Sustainable waste management and recycling of Zn–Al layered double hydroxide after adsorption of levofloxacin as a safe anti-inflammatory nanomaterial

Inorganic nano-layered double hydroxide (LDH) materials are used in the catalytic field, and have demonstrated great applicability in the pharmacological fields. In the current study, we report Zn–Al LDH as an adsorbent for levofloxacin (levo). The physical and chemical properties of the prepared material before and after adsorption were monitored using X-ray diffraction, Fourier-transform infrared (FT-IR) spectroscopic analysis, energy dispersive X-ray spectroscopy (EDX), Brunauer–Emmett–Teller (BET) surface area measurements, high-resolution transmission electron microscopy (HRTEM), and field emission scanning electron microscopy (FESEM). Density functional theory (DFT) calculations for levo and its protonated species were studied at the B3LYP/6-311G (d,p) level of theory. The removal percentage of levo was 73.5%. The adsorption isotherm was investigated using nine different models at pH 9, where the obtained correlation coefficients (R²) using the Redlich–Peterson and Toth models were 0.977. The thermodynamic parameters ΔS°, ΔG° and ΔH° were estimated and discussed in detail. Also, to support the adsorption research field, the applicability of the formed waste after the adsorption of levo onto Zn–Al LDH was investigated for medical purposes. The toxicity of levo in both normal and nanocomposite form was studied. Neither toxicological symptoms nor harmless effects were exhibited throughout the in vivo study. The oral anti-inflammatory activity, tested using 6% formalin to produce edema in the footpad, was manifested as a significant increase of 37% in the anti-inflammatory effect of the Zn–Al LDH/levo nanocomposite compared to levo in its normal form.

Zn-Al LDH was synthesized using the co-precipitation method, characterized and used as an efficient adsorbent for the removal of levofloxacin. The safety and toxicity of the administered Zn-AL LDH/levo as a safe anti-inflammatory material.     

Instant and quantitative epoxidation of styrene under ambient conditions over a nickel(ii)dibenzotetramethyltetraaza[14]annulene complex immobilized on amino-functionalized SBA-15

Nickel(ii)dibenzotetramethyltetraaza[14]annulene complex (Nitmtaa) was synthetized and immobilized on post amino-functionalized SBA-15 (N-SBA-15) to obtain a stable and reusable nanocatalyst named as Nitmtaa@N-SBA-15. Here (3-aminopropyl)triethoxysilane (APTES) was first grafted on the surface SBA-15, then Nitmtaa was added and coordinated on the silica surface via APTES amine groups. The structure and morphology, and thermal stability of the prepared nanocatalyst was investigated using SEM, HR-TEM, BET, FT-IR, powder XRD, and TGA. HR-TEM and XRD results revealed a high dispersion of Nitmtaa on the SBA-15 surface. The catalytic activity of this nanocatalyst was evaluated in the epoxidation of styrene, under ambient conditions, using meta-chloroperoxybenzoic acid (m-CPBA) as the oxygen donor. This nanocatalyst showed an immediate and quantitative epoxidation of styrene with high turn-over-frequency ∼31.58 s⁻¹. Moreover, the superior catalytic activity and high stability of Nitmtaa@N-SBA-15 could be maintained after four successive cycles. A possible reaction mechanism is also proposed.

Immediate and quantitative epoxidation of styrene under ambient conditions catalyzed by new nanocatalyst obtained by immobilizing nickel(ii)dibenzotetramethyltetraaza[14]annulene in amino-functionalized SBA-15.     

Endodontic complications in teeth with vital pulps restored with composite resins: a systematic review

Composite resin is used extensively for restoration of teeth with vital pulps. Although cell culture studies have disclosed harmful effects on pulpal cells, any untoward clinical effects, manifest as adverse pulpal responses, have yet to be determined. This study comprises a systematic review, designed to address the question of whether the risk of endodontic complications is greater with composite resin restorations than with other restorative materials, such as amalgam. The study methodology involved (i) formulation of the research question, (ii) construction and conduct of an extensive literature search with (iii) interpretation and assessment of the retrieved literature. A search of the medical database PubMed was complemented with a search of the Controlled Trials Register (CENTRAL). The initial search yielded 1043 publications, the abstracts of which were read independently by the authors. After additional searches, 10 studies were included in the review. In all the included studies, the level of evidence was assessed as low. No conclusions could therefore be drawn. The included studies reported few, if any, endodontic complications. Little or no differences emerged between teeth restored with composite resins and those restored with amalgam. To determine whether composite resin restorations of teeth with vital pulps are associated with an increased risk for development of endodontic complications such as apical periodontitis, further evidence is needed, from well‐constructed studies with a large number of participants.     

Predictors of prolonged survival after allogeneic hematopoietic stem cell transplantation for multiple myeloma

A total of 149 patients with multiple myeloma (MM) who received allogeneic hematopoietic stem cell transplantation (allo-HCT) with myeloablative (MAC; n = 38) or reduced-intensity conditioning (RIC; n = 110) regimens at MD Anderson Cancer Center were evaluated. Of the total, 120 (81%) patients had relapsed or had refractory disease. Median age of MM patients was 50 (28-70) years with a followup time of 28.5 (3-164) months. The 100-day and 5-year treatment related mortality (TRM) rates were 17% and 47%, respectively. TRM was significantly lower with RIC regimens (13%) vs. 29% for MAC at 100 days (P = 0.012). The cumulative incidence of Grade II-IV acute graft-versus-host disease (GVHD) was 35% and chronic GVHD was 46%. PFS and OS at 5 years were 15% and 21%, respectively. In multivariate analysis, allo-HCT for primary remission consolidation was associated with longer PFS (HR 0.35; 95% CI, 0.18-0.67) and OS (HR 0.29; 95% CI 0.15-0.55), while absence of high-risk cytogenetics was associated with longer PFS only (HR 0.59; 95% CI 0.37-0.95). We observe that TRM has decreased with the use of RIC regimens, and long-term disease control can be expected in a subset of MM patients undergoing allo-HCT. Further studies should be conducted in carefully designed clinical trials in this patient population.     

