Intraoperative evaluation of ureteral patency is often performed in gynecologic and urogynecologic surgery. Many agents are used to help assess the patency, each with its own associated cost, ease of ...use, and adverse reactions. Some agents, such as dextrose, are used as an instillation fluid to create a viscosity difference and aid the visualization of a ureteral jet. Others, such as oral phenazopyridine or the intravenous use of sodium fluorescein and indigo carmine, cause a color change of the urine to directly aid the visualization of ureteral jets. Recently, numerous studies have examined the efficacy and surgeon satisfaction of these agents. The studies have also emphasized certain options as associated with a lower cost. However, there have not been any cost studies comparing these agents.
To compare the cost-effectiveness of the following 4 agents that are commonly used in assessing ureteral patency intraoperatively: oral phenazopyridine, dextrose instillation, intravenous sodium fluorescein, and intravenous indigo carmine.
We constructed a decision-analytic model to compare cystoscopy using oral phenazopyridine, dextrose instillation, intravenous sodium fluorescein, and intravenous indigo carmine. Failure to see efflux resulted in work-ups for ureteral obstruction. The probabilities were obtained from published studies, and the probability of successfully seeing efflux ranged from 0.92 with oral phenazopyridine to 0.99 with intravenous indigo carmine. The costs of the agents, adverse effects, and ureteral obstruction work-ups were obtained from the University of North Carolina at Chapel Hill Department of Pharmacy, the Healthcare Cost and Utilization Project 2016 database and the FAIR Health Consumer database. The cost of a ureteral obstruction work-up used in our model ranged from $9755 for intraoperative evaluation with retrograde pyelograms and stents to $29,034 for hospitalization. Our primary outcome was the incremental cost-effectiveness ratio per unnecessary work-up for ureteral obstruction avoided. Sensitivity analyses were performed to identify the key uncertainties.
Oral phenazopyridine, followed by an intravenous agent if needed, had a mean cost of $110 per patient. Dextrose averaged $151 more per patient, with only a slight improvement in avoiding unnecessary ureteral obstruction work-ups and a higher cost associated with adverse reactions (incremental cost-effectiveness ratio, $62,000). Intravenous agents cost approximately $1000 more per patient and were less effective at preventing unnecessary work-ups. Sensitivity analyses did not identify any thresholds that would significantly change the outcomes.
Our model suggests that oral phenazopyridine and dextrose instillation are the least expensive and the most effective agents to aid in the visualization of ureteral patency during intraoperative cystoscopy, although dextrose is associated with higher costs owing to a higher rate of adverse reactions (primarily urinary tract infections). Intravenous sodium fluorescein and indigo carmine are historically popular first-choice agents. However, they were found to be more expensive and less effective as primary agents in our model and should likely be reserved for use as secondary agents in the event that the visualization of ureteral jets is unclear with the initial use of phenazopyridine or dextrose.
As a current trend of fabricating healthier products, food manufacturing companies seek for natural-based food colorant aiming to replace the synthetic ones, which apart from meeting sensorial and ...organoleptic aspects, they can also act as health promoters offering additional added value. Carminic acid is a natural based food colorant typically found in several insect taxa. However, there are current approaches which pursue the production of this natural pigment via biotechnological synthesis. To date, this colorant has been intensively applied in the manufacture of several food items. Unfortunately, one of the main limitations deals with the establishment of the right protocol of extraction and purification of this component since there is no report analyzing the main extraction techniques for obtaining carminic acid. Therefore, this review, for the first time, comprehensively analyzes the ongoing strategies and protocols proposed by scientists towards either extraction or purification of carminic acid from its origin source, and from biotechnological systems. Emphasis has been focused on the main findings dealing with extraction techniques and the relevant insights in the field. A detailed discussion is provided on the advantages and drawbacks of the reported extraction and purification methods, main solvents used and their key interactions with target molecules.
Indigo naturalis (IN) is a traditional Chinese medicine that contains ligands for the aryl hydrocarbon receptor and promotes regeneration of the mucosa by inducing production of interleukin 22. IN ...might induce mucosal healing in patients with ulcerative colitis (UC). We performed a randomized controlled trial to investigate the safety and efficacy of IN in patients with UC.
