Adsorptive removal of lead from aqueous solutions by amine–functionalized magMCM-41 as a low–cost nanocomposite prepared from rice husk: Modeling and optimization by response surface methodology

Amorphous silica that was extracted from rice husk was used to synthesize the magMCM-41 mesoporous silica. This was then functionalized by the APTMS group in order to produce NH₂-magMCM-41 as a novel and low–cost adsorbent. The XRD, VSM, N₂ adsorption–desorption, FT–IR, TGA, SEM and TEM analyses were utilized to characterize the produced materials. In order to optimize the adsorption of the Pb(II) ions, the RSM (response surface methodology) was applied by using the synthesized adsorbent in aqueous solutions. A rotatable CCD (central composite design) was adopted to carry out the experiments and RSM was used to analyze them. Three independent factors namely, initial solution pH (3–7), adsorbent dosage (0.1–2 g L^?1), and initial Pb(II) concentration (15–150 mg L^?1) were used to investigate the removal procedure. According to the obtained results, the initial solution pH of 5.22, adsorbent dosage of 0.1 g L^?1, and initial Pb(II) concentration of 150 mg L^?1 were considered as the optimum conditions with 64.32% removal of Pb(II) and an adsorption capacity of 540.64 mg g^?1. The maximum removal efficiency of Pb(II) ions was found to be 96.76%. The Sips isotherm model represents a better correlation with equilibrium data. It was reported by the kinetic study that data taken from the experiments fitted better to the pseudo–second–order model compared to the pseudo–first–order and intraparticle diffusion models. Finally, according to the thermodynamic study, the removal process strongly depends on temperature, which indicates an exothermic behavior and spontaneous nature of the adsorption.     

Extended-release niacin with laropiprant : a review on efficacy, clinical effectiveness and safety

INTRODUCTION: Although treatment with statins reduces cardiovascular (CV) events in patients with dyslipidemia, a residual 60 - 70% CV risk remains. This CV risk may be inversely related to high-density lipoprotein-cholesterol (HDL-C). Interest in niacin has re-emerged because of its HDL-C raising effects. The flushing associated with niacin which has previously affected patient compliance can now be significantly blocked with laropiprant (LRPT). AREAS COVERED: This review aims to assess the efficacy, clinical effectiveness and safety of extended-release niacin (ERN) with LRPT. The authors searched PubMed and MEDLINE for literature published between January 2006 and November 2011, for efficacy, clinical effectiveness and safety reports of ERN with LRPT. EXPERT OPINION: Niacin has been shown to prevent CV events, reduce mortality and has beneficial effects on vascular endothelial function. Evidence suggests that this is due to its broad-spectrum lipid altering properties, including lowering lipoprotein (a) (Lp(a)), and its pleiotropic actions. While side effects associated with niacin have limited its use in the past, the extended-release formulations and co-administration of LRPT have increased its tolerability, particularly by reducing flushing. The authors advise that ERN should be used in patients with a high risk of cardiovascular disease, who have failed to reach conventional targets.     

The short-term effects of low-level laser therapy in the management of breast-cancer-related lymphedema

Background  

Breast-cancer-related lymphedema (BCRL) is a chronic disease, and currently there is no definitive treatment for it. There are some therapeutic interventions targeted to decrease the limb swelling and the associated problems. Low-level laser therapy (LLLT) has been used in the treatment of post-mastectomy lymphedema since 2007 in the US. The aim of this study is to review our short-term experience with LLLT in the treatment of BCRL.     

Doctors' perceptions of laboratory monitoring in office practice

Background Laboratory monitoring has been increasingly recognized as an important area for improving patient safety in ambulatory care. Little is known about doctors' attitudes towards laboratory monitoring and potential ways to improve it. Methods Six focus groups and one individual interview with 20 primary care doctors and nine specialists from three Massachusetts communities. Results Participants viewed laboratory monitoring as a critical, time‐consuming task integral to their practice of medicine. Most believed they commit few laboratory monitoring errors and were surprised at the error rates reported in the literature. They listed various barriers to monitoring, including not knowing which doctor was responsible for ensuring the completion of laboratory monitoring, uncertainty regarding the necessity of monitoring, lack of alerts/reminders and patient non‐adherence with recommended monitoring. The primary facilitator of monitoring was ordering laboratory tests while the patient is in the office. Primary care doctors felt more strongly than specialists that computerized alerts could improve laboratory monitoring. Participants wanted to individualize alerts for their practices and warned that alerts must not interrupt work flow or require too many clicks. Conclusions Doctors in community practice recognized the potential of computerized alerts to enhance their monitoring protocols for some medications. They viewed patient non‐adherence as a barrier to optimal monitoring. Interventions to improve laboratory monitoring should address doctor workflow issues, in addition to patients' awareness of the importance of fulfilling recommended therapeutic monitoring to prevent adverse drug events.     

Can Nomograms Predict Non–Sentinel Lymph Node Metastasis After Neoadjuvant Chemotherapy in Sentinel Lymph Node–Positive Breast Cancer Patients?

