Aims
The aim of this study was to assess long‐term safety of intravenous cardiovascular agents—vasodilators, inotropes and/or vasopressors—in acute heart failure (AHF).
Methods and results
The ...European Society of Cardiology Heart Failure Long‐Term (ESC‐HF‐LT) registry was a prospective, observational registry conducted in 21 countries. Patients with unscheduled hospitalizations for AHF (n = 6926) were included: 1304 (18.8%) patients received a combination of intravenous (i.v.) vasodilators and diuretics, 833 (12%) patients received i.v. inotropes and/or vasopressors. Primary endpoint was long‐term all‐cause mortality. Main secondary endpoints were in‐hospital and post‐discharge mortality. Adjusted hazard ratio (HR) showed no association between the use of i.v. vasodilator and diuretic and long‐term mortality HR 0.784, 95% confidence interval (CI) 0.596–1.032 nor in‐hospital mortality (HR 1.049, 95% CI 0.592–1.857) in the matched cohort (n = 976 paired patients). By contrast, adjusted HR demonstrated a detrimental association between the use of i.v. inotrope and/or vasopressor and long‐term all‐cause mortality (HR 1.434, 95% CI 1.128–1.823), as well as in‐hospital mortality (HR 1.873, 95% CI 1.151–3.048) in the matched cohort (n = 606 paired patients). No association was found between the use of i.v. inotropes and/or vasopressors and long‐term mortality in patients discharged alive (HR 1.078, 95% CI 0.769–1.512). A detrimental association with inotropes and/or vasopressors was seen in all geographic regions and,
among catecholamines, dopamine was associated with the highest risk of death (HR 1.628, 95% CI 1.031–2.572 vs. no inotropes).
Conclusions
Vasodilators did not demonstrate any association with long‐term clinical outcomes, while inotropes and/or vasopressors were associated with increased risk of all‐cause death, mostly related to excess of in‐hospital mortality in AHF.
The development of cardiac allograft vasculopathy remains the Achilles heel of cardiac transplantation. Unfortunately, the definitions of cardiac allograft vasculopathy are diverse, and there are no ...uniform international standards for the nomenclature of this entity. This consensus document, commissioned by the International Society of Heart and Lung Transplantation Board, is based on best evidence and clinical consensus derived from critical analysis of available information pertaining to angiography, intravascular ultrasound imaging, microvascular function, cardiac allograft histology, circulating immune markers, non-invasive imaging tests, and gene-based and protein-based biomarkers. This document represents a working formulation for an international nomenclature of cardiac allograft vasculopathy, similar to the development of the system for adjudication of cardiac allograft rejection by histology.
Data on gastroenteropancreatic neuroendocrine neoplasms (NEN) G3 (well-differentiated neuroendocrine tumors (NET G3) and neuroendocrine carcinoma (NEC)) are limited. We retrospectively study patients ...with NET G3 and NEC from eight European centers. Data examined included clinical and pathological characteristics at diagnosis, therapies and outcomes. Two hundred and four patients were analyzed (37 NET G3 and 167 NEC). Median age was 64 (21–89) years. Tumor origin included pancreas (32%) and colon-rectum (27%). The primary tumor was resected in 82 (40%) patients. Metastatic disease was evident at diagnosis in 88% (liver metastases: 67%). Median Ki-67 index was 70% (30% in NET G3 and 80% in NEC; P<0.001). Median overall survival (OS) for all patients was 23 (95% CI: 18–28) months and significantly higher in NET G3 (99 vs 17 months in NEC; HR=8.3; P<0.001). Platinum-etoposide first line chemotherapy was administered in 113 (68%) NEC and 12 (32%) NET G3 patients. Disease control rate and progression free survival (PFS) were significantly higher in NEC compared to NET G3 (P<0.05), whereas OS was significantly longer in NET G3 (P=0.003). Second- and third-line therapies (mainly FOLFIRI and FOLFOX) were given in 79 and 39 of NEC patients; median PFS and OS were 3.0 and 7.6 months respectively after second-line and 2.5 and 6.2 months after third-line chemotherapy. In conclusion, NET G3 and NEC are characterized by significant differences in Ki-67 index and outcomes. While platinum-based chemotherapy is effective in NEC, it seems to have limited value in NET G3.
