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Despite a large body of evidence, the implementation of guidelines on hemodynamic optimization and goal-directed therapy remains limited in daily routine practice. To facilitate/accelerate this implementation, a panel of experts in the field proposes an approach based on six relevant questions/answers that are frequently mentioned by clinicians, using a critical appraisal of the literature and a modified Delphi process. The mean arterial pressure is a major determinant of organ perfusion, so that the authors unanimously recommend not to tolerate absolute values below 65 mmHg during surgery to reduce the risk of postoperative organ dysfunction. Despite well-identified limitations, the authors unanimously propose the use of dynamic indices to rationalize fluid therapy in a large number of patients undergoing non-cardiac surgery, pending the implementation of a "validity criteria checklist" before applying volume expansion. The authors recommend with a good agreement mini- or non-invasive stroke volume/cardiac output monitoring in moderate to high-risk surgical patients to optimize fluid therapy on an individual basis and avoid volume overload. The authors propose to use fluids and vasoconstrictors in combination to achieve optimal blood flow and maintain perfusion pressure above the thresholds considered at risk. Although purchase of disposable sensors and stand-alone monitors will result in additional costs, the authors unanimously acknowledge that there are data strongly suggesting this may be counterbalanced by a sustained reduction in postoperative morbidity and hospital lengths of stay. Beside existing guidelines, knowledge and explicit clinical reasoning tools followed by decision algorithms are mandatory to implement individualized hemodynamic optimization strategies and reduce postoperative morbidity and duration of hospital stay in high-risk surgical patients.

Radiofrequency denervation has been established for many years as an important minimally invasive procedure for the treatment of chronic pain conditions. Positive experiences of many users for various indications are contrasted by a nonuniform evidence. With meticulous patient selection and correct assessment of the indications a longer term reduction of pain, a reduced need for analgesics and an improvement in the quality of life can be achieved. The aim of this interdisciplinary position paper is to present the value of radiofrequency denervation in the treatment of chronic pain. The summarized recommendations of the expert group are based on the available evidence and on the clinical experiences of Austrian centers that frequently implement the procedure. The position paper contains recommendations on patient selection and proven indications. We discribe safety aspects, complications, side effects and contraindications.

The cohort consisted of 11,178 Mead Corporation employees (9,358 males and 1,820 females) who had worked for at least one year between January 1, 1975 and December 31, 1992 at seven pulp and/or paper mills in the United States. The vital status of the cohort was determined through a variety of sources over an observation period of 17 years (1976-1992). Mortality data were analyzed in terms of cause-specific standardized mortality ratios (SMRs), with expected deaths based on U.S. national mortality rates. Job categories with similar exposures were created based on an historical exposure assessment. Mortality analyses were performed separately for total female and male employees. Among female employees, overall mortality was less than expected, and no significant cause-specific mortality excesses were observed. The small number of deaths among female employees did not permit further detailed analyses. Among male employees, statistically significant deficits from overall mortality (SMR = 69.0) and from all cancers (SMR = 71.3) were reported. In addition, low mortality risks for many specific causes were also observed, including many specific cancer sites, various types of cardiovascular diseases, and different forms of nonmalignant respiratory diseases. In particular, there was no mortality excess from lung cancer (SMR = 77.5), digestive cancer (SMR = 69.4), stomach cancer (SMR = 46.7), laryngeal cancer (no observed death), rectal cancer (SMR = 82.8). Hodgkin's lymphoma (no observed death), non-Hodgkin's lymphoma (SMR = 103.6), leukemia (SMR = 72.2), diabetes mellitus (SMR = 110.4), ischemic heart disease (SMR = 80.0), and nonmalignant respiratory diseases (SMR = 36.7). Furthermore, detailed analyses by length of employment, interval since hire (latency), and job category demonstrated no occupationally related mortality increases from any of the diseases examined. Specifically, based on internal comparisons, no upward trends in cause-specific mortality risk were observed by duration of employment. In conclusion, the results of this epidemiologic investigation demonstrated a favorable mortality experience for employees at the seven pulp and/or paper mills.

