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Impedance cardiography (ICG) is a non-invasive tool for assessing the hemodynamic parameters. It has been used for diagnosing several cardiovascular diseases, such as heart failure, cardio-myopathy, and valvular diseases. Particularly, the valvular heart disease is characterized by the damage in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary valves. The mitral valve insufficiency and the aortic valve stenos are the most frequent valve diseases in the world. In this paper, we propose to diagnosis the mitral valve insufficiency using the impedance cardiography technique. The study group consisted of 40 subjects (20 control subjects and 20 patients with mitral insufficiency). A parameter “I” is calculated from the impedance cardiogram waveform and it is used to differentiate control subjects from patients with mitral insufficiency. The parameter “I” was related significantly to the abnormalities of the impedance cardiogram waveform. For patients with mitral insufficiency, “I” was higher than for the healthy subjects with a difference ratio of 89% (p

Mediterranean Food Waste (FW) with high Carbon/Nitrogen (C/N) ratio (≈31) and a biodegradability (BD) above 75%, were anaerobically co‐digested with Sewage Sludge (SS), in both batch and semicontinuous processing systems. Biochemical Methane Potential (BMP) tests were carried out for five mixture ratios (VS basis). The highest methane yield was obtained for the Food Waste to Sewage Sludge (FW/SS) ratio of 3:1, reaching a Specific Methane Production (SMP) of of 452 ml CH4/g VSadded. Moreover, this ratio has shown a BD of 40%, twofold lower than the one obtained for digestion of FW alone. Applying the semi‐continuous process, a methane yield of 200 ml CH4/g VS was obtained at the high Organic Loading Rate (OLR) of 8 g VS/L·day, indicating a good performance of the system facing a high daily feeding. A predictive study of the energy efficiency of this system provided an estimated daily production of 1.4 kilowatt‐hour electricity load (KWhel)/kg VSadded and 2.2 kilowatt‐hour thermal load (KWhth)/kg VSadded. [ABSTRACT FROM AUTHOR]

Characterization of seawater quality is crucial to determine the selection and design of pretreatment process as well as to manage membrane fouling in seawater reverse osmosis (SWRO) plants. In some cases, conventional seawater quality parameters are limited in explaining the regional variations of raw seawater and/or in predicting the extent of membrane fouling because of poor correlations between the amounts of impurities in seawater and the resultant membrane fouling. In this study, four seawater quality parameters (P-MFI, C-MFI, PROTEIN and HUMIC) are newly employed to investigate whether those parameters could overcome the current limitations of conventional parameters. Seawater samples have been collected periodically from five different SWRO plants and then analyzed by multiple membrane array system to obtain the two different MFI values and by fluorescence spectrophotometer for PROTEIN and HUMIC quantifications. Statistical analyses of seawater quality data from the SWRO plants showing the different extent of membrane fouling suggest that those parameters are useful to estimate membrane fouling by all types of impurities such as particles, colloids and organic matters in seawater. In addition, the four suggested parameters (P-MFI, C-MFI, PROTEIN and HUMIC) could better specify the regional differences of seawater quality and the changes of impurities from raw seawater to RO feedwater according to operating conditions, which would be the basis to establish the practical guidelines for a pretreatment design and an efficient operation of SWRO plants. [ABSTRACT FROM AUTHOR]

The article describes the application of the Karhunen–Loéve (K–L) decomposition in characterizing miscible displacements in geostatistically generated permeable media. A large number of simulation runs were performed in several heterogeneous reservoirs, each with different dimensionless scaling groups, and the spatial fluid concentrations were mapped at various times. The heterogeneous permeable media were generated geostatistically using the Matrix Decomposition Method with various degrees of permeability variations and correlation lengths. A finite difference numerical simulator (UTCHEM) has been used for this purpose. Results show that the correlation length and the permeability variation significantly affect the performance of miscible displacements and the transition between gravity-dominated and viscous-dominated displacements. The K–L decomposition was then used to determine an optimum set of eigenfunctions representing the coherent structure of all the simulated data. Results show that these complex patterns arising from a large number of simulation runs can be described by twenty dominant eigenfunctions. From these eigenfunctions and the eigenvalues associated with them, one can in principle predict the results of a simulation run without actually performing the run. These include the prediction of the fluid distribution in time and space as well as the production history curve. [ABSTRACT FROM AUTHOR]

The article presents three case studies related to memantine treatment. In the first study, a male patient of age 58, developed slowly progressive extrapyramidal features, and cognitive decline but no significant psychiatric or behavioral features aside from mild depression. At age 65 he developed visual hallucinations of fox and mice. In the second case, a male patient of age 64, developed episodic memory impairment, executive dysfunction, became lost in familiar surroundings and misplaced items at home. In the third case, a male patient of age 77, was diagnosed with probable Alzheimer's Disease and began donepezil therapy.

