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Traditionally, bio-butanol is produced with the ABE (Acetone Butanol Ethanol) process using Clostridium species to ferment sugars from biomass. However, the route is associated with some disadvantages such as low butanol yield and by-product formation (acetone and ethanol). On the other hand, butanol can be directly produced from ethanol through aldol condensation over metal oxides/ hydroxyapatite catalysts. This paper suggests that the chemical conversion route is more preferable than the ABE process, because the reaction proceeds more quickly compared to the fermentation route and fewer steps are required to get to the product.

Purpose: To introduce a novel in vivo method (Visual Acuity Dry Up; VADU) for testing the visual performance during the dewetting of the pre-lens tear film on a contact lens (CL)., Methods: Thirty-nine subjects were fitted with daily disposable CL (Nelfilcon A). Visual performance and dewetting characteristics of the pre-lens tear film were simultaneously assessed using a modified multifunctional topographer (Keratograph 5 M, OCULUS Optikgeräte GmbH, Wetzlar, GERMANY) and the Non-Invasive Keratograph Dry-Up Time (NIKDUT) method. Measures were taken after five minutes and eight hours of CL wear and included the Visual Acuity Dry-Up Time (VADUT; time between last blink and visual breakdown) and the Visual Acuity Dry-Up Area (VADUA; dewetted CL area at visual breakdown) at one (VA +0.1logMAR ), two (VA +0.2logMAR ) and three (VA +0.3logMAR ) log units below maximal visual acuity (VA)., Results: Participants lost one, two or three log units of VA after 13.1 ± 17.4 s, 20.83 ± 21.81, 34.67 ± 29.11 (VADUT), corresponding to a dewetted CL area of 4.82 ± 6.64 mm², 9.5 ± 8.26 and 13.0 ± 8.68 (VADUA), respectively. Differences in VADUT und VADUA for all visual requirements were significant (all p < 0.05). VADUT and VADUA did not vary with CL wear duration (all p > 0.05). A median VA loss of one log unit occurred five seconds after the first dewetting., Conclusions: The novel VADU method can be used to analyze the role of the tear film stability on the visual performance during CL wear. Hereby, visual loss is quantified based on the threshold definition of the psychometric function., Competing Interests: Declaration of Competing Interest The authors declare that there are no conflicts of interest., (Copyright © 2020. Published by Elsevier Ltd.)

Purpose: To evaluate meibomian gland (MG) width and determine its impact on successful contact lens (CL) use and ocular health., Methods: A five-site study was conducted by recruiting 18- to 45-year-old subjects who had dropped out of CLs because of discomfort. CL dropouts were compared to age- and sex-matched successful CL wearers. Right eyes were evaluated for tear break-up time, tear meniscus height, MG expressibility, meibum quality, and meibography. Central MG widths were evaluated with a custom MATLAB program., Results: CL dropouts (n = 56) and successful CL (n = 56) wearers had similar grades for upper (p = 1.0) and lower (p = 0.22) MG atrophy, upper (p = 0.07) and lower (p = 0.89) MG tortuosity, and upper (p = 0.92) and lower (p = 0.97) MG widths. Upper eyelid MG widths were narrower than lower eyelid MG widths (p = 0.03). Upper and lower MG tortuosity (p < 0.001) and widths (p = 0.03) were associated, but not atrophy (p = 0.42). Lower eyelid MG widths were associated with MG expressibility (p = 0.01), but MG widths were not with any other factors., Conclusions: Successful CL wear does not appear to be clinically influenced by MG width or other measures of MG structural integrity. Lower eyelid MGs were wider than upper eyelid MGs and narrower lower eyelid MGs were associated with worse MG expressibility, suggesting that narrower MGs may produce abnormal meibum. Data also suggests that MG factors of both eyelids should be evaluated in practice., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: Contact lens (CL) dropout is estimated to be approximately equal to the number of new wearers per year, resulting in virtually no growth in the global CL market. The purpose of this study was to determine ocular and CL factors associated with CL dropout., Methods: This five-site study recruited subjects 18-45 years of age who had ceased CL wear within the past 6-12 months due to discomfort. Dropout subjects were compared to age- and sex-matched currently successful CL wearers. Each subject was administered a symptoms survey and a study-specific survey that queried general CL history and compliance. Clinical testing included non-invasive tear break-up time, tear meniscus height, blepharitis