Radiation-induced damage of the upper gastrointestinal (GI) tract results from radiation of GI tumors or structures adjacent to the GI tract. Radiation-induced damages of the upper GI tract may be ...acute or delayed, and ranges from lack of appetite, mucosal inflammation (i.e. esophagitis, gastritis, duodenitis) to ulcers, which may be complicated by perforation, penetration, bleeding and stenosis. Radiation-related factors as well as individual patient predisposing factors may increase susceptibility to post-radiation damage. High quality evidence for the treatment of radiation-induced GI damage is scarce and the management is often extrapolated from studies on GI lesions of different etiology. Treatment depends on severity and localization of the radiation-induced damage, and ranges from supportive and dietary measures to endoscopic interventions or surgery. Modern radiation techniques may decrease the incidence and severity of the radiation-induced upper gastrointestinal disease.
Objective
To evaluate the efficacy of isosorbide mononitrate (IMN) for stimulating cervical ripening among pregnant women with premature rupture of membranes (PROM) at or post term.
Methods
A ...prospective randomized double‐blind, placebo‐controlled trial at Kasr El‐Ainy Hospital, Cairo, Egypt, from October 2018 to May 2019. Pregnant women at or post term with PROM and unfavorable cervix (Bishop score ≤6) were randomly assigned to receive intra‐vaginal IMN (n = 70) or placebo (n = 70) before admission for induction of labor. The main outcome was induction to the delivery interval. Data were compared between groups by t test.
Results
The mean ± SD duration from the initial dose of IMN/placebo to the beginning of the active phase of labor was significantly shorter in the IMN group than in the control group (9.7 ± 5.6 h vs. 12.9 ± 5.3 h). The IMN group also had a shorter time interval from induction to delivery (P < 0.01). There was no difference in adverse effects between the groups.
Conclusion
Intra‐vaginal IMN for cervical ripening in the induction of labor among pregnant with PROM at or post term was found to be effective and safe with minimal adverse effects, and good neonatal and maternal outcomes.
ClinicalTrials.gov: NCT03665779.
Synopsis
Isosorbide mononitrate was found to be safe and effective for cervical ripening before induction of labor among pregnant women with PROM at or post term.
Abstract Objective To evaluate the efficacy of isosorbide mononitrate (IMN) for stimulating cervical ripening among pregnant women with premature rupture of membranes (PROM) at or post term. Methods ...A prospective randomized double‐blind, placebo‐controlled trial at Kasr El‐Ainy Hospital, Cairo, Egypt, from October 2018 to May 2019. Pregnant women at or post term with PROM and unfavorable cervix (Bishop score ≤6) were randomly assigned to receive intra‐vaginal IMN ( n = 70) or placebo ( n = 70) before admission for induction of labor. The main outcome was induction to the delivery interval. Data were compared between groups by t test. Results The mean ± SD duration from the initial dose of IMN/placebo to the beginning of the active phase of labor was significantly shorter in the IMN group than in the control group (9.7 ± 5.6 h vs. 12.9 ± 5.3 h). The IMN group also had a shorter time interval from induction to delivery ( P < 0.01). There was no difference in adverse effects between the groups. Conclusion Intra‐vaginal IMN for cervical ripening in the induction of labor among pregnant with PROM at or post term was found to be effective and safe with minimal adverse effects, and good neonatal and maternal outcomes. ClinicalTrials.gov : NCT03665779.
Synopsis Isosorbide mononitrate was found to be safe and effective for cervical ripening before induction of labor among pregnant women with PROM at or post term.
The sustainable energy sources are potentially employed to substitute petrol fuels in transport engines such as buses and small vehicles. Hydrogen-enriched compressed natural gas engines are ...forthcoming energy carriers for the internal combustion engine, with higher thermal efficiency and less pollutant emissions. The different availability of renewables has allowed various countries to adopt the most appropriate type of renewable energy technology according to their energy source adequacy/abundance. In Taiwan, ocean energy is considered as an abundant source of renewables due to its geographical location as an island. The Taiwanese government has approved the investment to construct an MW-scale demonstration electricity plant. In this book, the Taiwanese ocean energy experience is comprehensively presented. The technical and legal analyses of ocean energy implementation are provided. The challenges that they had to overcome to optimize the utilization of the most available ocean energy potential are discussed. The sustainable transition in South Africa would be a good example for implementing rooftop solar, especially in low-income communities. Apart from the environmental benefits, sustainable energy technologies can boost the socioeconomic level of developing countries. Other advantages may be the continuous supply of energy and creation of new job opportunities. Moreover, sustainable renewable energy sources such as the wind could be employed for generating electricity to operate water purification systems in remote areas. This, in turn, would overcome the health problems associated with drinking water scarcity issues. This book is an attempt to cover the sustainable energy issues from a technical perspective. Furthermore, the sustainable energy applications and existing case studies are helpful illustrations for the broad understanding of the importance of sustainable energy.