Background: Lower gastrointestinal bleeding (LGIB) is a common reason for emergency department visits and subsequent hospitalizations. Recent data suggests that low-risk patients may be safely evaluated as an outpatient. Recommendations for healthcare systems to identify low-risk patients who can be safely discharged with timely outpatient follow-up have yet to be established. The primary objective of this study was to determine the role of patient predictors for the patients with LGIB to receive urgent endoscopic intervention., Methods: A retrospective chart review was performed on 142 patients. Data was collected on patient demographics, clinical features, comorbidities, medications, hemodynamic parameters, laboratory values, and diagnostic imaging. Logistic regression analysis, independent samples t-testing, Mann Whitney U testing for non-parametric data, and univariate analysis of categorical variables by Chi square test was performed to determine relationships within the data., Results: On logistic regression analysis, A hemoglobin drop of > 20 g/L was the only variable that predicted endoscopic intervention (p = 0.030). Tachycardia, hypotension, or presence of anticoagulation were not significantly associated with endoscopic intervention (p > 0.05)., Conclusions: A hemoglobin drop of > 20 g/L was the only patient parameter that predicted the need for urgent endoscopic intervention in the emergency department., (© 2024. Crown.)

Background: Carotid body tumours (CBTs) are neoplasms originating from the paraganglionic cells of the carotid body. Excision is the main route of treatment. This study sought to assess the surgical outcomes of post-carotid body tumour resection without preoperative embolization and discern any underlying relationships between modified Shamblin classes (MSC) and related complications., Methods: A retrospective medical record review of prospectively collected data is performed at Sulaymaniyah Teaching Hospital between 2008 and 2019, for 54 patients. Presurgical and postsurgical variables such as comorbidities and complications were noted, respectively., Results: Patient ages ranged between 26 and 60 years (x̄=40.06) with a minimal female predominance (57.4%). Complications included one minor stroke. MSC and postoperative complications were significantly related ( P ≤0.001). Our analyses also suggested a significant relationship between intraoperative blood loss and the incidence of postoperative complications ( P =0.001, χ²=25). The MSC III subtype was significantly associated with intraoperative blood loss ( P =0.000), length of stay ( P =0.000), and operating time ( P =0.001)., Conclusions: Our study purports a strong relationship between greater MSC and complications of all types. As such, surgeons may benefit from preoperative strategies to minimize complications., Competing Interests: Not applicable.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Gait is emerging as a potential diagnostic tool for cognitive decline. The 'Deep and Frequent Phenotyping for Experimental Medicine in Dementia Study' (D&FP) is a multicenter feasibility study embedded in the United Kingdom Dementia Platform designed to determine participant acceptability and feasibility of extensive and repeated phenotyping to determine the optimal combination of biomarkers to detect disease progression and identify early risk of Alzheimer's disease (AD). Gait is included as a clinical biomarker. The tools to quantify gait in the clinic and home, and suitability for multi-center application have not been examined. Six centers from the National Institute for Health Research Translational Research Collaboration in Dementia initiative recruited 20 individuals with early onset AD. Participants wore a single wearable (tri-axial accelerometer) and completed both clinic-based and free-living gait assessment. A series of macro (behavioral) and micro (spatiotemporal) characteristics were derived from the resultant data using previously validated algorithms. Results indicate good participant acceptability, and potential for use of body-worn sensors in both the clinic and the home. Recommendations for future studies have been provided. Gait has been demonstrated to be a feasible and suitable measure, and future research should examine its suitability as a biomarker in AD.

Effective combination antiretroviral therapy (cART) has lead to a significant reduction in the prevalence and incidence of central nervous system (CNS) HIV-associated brain disease, particularly CNS opportunistic infections and HIV encephalitis. Despite this, cognitive deficits in people living with HIV, also known as HIV-associated neurocognitive disorders (HAND) have become more prevalent in recent years. The pathogenesis of HAND is likely to be multifactorial, however recent evidence suggests that brain microglial activation is the most likely pathogenic mechanism. Recent developments in positron emission tomography (PET) brain neuroimaging using novel brain radioligands targeting a variety of physiological changes in the brains of HIV-positive individuals have improved our understanding of the mechanisms associated with the development of HAND. This review will highlight recent PET brain neuroimaging studies in the cART era, focusing on physiological and neurochemical changes associated with HAND in people living with HIV.