Value of conventional and tissue Doppler echocardiography in the noninvasive measurement of right atrial pressure

Background: Evaluation of right atrial pressure (RAP) provides useful diagnostic, therapeutic, and prognostic information. Aim: To assess the utility of several conventional and tissue Doppler parameters in the estimation of RAP. Methods: Among 50 consecutive patients (median age: 50 years; all in sinus rhythm), invasively measured RAP was simultaneously correlated with pulsed Doppler of tricuspid inflow (peak E and A velocities, E‐wave deceleration time) and pulsed tissue Doppler of lateral tricuspid annulus (peak E’ and A’ velocities, isovolumic relaxation time [IVRT], acceleration time and rate of E’‐wave, deceleration time and rate of E’‐wave). These ratios were calculated: E/A, E’/A’, E/E’, and E/IVRT. Results: The median RAP was 14 mmHg (range 1–27 mmHg) with 29 patients (58%) having an elevated RAP (>10 mmHg). Among all studied Doppler variables, E/E’ ratio showed the strongest correlation with RAP (r = 0.84, P < 0.001) with the following regression equations: RAP = 1.24 + (1.69 × E/E’). The mean difference between Doppler and invasively measured RAP was 0.21 ± 2.6 mmHg. E/ E’ ratio ≥ 4.5 provides 89% sensitivity and 100% specificity for detection of elevated RAP (receiver operating characteristic area 0.95; P < 0.001). Conclusion: Of all echocardiographic variables investigated, tricuspid annular E/E’ ratio is identified as the best index for noninvasive determination of RAP.     

Epidemiology of uncontrolled epilepsy in the Al-Kharga District,New Valley,Egypt

BackgroundDespite advances in treating epilepsy, uncontrolled epilepsy continues to be a major clinical problem. Therefore, this work aimed to study the epidemiology of uncontrolled epilepsy in Al-Kharga District, New Valley.MethodsThis study was carried out in 3 stages via door-to-door screening of the total population (62,583 persons). All suspected cases of epilepsy were subjected to case ascertainment, conventional ElectroEncephaloGraphy (EEG), and the Stanford-Binet Intelligence Scale. Patients who had been receiving suitable anti-epileptic drugs (AEDs) over the previous 6 months and were having active seizures were considered uncontrolled, according to Ohtsuka et al.²³ The patients underwent serum AED level estimation, video EEG monitoring, and brain MRIs. Fifty age- and gender-matched patients with controlled epilepsy were chosen for statistical analysis and compared with true intractable patients.ResultsA total of 437 patients with epilepsy were identified, 30.7% of whom (n = 134/437) were uncontrolled, with a prevalence of 2.1/1000. A total of 52.2% of uncontrolled patients (n = 70/134) were inappropriately treated, while 47.8% (n = 64/134) were compliant with appropriate treatments. Video monitoring EEG of compliant uncontrolled patients demonstrated that 78.1% patients (n = 50/64) had definite epilepsy, while 21.9% (n = 14/64) had psychogenic non-epileptic seizures (PNES). A logistic regression analysis revealed that status epilepticus, focal seizures, and mixed seizure types were risk factors for intractability.     

Laparoscopic-assisted abdominoperineal resection for low rectal cancer provides a shorter length of hospital stay while not affecting the recurrence or survival: a propensity score-matched analysis

Purpose

To compare the short- and intermediate-term outcomes of open versus laparoscopic abdominoperineal resection (APR) for low rectal cancer.

Methods

Elective open and laparoscopic APRs were identified in a prospective database and were 1:1 propensity score-matched for age, ASA grade, tumour stage and type of neoadjuvant therapy. The short- and intermediate-term outcomes were compared.

Results

From January 2003 until June 2013, a total of 135 APRs (87 open, 48 laparoscopic) were identified and matched (n = 96, standardised mean difference of covariates <0.25). The thirty-day mortality, R0 rate, lymph nodes harvested and reoperations were similar. The length of the hospital stay was shorter in the laparoscopic group [10 versus 14 days, p = 0.004 (Mann–Whitney U test), Bonferroni-corrected significance level = 0.0083]. The median follow-up was 4.6 (IQR: 2.0–6.0) years. The overall and recurrence-free 3-year survival rate estimates (Kaplan–Meier method; 95 % CI in brackets) were 71 % (59–86) and 57 % (44–73) in the open group versus 78 % (66–92) and 72 % (60–87) in the laparoscopic group, respectively [p = 0.167 and p = 0.186 (log-rank test), respectively]. The 3-year cumulative incidence of recurrence was 27 % (15–40) in the open group and 16 % (8–29) in the laparoscopic group [p = 0.359 (Gray’s test)].

Conclusions

Compared to open APR, laparoscopic APR provided a shorter length of hospital stay while showing no intermediate-term differences in the survival or cumulative incidence of recurrence.