Necrotising enterocolitis (NEC) causes significant morbidity and mortality in premature infants. The role of innate immunity in the pathogenesis of NEC remains unclear. Mannose-binding lectin (MBL) ...recognizes microorganisms and activates the complement system via MBL-associated serine protease-2 (MASP-2). The aim of this study was to investigate whether MBL and MASP-2 are associated with NEC. This observational case-control study included 32 infants with radiologically confirmed NEC and 64 controls. MBL and MASP-2 were measured in cord blood using ELISA. Multivariate logistic regression was performed. Of the 32 NEC cases (median gestational age, 30.5 wk), 13 (41%) were operated and 5 (16%) died. MASP-2 cord blood concentration ranged from undetectable (<10 ng/mL) to 277 ng/mL. Eighteen of 32 (56%) NEC cases had higher MASP-2 levels (> or =30 ng/mL) compared with 22 of 64 (34%) controls (univariate OR 2.46; 95% CI 1.03-5.85; p = 0.043). Higher cord blood MASP-2 levels were significantly associated with an increased risk of NEC in multivariate analysis (OR 3.00; 95% CI 1.17-7.93; p = 0.027). MBL levels were not associated with NEC (p = 0.64). In conclusion, infants later developing NEC had significantly higher MASP-2 cord blood levels compared with controls. Higher MASP-2 may favor complement-mediated inflammation and could thereby predispose to NEC.
BackgroundDifferentiation of syncope from seizure is challenging and has therapeutic implications. Cardioinhibitory reflex syncope typically affects young patients where permanent pacing should be ...avoided whenever possible. Cardioneuroablation may obviate the need for a pacemaker in well-selected patients.Case summaryA previously healthy 24-year-old woman was referred to the emergency department after recurrent episodes of transient loss of consciousness (TLOC). The electrocardiogram (ECG) and the echocardiogram were normal. An electroencephalogram (EEG) showed intermittent, generalized pathological activity. During EEG under photostimulation, the patient developed a short-term TLOC followed by brachial myocloni, while the concurrent ECG registered a progressive bradycardia, which turned into a complete atrioventricular block and sinus arrest with asystole for 14 s. Immediately after, the patient regained consciousness without sequelae. The episode was interpreted as cardioinhibitory convulsive syncope. However, due to the pathological EEG findings, an underlying epilepsy with ictal asystole could not be fully excluded. Therefore, an antiseizure therapy was also started. After discussing the consequences of pacemaker implantation, the patient agreed to undergo a cardioneuroablation and after 72 h without complications, she was discharged home. At 10 months, the patient autonomously discontinued the antiepileptics. The follow-up EEG displayed unspecific activities without clinical correlations. An implantable loop recorder didn't show any relevant bradyarrhythmia. At 1-year follow-up, the patient remained asymptomatic and without syncopal episodes.DiscussionReflex syncope must be considered in the differential diagnosis of seizures. The cardioneuroablation obviated the need for a pacemaker and allowed for the withdrawal of anticonvulsants, originally started on the premise of seizure.
•Laboratory study of fly ash leaching using HCl 5% and NaCl-solution (300 g/L).•Mobilization of Pb and Cu mainly dependent from redox conditions and metal-chloride-complex formation.•Thermodynamic ...modelling used to determine speciation of Pb, Cu, Zn and Cd in leaching solutions.•Results of this study indicate a way forward for an improved metal depletion and recovery from fly ash.
Fly ash from municipal solid waste incineration contains a large potential for recyclable metals such as Zn, Pb, Cu and Cd. The Swiss Waste Ordinance prescribes the treatment of fly ash and recovery of metals to be implemented by 2021. More than 60% of the fly ash in Switzerland is acid leached according to the FLUWA process, which provides the basis for metal recovery. The investigation and optimization of the FLUWA process is of increasing interest and an industrial solution for direct metal recovery within Switzerland is in development. With this work, a detailed laboratory study on different filter cakes from fly ash leaching using HCl 5% (represents the FLUWA process) and concentrated sodium chloride solution (300 g/L) is described. This two-step leaching of fly ash is an efficient combination for the mobilization of a high percentage of heavy metals from fly ash (Pb, Cd ≥ 90% and Cu, Zn 70–80%). The depletion of these metals is mainly due to a combination of redox reaction and metal-chloride-complex formation. The results indicate a way forward for an improved metal depletion and recovery from fly ash that has potential for application at industrial scale.
The safety of a geological repository designed for deep storage of nuclear waste rests on the long-lived isolation properties of the geological environment and the engineered barrier system. To study ...the chemical and physical behaviour of cementitious/clayey interfaces, such interfaces have been collected during repeat sampling campaigns of the CI Experiment (Cement-Clay Interaction Experiment) at the Mont Terri rock laboratory (St. Ursanne, Switzerland, www.mont-terri.ch) over the last decade. This study focuses on the advanced analysis by μ-XRD mapping to locate and identify the mineral phases on each side of the interface. The hydrates portlandite, ettringite and C–S–H present in the Portland cement (PC) were dissolved in contact with the Opalinus Clay (OPA) up to different depths (~0.2 mm for portlandite; ~1 mm for ettringite; completely depleted for C–S–H up to 0.1 mm and less visible on a 1-mm-depth) while the ettringite from ESDRED (a low-pH cement type) seems to be destabilized to a larger depth (≥3 mm). In contrast to former studies, calcite could not be clearly observed at the interface PC - OPA but was well developed at the interface ESDRED - OPA. The extent of reaction after 10 years is very small in both cases, and dissolution of clay minerals remains below detection. The identification of mineral phases involved in reactions facilitates the understanding of the processes, thus, will help to improve the reactive transport models used to simulate the evolution over long times.