Abstract
Background
Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in ...cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union.
Methods
Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected.
Results
Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27.
Conclusion
Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss.
Level of evidence
Level IV, Therapeutic study
Designing of high efficient composition for heavy metal removal from solutions has become a pivotal demand to keep people's health level. In this issue, nanocomposites containing different ...contributions of brushite and vivianite phases were fabricated using a facile technique. The obtained compositions were characterized using XRD, TEM, FESEM, and XPS. Upon TEM investigation, it was shown that brushite was formed as ellipsoidal particles with dimensions of 47.6 × 50.1–76.2 × 107.3 nm, while vivianite was formed as elongated fibers with diameters of 18.2 nm and lengths over 270 nm. The surface morphology of 0.2Br/0.8Viv seems to be multilayered rectangles of brushite stacked in a cauliflower configuration with lengths of 4.8 μm and decorated with vivianite fluffy grains with dimensions of 0.8–1.6 μm. Moreover, the maximum height of roughness developed from 262.7 to 373.3 nm for 1.0Br/0.0Viv and 0.2Br/0.8Viv, respectively. In addition, the superficial charges of the compositions were estimated using Zeta potential and displayed a growth from −20.8 ± 4.91 to −27.4 ± 6.26 mV from pure brushite to vivianite, respectively. Furthermore, the removal behavior of Se(IV) and Cd(II) from aqueous solutions was conducted. It was shown that the highest removal efficiency upon variation of contact time was saturated after 6 h and after 24 h, reached around 83.2, 87.6, 89.5, 91.3, 95.0 and 98.1% for Se(IV) and 86.8 to 87.7, 91.5, 93.7, 96.0 and 98.5% for Cd(II) upon compositions of for 1.0Br/0.0Viv, 0.8Br/0.2Viv, 0.6Br/0.4Viv, 0.4Br/0.6Viv, 0.2Br/0.8Viv and 0.0Br/1.0Viv, respectively. The obtained behaviors of these nanocomposites encourage their utilization for numerous water filtration applications.
•Brushite/vivianite nanocomposites were fabricated using the co-precipitation method.•The maximum height of roughness developed from 262.7 to 373.3 nm for 1.0Br/0.0Viv and 0.2Br/0.8Viv, respectively.•Zeta potential progressed from −20.8 ± 4.91 to −27.4 ± 6.26 mV from pure brushite to vivianite, respectively.•The removal efficiency (η) was saturated after 6 h, reached around 83.2, 87.6, 89.5, 91.3, 95.0 and 98.1% for Se(IV).•For Cd(II), (η) achieved about 86.8–87.7, 91.5, 93.7, 96.0 and 98.5% after 6 h of exposure.
Early risk stratification of acutely poisoned patients is essential to identify patients at high risk of intensive care unit (ICU) admission. We aimed to develop a prognostic model and ...risk‐stratification nomogram based on the readily accessible clinical and laboratory predictors on admission for the probability of ICU admission in acutely poisoned patients. This retrospective cohort study included adult patients with acute toxic exposure to a drug or a chemical substance. Patients' demographic, toxicologic, clinical and laboratory data were collected. Among the 1260 eligible patients, 180 (14.3%) were admitted to the ICU. We developed a generalized prognostic model for predicting ICU admission in patients with acute poisoning. The predictors included the Glasgow coma scale, oxygen saturation, diastolic blood pressure, respiratory rate and blood bicarbonate concentration. The model displayed excellent discrimination and calibration (optimistic‐adjusted area under the curve = 0.924 and optimistic‐adjusted Hosmer and Lemeshow test = 0.922, respectively) when internally validated. Additionally, we developed prognostic models that determine ICU admission in patients with specific poisonings. Furthermore, we constructed risk‐stratification nomograms that rank the probability of ICU admission in these patients. The developed risk‐stratification nomograms help decision‐making regarding ICU admission in acute poisonings. Future external validation in independent cohorts is necessary before clinical application.
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