Abstract Mucous membrane pemphigoid is a systemic disorder that primarily affects mucous membranes. When localized to the conjunctiva, it is known as ocular cicatricial pemphigoid, a potentially ...blinding disease. Ocular cicatricial pemphigoid is an indication for systemic immunosuppressive treatment to achieve adequate remission. Immunosuppressive agents are selected with a “stepladder” approach, commencing with medications having the fewest side effects. We provide an update of the literature on immunomodulatory agents since 2011 as additional treatment modalities have been explored in the last 4 years.
Background:
Frailty has important implications for the care of the elderly and how their needs are met.
Objective:
To assess clinicians’ acknowledgement of frailty in the electronic medical records ...(EMR) and the impact of frailty recognition on advance care planning (ACP).
Methods:
We performed a retrospective study on 119 patients 65 years or older with moderate or severe frailty assessed using a validated frailty scale. We reviewed notes to determine if primary team identified frailty and obtained data regarding ACP planning. We present the characteristics and outcomes of patients who were identified as frail and compared them with patients whose frailty was unrecognized in EMR.
Results:
Among the 119 frail patients, one third were ≥85 years and one-year mortality was 25.4%. Most patients were taking ≥5 medications and only 14.3% rated their health as excellent or good prior to hospitalization. Only 15 patients (12.6%) were identified as frail in the EMR. The only significant differences between those recognized versus unrecognized frail were body mass index (23.4 vs 28.6, p = 0.02) and reported weight loss in the 3 months prior to admission (93.3% vs 59.6%, p = 0.009). Geriatric or palliative care consults, and changes in code status to do-not resuscitate were more frequent among those recognized vs not. (33.3% vs 11.5%; 13.3% vs 1.9% respectively).
Conclusion:
Documentation of frailty in the EMR was rare and it was associated with a lower likelihood of providing advance care planning. These findings suggest a need for consistent frailty assessment, which might promote patient-centered care.
In this work, Additive Friction Stir Deposition (AFSD) was employed for ballistic repair of AA7075-T6511 plates. After penetration with 7.62 × 51 mm FMJ rounds, the AA7075-T6511 plates were repaired ...by AFSD using the same AA7075-T6511 feedstock material. The repaired plates were impacted and penetrated with the same 7.62 × 51 mm FMJ rounds, and the surface damage characteristics including the initial and residual velocities were compared against the control wrought plates. The AFSD process successfully repaired the damaged control plates with the same alloy, without any observable defects such as large cracks or pores prior to impact tests. Although the surface appeared pristine other than milling marks, the surface damage characteristics of the repaired plates were significantly different than the control plates. The increase of spalling and petalling with the repaired material can be attributed to the thermomechanical processing of AFSD, which would alter the control T6511 temper of the feedstock due to coarsening of strengthening precipitates. A cross-sectioned repaired plate was analyzed using microhardness plots and optical microscopy to illustrate the effectiveness of the AFSD process for ballistic repair by depositing the same material into the damaged area. Despite the surface damage discrepancy, the repaired plates performed similarly to the control plates with respect to initial and residual velocities.
Graphical Abstract
•Application of aromatic-selective size exclusion chromatography (ASSEC) for the quantification of petroleum aromatics.•The method is suitable for the whole boiling range of petroleum samples ...(naphtha to vacuum gas oil).•Benzene, naphthalene, and phenanthrene were selected as external standards for the quantification of low-boiling, mid-boiling and high-boiling samples, respectively.•The method can potentially be used for simultaneous quantification and average compositional information of aromatics.