We performed a multicenter, double-blind trial evaluating the safety of 86 patients in Japan with active UC (Mayo scores of 6 or more), enrolled from March 30 through December 27, 2016. Patients were randomly assigned to groups and given a daily dose of 0.5, 1.0, or 2.0 g IN or placebo (1:1:1:1 ratio) for 8 weeks. The primary endpoint was the rate of clinical response at week 8, defined as a 3-point decrease in the Mayo score and a decrease of at least 30% from baseline, with a decrease of at least 1 point for the rectal bleeding subscore or absolute rectal bleeding score of 0–1. The main secondary endpoint was the rate of clinical remission at week 8, defined as a Mayo score or ≤2 and no subscores with a value >1. Mucosal healing was also assessed at week 8.
The trial was terminated because of an external reason: a report of pulmonary arterial hypertension in a patient who used self-purchased IN for 6 months. In the intent-to-treat analysis, we observed a significant, dose-dependent linear trend in proportions of patients with clinical responses (13.6% with a clinical response to placebo; 69.6% to 0.5 g IN; 75.0% to 1.0 g IN; and 81.0% to 2.0 g IN) (Cochran-Armitage trend test P < .0001 compared with placebo). Proportions of patients in clinical remission at week 8 were significantly higher in the 1.0 g IN group (55.0%, P = .0004) and the 2.0 g IN group (38.1%, (P = .0093) than in the placebo group (4.5%). Proportions of patients with mucosal healing were 13.6% in the placebo group, 56.5% in the 0.5 g IN group, 60.0% in the 1.0 g IN group, and 47.6% in the 2.0 g IN group (P = .0278 compared with placebo). Although mild liver dysfunction was observed in 10 patients who received IN, no serious adverse events were observed.
In a randomized, placebo-controlled trial, we found 8 weeks of IN (0.5–2.0 g per day) to be effective in inducing a clinical response in patients with UC. However, IN should not yet be used because of the potential for adverse effects, including pulmonary arterial hypertension.
Clinical Trials Registry no: UMIN000021439 (http://www.umin.ac.jp/ctr/).
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Accurately diagnosing biliary strictures is crucial for surgical decisions, and although peroral cholangioscopy (POCS) aids in visual diagnosis, diagnosing malignancies or determining lesion margins ...via this route remains challenging. Indigo carmine is commonly used to evaluate lesions during gastrointestinal endoscopy. We aimed to establish the utility of virtual indigo carmine chromoendoscopy (VICI) converted from POCS images using artificial intelligence.
This single-center, retrospective study analyzed 40 patients with biliary strictures who underwent POCS using white light imaging (WLI) and narrow-band imaging (NBI). A “cycle-consistent adversarial network” (CycleGAN) was used to convert the WLI into VICI of POCS images. Three experienced endoscopists evaluated WLI, NBI, and VICI via POCS in all patients. The primary outcome was the visualization quality of surface structures, surface microvessels, and lesion margins. The secondary outcome was diagnostic accuracy.
VICI showed superior visualization of the surface structures and lesion margins compared with WLI (P<0.001) and NBI (P<0.001). The diagnostic accuracies were 72.5%, 87.5%, and 90.0% in WLI alone, WLI and VICI simultaneously, and WLI and NBI simultaneously, respectively. WLI and VICI simultaneously tended to result in higher accuracy than WLI alone (P=0.083) and the results were not significantly different from WLI and NBI simultaneously (P=0.65).
VICI in POCS proved valuable for visualizing surface structures and lesion margins and contributed to higher diagnostic accuracy comparable to NBI. In addition to NBI, VICI may be a novel supportive modality for POCS.
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As incorporating silver nanoparticles (Ag NPs) into zirconium metal-organic frameworks (UiO-66) offer an extensive potential in numerous applications such as wastewater treatment and catalysis, we ...herein synthesized UiO-66, followed by incorporating different contents of Ag NPs into UiO-66. The prepared UiO-66 composites were identified by means of various techniques like X-ray-diffraction patterns (XRD), nitrogen adsorption desorption (BET), transmission electron microscopy (TEM), Scanning electron microscopy (SEM), Energy dispersive X-ray spectroscopy (EDX), and Fourier transform infrared (FTIR) analysis. Besides, acidic properties of composites were examined using FTIR of chemisorbed pyridine and non-aqueous potentiometric titration. The results displayed that UiO-66 crystals exhibited sizes of 180 and 240 nm. Their surface area and total pore volume respectively reached 1593 m2 g−1 and 0.834 m3 g−1, and decreased by incorporating Ag NPs to 863 m2 g−1 and 0.432 m3 g−1 at 5.0 wt% Ag/UiO-66. TGA data manifested that adding Ag NPs could improve the thermal stability of the primitive UiO-66. The as-synthesized composites were tested towards indigo carmine (IC) adsorption from aqueous media and in synthesis of 3,4-dihydro-pirimidin-2(1H)-ones (3,4-DHPs). The adsorption data showed that silver nanoparticles incorporation enhanced IC removal performance of UiO-66 and adsorption capacity was augmented from 87.2 mg g−1 (UiO-66) to 312.8 mg g−1 at 2.0 wt% Ag/UiO-66. This performance was efficient relying on adsorption isotherm measurements, indicating that incorporating Ag NPs augmented the number of adsorption sites and π–π interactions between adsorbate and adsorbent were enhanced, resulting in improved adsorption capacity towards anionic dyes. Also, incorporated Ag NPs show better catalytic activity in the preparation of DHPs and the yield reached 88% using 2.0 wt% Ag/UiO-66, imparting excellent recyclability for four cycles.
