB, thus being able to potentially become a main resource in the treatment of Cs and Tl poisoning in any accidental or intended of the population. This development opens up the possibility of creating drug formulations that incorporate PB at a local level, making it a potentially significant resource in the treatment of Cs and Tl poisoning. The ability to locally produce and utilize PB in oral dosage forms could be crucial in addressing cases of accidental or intentional exposure within the population. This advancement not only contributes to the scientific understanding of PB but also holds promising implications for practical applications in public health and emergency situations.

ПРОГНОЗИРОВАНИЕ НЕБЛАГОПРИЯТНЫХ КЛИНИЧЕСКИХ ИСХОДОВ ПАЦИЕНТОВ С КАРДИОГЕННЫМ ШОКОМ ПОСЛЕ ОПЕРАЦИЙ НА ОТКРЫТОМ СЕРДЦЕ ПРИ ПОДКЛЮЧЕНИИ ВНУТРИАОРТАЛЬНОЙ БАЛЛОННОЙ КОНТРАПУЛЬСАЦИИ

Aim. To determine preimplantation risk factors and predictors of unfavorable outcome in patients with cardiogenic shock after open-heart surgery, who had an intraoperative system of mechanical circulatory support – intra-aortic balloon contrapulsation. Methods. A retrospective study was conducted at the Republican Scientific and Practical Center “Cardiology” for 2015–2020. It included 66 patients who underwent heart surgery on bypass and who intraoperatively developed cardiogenic shock, refractory to drug therapy, which resulted in the use of intra-aortic balloon counterpulsation. The diagnosis of cardiogenic shock was determined based on the generally accepted criteria, as well as based on the SCAI (Society for Cardiovascular Angiography and Interventions) classification of shock: systolic blood pressure < 90 mmHg for > 30 minutes or the need for infusion of vasopressors or inotropes to achieve the blood pressure of ≥ 90 mm Hg. The Pearson Chi-square test used for nonparametric analysis of qualitative characteristics. The predictors were identified based on logistic regression. Differences were considered significant at p < 0.05 (5%).Results. Risk factors for adverse outcome in case of CS before the use of IABP were: age over 65 years OR = 6.04 [95% CI 1.73 – 21.06], p = 0.003; female gender OR = 3.24 [95% CI 1.064 – 9.873], p = 0.048; vasoactive and inotropic support of more than 42 points OR = 7.85 [95% CI 2.33 – 26.45], p = 0.001; blood lactate of more than 4.7 mmol/l OR = 4.12 [95% CI 1.27 – 13.37], p = 0.014; blood acidity pH < 7.33 OR = 6.34 [95% CI 1.97 – 20.37], p = 0.003; base deficit BE > –5.6 OR = 7.32 [95% CI 2.19 – 24.42], p = 0.001. According to the β-coefficients of the logistic regression equation, predictors were scored as follows: age > 65 years = 2 points, VIP > 42 = 2 points, lactate > 4.7 mmol/L = 1 point. The cumulative probability of 30-day mortality was as follows: 9% when defined as 1 point, 20% – 2 points, 55% – 3 points, 60% – 4 points, 75% – 5 points (Chi-square 24.1; df = 5; p = 0.001). Conclusions. Cardiogenic shock is a fatal complication in cardiac surgery. The use of vasopressor and inotropic drugs has an important role in the treatment of CS; however, escalation of catecholamine doses leads to the progression of multiple organ failure due to hypoperfusion and hypoxia of target organs. Therefore, the use of intra-aortic balloon counterpulsation can improve the results of CS treatment. However, the effect of IABP is limited to increasing cardiac output by no more than 1 l/minute. Based on the calculator we developed, when determining a high risk of an unfavorable outcome of the IABP use, options for circulatory support should be considered including extracorporeal membrane oxygenation, ventricular assist device.

