Abstract Purpose To evaluate the efficacy and safety of adjunctive prednisolone therapy in children with cryptogenic epileptic encephalopathy, other than infantile spasms, and to determine its ...prognosis. Methods Prednisolone, 2 mg/kg per day for 6 weeks, tapered for a further 2 weeks, was given in combination with previously prescribed antiepileptic drugs. A retrospective assessment of 41 children thus treated included measurements of seizure frequency, electroencephalographic findings, global assessments of cognitive function, and adverse drug events. Long-term patient prognoses over a mean follow-up period of 3 years and 5 months (range, 14–90 months) were also examined. Results Of 41 patients, 32 had Lennox–Gastaut syndrome, 4 had Doose syndrome, 1 had Otahara syndrome, 2 had Landau–Kleffner syndrome, and 2 had other unspecified generalized epilepsies. After prednisolone therapy, 73% (30/41) of patients showed a reduction in seizure frequency of >50%, and 59% (24/41) became seizure free. However, only seven patients (four with Lennox–Gastaut syndrome, two with Doose syndrome, and one with unspecified generalized epilepsy) who became seizure free remained free of seizures at the time of the final follow-up. Electroencephalographic findings and global assessments of cognitive function correlated well with seizure outcomes. No significant demographic factors influenced the efficacy of prednisolone or patient prognoses after prednisolone tapering. Most adverse events were transient, or were tolerated well with conservative management, with maintenance of the medication. Conclusion Prednisolone therapy may be a safe and effective adjunct in patients with cryptogenic epileptic encephalopathies, but the high relapse rate is of concern.
This study investigated the feasibility of improving the removal of anions from a secondary effluent by coagulation/flocculation (Coag/Floc) and dissolved air flotation (DAF) using a pilot-scale ...wastewater reclamation plant in a high-tech industrial park. The pilot plant was equipped with units of Coag/Floc, DAF, activated carbon beds (AC), micro-filtration modules (MF) and a reverse-osmosis membrane (RO). It was operated in-situ continuously for around one year to evaluate the performance of anion removal in two processes - the AC-RO process and the DAF-AC-RO process. Long-term experimental results indicated that combining Coag/Floc, DAF and AC units increased the potential of pretreatment to remove anions. The removal efficiencies in Coag/Floc-DAF units were in the order phosphate > fluoride > chloride > sulfate > silicate. The charged complex of PACl flocs revealed a higher affinity for adsorption onto phosphate and fluoride than on chloride, sulfate and silicate. Comparison of the performance of Coag/Floc-DAF-AC units in the DAF-AC-RO process with that of a single AC unit in the AC-RO process demonstrated that adding Coag/Floc-DAF units increased the removal efficiencies of phosphate, fluoride and silicate by approximately 70.0 %, 42.7 % and 70.1 %, respectively. Most of the phosphate and fluoride were removed in Coag/Floc-DAF units, while most of the silicate escaped from the Coag/Floc-DAF units, and was adsorbed and/or trapped in the AC unit. The quality of reclaimed water in the DAF-AC-RO process complied with the requirements of high-tech industries in cleaning processes. Combined units of Coag/Floc-DAF-AC were therefore recommended for use in pretreatment in wastewater reclamation in high-tech industrial parks.
We present rf power dissipation mode transitions in capacitively coupled plasma (CCP) at various experimental conditions. We investigated power dissipation mode transitions from ion-dominated to ...electron-dominated dissipation mode and vice versa. Suggesting a modified simple model for rf dissipation, we theoretically evaluated the mode transitions induced by changing rf current, gas pressure, driving frequency, magnetic field, and gas species. We also observed power dissipation mode transitions for various experimental conditions by measuring the electrical characteristics. The calculated result from the simple model agreed well with the experimental result. Through a consideration of the power dissipation mode transition under different experimental conditions, this study suggests various ways to control rf power dissipation between electrons and ions.
The textile industry is one of the major industries of Taiwan but unfortunately it produces toxic and low biodegradable wastewater. To remedy this problem, this study compared the performance of the ...membrane bioreactor (MBR) and sequencing batch reactor (SBR) processes for treating real textile dyeing wastewater. The microbial diversity of the MBR process was also identified by a combination of culturing methods and molecular biotechnology. The removal efficiencies of the MBR process for color, COD, BOD, and SS were 54, 79, 99, and 100%, respectively, all higher than the corresponding parameters for the SBR process: i.e., 51, 70, 96, and 60%. All the above four parameters for the MBR effluent meet the criteria of the Taiwan EPA, while on the other hand, for the SBR process, only color and COD meet the Taiwan EPA effluent criteria. Furthermore, the genus Microbacterium, in particular Microbacterium aurum, was the most predominant population, accounting for 70.6% of the total isolates, and might be responsible for the degradation of the dyeing wastewater. Another two textile dyeing degradation bacteria, Paenibacillus azoreducens and Bacillus sp., were also observed as predominant bacteria in MBR sludge.