assessment, meibum quality and expression, and meibography., Results: A total of 56 matched-pairs were recruited. Dry eye was found to significantly increase a subject's odds of dropping out of CLs. The odds of dropping out of CLs was also significantly increased with each worsening grade of upper or lower eyelid meibomian gland (MG) plugging, upper eyelid meibum quality, and upper eyelid MG tortuosity. No other factors analyzed increased a subject's odds of dropping out of CLs., Conclusions: CL dropout may be precipitated by underlying dry eye symptoms, though most dry eye signs, with the exception of MG structure and function, had minimal predictive value for CL dropout. Nevertheless, evidence suggests that practitioners should screen for and educate CL patients about the importance of maintaining healthy MGs, which may potentially allow them to maintain comfortable CL use and increase their CL longevity., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Background: Primary leptomeningeal melanocytic tumors of the central nervous system are rare and, especially in the spine, less frequent compared with other entities. There is no consensus regarding the best care of these tumors., Case Description: We report 2 cases of primary leptomeningeal melanocytic tumors, 1 primary leptomeningeal melanoma (PLM) and 1 primary leptomeningeal melanocytoma (PLMC) of the upper cervical spine, and emphasize different surgical findings and clinical courses of these patients. A review of the literature according to primary leptomeningeal melanocytic tumors of the spine was done, especially to compare different treatment modalities in the younger history., Conclusions: Primary melanocytic tumors of the spine are exceedingly rare. Before surgery it is difficult to make a correct diagnosis. Usually an unexpected intraoperative finding with consecutive histopathologic analyses leads to the final diagnosis. An accurate search for melanocytic tumors outside the central nervous system as a primary source is mandatory. PLMC has a better prognosis than PLM. There is no consensus regarding the adjuvant therapy, but patients with PLM should be given radiotherapy, chemotherapy, and immunotherapeutic approaches as immune checkpoint blockade after surgery. Communicating hydrocephalus is highly associated with PLM, but may occur in PLMC as well., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Vertebrobasilar dolichoectasia (VBD) is a rare cause of hemifacial spasm. The ectatic vessel hinders microscopic visualization of the root exit zone. The aim of this study was to evaluate the benefit of endoscopic visualization during microvascular decompression (MVD) in managing this type of neurovascular compression., Methods: Retrospective evaluation of patients with VBD treated by endoscope-assisted MVD for hemifacial spasm between 2007 and 2016 was performed. A prospectively maintained database of all patients treated by MVD for hemifacial spasm was screened for vascular compression. Magnetic resonance imaging was evaluated to detect patients who had VBD according to defined criteria. The value of endoscopic inspection to detect offending vessels was analyzed, and clinical outcome was evaluated., Results: VBD was detected in 11 of 290 patients (incidence 3.8%). In these patients, 12 MVD procedures were performed. The endoscope was useful in identifying the offending vessels and adjacent perforators without any brain retraction in all patients. At last clinical follow-up, all patients had almost complete to complete resolution of clinical symptoms. The interposing technique alone was effective with excellent results in 8 patients. Three patients required an additional transposition-fixation technique to achieve sufficient decompression., Conclusions: VBD is a rare cause of hemifacial spasm. Because of the large diameter of the offending vessel, MVD is technically more demanding. Endoscopic inspection with a 45° endoscope enables accurate visualization of the root exit zone, offending vessels, and perforating arteries. Furthermore, accurate placement of the Teflon pledgets can be confirmed leading to a favorable outcome., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Ventriculoperitoneal (VP) shunting is the most commonly performed procedure in the treatment of hydrocephalus. VP shunt migration can occur at different sites. The aim of the study was to present different sites of abnormal distal shunt location, pathophysiology, and the management in each situation., Methods: Between 2014 and 2017, all patients with hydrocephalus in the Department of Neurosurgery, Cairo University, were gathered prospectively. All pediatric