Aromatics in petroleum mixtures draw significant attention from exploration, refining (fuels and petrochemicals) and environmental emissions perspectives. The current trend of shifting petroleum feedstock to chemicals rather than fuels further demands comprehensive aromatics characterization. While qualitative methods are readily available, quantitative approaches are always sought to determine the yield of products and/or conversion of petroleum aromatics. Here, we introduce a method based on aromatic-selective size exclusion chromatography (ASSEC) for the quantification of aromatics in petroleum mixtures. The method is simple to adapt, easy to operate, and relatively fast (minutes). Additionally, it has the ability to provide a trend of aromatics content across the whole boiling range of petroleum samples (naphtha to vacuum gas oil). The data from ASSEC can be used for relevant industrial applications, such as the optimization of high-throughput experiments during conversion of petroleum to petrochemicals via thermal/catalytically cracked reactions. Further optimization of external calibration standards and detection wavelengths will reduce the difference in determined aromatic content between ASSEC and contemporary time- intensive analytical techniques (GC × GC and SARA fractionation).
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•Coined a new term “Aromatic-selective size exclusion chromatography (ASSEC)” in petroleum characterization.•Evaluation of ASSEC in distilled cuts, residues, and crude oils.•A simple ...and fast approach for the analysis of aromatic compounds in petroleum samples.•Aromatic profiles of the distilled cuts displayed marked similarities irrespective of the crude oil’s origin.
The shifting of focus of petroleum products from fuels to petrochemicals demands the comprehensive characterization of petroleum components, particularly of aromatic compounds. Reliable characterization will help in the conversion of low-value aromatics to high-value petrochemicals using different processing conditions. To that end, we have applied an aromatic-selective size exclusion chromatographic method for the characterization of aromatic compounds in high-boiling fractions (cuts), distilled from three crude oils differing in density (or API gravity). Crude oils were fractionated to predefined cut temperatures and the average compositional information (in terms of Mn and Mw) was obtained. It was found that the compositions of the distilled cuts displayed marked similarities, irrespective of the crude oil’s origin. The compositional information was further supported by high performance liquid chromatography and comprehensive two-dimensional gas chromatography. The increase in average molar mass of the residue fraction was reflected in the increase in density of each crude oil studied. This method is simple to adapt, fast (<30 min), and suitable for providing average compositional information. Moreover, the analysis time can further be reduced (<10 min) using smaller particle size columns, as demonstrated in the case of polymer analysis. This new approach will provide a rapid alternative for average compositional information of aromatic compounds in complex petroleum samples to support high-throughput process experiments.
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•A new empirical model is presented for calculating the boiling profile of a petroleum sample based on experimentally available parameters from typical speciation methods, such as ...GCxGC and FT-ICR MS.•The model predicts the boiling temperature of average components, ranging from saturated compounds to polyaromatic compounds with 2 sulfur atoms and 6 aromatic rings, in a wide range of crude oil fractions from middle distillates to the vacuum residue.•Boiling distributions produced from GCxGC and FT-ICR MS data compare within 20 °C against measured distillation curves.•A coverage factor is produced to qualify how well a speciation data set covers the sample composition, and how much of the lower and higher-boiling portions have been omitted in the data set.
An empirical model is presented for generating the boiling curve of a petroleum sample based on parameters that are experimentally available using typical speciation techniques. The approach estimates the boiling point distribution of the detected components and allows a comparison with the simulated distillation profile of the sample. The model is shown to predict the boiling behavior of the speciation-derived average components in crude oil distillation fractions, which match the measured average distillation temperature of the fractions. The model is then applied to generate boiling distributions, based on mass spectrometric and gas chromatographic speciation data, which match the measured simulated-distillation curves with less than 20 °C difference. The model is also applied to the isolated fraction of saturated compounds, where the modeled boiling profile matches well with the measured distillation profile of the entire sample. This confirms that the model, although built using Fourier transform ion cyclotron resonance mass spectrometry data of aromatic compounds, extends to data obtained using comprehensive 2-dimensional gas chromatography, and also describes the boiling behavior of saturated compounds speciated by field desorption time of flight mass spectrometry. Consequently, the modeled boiling distribution enables an assessment of how well a speciation measurement describes the sample, and provides an estimation of lower and higher-boiling portions that have been omitted in the data set.