The molecular characteristics of β-glucans and arabinoxylans from selected hull-less barleys were examined following their sequential extraction with water (45 and 95 °C), Ba(OH)
2, Ba(OH)
2/H
2O, ...and NaOH which resulted in five distinct fractions designated as WE45, WE95, Ba(OH)
2, Ba(OH)
2/H
2O, and NaOH, respectively. Both water-extractable fractions consisted mainly of β-glucans but up to 20% of arabinoxylans were found in WE45 of normal and high amylose barley varieties. Analysis of the water-extractable β-glucans, indicated differences in molecular features (weight average molecular weight (
M
w), β-(1→4) to β-(1→3) linkage ratios, and amounts of cellulosic regions along the β-glucan chain) between WE45 and WE95, and among β-glucans from different cultivars. The variation observed in the viscoelastic behaviour of WE45 and WE95 fractions confirmed differences in the molecular weight among water-extractable β-glucans derived from various barley cultivars.
Differences in the structure of arabinoxylans from the various fractions and cultivars were also observed. Water-extractable arabinoxylans (WE45 and WE95 fractions) had significantly lower xylose to arabinose (Xyl
p/Ara
f) ratios (1.47 and 1.52) than those extracted with Ba(OH)
2 (1.70), implying a greater degree of branching in the more readily soluble fractions. Small varietal differences in molecular weight (
M
w), root mean square radius (
R
g), and polydispersity (
M
w/
M
n) among Ba(OH)
2 fractions correlated with the substitution pattern of the xylan backbone.
High-protein diets (e.g., Paleo, Atkins, South Beach, ketogenic) have gained popularity as a means to promote weight loss and avoid excess carbohydrate consumption. Yet in chronic kidney disease ...(CKD) patients, evidence suggests low dietary protein intake (DPI) leads to attenuation of kidney function decline, although concerns remain for risk of protein-energy wasting.
To examine associations of DPI with mortality in a nationally representative cohort of US adults, stratified by kidney function.
We examined the association between daily DPI scaled to actual body weight (ABW), ascertained by 24-h dietary recall, with all-cause mortality among 27,604 continuous NHANES adult participants (1999–2010), stratified according to impaired versus normal kidney function (estimated glomerular filtration rates <60 compared with ≥60 ml/min/1.72 m2, respectively), using multivariable Cox models. We also examined the relation between high biological value (HBV) protein consumption with mortality.
In participants with impaired kidney function, a high DPI of ≥1.4 g/kg ABW/day was associated with higher mortality, while lower DPI levels were not associated with mortality (reference, 0.6 to <1.0 g/kg ABW/day): the adjusted HRs (aHRs) were 1.09 (95% CI: 0.90, 1.32), 1.03 (95% CI: 0.82, 1.29), and 1.37 (95% CI: 1.02, 1.85) for DPI <0.6, 1.0 to <1.4, and ≥1.4 g/kg ABW/day, respectively. Yet in participants with normal kidney function, a low DPI of <0.6 g/kg ABW/day was associated with higher mortality, whereas higher DPI levels were not associated with death: the aHRs were 1.18 (95% CI: 1.04, 1.34), 0.92 (95% CI: 0.81, 1.04), and 0.99 (95% CI: 0.85, 1.16) for DPI <0.6, 1.0 to <1.4, and ≥1.4 g/kg ABW/day, respectively. The highest 2 tertiles of HBV consumption were associated with higher mortality in participants with impaired kidney function.
Among participants with impaired kidney function, a higher DPI and greater HBV consumption were associated with higher mortality, whereas a lower DPI was associated with higher mortality in those with normal kidney function. Further studies are needed to elucidate the specific pathways between higher DPI and mortality in CKD.
Patient self-management is a key approach to manage non-communicable diseases. A pharmacist-led approach in patient self-management means collaborative care between pharmacists and patients. However, ...the development of both patient self-management and role of pharmacists is limited in Hong Kong. The objectives of this study are to understand the perspectives of physicians, pharmacists, traditional Chinese medicine (TCM) practitioners, and dispensers on self-management of patients with chronic conditions, in addition to exploring the possibilities of developing pharmacist-led patient self-management in Hong Kong.
Participants were invited through the University as well as professional networks. Fifty-one participants comprised of physicians, pharmacists, TCM practitioners and dispensers participated in homogenous focus group discussions. Perspectives in patient self-management and pharmacist-led patient self-management were discussed. The discussions were audio recorded, transcribed and analysed accordingly.
The majority of the participants were in support of patients with stable chronic diseases engaging in self-management. Medication compliance, monitoring of disease parameters and complications, lifestyle modification and identifying situations to seek help from health professionals were generally agreed to be covered in patient self-management. All pharmacists believed that they had extended roles in addition to drug management but the other three professionals believed that pharmacists were drug experts only and could only play an assisting role. Physicians, TCM practitioners, and dispensers were concerned that pharmacist-led patient self-management could be hindered, due to unfamiliarity with the pharmacy profession, the perception of insufficient training in disease management, and lack of trust of patients.