Effectiveness and safety of non-invasive ventilation in the management of cardiogenic shock

Introduction and objectivesCardiogenic shock (CS) has long been considered a contraindication for the use of non-invasive ventilation (NIV). The main objective of this study was to analyze the effectiveness, measured as NIV success, in patients with respiratory failure due to CS. As secondary objective, we studied risk factors for NIV failure and compared the outcome of patients treated with NIV versus invasive mechanical ventilation (IMV). MethodsRetrospective study on a prospective database, over a period of 25 years, of all consecutively patients admitted to an intensive care unit, with a diagnosis of CS and treated with NIV. A comparison was made between patients on NIV and patients on IMV using propensity score matching analysis. ResultsThree hundred patients were included, mean age 73.8 years, mean SAPS II 49. The main cause of CS was acute myocardial infarction (AMI): 164 (54.7%). NIV failure occurred in 153 (51%) cases. Independent factors for NIV failure included D/E stages of CS, AMI, NIV related complications, and being transferred from the ward. In the propensity analysis, hospital mortality (OR 1.69, 95% CI 1.09–2.63) and 1 year mortality (OR 1.61, 95% CI 1.04–2.51) was higher in IMV. Mortality was lower with NIV (vs. EIT-IMV) in C stage (10.1% vs. 32.9%; p<0.001) but did not differ in D stage or E stage. ConclusionsNIV seems to be relatively effective and safe in the treatment of early-stage CS.

Clinical outcomes of surgical treatment for Copenhagen syndrome: a case series

BackgroundCopenhagen syndrome (CS) is a rare disorder mostly observed in adolescent. The onset of the disease, with a progressive anterior vertebral ankylosis in the thoracic and/or lumbar areas often clinically revealed by thoracolumbar kyphosis. We report a series of three patients of CS with good outcome.Case presentationThe mean age of patients were 14.0 (SD = 3.6) years at admission time. Patients underwent clinical and radiological examination (MRI, CT scan, and bone scan) before surgery and revealed Copenhagen syndrome. Case 2 received conservative treatment braces and regular follow-up. Finally, all patients were treated according to their clinical conditions through a combined surgical approach such as pedicle subtraction osteotomy (PSO), ponte osteotomy, hook, pedicular screw insertion, and fusion. In postoperative follow-up, the deformity correction was achieved with proper alignment in all the cases.ConclusionThe treatment of CS with PSO plus ponte osteotomy seems to result in an excellent surgical procedure and outcome for our patients based on deformity severity. Bone scan imaging could be considered as an aid to differential diagnosis, which is an effective method.

ODP303 Cushing's Syndrome Due to Ectopic Adrenocorticotropic Hormone-Secreting Metastatic Neuroendocrine Tumor

Abstract Introduction Cushing's syndrome (CS) due to ectopic ACTH secretion (EAS), is an infrequent form of ACTH-dependent CS. EAS results from unregulated ACTH secretion by neuroendocrine tumors (NETs) of various locations resulting in severe hypercortisolism. The progression of CS is usually precipitous. To improve outcomes, it is imperative to recognize early so that treatments of cortisol-induced comorbidities and targeted treatments can be initiated. Case Presentation A 74-year-old female presented to an outside hospital with fatigue, bilateral lower extremity edema and intractable hypokalemia. She was later transferred to our facility, where workup of CS was initiated. She underwent a 1mgdexamethasone suppression test (DST)which resulted in an unsuppressed 8amcortisol of 34.7 ug/dL (&amp;lt;2 ug/dL). This was followed by a 4mgDST, again resulting in an unsuppressed 8amcortisol of25.4 ug/dL. A 24-hour urine cortisol level was collected and resulted at 2,108.9 ug/d (&amp;lt;45 ug/d). ACTH level was elevated at 136 pg/ml (7.2-63.3 pg/ml). CT abdomen/pelvis identified liver lesions concerning for metastatic disease. PET DOTATATE revealed multiple liver lesions and a few pulmonary nodules. Biopsy of liver lesions demonstrated strongly positive staining of synaptophysin and chromogranin confirming NET, with a weak TTF-1 positivity suggestive of pulmonary origin. Lanreotide injections were initiated for tumor control and ketoconazole for treatment of persistent hypercortisolism. Despite titration of ketoconazole, symptoms and labs showed minimal improvement. Osilodrostat was then added as a third line and examethasone was initiated in a block and replace approach. The regimen of lanreotide, osilodrostat and ketoconazole improved her24-hoururine cortisol to 15 from 2,109 ug/24hr. Subsequently patient underwent trans-arterial chemoembolization (TACE) of the liver lesions with resolution of hypercortisolism. She is currently only on Lanreotide for tumor control. Discussion NET with ectopic ACTH production is rare. While primary tumor location was not definitively identified, multiple lung lesions and histopathology suggested primary lung tumor with hepatic metastases. 20-40% of all NETS originate in the chest. Patient management necessitates a multidisciplinary approach not only for the diagnosis and treatment of CS but also for the specific management of neuroendocrine tumors (NET). This case highlights a rare presentation of EAS, and aggressive treatment modalities needed to treat symptoms of excess cortisol production and tumor progression. Presentation: No date and time listed