Natural extracts obtained from grape pomace are particularly interesting, due to the substantial variety of valuable compounds present with health benefits, specifically phenolic compounds such as ...anthocyanins, trans‐resveratrol, quercetin, and proanthocyanidins. The production of such extracts has been recognized as a profitable way to valorize grape byproducts, which are low‐value and most abundant. First, the effect of the solvent on the extraction of bioactive compounds from grape pomace is studied. The selected solvents are water and ethanol, biocompatible and available in wineries and distilleries. Then, different types of grape pomace obtained along the various stages of current industrial winemaking and distillation processes are analyzed. As a result, the best stage of the winemaking and distillation processes for pomace valorization is identified, corresponding to the grape byproduct with the highest potential as source of bioactive compounds. These studies were performed with Vitis vinifera variety of Tempranillo grapes (same year, same vineyard).
Ionic liquids (ILs), with their unique and tunable properties, are attracting the interest of both academia and refining companies as potential solvents for the extraction of specific compounds from ...hydrocarbons’ streams. For such a purpose, the knowledge of the mutual solubilities between ionic liquids and hydrocarbons is required. Experimental measurements for all these systems are impracticable due to the large number of possible combinations of ionic liquids and hydrocarbons. Thus, a deeper understanding of the interactions taking place, and ruling the phase behavior, and the development of predictive models are essential issues to forecast a general picture of the liquid−liquid equilibria (LLE) between ionic liquids and hydrocarbons. In this work an overview of the mutual solubilities between ionic liquids and hydrocarbons is presented. A review of the experimental data available is reported, and the effect of various structural features of both the ionic liquids and the hydrocarbons through their mutual solubilities behavior is discussed. The capability of the Conductor-like Screening Model for Real Solvents (COSMO-RS) to predict the LLE of (IL + hydrocarbon) binary systems is further evaluated. More than 150 binary systems were investigated. It is shown that COSMO-RS allows a semiquantitative description of the LLE experimental data for the systems studied. Moreover, COSMO-RS majorly provides a correct qualitative trend of the phase behavior dependence of the ionic liquids and molecular compounds. Therefore, COSMO-RS can be a useful predictive tool with great potential in the screening of ionic liquids for specific extraction applications.
•The effect of anion-exchange membrane type on arsenate transport was investigated.•A new concept of using sulphate as a driving counter-ion for arsenate removal is proposed.•Addition of ferric ...sulphate for arsenic precipitation improved the process performance.•The ion-exchange membrane process for arsenate removal proved to be simple, efficient and safe.•The treatment proposed could be of potential interest for applications in rural regions.
A possible limitation of applying Donnan dialysis for arsenate removal from drinking water supplies is when sulphate is present as an accompanying anion in the water to be treated, due to strong competition between arsenate and sulphate transport through standard grade anion-exchange membranes. This work aims at evaluating the feasibility of employing an ion-exchange membrane Donnan dialysis based process with a new strategy of using sulphate as the driving counter-ion for arsenate counter-transport and removal from sulphate-containing drinking water streams. The process performance with different arsenate receiving solutions (containing chloride or sulphate as driving counter-ions and with or without arsenic precipitation) was investigated and compared. Experiments were carried out to separate arsenate from contaminated water comparing the performance of three anion-exchange membranes: one with mono-valent anion permselective properties and two standard grade membranes. As selection criteria, the transport rate of arsenate and its membrane retention were investigated. The effects of pH variation and co-ion (cation) leakage on the Donnan dialysis process efficiency were also studied. Efficient arsenic removal was achieved through integrating Donnan dialytic transport of arsenate with its simultaneous precipitation in the receiving compartment with FeSO4. The process proposed is environmentally friendly and with minimal maintenance requirements, which makes it especially attractive to be applied in rural areas located far from centralized drinking water supply infrastructures.
Membrane processes are complex systems, often comprising several physicochemical phenomena, as well as biological reactions, depending on the systems studied. Therefore, process modelling is a ...requirement to simulate (and predict) process and membrane performance, to infer about optimal process conditions, to assess fouling development, and ultimately, for process monitoring and control. Despite the actual dissemination of terms such as Machine Learning, the use of such computational tools to model membrane processes was regarded by many in the past as not useful from a scientific point-of-view, not contributing to the understanding of the phenomena involved. Despite the controversy, in the last 25 years, data driven, non-mechanistic modelling is being applied to describe different membrane processes and in the development of new modelling and monitoring approaches. Thus, this work aims at providing a personal perspective of the use of non-mechanistic modelling in membrane processes, reviewing the evolution supported in our own experience, gained as research group working in the field of membrane processes. Additionally, some guidelines are provided for the application of advanced mathematical tools to model membrane processes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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