patients below the age of 12 years with shunt migration of the distal end of the VP shunt were identified., Results: Of 1092 patients operated on by the VP shunt between 2014 and 2017, 15 presented with shunt dysfunction because of distal shunt migration (6 anal, 3 scrotal, 1 colon, 1 peroral, 1 upper lumbar extrusion, 1 paraspinal, 1 penile, and 1 umbilical). Especially upper lumbar extrusion and paraspinal shunt location are extremely rare. All the 15 patients were treated successfully with VP shunts and prospectively followed until they presented with complications on different occasions., Conclusions: Peritoneal complications are among the most common causes of VP failure. We present a rare complication where the shunt migrates outside the peritoneal cavity elsewhere with ambiguous pathogenesis. Special considerations have to be appointed during the shunt revision surgeries of these cases., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Tumor-infiltrating lymphocytes (TIL) play an important role in the pathogenesis of renal cell carcinoma. Characterization of TIL requires efficient isolation procedures, especially in early stage disease when the tumor is of small in size. Conventional methods for isolating TIL are based on enzymatic tissue digestion, most frequently with collagenase. Collagenase isolation is limited by poor cell recovery, altered expression of cell-surface molecules, and impaired TIL-functionality. To overcome these limitations, we developed and optimized conditions for a robust collagenase-free mechanical procedure for improved isolation of TIL from renal cell carcinoma samples., Methods: TIL from tumor samples and T cells from peripheral blood were collected from 12 patients undergoing partial or radical nephrectomy. Samples were subjected to an enzymatic reference protocol and to a newly established mechanical isolation protocol. After viability staining, TIL-subpopulations were quantified and phenotyped by immunohistochemistry and flow-cytometric analysis, and were compared to characteristics of peripheral blood T cells. As a marker for TIL-functionality, T-cell cytokine induction was quantified after polyclonal stimulation., Results: We show that this new technique is rapid and allows identification of CD4 and CD8 T-cell subpopulations including CD4, CD8, and regulatory T cells expressing anergy markers such as programmed death-1 (PD-1) or B- and T-lymphocyte attenuator. When compared to the reference protocol involving collagenase digestion, the yield of TIL after mechanical isolation was higher and the expression of cell-surface markers was better preserved. Moreover, although antitumor activity was not assessed, mechanically isolated TIL are at least equally functional as T cells from peripheral blood, as polyclonal stimulation induced cytokines such as interferon-γ and tumor necrosis factor-α in both TIL and T cells from peripheral blood., Conclusion: The mechanical procedure may be applied as a robust and rapid alternative to collagenase digestion for isolation of high amounts of phenotypically and functionally intact TIL from fresh tumor samples., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the tolerability of and subject and investigator satisfaction with delefilcon A (DAILIES TOTAL1 ® ) daily disposable contact lenses in first-time contact lens wearers., Methods: This European multicenter, open-label, single-arm, two-week trial enrolled first-time contact lens wearers and fitted them with delefilcon A contact lenses. Assessments were made at dispensing and at Weeks 1 and 2. Subject-reported outcomes included comfort, quality of vision, convenience, and intent to purchase, which were ranked by agreement responses. Investigator-reported outcomes included slit-lamp biomicroscopy findings and lens fit satisfaction., Results: Ninety-two subjects were included in the per protocol dataset. Mean scores at Weeks 1 and 2 for subject-reported quality of vision and ocular comfort were significantly higher with delefilcon A contact lenses than with the subjects' habitual spectacles during the day, at the end of the day, and overall (all p ≤ 0.02). Ninety-one percent of subjects reported that their study lenses were more comfortable than expected, 98% agreed that they were convenient to use, and 92% were interested in purchasing the lenses (all p < 0.001). Investigators reported that study lenses had an acceptable fit in at least 97% of subjects., Conclusions: Practitioners can expect favorable outcomes when transitioning first-time contact lens wearers from spectacles to delefilcon A daily disposable contact lenses., (Copyright © 2017. Published by Elsevier Ltd.)