PSUN42 New-Onset Rheumatoid Arthritis After Surgical Treatment of Cushing Syndrome

Abstract Background Cushing syndrome (CS) is a rare endocrinopathy resulting from prolonged exposure to endogenous or exogenous glucocorticoids. CS can be subclinical or can present with an array of overt signs and symptoms. The goal of treatment in CS is to reestablish normal cortisol levels in the body by eliminating the source of excess cortisol. Autoimmune diseases are often treated successfully with exogenous glucocorticoids. There are several case reports/series in the literature describing patients who developed autoimmune diseases, or experienced recrudescence of otherwise quiescent autoimmune processes, after the withdrawal of glucocorticoids. Such diseases include rheumatoid arthritis, Graves disease, Hashimoto's thyroiditis, systemic lupus erythematosus, psoriasis, and myasthenia gravis. Below we share a case of rheumatoid arthritis that presented after unilateral adrenalectomy for CS. Clinical case A 55 year old female with a history of Graves disease status post radioactive iodine ablation many years ago with post-ablative hypothyroidism was found to have a left adrenal mass on CT in 2016. An MRI in February 2021 showed interval growth from 3.8×2.9×3.6cm to 5.1×3.5×4.8cm. ACTH was suppressed to &amp;lt;1.5 pg/mL (7.2-63.3 pg/mL), 24 hour urine free cortisol was elevated to 256 ug/24hr (10-34 ug/24hr), midnight salivary cortisol was elevated to 219 ng/dL then 430 ng/dL on repeat (n&amp;lt;100 ng/dL), and AM cortisol was 13.7 ug/dL (6.0-18.4 ug/dL) after 1mg overnight dexamethasone administration. This biochemical testing was supportive of the diagnosis of ACTH-independent adrenal CS. Our patient underwent successful left adrenalectomy in March 2021 and was started on hydrocortisone postoperatively given long-standing suppression of her hypothalamic-pituitary-adrenal axis. Within three months, she developed muscle aches and pain in bilateral hands, ankles and feet with stiffness and swelling. These symptoms worsened with glucocorticoid taper. She was found to have a rheumatoid factor of 32 IU/mL (0-13 IU/mL) and was diagnosed with rheumatoid arthritis, for which she was started on hydroxychloroquine and briefly switched from hydrocortisone to prednisone. She has since been tapered off steroids with resolution of adrenal insufficiency. Her rheumatoid arthritis symptoms remain adequately controlled on hydroxychloroquine. Conclusions While it is known that withdrawal of exogenous chronic steroids can result in exacerbation of pre-existing autoimmune disease, the emergence of new autoimmune disease upon withdrawal of endogenous steroid production after treatment of pituitary ACTH-dependent or adrenal ACTH-independent CS is extremely rare. Of special interest, our patient described above had a history of Graves disease years before her CS diagnosis was made, suggesting an underlying proclivity towards autoimmunity. Further study may reveal the need for higher vigilance in postoperative monitoring in patients with preexisting autoimmune conditions. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Response of Amaranthus tricolor to cesium stress in hydroponic system: Growth, photosynthesis and cesium accumulation