A paper-based visual fluorescence immunoassay is presented for the detection of matrix metalloproteinase-7 (MMP7) that is related to renal cancer. The method is based on the distance-dependent fluorescence quenching of CdTe quantum dots (QDs) on a nitrocellulose membrane by Ag + following a sandwich-type immunoreaction on microtiter wells using silver nanoparticle (AgNP)-labeled secondary antibody- and primary antibody-coated microtiter wells. The silver nanoparticles captured in the well are dissolved with HNO 3 , while the quenching effect of QDs is based on silver ion-exchange reaction under 365-nm excitation light irradiation. Increasing concentration of released Ag + , thus higher concentration of the protein, leads to an increased distance of quenching on the nitrocellulose membrane. The paper-based immunoassay by combination of AgNP-assisted ion-exchange reaction with QD gives good distance-dependent responses and allows the detection of MMP7 at a concentration as low as 7.3 pg mL -1 . The coefficients of variation are less than 6.9% and 12.4% for intra-assay and inter-assay, respectively. High specificity and long-term stability are achieved during the assay. Importantly, the testing of human serum samples using our strategy shows well-matched results with commercial human MMP7 ELISA kits. Graphical abstract A distance-dependent visual immunoassay is developed for the determination of serum matrix metalloproteinase-7 on CdTe quantum dot-impregnated paper with silver ion-exchange reaction.

A rapid and sensitive colorimetric assay is described for Salmonella typhimurium (S. typhimurium) detection using urea/phenol red impregnated test paper. Aptamer-modified Fe 3 O 4 @Ag multifunctional hybrid nanoprobes (apt-Fe 3 O 4 @Ag NPs) were used to specifically captured S. typhimurium; the nanoprobes were quickly etched by H 2 O 2 to form Ag + . The generated Ag + can inhibit the urease-catalyzed hydrolysis reaction of urea to produce NH 4 . Consequently, the as-prepared test paper displayed a yellow color. In the presence of S. typhimurium, the target bacteria can cause aggregation of apt-Fe + . Consequently, the as-prepared test paper displayed a yellow color. In the presence of S. typhimurium, the target bacteria can cause aggregation of apt-Fe 3 O 4 @Ag NPs, and the deposited Ag on the nanoprobe's surface is shielded against H 2 O 2 -induced oxidative decomposition leading to reduced Ag + . An obvious color change from yellow to pink can be monitored directly using our test paper as a result of increased NH + . An obvious color change from yellow to pink can be monitored directly using our test paper as a result of increased NH 4 + . The entire assay procedure could be completed within 1 h. A limit of detection of 48 cfu/mL is achieved with a linear range of 1 × 10 2 to 1 × 10 6  cfu/mL. The recoveries of S. typhimurium spiked in pure milk samples were 92.48-94.05%. Graphical abstract Schematic diagram of the proposed colorimetric assay for S. typhimurium detection based on etching of bifunctional apt-Fe 3 O 4 @Ag NPs and inhibiting catalytic activity of urease by Ag + . A color change from yellow to pink can be observed and correlated to the concentration of S. typhimurium.

Thirty subjects engaged in maintenance and repair of moulds used for producing watermarks on paper were studied, along with 27 control subjects from the same paper mill. The workers were simultaneously exposed to copper, chromium, zinc, xylol, and fumes of sulphuric acid in the course of their work. The study subjects were investigated for clinical, occupational, radiological haematological and psychological details. The aforementioned combined exposure was found to be responsible for a high prevalence of symptoms pertaining to the respiratory system and higher nervous functions. Breathlessness (26.7%), expectoration (10.0%) and emphysema (10.0%) were significantly higher among the exposed subjects. The exposed subjects also showed lowered visuomotor coordination and delayed reaction to light and sound stimuli.

Non-radiologist point-of-care ultrasonography (US) is increasingly implemented in paediatric care because it is believed to facilitate a timely diagnosis, such as in ascites or dilated renal pelvicalyceal systems, and can be used to guide interventional procedures. To date, all policy statements have been published by non-radiologic societies. The European Society of Paediatric Radiology hereby issues a position statement on paediatric non-radiologist point-of-care US from the point of view of those leading on children's imaging, i.e. paediatric radiologists. In this position statement, we will address the boundaries, education, credentialing, quality control, reporting and storage of images in paediatric practice.

This consensus paper summarizes the expert consensus and recommendations of the working group "Heart and Kidney" of the German Cardiac Society (DGK) and the German Society of Nephrology (DGfN) on contrast medium-induced acute kidney injury. Potentially nephrotoxic contrast agents containing iodine are frequently used in interventional medicine and for computer tomography diagnostics. Acute kidney injury occurs in approximately 8-17% of patients exposed to contrast media. The risk factors and underlying pathophysiology are discussed and recommendations for the prophylaxis and treatment of contrast medium-induced acute nephropathy are presented.