•Micro-X-ray diffraction (μ-XRD) is a powerful tool for spatially resolved (2D) phase identification in heterogeneous materials.•μ-XRD measurements result in mineral distribution maps across claystone – concrete interfaces.•In the concrete, ettringite, C–S–H and portlandite (if present) are not observed in layers parallel to the interface.•Calcite precipitates evenly spread in the cement or concentrated at the interface depending on the type of cement.
Repetitive transcranial magnetic stimulation (rTMS) is a recent putative treatment for affective disorders. Several studies have demonstrated antidepressant effects of rTMS in younger patients; we ...aimed to assess its effect in older outpatients with treatment-resistant major depression. Twenty-four outpatients (mean age=62 years, S.D.=12) with major depression were randomized for sham or real stimulation and received 10 daily rTMS sessions (20 Hz, 2-s trains, 28-s intertrain intervals, 100% of motor threshold) in addition to the antidepressant medication. For sham stimulation, the coil was tilted 90°. Depression severity was assessed using the Hamilton Depression Rating Scale, the Beck Depression Inventory, items from the NIMH self-rated symptom scale, and a visual analog depression scale. Mini-Mental Status Examination performance, memory, and executive and attentional functions were measured to control for cognitive side effects. Depression ratings revealed significant antidepressant effects within 2 weeks in both sham and real stimulation groups; however, there were no between-group differences. Treatment with rTMS was safe; adverse events were rare and not more prevalent in either group, and cognitive assessment did not show any deterioration. We were unable to demonstrate any additional antidepressant effects of real stimulation in elderly patients with treatment-resistant major depression. Therapeutic effects of rTMS in this clinically challenging patient group remain to be demonstrated.
Objective
To examine rates of intravenous thrombolysis (IVT), mechanical thrombectomy (MT), door‐to‐needle (DTN) time, door‐to‐puncture (DTP) time, and functional outcome between patients with ...admission magnetic resonance imaging (MRI) versus computed tomography (CT).
Methods
An observational cohort study of consecutive patients using a target trial design within the nationwide Swiss‐Stroke‐Registry from January 2014 to August 2020 was carried out. Exclusion criteria included MRI contraindications, transferred patients, and unstable or frail patients. Multilevel mixed‐effects logistic regression with multiple imputation was used to calculate adjusted odds ratios with 95% confidence intervals for IVT, MT, DTN, DTP, and good functional outcome (mRS 0–2) at 90 days.
Results
Of the 11,049 patients included (mean SD age, 71 15 years; 4,811 44% women; 69% ischemic stroke, 16% transient ischemic attack, 8% stroke mimics, 6% intracranial hemorrhage), 3,741 (34%) received MRI and 7,308 (66%) CT. Patients undergoing MRI had lower National Institutes of Health Stroke Scale (median interquartile range 2 0–6 vs 4 1–11), and presented later after symptom onset (150 vs 123 min, p < 0.001). Admission MRI was associated with: lower adjusted odds of IVT (aOR 0.83, 0.73–0.96), but not with MT (aOR 1.11, 0.93–1.34); longer adjusted DTN (+22 min 13–30), but not with longer DTP times; and higher adjusted odds of favorable outcome (aOR 1.54, 1.30–1.81).
Interpretation
We found an association of MRI with lower rates of IVT and a significant delay in DTN, but not in DTP and rates of MT. Given the delays in workflow metrics, prospective trials are required to show that tissue‐based benefits of baseline MRI compensate for the temporal benefits of CT. ANN NEUROL 2022;92:184–194
Transcranial magnetic stimulation has evolved into a powerful neuroscientific tool allowing to interfere transiently with specific brain functions. In addition, repetitive TMS (rTMS) has long-term ...effects (e.g. on mood), probably mediated by neurochemical alterations. While long-term safety of rTMS with regard to cognitive functioning is well established from trials exploring its therapeutic efficacy, little is known on whether rTMS can induce changes in cognitive functioning in a time window ranging from minutes to hours, a time in which neurochemical effects correlated with stimulation have been demonstrated.
This study examined effects of rTMS on three measures of executive function in healthy subjects who received one single rTMS session (40 trains of 2
s duration 20
Hz stimuli) at the left dorsolateral prefrontal cortex (DLPFC). Compared to a sham condition one week apart, divided attention performance was significantly impaired about 30–60
min after rTMS, while Stroop-interference and performance in the Wisconsin Card Sorting Test was unaffected after rTMS.
Repetitive TMS of the left DLPFC, at stimulation parameters used in therapeutic studies, does not lead to a clinically relevant impairment of executive function after stimulation. However, the significant effect on divided attention suggests that cognitive effects of rTMS are not limited to the of acute stimulation, and may possibly reflect known neurochemical alterations induced by rTMS. Sensitive cognitive measures may be useful to trace those short-term effects of rTMS non-invasively in humans.
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