Purpose: This study was designed to develop a novel technique called non-invasive keratograph dry-up time (NIK-DUT), which used an adapted corneal topographer, to analyse in-vitro contact lens surface dewetting and the effects of combinations of lenses and lens care solutions on dewetting., Methods: Variables were assessed to optimise sensitivity and reproducibility. To validate the method, in-vitro dewetting of silicone hydrogel contact lenses (balafilcon A, comfilcon A, lotrafilcon A, lotrafilcon B and senofilcon A) was tested. All lens types were soaked in OPTI-FREE ® PureMoist ® Multipurpose Disinfecting Solution (OFPM) and Sensitive Eyes ® Saline Solution. The mean NIK-DUT, defined as drying of 25% of the placido ring measurement segments (NIK-DUT&#95;S25), was calculated for each lens/lens solution combination and a visual map constructed representing the time and location of the dry-up event., Results: Optimal conditions for NIK-DUT measurement included mounting onto a glass stage with a surface geometry of r=8.5mm, e=0, and measuring with high intensity red or white illumination. This method detected significant differences in contact lens dewetting with different lens soaking solutions. NIK-DUT&#95;S25 for all lenses was longer when pre-soaked in OFPM versus saline. Visual analysis showed that dewetting of contact lenses was not uniform across surfaces and differed between test solutions., Conclusions: NIK-DUT is suitable for detecting differences in dewetting among various contact lenses and lens-care combinations. NIK-DUT can quantify the dewetting of large areas of lens surfaces with little subjective influence. Lens care solutions containing surface-active wetting agents were found to delay surface dewetting of silicone hydrogel lenses., (Copyright © 2017. Published by Elsevier Ltd.)

Background: Gross total resection is often avoided in posterior fossa ependymoma surgery because of the fear of permanent neurologic deficits after operation. However, the extent of resection is a major prognostic factor for progression-free and overall survival. This study evaluates the outcome of posterior fossa ependymoma gross total resection in adult patients using a 4-hand suction-irrigation technique at the floor of the fourth ventricle., Methods: All surgical procedures for posterior fossa ependymomas performed since 2001 in the Department of Neurosurgery, University Medicine Greifswald were analyzed., Results: Eight patients (2 women and 6 men; mean age, 41.9 years; range, 29-56 years) underwent surgery for posterior fossa ependymoma. All tumors were World Health Organization grade II. Tumor adherence was found to be in the caudal rhomboid fossa (between the obex and striae medullare, but below the facial colliculus) in all patients. The 4-hand suction-irrigation technique led to gross total resection in all patients (100%), without significant permanent neurologic deficits after surgery. None of the patients got further treatment (chemotherapy, radiation therapy, or second surgery). In none of these patients, tumor recurrence was seen on magnetic resonance imaging after a mean follow-up of 102 months (range, 14-181 months)., Conclusions: Long-term progression-free survival in adult patients suffering from posterior fossa ependymoma is possible by gross total resection without adjuvant radio- or chemotherapy. By careful bimanual microsurgical dissection using the 4-hand suction-irrigation technique and avoidance of bipolar coagulation on the floor of the fourth ventricle, the risk for permanent neurologic deficits is low., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Intraparenchymal cysts without communication to the ventricles or the subarachnoid space are named ependymal or epithelial cysts. The estimated ratio of their incidence compared with arachnoid cysts is 1:10. Neurologic deficit can occur when the cyst exerts mass effect on its surroundings. We evaluated the success rate of endoscopic fenestration of intracranial ependymal cysts., Methods: Our prospectively maintained endoscopy database was screened for all cases of ependymal cysts. The charts were retrospectively reviewed for symptoms, surgery, postoperative course, and complications. Magnetic resonance imaging scans performed before and after surgery were analyzed., Results: We identified 6 patients harboring an intracranial ependymal cyst. The cyst location was frontoparietal, parietal, occipital, or mesencephalic. Patients presented with several symptoms according to the location of the cyst (i.e., epilepsy, hemiparesis, diplopia, hemianopsia). All patients were treated by navigation-guided endoscopic fenestration of the cyst to the ventricular system. Two complications occurred: a cerebrospinal fluid leak, which was managed surgically by wound revision without the need for cerebrospinal fluid shunting, and a chronic subdural hematoma, which occurred 6 weeks after surgery and required burr hole