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Indigo carmine (IC) is one of the oldest, most important, and highly toxic dyes which is released from the effluents of many industries and results in serious pollution in water. In this study, the ...biogenic Mn oxides were activated by NaOH and then heated for 3 h at 350 °C to produce activated carbon doped with Mn oxide (Bio-MnOx-C), which were produced by culturing Mn (II)-oxidizing bacterial strain MnI7-9 in liquid A medium at 28 °C with 10 mmol/L MnCl2. Bio-MnOx-C was characterized by SEM, TEM, IR, XPS, XRD, etc. It contained C, O, and Mn which comprised Mn (IV) and Mn (III) valence states at a ratio of 3.81:1. It had poorly crystalline ε-MnO2 with a specific surface area of 130.94 m2/g. A total of 0.1 g Bio-MnOx-C could remove 45.95 g IC from 500 mg/L IC solution after 0.5 h contact time. IC removal by Bio-MnOx-C included a rapid oxidation reaction and the removal reaction followed second-order kinetic equation. These results confirmed that Bio-MnOx-C could be a potential material for wastewater remediation.
•A new eco-material (Bio-MnOx-C) was produced by carbonizing biogenic Mn oxides.•Bio-MnOx-C contained C, O and Mn composed of Mn (IV) and Mn (III).•IC removal by Bio-MnOx-C included a rapid oxidation reaction and slow adsorption.•IC removal by Bio-MnOx-C followed second-order kinetic equation.•Bio-MnOx-C can efficiently remove indigo carmine from waste water.
The kinetic and equilibrium parameters of the quantitative adsorption for Indigo Carmine (IC) removed by commercial activated carbon (AC) were studied by UV–visible absorption spectroscopy. AC with a ...high specific surface area (1250.320 m2/g) was characterized by the Brunauer–Emmett–Teller (BET) method and point of zero charge (pzc).
The effect of the initial dye concentration (10–60 mg/L), contact time (0–90 min), pH (1−12), agitation speed (0–600 rpm), adsorbent dose (1–10 g/L) and temperature (298–323 K) were determined to find the optimal conditions for a maximum adsorption. The adsorption mechanism of Indigo Carmine onto AC was studied using the first pseudo order, second pseudo order and Elovich kinetics models. The adsorptions kinetic were found to follow a pseudo second order kinetic model with a determination coefficient (R2) of 0.999. To get an idea on the adsorption mechanism, we applied the Webber-Morris diffusion model. The equilibrium adsorption data for Indigo Carmine on AC were analyzed by the Langmuir, Freundlich, Elovich, Dubinin and Temkin models. The results indicate that the Langmuir model provides the best correlation at 25 °C (qmax = 79.49 mg/g) and Dubinin at 40 °C (qmax = 298.34 mg/g). The adsorption isotherms at different temperatures have been used for the determination of thermodynamic parameters such as free energy (ΔG° = −0.071 to −1.050 kJ/mol), enthalpy (ΔH° = 28.11 kJ/mol), entropy (ΔS° = 0.093 kJ/mol·K) and activation energy (Ea) of 51.06 kJ/mol of adsorption. The negative ΔG° and positive ΔH° values indicate that the overall adsorption is spontaneous and endothermic.
•An activated carbon is used to remove Indigo Carmine (IC) from aqueous solution.•The equilibrium experimental data were well fitted by the Langmuir and Dubinin isotherms models.•Under optimized conditions, 79.49 mg/g at 25 °C and 298·34 mg/g at 40 °C of the dye could be removed from solution.•The adsorption of the dye follows the pseudo-second order kinetic model.•A thermodynamic study showed the spontaneous and endothermic nature of the adsorption.