Remediation of the cesium-contaminated environment is of paramount importance, and phytoremediation is a cost-effective and green technique. In this paper, the response of Amaranthus tricolor to cesium ions in hydroponic solution was investigated at various cesium concentration (0, 0.05, 0.2, 0.4 and 0.6 mM), in terms of the growth weight, height and photosynthesis. The maximal Cs content in stems and leaves of A. tricolor was 13.05 mg/g dry wt under spiked Cs level of 0.4 mM in solution. The maximal transfer factor (TF) and bioconcentration factor (BCF) were 1.87 and 181.25 respectively, when the corresponding Cs content in roots and shoots was 7.04 mg/g and 13.05 mg/g dry wt respectively. TFs are higher than 1 in the conditions of normal plant growth. The growth of A. tricolor was enhanced after the treatment of Cs at low concentrations (0.05 and 0.2 mM), while it was inhibited at 0.4 and 0.6 mM. The leaf number and dry weight of stem, leaf parts and root parts were maximum at the spiked cesium level of 0.2 mM, which significantly increased by 19.19%, 47.56% and 94.56% respectively, compared with the control samples. Under 0.6 mM cesium stress, curl and withering of the leaves occurred, and the plant growth and cesium accumulation dropped to the minimum. Cs at the spiked level of 0.6 mM in solution inhibited the performance of PSII, especially in terms of blockage in electron transfer process beyond QA and restraint of P700 reduction. On contrast, the performance of PSII was enhanced by the spiked Cs at level of 0.2 mM, leading to the growing density of reaction centers per excited cross-section and increasing electron transfer process beyond QA. In summary, A. tricolor has potential for remediating the Cs-contaminated environment.

Current clinical practice for thromboprophylaxis management in patients with Cushing\u2019s syndrome across reference centers of the European Reference Network on Rare Endocrine Conditions (Endo-ERN)

BackgroundCushing’s syndrome (CS) is associated with an hypercoagulable state and an increased risk of venous thromboembolism (VTE). Evidence-based guidelines on thromboprophylaxis strategies in patients with CS are currently lacking. We aimed to map the current clinical practice for thromboprophylaxis management in patients with CS across reference centers (RCs) of the European Reference Network on Rare Endocrine Conditions (Endo-ERN), which are endorsed specifically for the diagnosis and treatment of CS. Using the EU survey tool, a primary screening survey, and subsequently a secondary, more in-depth survey were developed.ResultsThe majority of the RCs provided thromboprophylaxis to patients with CS (n = 23/25), although only one center had a standardized thromboprophylaxis protocol (n = 1/23). RCs most frequently started thromboprophylaxis from CS diagnosis onwards (n = 11/23), and the majority stopped thromboprophylaxis based on individual patient characteristics, rather than standardized treatment duration (n = 15/23). Factors influencing the initiation of thromboprophylaxis were ‘medical history of VTE’ (n = 15/23) and ‘severity of hypercortisolism’ (n = 15/23). Low-Molecular-Weight-Heparin was selected as the first-choice anticoagulant drug for thromboprophylaxis by all RCs (n = 23/23). Postoperatively, the majority of RCs reported ‘severe immobilization’ as an indication to start thromboprophylaxis in patients with CS (n = 15/25). Most RCs (n = 19/25) did not provide standardized testing for variables of hemostasis in the postoperative care of CS. Furthermore, the majority of the RCs provided preoperative medical treatment to patients with CS (n = 23/25). About half of these RCs (n = 12/23) took a previous VTE into account when starting preoperative medical treatment, and about two-thirds (n = 15/23) included ‘reduction of VTE risk’ as a goal of treatment.ConclusionsThere is a large practice variation regarding thromboprophylaxis management and perioperative medical treatment in patients with CS, even in Endo-ERN RCs. Randomized controlled trials are needed to establish the optimal prophylactic anticoagulant regimen, carefully balancing the increased risk of (perioperative) bleeding, and the presence of additional risk factors for thrombosis.

Sustainable biocomposites produced from cotton stalk wastes: Effect of heat treatment

The novelty of this study is to explore the effect of heat treatment of CS on the properties of biocomposites. 200°C, 300°C, 500°C, and burning of 500°C were selected to heat treat CS to obtain CS fillers, and the biocomposites were prepared using CS fillers and LLDPE. The heat treatment of CS can improve the interface bonding and compatibility of biocomposites by the results of FTIR, SEM, and CA. The crystal planes were not changed by the addition of CS fillers. The results of DSC and TGA showed that the heat treatment of CS promoted crystallization and improved the heat resistance of LLDPE. In addition, the flexural properties, tensile properties, stiffness, elasticity, creep resistance, and stress relaxation resistance were all increased by the heat treatment of CS, although it exhibited an adverse effect on the impact strength of LLDPE. After comparison, the best flexural strength and modulus (13.00 MPa and 0.75 GPa) were obtained in 200CSB-L due to the enhancement of CS rigidity by 200°C heat treatment. Also, 200CSB-L showed the best stiffness, elasticity, and dimensional stability than others. The best tensile strength and modulus (10.89 MPa and 0.26 GPa) were obtained in 500CSB-L due to its mechanical interlocking structure. The results of this study indicate that heat treatment would play an important role in biocomposites in terms of the benefit in mechanical properties.