Antiphospholipid syndrome is characterised by a variety of clinical and immunological manifestations. The clinical hallmarks of this syndrome are thrombosis and poor obstetric outcomes, including ...miscarriages, fetal loss and severe pre-eclampsia. The main antiphospholipid antibodies include lupus anticoagulant, anticardiolipin and anti-β2-glycoprotein I. The combination of aspirin and heparin is considered the standard of care for women with antiphospholipid syndrome and embryo–fetal losses; however, aspirin in monotherapy may have a place in women with recurrent early miscarriage. A good benefit–risk ratio of low-molecular-weight heparin in pregnancy thrombosis treatment has been reported. Warfarin must be avoided if possible throughout the first trimester of pregnancy. Adequate pregnancy management of women with antiphospholipid syndrome should include co-ordinated medical-obstetrical care, a close follow-up protocol and a good neonatal unit. Close blood pressure control and early detection of proteinuria, together with Doppler studies of the utero–placental circulation should be included in the management protocol.
Anti-TNF agents are increasingly being used for a rapidly expanding number of rheumatic and systemic autoimmune diseases. As a result of this use, and of the longer follow-up periods of treatment, ...there are a growing number of reports of the development of autoimmune processes related to anti-TNF agents. The clinical characteristics, outcomes, and patterns of association with the different anti-TNF agents used in all reports of autoimmune diseases developing after TNF-targeted therapy, were analyzed through a baseline Medline search of articles published between January 1990 and May 2008 ( www.biogeas.org ). A total of 379 cases of autoimmune diseases secondary to TNF-targeted therapies were identified. The anti-TNF agents were administered for rheumatoid arthritis in more than 80% of cases. The use of anti-TNF agents has been associated with an increasing number of cases of autoimmune diseases, principally cutaneous vasculitis, lupus-like syndrome, systemic lupus erythematosus and interstitial lung disease. Other autoimmune diseases associated with TNF-targeted therapies have been recently described, e.g. sarcoidosis, antiphospholipid syndrome-related features, and autoimmune hepatitis or uveitis. Large, prospective, postmarketing studies are required to evaluate the risk of developing autoimmune diseases in patients receiving TNF-targeted therapies.
Abstract Introduction Hemophagocytic syndromes (hemophagocytic lymphohistiocytosis, HLH) are characterized by a wide range of etiologies, symptoms, and outcomes, but have a common etiopathogenic ...pathway leading to organ damage: an excessive inflammatory response. Biological therapies have been proposed as a therapeutic option for refractory HLH, but have also been related to the development of HLH in severe immunosuppressed patients. Objectives and methods The purpose of this study was to analyze the clinical characteristics and outcomes of adult patients who developed HLH after receiving biological therapies. Results We identified 30 patients (29 from the PubMed search and one unpublished case), including 19 women and 11 men, with a mean age of 46.5 years. Underlying diseases consisted of rheumatologic/autoimmune diseases in 24 patients and hematological neoplasia in the remaining 6. Biological agents received before the development of HLH were mainly anti-TNF agents ( n = 19). Search for microorganisms confirmed systemic infection in 20 (67%) patients, including Mycobacterium tuberculosis ( n = 5), cytomegalovirus (CMV) ( n = 4), Epstein–Barr virus (EBV) ( n = 3), Histoplasma capsulatum ( n = 3), Escherichia coli ( n = 2), Staphylococcus aureus , Leishmania amastigotes and Brucella melitensis ( n = 1, respectively); viral infections were mainly reported in inflammatory bowel disease (IBD) patients. Patients with infections had more frequently received previous immunosuppressive therapies ( p = 0.036) and had lower leukocyte counts ( p = 0.020) in comparison with patients without associated infections. The outcome was described in 29 patients. After a mean follow-up of 6.3 months, 8 patients died (28%) and 6 had received anti-TNF agents. There was a high mortality rate in patients aged >65 years and those with tuberculosis (62% and 60%, respectively). Conclusions In patients receiving biological therapies who develop HLH, searching for a concomitant infectious process is mandatory, and specific surveillance for EBV/CMV infections (in patients with IBD) and for bacteria, including mycobacteria (in elderly patients receiving anti-TNF therapy), is recommended.