Background: Combining PET amyloid-β (Aβ) and tau imaging may be critical for tracking disease progression in Alzheimer's disease (AD)., Objective: We sought to characterize the relationship between Aβ and tau ligands as well as with other measures of pathology., Methods: We conducted a multi-center observational study in early AD (MMSE >20) participants aged 50 to 85 y. The schedule included cognitive assessments (ADAS-Cog) and CSF measurement of Aβ and tau at baseline and 6 months; PET-CT imaging with Aβ ([18F]AV45) and tau ([18F]AV1451) ligands at baseline., Results: 22 participants took part in the study with 20 completing its 6-month duration and 12 having both tau and amyloid PET. The PET biomarker analysis revealed a strong negative correlation between age and tau in multiple regions. Entorhinal cortex tau and age interacted significantly in terms of cognitive change over 6 months which may have been to older participants deteriorating faster despite lower levels of cortical tau. Cortical Aβ associated with entorhinal cortex tau while CSF tau/Aβ ratio correlated strongly with cortical tau but not Aβ., Conclusion: The negative relationship between age and cortical tau whereby younger patients with mild AD had relatively greater tau burden is potentially important. It suggests that younger-age onset AD may be primarily driven by tau pathology while AD developing later may depend on a multitude of pathological mechanisms. These data also suggest that PET-tau performs better than PET-amyloid in predicting the best validated AD diagnostic marker- the CSF total tau/Aβ ratio.

The microbiological composition of tobacco products was studied using culture and chemical analysis (of tobacco leaves) or chemical analysis only (tobacco and tobacco smoke). The chemical analyses utilized gas chromatography-tandem mass spectrometry for determining 3-hydroxy fatty acids, muramic acid, and ergosterol as markers of respectively lipopolysaccharide (LPS), peptidoglycan, and fungal biomass. Mesophilic bacteria dominated in both fresh and cured tobacco leaves; a range of additional bacteria and fungi were also found albeit in minor amounts. The peptidoglycan and LPS concentrations were approximately the same in tobacco leaves as in cigarette tobacco. The concentrations of the measured microbial components were much lower in some cigarettes locally produced in China, Korea, and Vietnam than in cigarettes of international brands purchased in the same countries, and the concentrations in the smoke were in general agreement with the concentrations in cigarette tobacco. No differences in microbial load in tobacco of "light" and "full flavor" cigarettes were seen. Storing cigarettes at high humidity resulted in elevated levels of fungi in the cigarette tobacco leading to increased ergosterol concentrations in the smoke. The fact that tobacco smoke is a bioaerosol may help to explain the high prevalence of respiratory disorders among smokers and non-smokers exposed to second hand smoke since the same symptoms are also commonly associated with exposure to bioaerosols.

Rare monogenic dementias have repeatedly exposed novel pathways guiding to details of the molecular pathogenesis behind this complex clinical phenotype. In this paper, we have studied polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL), an early onset dementia with bone fractures caused by mutations in TYROBP (DAP12) and TREM2 genes, which encode important signaling molecules in human dendritic cells (DCs). To identify the pathways and biological processes associated with DAP12/TREM2-mediated signaling, we performed genome wide transcript analysis of in vitro differentiated DCs of PLOSL patients representing functional knockouts of either DAP12 or TREM2. Both DAP12- and TREM2-deficient cells differentiated into DCs and responded to pathogenic stimuli. However, the DCs showed morphological differences compared to control cells due to defects in the actin filaments. Not unexpectedly, transcript profiles of the patient DCs showed differential expression of genes involved in immune response. Importantly, significantly diverging transcript levels were also evident for genes earlier associated with other disorders of the central nervous system (CNS) and genes involved in the remodeling of bone, linking these two immunological genes with critical tissue phenotypes of patients. The data underline the functional diversity of the molecules of the innate immune system and implies their significant contribution also in demyelinating CNS disorders, including those resulting in dementia.

Background and Purpose: Alzheimer disease (AD) is accompanied by macroscopic atrophy on volumetric MR imaging. A few studies have also demonstrated reduction in magnetization transfer ratio (MTR), suggesting microstructural changes in remaining brain tissue. This study assessed the value of measuring MTR in addition to volumetric MR in differentiating patients with AD from control subjects., Materials and Methods: Volumetric T1-weighted images and 3D MTR maps were obtained from 18 patients with AD and 18 age-matched control subjects. Whole-brain (WB) and total hippocampal (Hc) volumes were measured using semiautomated techniques and adjusted for total intracranial volume. Mean MTR was obtained for WB and in the Hc region. Histogram analysis was performed for WB MTR. Among patients, associations between volumetric and MTR parameters and the Mini-Mental State Examination (MMSE) were explored., Results: Patients with AD had significantly reduced WB volume (P<.0001) and mean WB MTR (P=.002) and Hc volume (P<.0001) and Hc mean MTR (P<.0001) compared with control subjects. Histogram analysis of WB MTR revealed significant reduction in the 25th percentile point in patients with AD (P=.03). Both WB volume and mean MTR were independently associated with case-control status after adjusting for the other using linear regression models. However, measuring Hc mean MTR added no statistically significant discriminatory value over and above Hc volume measurement alone. Of all MR imaging parameters, only WB volume was significantly correlated with MMSE (r=0.47, P=.048)., Conclusions: This study demonstrates the independent reduction of WB volume and mean MTR in AD. This suggests that the 2 parameters reflect complementary aspects of the AD pathologic lesion at macrostructural and microstructural levels.