evacuation. Follow-up period ranged from 6 months to 9 years. Magnetic resonance imaging revealed that all cysts decreased in size. Symptoms improved in all patients., Conclusions: Endoscopic fenestration of ependymal cysts to an adjacent ventricular cavity is a treatment option with excellent long-term results and minimal morbidity. It should be considered as the therapy of choice to avoid craniotomy and shunt dependence., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: 68Ga-DOTATATE is a radiolabeled peptide-based agonist that targets somatostatin receptors overexpressed in neuroendocrine tumors. Here, we present our results on validation of organic matrix 68Ge/68Ga generators (ITG GmbH) applied for radiosynthesis of the clinical doses of 68Ga-DOTATATE (GalioMedixTM)., Methods: The clinical grade of DOTATATE (25 μg±5 μg) compounded in 1 M NaOAc at pH=5.5 was labeled manually with 514±218 MBq (13.89±5.9 mCi) of 68Ga eluate in 0.05 N HCl at 95°C for 10 min. The radiochemical purity of the final dose was validated using radio-TLC. The quality control of clinical doses included tests of their osmolarity, endotoxin level, radionuclide identity, filter integrity, pH, sterility and 68Ge breakthrough., Results: The final dose of 272±126 MBq (7.35±3.4 mCi) of 68Ga-DOTATATE was produced with a radiochemical yield (RCY) of 99%±1%. The total time required for completion of radiolabeling and quality control averaged approximately 35 min. This resulted in delivery of 50%±7% of 68Ga-DOTATATE at the time of calibration (not decay corrected)., Conclusions: 68Ga eluted from the generator was directly applied for labeling of DOTA-peptide with no additional pre-concentration or pre-purification of isotope. The low acidity of 68Ga eluate allows for facile synthesis of clinical doses with radiochemical and radionuclide purity higher than 98% and average activity of 272±126 MBq (7.3±3 mCi). There is no need for post-labeling C18 Sep-Pak purification of final doses of radiotracer. Advances in knowledge and implications for patient care. The clinical interest in validation of 68Galabeled agents has increased in the past years due to availability of generators from different vendors (Eckert-Ziegler, ITG, iThemba), favorable approach of U.S. FDA agency to initiate clinical trials, and collaboration of U.S. centers with leading EU clinical sites. The list of 68Ga-labeled tracers evaluated in clinical studies should growth because of the sensitivity of PET technique, the simplicity of the shakebake approach for the dose preparation and reliability of 68Ge/68Ga generators. Our studies have confirmed the reproducible elution profile, and high reliability of ITG GmbH generators required for routine doses preparation according to FDA recommendations., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: This retrospective study investigated 3-dimensional (3D) imaging with intraoperative Cone-Beam Computed Tomography (CBCT) in Mandibular Angle Fractures (MAF) treated by open reduction. The aim of this study was to demonstrate the image quality of intraoperative CBCT in this region and the benefit for the patients., Methods: 83 patients with 86 MAF were included in this study. 8 patients were female and 75 male. Patient age ranged from 11 to 68 years (average age 26.8 years). All patients were examined with the mobile CBCT scanner ARCADIS Orbic 3D (Siemens Medical Solutions, Erlangen, Germany) directly after surgical treatment of the MAF., Results: As a direct result of intraoperative CBCT four patients (5%) underwent intraoperative revision. The intraoperative acquisition of the data sets was uncomplicated and in all cases it was possible to effectively visualise and assess the MAF in 3D quality., Conclusion: The results showed that intraoperative CBCT is a reliable imaging technique for real-time intraoperative assessment of treated MAF. Use of the mobile 3D CBCT scanner is easy to integrate into routine practice and offers the advantage that immediate revision surgery can be performed., (Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Menin is a tumor suppressor required to prevent multiple endocrine neoplasia in humans. Mammalian menin protein is associated with chromatin modifying complexes and has been shown to bind a number of nuclear proteins, including the transcription factor JunD. Menin shows bidirectional effects acting positively on c-Jun and negatively on JunD. We have produced protein null alleles of Drosophila menin (mnn1) and have over expressed the Mnn1 protein. Flies homozygous for protein-null mnn1 alleles are viable and fertile. Localized over-expression of Mnn1 causes defects in thoracic closure, a phenotype that sometimes results from insufficient Jun activity. We observed complex genetic interactions between mnn1 and jun in different developmental settings. Our data support the idea that one function of menin is to modulate Jun activity in a manner dependent on the cellular context.