Ten-year experience in the surgical management of craniosynostosis. A series of 96 consecutive patients

• Craniosynostosis is characterized by the premature fusion of one or more cranial sutures; it has an estimated overall incidence of 1/2000 to 2500 live births. • The birth prevalence of all types of CS, both isolated and syndromic is 343/million. • The incidence of non-syndromic CS is 0.6/1000 live births. • The diagnosis and treatment of CS during the last two decades improved by new and different techniques, including molecular genetics of most of the classic CS syndromes. • Almost 20% of all CS are due to genetic causes. More than 180 syndromes are known to be associated with CS. • On behalf the surgical procedures, minor changes have been introduced but the basic principles and techniques remain unchanged depending on the type of synostosis, the reabsorbable osteosynthesis improved the stability of the cranial assemblies and endoscopic approaches have made some of these procedures less invasive. • I want to put our work to your consideration, the content is about 96 cases of craniosynosotosis, in which we report the techniques used for its treatment, some endoscopic cases, complications and especially the functional results. Thanks.

A Review of Prognosis Model Associated With Cardiogenic Shock After Acute Myocardial Infarction.

Objective: Cardiogenic shock seriously affects the survival rate of patients. However, few prognostic models are concerned with the score of cardiogenic shock, and few clinical studies have validated it. In order to optimize the diagnosis and treatment of myocardial infarction complicated with cardiogenic shock and facilitate the classification of clinical trials, the prognosis score model is urgently needed.Methods: Cardiogenic shock, severe case, prognosis score, myocardial infarction and external verification were used as the search terms to search PubMed, Embase, Web of Science, Cochrane, EBSCO (Medline), Scopus, BMC, NCBI, Oxford Academy, Science Direct, and other databases for pertinent studies published up until 1 August 2021. There are no restrictions on publication status and start date. Filter headlines and abstracts to find articles that may be relevant. The list of references for major studies was reviewed to obtain more references.Results and Conclusions: The existing related models are in urgent need of more external clinical verifications. In the meanwhile, with the development of molecular omics and the clinical need for optimal treatment of CS, it is urgent to establish a prognosis model with higher differentiation and coincidence rates.

Interleukin-1 blockade in cardiac sarcoidosis: study design of the multimodality assessment of granulomas in cardiac sarcoidosis: Anakinra Randomized Trial (MAGiC-ART)

BackgroundSarcoidosis is an inflammatory disease characterized by the formation of granulomas, which involve the heart in up to 25% of patients. Cardiac sarcoidosis can lead to life threatening arrhythmias and heart failure. While corticosteroids have been used as a treatment for over 50 years, they are associated with hypertension, diabetes, and weight gain, further increasing cardiovascular risk. Interleukin-1 (IL-1) is the prototypical proinflammatory cytokine that works to activate the nuclear transcription factor NF-kB, one of the targets of glucocorticoids. IL-1 also plays an important role also in the pathophysiology of heart disease including atherosclerosis, myocardial infarction, and myocarditis.MethodsBuilding on a network of research collaborators developed in the Cardiac Sarcoidosis Consortium, we will investigate the feasibility and tolerability of treatment of CS with anakinra at two National Institute of Health Clinical and Translational Science Award (CTSA) hubs with expertise in cardiac sarcoidosis. In this pilot study, up to 28 patients with cardiac sarcoidosis will be recruited to compare the administration of an IL-1 blocker, anakinra, 100 mg daily on top of standard of care versus standard of care only for 28 days and followed for 180 days. Utilizing surrogate endpoints of changes in systemic inflammatory biomarkers and cardiac imaging, we aim to determine whether IL-1 blockade with anakinra can combat systemic and cardiac inflammation in patients with cardiac sarcoidosis.DiscussionThe current trial demonstrates an innovative collaborative approach to clinical trial development in a rare, understudied disease that disproportionately affects females and minorities.Trial Registration The trial was registered prospectively with ClinicalTrials.gov on July 12, 2019, identifier NCT04017936.