An effective chronic disease management model should involve patients in stable condition to participate in self-management in order to prevent health deterioration and to save healthcare costs. The role of pharmacists should not be limited to drugs and should be extended in the primary healthcare system. Pharmacist-led patient self-management could be developed gradually with the support of government by enhancing pharmacists' responsibilities in health services and developing public-private partnership with community pharmacists. Developing facilitating measures to enhance the implementation of the pharmacist-led approach should also be considered, such as allowing pharmacists to access electronic health records, as well as deregulation of more prescription-only medicines to pharmacy-only medicines.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Chronic low back pain (CLBP), the most prevalent chronic pain condition, imparts substantial disability and discomfort. Cognitive behavioral therapy (CBT) reduces the effect of CLBP, but access is ...limited.
To determine whether a single class in evidence-based pain management skills (empowered relief) is noninferior to 8-session CBT and superior to health education at 3 months after treatment for improving pain catastrophizing, pain intensity, pain interference, and other secondary outcomes.
This 3-arm randomized clinical trial collected data from May 24, 2017, to March 3, 2020. Participants included individuals in the community with self-reported CLBP for 6 months or more and an average pain intensity of at least 4 (range, 0-10, with 10 indicating worst pain imaginable). Data were analyzed using intention-to-treat and per-protocol approaches.
Participants were randomized to (1) empowered relief, (2) health education (matched to empowered relief for duration and format), or (3) 8-session CBT. Self-reported data were collected at baseline, before treatment, and at posttreatment months 1, 2, and 3.
Group differences in Pain Catastrophizing Scale scores and secondary outcomes at month 3 after treatment. Pain intensity and pain interference were priority secondary outcomes.
A total of 263 participants were included in the analysis (131 women 49.8%, 130 men 49.4%, and 2 other 0.8%; mean SD age, 47.9 13.8 years) and were randomized into 3 groups: empowered relief (n = 87), CBT (n = 88), and health education (n = 88). Empowered relief was noninferior to CBT for pain catastrophizing scores at 3 months (difference from CBT, 1.39 97.5% CI, -∞ to 4.24). Empowered relief and CBT were superior to health education for pain catastrophizing scores (empowered relief difference from health education, -5.90 95% CI, -8.78 to -3.01; P < .001; CBT difference from health education, -7.29 95% CI, -10.20 to -4.38; P < .001). Pain catastrophizing score reductions for empowered relief and CBT at 3 months after treatment were clinically meaningful (empowered relief, -9.12 95% CI, -11.6 to -6.67; P < .001; CBT, -10.94 95% CI, -13.6 to -8.32; P < .001; health education, -4.60 95% CI, -7.18 to -2.01; P = .001). Between-group comparisons for pain catastrophizing at months 1 to 3 were adjusted for baseline pain catastrophizing scores and used intention-to-treat analysis. Empowered relief was noninferior to CBT for pain intensity and pain interference (priority secondary outcomes), sleep disturbance, pain bothersomeness, pain behavior, depression, and anxiety. Empowered relief was inferior to CBT for physical function.
Among adults with CLBP, a single-session pain management class resulted in clinically significant improvements in pain catastrophizing, pain intensity, pain interference, and other secondary outcomes that were noninferior to 8-session CBT at 3 months.
ClinicalTrials.gov Identifier: NCT03167086.
Multichannel spectroscopic diagnostics have been installed on the TS-4 compact toroid experiment at the University of Tokyo with view chords designed for measuring 2D ion bulk flow velocities and ...temperatures. Computerized vector tomography reconstructs velocities from the Doppler-shifted line shapes and scalar emissivity from the scalar tomography of the zeroth moment measurements. The first results show bulk ion flow field in a 2D plane with significant cross-field flow possibly due to the slingshot effect during reconnection merging of two counter-helicity spheromaks. The results are limited by a center column and available viewports in the vacuum chamber. This proof-of-principle experiment shows that, with increased access, 3D velocity flow fields can be completely reconstructed in compact toroid plasma experiments.
The effects of Ce addition on the microstructure, age hardening response and mechanical properties of an indirect-extruded Mg-5wt.%Sn-4Zn (TZ54) alloy were investigated. Addition of Ce accelerated ...the aging response with the peak aging time moving from 300 h in TZ54 to 30 h in Mg-5wt.%Sn-4Zn-1Ce (TZE541), while the peak harness was similar to each other. The addition of Ce also caused an increase in the precipitation stability during overageing. Though the tensile strength of extruded TZ54 was improved by the addition of Ce, the tensile strength of the TZE541 was reduced after T6-treatment. The combined mechanical properties of the present as-extruded alloys by solution heat-treatment and artificial aging (T6) were comparable to commercial wrought magnesium alloys.
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