Unlike in developed countries, most public toilets in China do not provide toilet paper onsite and users must bring their toilet paper. Moreover, an open waste bin is placed in each user's cubicle to collect used toilet paper and tissues. Such practices, which are common in East Asia and central America, have induced a dilemma of toilet paper disposal because some municipalities have removed waste bins from public toilets to prevent virus transmission by fecal matter. As a consequence, users were forced to flush down their used toilet paper and tissues. Yet, it is unknown whether standard toilet paper can be flushed easily without causing issues in sewer operations. Here, we surveyed the conditions of toilets in university campus and other public facilities in different regions across China. We also evaluated the disintegration characteristics of toilet paper products both by conducting online surveys and by physical disintegration experiments. We found that only 15% of toilets provided toilet paper, while open waste bins occurred at nearly all sites. Further, our survey indicated that 82% of toilet paper products sold in China did not give any indication on their flushability, whereas 77% of US products did. Disintegration results showed that none of the five popular, best-selling toilet paper products passed the flushability standard. We propose strategies to solve the current toilet paper dilemma in developing communities., Competing Interests: Conflict of interestAuthors declare no conflict of interest in this work., (© Springer Nature Switzerland AG 2020.)

A disposable paper-based bipolar electrochemical biosensor is reported for determination of glucose. The closed bipolar electrochemical cell is fabricated on a small part of paper using a laser printing-based process for paper hydrophobization. The bipolar and driving electrodes are provided by pressing the writing pencil HB on the paper. The mechanism of sensing of glucose is oxidation of the analyte in the sensing cell using glucose oxidase followed by reduction of the produced H 2 O 2 by application of an external potential (10.0 V). This causes the oxidation of K 4 Fe(CN) 6 in the presence of Fe(II) ions and subsequent formation of Prussian Blue (PB) particles in the reporting cell. The intensity of the blue color in the reporting cell is used as a visual and colorimetric signal that can be digitally read using a scanner of digital camera. The parameters affecting the performance of the device were optimized using experimental design and chemometrics modeling. The P-BPE represents a very wide response range that extends from 0.1 mmol.L -1 to 4.0 mol.L -1 in the case of hydrogen peroxide, and from 0.1 to 50 mmol.L -1 in the case of glucose. The limit of detections for hydrogen peroxide and glucose are 4.9 μmol.L -1 and 70 μmol.L -1 respectively. Graphical abstract Analyte solution (H 2 O 2 ) and deionized water is injected to the sensing and the reporting cells respectively. By applying of an external potential, H 2 O 2 reduction and potassium ferrocyanide (K 4 Fe(CN) 6 ) oxidation is performed. This provides the appropriate condition for Prussian blue (PB) production (dark blue) in the reporting cell.

Process-monitoring laboratories in the pulp and paper industry generally use a combination of wet chemical analyses and physical measurements to certify the fitness of a production pulp for a specific end-use. These laboratory tests require time and the effort of trained personnel, limiting their utility for real-time process control. Here we show that Raman probes of unrefined cellulosic pulps, well-suited to the online measurement of in-process materials, can predict the quality attributes of manufactured papers. The accuracy of prediction improves when the covariance is modelled in a reduced measurement space selected by a data-driven, feature-selection technique referred to as a Template Oriented Genetic Algorithm (TOGA). TOGA, combined with discrete wavelet transform (DWT), isolates functional-group features that correlate best with mechanical properties paper derived from refined pulp. Paper makers refine market pulps to build sheet strength using a beating process that decreases freeness as it increases fibre-fibre bonding. Methods demonstrated here predict manufactured sheet properties obtainable after any specified degree of refining from the Raman spectrum of an unrefined pulp. This analysis capacity will enable both vendors of market pulp and makers of sheet paper to specify in advance the amount of beating required to produce a desired product, thereby saving cost and conserving resources.

Bioprocessing of pulp requires lignolytic as well as hemicellulolytic enzymes. The present study is the first report of a cocktail of laccase (L), xylanase (X), and mannanase (M), from a single bacterium for pulp biobleaching. A novel strain Bacillus tequilensis LXM 55 produced thermo-alkali stable L + X + M. On optimization higher enzyme yield (IUml -1 /fold increase) of laccase (396.35/24.16), xylanase (212.95/81.90) and mannanase (153.33/102.90) were achieved in the cocktail. Treatment of pulp with cocktail of enzymes led to 49.35% reduction in kappa number and considerable enhancement in the brightness (11.59%), whiteness (4.11%), and other pulp properties. Most importantly, no mediator system was required for the application of laccase. 40% less chlorine consumption was required to obtain the paper of the same quality as that of pulp treated without enzyme but with 100% chlorine. Therefore, this cocktail of enzymes is highly suitable for pulp biobleaching in the paper mill.