•A novel ion pairing between IC and N@C-dots was proposed for the first time.•The interaction resulted in cyan blue color and quenching of N@C-dots fluorescence.•The nanoprobe exhibited good ...sensitivity and selectivity towards IC.•The application of nanoprobe was extended for analysis of IC in beverages.
Indigo carmine (IC) dye is hazardous and allergenic for humans even though it has been excessively used in a wide range of industries. Therefore, the quantitative determination of IC is still challenging. Herein, for the first time, we have developed fluorometric and colorimetric dual-mode nanoprobe derived from the ion-pair association complex between the negatively charged IC and positively charged N@C-dots in pH = 3.0. Consequently, the binding between N@C-dots and IC resulted in cyan blue and quenching of N@C-dots fluorescence. The dependence of the fluorescence response on IC concentrations was linear over the range of 0.73–10.0 µM (R2 = 0.9989) with LOD of 0.24 µM. On the other hand, the linearity of the colorimetric method ranged from 9.97 to 80.0 µM (R2 = 0.9986) with LOD of 3.3 µM. The sensor was applied for estimation of IC in fruit juice and soft drink without the need for exhaustive extraction steps.
Artificial molecular photoswitches that can be reversibly controlled into different configurations by external light stimulation have broad application prospects in various fields, such as materials ...and chemical biology. Among them, the pyrrole hemithioindigo (PHT) photoswitch has a geometric structure similar to that of the fluorescent protein chromophore. What happens when the chromophore is replaced by PHT, and does it achieve similar functions to the original one? To answer these questions, we carried out ONIOM(QM/MM) and classical molecular dynamics studies on the photoisomerization mechanism and spectroscopic properties of PHT in the fluorescent protein. The results showed that in the protein environment, the fate of excited PHT is governed by the competition between fluorescence emission and hula-twist isomerization. Due to the strong steric hindrance effects caused by the interlacing residues in the protein that restrict the PHT conformation transformation, the cis-to-trans isomerization process of PHT needs to overcome a barrier of at least 4.9 kcal/mol; thus, fluorescence emission is more dominant in competition. It is also found that the intermolecular interaction between LYS67 and the carbonyl oxygen of PHT has a significant effect on the fluorescence emission. These results revealed the photochemical reaction mechanism of a light-driven molecular switch in the fluorescent protein and provided further theoretical support for the field of chemical biology.
Ternary heterostructure nanotubes of In2S3-CdIn2S4@X(X = Ag, Ag3PO4, AgI) were synthesized with enhanced photocatalytic activity for efficiently degrading pollutants. Electron beam irradiation was ...employed to artificially introduce interface defects to the heterostructure nanotubes. The experimental results for degrading carmine and Cr6+ under visible light irradiation showed that the photocatalytic efficiency of In2S3-CdIn2S4 was improved to some extent by the introduction of silver compounds. DRS results confirmed that the band gaps of In2S3-CdIn2S4 were reduced to 1.62 eV and 1.58 eV by introducing Ag3PO4 and AgI, respectively. Interestingly, the band gap of In2S3-CdIn2S4@AgI after electron beam irradiation was further reduced to 1.56 eV, resulting in that the degradation time of both Cr6+ and carmine by In2S3-CdIn2S4@AgI after high-energy electron beam irradiation was shortened to only 5 min. The XRD spectra of the photocatalysts after five cycles could maintain the original crystal form to a large extent. The OH stretching vibration peaks of In2S3-CdIn2S4@AgI after electron beam irradiation at 3387 cm−1 became wider and sharper, thus indicating that the number of free hydroxyl groups on the heterostructure surface significantly increased. PL results showed that electron beam irradiation could significantly reduce the PL emission peak and enhance the utilization of photogenerated charge carriers. EIS results further confirmed that In2S3-CdIn2S4@AgI processed by electron beam irradiation had higher photogenerated electron-hole separation efficiency. Based on the experimental results, a feasible reaction pathway and photocatalytic mechanism for the degradation of carmine was investigated. ESR results showed that the main active groups in the whole photocatalytic system were •O2– and h+.
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•In2S3-CdIn2S4@(Ag, Ag3PO4, AgI) ternary heterostructure nanotube was synthesized.•Silver compounds could greatly enhance the photostability of In2S3-CdIn2S4.•Its narrow band gap could effectively promote carrier separation and migration.•Electron beam irradiation could introduce interface defects to the material.•The treated material possessed enhanced photocatalytic activity for Cr6+ and P-4R.
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