Non-thermal plasma irradiated polyaluminum chloride for the heterogeneous adsorption enhancement of Cs+ and Sr2+ in a binary system

The natural ecosystem will continually deteriorate for decades by the leakage of Cs and Sr isotopes. The exploration of the new materials or techniques for the efficient treatment of radioactive wastewater is critically important. In this study, a dielectric barrier discharge (DBD) configuration was constructed to operate the non-thermal plasma (NTP). The NTP was incorporated into the synthesis of polyaluminum chloride (PAC) in two different procedures to intensify the synthesis of PAC (NTP-PAC) and enhance the further removal of Cs and Sr from wastewater. The employment of NTP in two procedures both had significantly changed the physicochemical characteristics of PAC materials, which facilitated the further adsorption application of NTP-PAC on the treatment of Cs+ and Sr2+. Different molecular, morphological, and adsorption characteristics were confirmed to the NTP-PAC materials. The heterogeneous adsorption of the NTP-PAC can be appropriately fitted by both the pseudo-first-order kinetic model and the Elovich model. Both physisorption and chemisorption reaction mechanisms were ensured for the heterogeneous adsorption of the NTP-PAC material towards Cs+ and Sr2+, which guaranteed the excellent adsorption performance of NTP-PAC materials compared to PAC. The electron collisions caused by NTP with alum pulp created highly reactive growth precursors and intensified the nucleation and hydrolysis polymerization of PAC. The employment of NTP explicitly broadens the reaction pathways between PAC and cationic contaminants in the aqueous environment, which expands the application area of PAC materials in environmental sustainability.

Management of Cardiac Sarcoidosis Using Mycophenolate Mofetil as a Steroid-Sparing Agent

BackgroundCardiac sarcoidosis (CS) is a major cause of morbidity and mortality in patients with systemic sarcoidosis. Steroid-sparing agents are increasingly used, despite a lack of randomized trials or published guidelines to direct treatment. Methods and ResultsThis retrospective study included 77 patients with CS treated with prednisone monotherapy (n = 32) or a combination with mycophenolate mofetil (n = 45) between 2003 and 2018. Baseline characteristics and clinical outcomes were evaluated. The mean patient age was 53 ± 11 years at CS diagnosis, 66.2% were male, and 35.1% were Black. The total exposure to maximum prednisone dose (initial prednisone dose × days at dose) was lower in the combination therapy group (1440 mg [interquartile range (IQR), 1200–2760 mg] vs 2710 mg [IQR, 1200–5080 mg]; P = .06). On 18F-fluorodeoxyglucose positron emission tomography scans, both groups demonstrated a significant decrease in the cardiac maximum standardized uptake value after treatment: a median decrease of 3.9 (IQR 2.7–9.0, P = .002) and 2.9 (IQR 0–5.0, P = .001) for prednisone monotherapy and combination therapy, respectively. Most patients experienced improvement or complete resolution in qualitative cardiac 18F-fluorodeoxyglucose uptake (92.3% and 70.4% for the prednisone and combination therapy groups, respectively). Mycophenolate mofetil was well tolerated. ConclusionsMycophenolate mofetil in combination with prednisone for the treatment of CS may minimize corticosteroid exposure and decrease cardiac inflammation without significant adverse effects.

Escalation and de-escalation of mechanical circulatory support in cardiogenic shock.

Cardiogenic shock (CS) is a clinical entity that includes a wide spectrum of different scenarios. Mechanical circulatory support (MCS) plays a fundamental role in the contemporary treatment of CS, and device selection is a key element in determining optimal treatment in this complex population. Cardiac support with mechanical devices should allow reduction and complete weaning from inotropes. Persistence of elevated left ventricular (LV) filling pressures, pulmonary congestion, metabolic decompensation, and end-organ damage during current MCS are criteria for MCS escalation. Precise diagnosis of the underlying cause of right ventricular (RV) failure is fundamental for undertaking the correct escalation strategy. In the setting of both MCS escalation and de-escalation, it is important to select a strategy in relation to long-term perspectives (bridge-to-recovery, bridge-to-LV assist device, or bridge-to-heart transplantation). Small retrospective studies have demonstrated that the BiPella approach is feasible, reduces cardiac filling pressures and improves cardiac output across a range of causes of CS. Simultaneous LV and RV device implantation and lower RV afterload may be associated with better outcomes in biventricular CS, but prospective studies are still required.