Background/aims: Hepatitis G virus (HGV) and hepatitis GB virus-C (GBV-C) are recently identified non-A-E hepatitis-associated viruses. The prevalence of HGV/GBV-C in the general population is high (1.0-1.7%), but data on the clinical and histological manifestations of the new viruses are sparse. In the present study we investigated the prevalence and clinical and histological manifestation of HGV/GBV-C infections in patients with elevated aminotransferase levels of unknown etiology., Methods: In 52 of 630 consecutive patients referred for evaluation of elevated aminotransferases the underlying liver disease remained unknown. Serum samples of these 52 patients with elevated aminotransferase levels of unknown etiology were tested for HGV/GBV-C RNA by reverse transcription-polymerase chain reaction (RT-PCR) using primers deduced from nonstructural regions. Cloned PCR products were sequenced and compared by phylogenetic analysis., Results: HGV/GBV-C RNA was consistently detected in 7 of the 52 patients (13%). Sequence and phylogenetic analysis revealed the presence of only one subtype, with nucleotide sequence homologies between 86 and 91%. All seven patients had persistent viremia for at least 9 months. In six patients liver function test results normalized, and alanine aminotransferase levels remained persistently elevated in only one patient. Four HGV/GBV-C positive and ten HGV/GBV-C negative patients consented to a liver biopsy, which revealed similar results with minimal to mild chronic hepatitis and mild portal fibrosis., Conclusions: The prevalence of HGV/GBV-C infections in patients with elevated aminotransferases of unknown etiology is low. Since clinical, biochemical and histomorphologic features of patients with elevated aminotransferases of unknown etiology with and without HGV/GBV-C infection are indistinguishable, the role of HGV/GBV-C in the pathogenesis of chronic liver disease appears insignificant.

Crosslinking the Fas (CD95, APO-1) antigen by mAb or Fas-ligand (Fas-L)-expressing cells triggers apoptosis. We have investigated the early consequences of Fas signaling on the expression of various cell surface antigens on T lymphocytes. Incubation of Fas-sensitive Jurkat (JM) cells with agonistic anti-Fas mAb induced rapid (within 4 hr) downmodulation of L-selectin (CD62L) and CD7 but not of CD3 or CD71. No modulation was observed on Fas-expressing but Fas-resistant JM variant 432.1. On PHA-activated, Fas-sensitive T cell blasts, anti-Fas mAb rapidly triggered downmodulation of a variety of antigens, including CD2, CD4, CD8, CD7, CD44, LFA1alpha, LFA1beta, and CD62L, but not CD3, CD25, or CD26. Most of these antigens were not downmodulated by either CD3 crosslinking (except CD3) or PMA treatment (except CD3, CD4, and CD62L). Comparable patterns of biphasic CD44, LFA1alpha, and LFA1beta expression were observed on CD4+ and CD8+ T cell blasts in response to Fas crosslinking. In these instances, downregulation occurred preferentially on cells undergoing rapid shrinkage. These results indicate that rapid downregulation of selected surface antigens is an early response of both normal and transformed T cells to Fas crosslinking.