BackgroundThe predictive probability of breast cancer nomograms for non–sentinel node metastases (NSLNM) after neoadjuvant chemotherapy (NCT) in patients with a positive sentinel lymph node (SLN) biopsy is unknown. The aim of this study was to evaluate the accuracy of 3 different nomograms in patients receiving NCT.Patients and MethodsBetween 1999 and 2007, 54 patients presented with clinically N0 disease received NCT. Nomograms developed by Memorial Sloan-Kettering Cancer Center (MSKCC), Stanford University, and Tenon Hospital were used to calculate the probability of NSLNM by using tumor size at presentation and after NCT for the same patient. The discrimination of the nomograms was assessed by calculating the area under (AUC) the receiver operating characteristic curve, and it was accepted that AUC values 0.7-0.8 represent considerable discrimination.ResultsThe median patient age was 50.9 years (range, 29–67 years). Twenty-two patients (38.8%) had positive NSLNM. The MSKCC and the Stanford nomograms yielded similar AUC regardless of whether initial or post-NCT tumor size was used to determine predicted probability of NSLNM (AUCs were < 0.70). AUC was 0.74 for the Tenon model using tumor size at presentation. After NCT, the AUCs were 0.64, 0.57, and 0.78 for the MSKCC, the Stanford, and the Tenon nomograms, respectively.ConclusionAlthough the AUC of the Tenon model was acceptable for accuracy, we found a lower rate for predicting negative NSLNM in our group than in the Tenon Hospital report. All of the nomograms developed for use in the non-NCT population need to be used with caution in the NCT population     

Small-fibre neuropathy in men with type 1 diabetes and erectile dysfunction: a cross-sectional study

Aims/hypothesis

The aim of this study was to identify the contribution of small- and large-fibre neuropathy to erectile dysfunction in men with type 1 diabetes mellitus.

Methods

A total of 70 participants (29 without and 41 with erectile dysfunction) with type 1 diabetes and 34 age-matched control participants underwent a comprehensive assessment of large- and small-fibre neuropathy.

Results

The prevalence of erectile dysfunction in participants with type 1 diabetes was 58.6%. After adjusting for age, participants with type 1 diabetes and erectile dysfunction had a significantly higher score on the Neuropathy Symptom Profile (mean ± SEM 5.3 ± 0.9 vs 1.8 ± 1.2, p = 0.03), a higher vibration perception threshold (18.3 ± 1.9 vs 10.7 ± 2.4 V, p = 0.02), and a lower sural nerve amplitude (5.0 ± 1.1 vs 11.7 ± 1.5 mV, p = 0.002), peroneal nerve amplitude (2.1 ± 0.4 vs 4.7 ± 0.5 mV, p < 0.001) and peroneal nerve conduction velocity (34.8 ± 1.5 vs 41.9 ± 2.0 m/s, p = 0.01) compared with those without erectile dysfunction. There was also evidence of a marked small-fibre neuropathy with an impaired cold threshold (19.7 ± 1.4°C vs 27.3 ± 1.8°C, p = 0.003), warm threshold (42.9 ± 0.8°C vs 39.0 ± 0.9°C, p = 0.005) and heart rate variability (21.5 ± 3.1 vs 30.0 ± 3.7 beats/min, p = 0.001) and reduced intraepidermal nerve fibre density (2.8 ± 0.7 vs 5.9 ± 0.7/mm, p = 0.008), corneal nerve fibre density (12.6 ± 1.5 vs 23.9 ± 2.0/mm², p < 0.001), corneal nerve branch density (12.7 ± 2.5 vs 31.6 ± 3.3/mm², p < 0.001) and corneal nerve fibre length (8.3 ± 0.7 vs 14.5 ± 1.0 mm/mm², p < 0.001) in participants with type 1 diabetes and erectile dysfunction. Erectile dysfunction correlated significantly with measures of both large- and small-fibre neuropathy.

Conclusions/interpretation

Small-fibre neuropathy is prominent in patients with type 1 diabetes, and is associated with erectile dysfunction and can be objectively quantified using corneal confocal microscopy. This may allow the identification of patients who are less likely to respond to conventional therapies such as phosphodiesterase type 5 inhibitors.

     

Cutaneous facial sinus tract of dental origin

Abstract: Cutaneous sinus tract on the head and neck area in a child may originate from dental disease. A high degree of clinical suspicion and complementary tests are often needed, as the diagnosis is usually not straight forward. Anatomical correlation is also useful in tracing the affected tooth or teeth. We present the case of a boy with a facial sinus tract that originated from periapical abscesses of maxillary molars.     

Effect of oral pancreatic enzyme administration on digestive function in healthy subjects: comparison between two enzyme preparations

Background : Intraduodenal proteases exert a negative feedback on pancreatic secretion.
Aim : To investigate the effect of two pancreatic enzyme preparations (enteric-coated tablets, and capsules with enteric-coated microtablets) on postprandial pancreatic and bile acid secretion, gastroduodenal motility and release of gastrin and pancreatic polypeptide in healthy humans.
Methods : Twenty healthy males were studied on two different days one week apart. After an overnight fast a nine-lumen motility tube was positioned with the distal tip at the Treitz angle. On each study day, 30 min after an interdigestive migrating motor complex-phase III, a semi-liquid test meal was given either alone ( n =20) or with enzymes (3 tablets ( n =10) or 2 capsules with microtablets ( n =10); 40000 U lipase and 2000 proteases) in a randomized order, and the study continued over 2 h. Motility was continuously recorded with four ports in the antrum and three in the duodenum, using a low-compliance pneumohydraulic perfusion system. Secretion of human-specific pancreatic elastase and bile acids was measured by a standard duodenal intubation perfusion technique. Plasma concentrations of gastrin and pancreatic polypeptide were measured by specific radioimmunoassays.
Results : Postprandial pancreatic secretion was significantly reduced by administration of microtablets (median 82 mg/2 h vs. 70 mg/2 h, P <0.02) but not by tablets (median 59 mg/2 h vs. 58 mg/2 h, N.S.). No changes were observed in bile acid secretion, antroduodenal motility or release of gastrin and pancreatic polypeptide.
Conclusions : Oral administration of pancreatic enzymes at normal therapeutic doses significantly inhibits postprandial pancreatic secretion in healthy humans, when capsules with enteric-coated microtablets are given. Exogenous pancreatic enzymes have no significant effect on bile acid secretion, gastroduodenal motility and hormone release.