Anaerobic co-digestion is a well established process for treating many types of organic wastes, both solid and liquid. In this study we have investigated, on a laboratory scale, the anaerobic co-digestion of olive mill wastewater (OMW) with olive mill solid waste (OMSW) using semi-continuous, feeding, tubular digesters operated at mesophilic temperatures. Each digester was fed with an influent, composed of OMW and OMSW, at an organic loading rate (OLR) varying between 0.67 and 6.67 g COD/l/d. The hydraulic retention times (HRT) were 12, 24 and 36 days. The TCOD concentrations of OMW used as the main substrate were 24, 56 and 80 g COD/l; the amount of the dry OMSW used as a co-substrate was fixed to approximately 56 g/l of OMW. The results indicated that the best methane production was about 0.95 l/l/day obtained at an OLR = 4.67 g COD/l/d, corresponding to influent TCOD = 56 g COD/l at an HRT = 12d. In contrast, the maximum TCOD removal efficiency (89%) was achieved at an OLR = 0.67 g COD/l/d, corresponding to influent TCOD = 24 g COD/l at an HRT = 36 d. Moreover, the inhibition of biogas production was observed at the highest OLR studied.

Background: Young-onset dementia is best defined as dementia presenting at age less than 65 years. And, while cognitive impairment in the elderly is dominated by dementia of the Alzheimer type, young-onset dementia has a vast differential diagnosis., Review Summary: This article reviews an extensive differential diagnosis for young-onset dementia by utilizing different clues in the historical records and laboratory findings to aid with diagnosis. Laboratory testing should be completed in at least 2 stages. In the first stage, referred to as the first "wave," we suggest more routine testing, particularly for treatable causes of dementia. The second "wave," which we also outline, emphasizes more esoteric testing that may require referral to a tertiary care medical facility. The manuscript is divided into 2 parts, with part 1 focusing on clues from the historical data, while part 2 focuses on laboratory abnormalities., Conclusion: Unlike dementia presenting in the elderly, the differential diagnosis in young-onset dementia is vast. A thorough historical review of the symptoms, with special emphasis on the pattern of cognitive impairment, temporal profile of the disease, detailed family history, and extensive but coordinated laboratory and ancillary testing, may yield subtle clues to the diagnosis.

Objective: To determine the etiological agents of diarrhea in children from a small semi-urban city in Libya and the association of age, gender, seasonal variation, breast-feeding, source of water for drinking, or antibiotic use with the isolation of enteropathogens and whether such agents are community or hospital acquired., Methods: Using standard microbiological techniques we examined stool samples from 169 children (70 females) aged a few days to 12 years with acute diarrhea for viral, bacterial and parasitological agents. We used the disc diffusion method to determine the susceptibility of bacterial pathogens to antimicrobial agents. We carried out the study between April 2000 to March 2001., Results: We detected a single agent in 44.4%, rotavirus in 26.6%, Salmonella in 13.6%, and Cryptosporidium in 13% of patients and other enteric pathogens, Shigella in 3.6%, Aeromonas in 5.5%, Entamoeba histolytica/dispar in 11.8, and Giardia lamblia in 1.2%. Serotyping of isolated Salmonella resulted in 21 being Salmonella enteric serotype heidelberg and 3 Salmonella enteritidis. We detected both serotypes in one child. More than 75% of the isolated Salmonella were resistant to 6 different commonly used antimicrobial agents., Conclusion: We found rotavirus, non-typhoid Salmonella and Cryptosporidium to be the most important enteric agents associated with childhood diarrhea in Zliten. The isolated bacterial pathogens showed high resistant rates, particularly among the Salmonella, to the commonly used antimicrobial agents. The ease of which one can obtain these drugs in Zliten may play a role in such resistance.

Three patients with probable dementia with Lewy bodies (DLB) experienced worsening delusions and visual hallucinations as a result of memantine therapy. Significant resolution occurred once treatment was discontinued. Caution is required when prescribing memantine to patients with possible DLB.