Sulfur-encapsulated zeolite micromotors for the selective removal of cesium from high-salt water with accelerated cleanup times

Bubble-propelled sulfur-encapsulated NaX zeolite (S-NaX) micromotors were developed for the selective removal of cesium from high-salt conditions with accelerated cleanup times. NaX was first modified with sulfur to provide additional Lewis acid−base interactions with Cs+ for enhanced Cs+ selectivity, and then Pt was half-deposited on S-NaX for bubble propulsion via the catalytic decomposition of H2O2. The average velocity of the resulting S-NaX/Pt micromotors in 5 wt% H2O2 is 39.7 ± 17.1 μm/s, which is higher than that of a previously reported Cs adsorbent micromotor (35.4 μm/s). The Cs+ ion-exchange kinetics of the S-NaX micromotor is 1.32 times higher than that of the NaX micromotor in a 5 wt% H2O2 solution where the molar ratio of Na+ to Cs+ is 200, even though the sulfur in the S-NaX micromotor causes an adverse effect on the propulsion speed due to the sulfur poisoning effect. Moreover, the S-NaX micromotor in simulated groundwater also exhibited excellent Cs+ removal performance with distribution coefficient (Kd) values at least 3.2 times higher than those of the nonpropelled S-NaX and NaX micromotor, demonstrating the great potential for the treatment of radioactive Cs+-contaminated water.

A comparative study of immobilizing ammonium molybdophosphate onto cellulose microsphere by radiation post-grafting and hybrid grafting for cesium removal.

Ammonium molybdophosphate (AMP) exhibits high selectivity towards Cs but it cannot be directly applied in column packing, so it is necessary to prepare AMP-based adsorbents into an available form to improve its practicality. This work provided two AMP immobilized cellulose microspheres (MCC@AMP and MCC-g-AMP) as adsorbents for Cs removal by radiation grafting technique. MCC-g-AMP was prepared by radiation graft polymerization of GMA on microcrystalline cellulose microspheres (MCC) followed by reaction with AMP suspension, and MCC@AMP was synthesized by radiation hybrid grafting of AMP and GMA onto MCC through one step. The different structures and morphologies of two adsorbents were characterized by FTIR and SEM. The adsorption properties of two adsorbents against Cs were investigated and compared in batch and column experiments under different conditions. Both adsorbents were better obeyed pseudo-second-order kinetic model and Langmuir model. MCC-g-AMP presented faster adsorption kinetic and more stable structure, whereas MCC@AMP presented more facile synthesis and higher adsorption capacity. MCC@AMP was pH independent in the range of pH 1-12 but MCC-g-AMP was sensitive to pH for Cs removal. The saturated column adsorption capacities of MCC@AMP and MCC-g-AMP were 5.4g-Cs/L-ad and 0.75g-Cs/L-ad in column adsorption experiments at SV 10 h-1. Both adsorbents exhibited very high radiation stability and can maintain an adsorption capacity of >85% even after 1000kGy γ-irradiation. On the basis, two AMP-loaded adsorbents possessed promising application in removal of Cs from actual contaminated groundwater. These findings provided two efficient adsorbents for treatment of Cs in radioactive waste disposal.

THE EFFECTIVENESS OF ATYPICAL MINOR ANTIPSYCHOTICS IN THE TREATMENT OF MENOPAUSAL SYNDROME IN WOMEN WITH PERIMENOPAUSE ENDOMETRIOSIS

Despite the huge achievements in the study of the period of perimenopause and endometriosis, this problem continues to attract the attention of both scientists and practitioners. Among the most significant consequences and clinical manifestations of estrogen deficiency developing in the peri- and postmenopausal periods and that have a significant impact on the quality of life of women of transitional age, combined in the concept of “postmenopausal syndrome,” are neuropsychiatric manifestations with menopausal syndrome (CS). The choice of the drug in the treatment of CS in the presence of contraindications to traditional menopausal hormone therapy creates its own difficulties.