Pancreatitis preceding acute episodes of thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: report of five patients with a systematic review of published reports

BACKGROUND AND OBJECTIVES: The thrombotic thrombocytopenic purpura-hemolytic uremic syndromes (TTP-HUS) have diverse etiologies, clinical manifestations, and risk factors, but the events that may trigger acute episodes are often unclear. We describe the occurrence of TTP-HUS following pancreatitis and consider whether pancreatitis may be a triggering event for acute episodes of TTP-HUS. DESIGN AND METHODS: We report on three patients from the Oklahoma Registry and two patients from Northwestern University who had an acute episode of TTP-HUS following pancreatitis. A systematic review of published case reports was performed to identify additional patients who had TTP-HUS following pancreatitis. RESULTS. In each of our five patients there was an apparent etiology of alcoholism or common bile duct obstruction for the pancreatitis and no evidence of TTP-HUS when the pancreatitis was diagnosed. Two patients had severe ADAMTS13 deficiency with an inhibitor; in one of these patients TTP-HUS recurred following a subsequent recurrent episode of pancreatitis. The systematic review identified 16 additional patients who had TTP-HUS following pancreatitis; recurrent TTP-HUS occurred in three of these patients following a subsequent episode of recurrent pancreatitis. In all 21 patients, the interval between the diagnosis of pancreatitis and TTP-HUS was short (1-13 days; median, 3 days). The three Oklahoma patients represent approximately 1% of the 356 patients in the Registry. INTERPRETATION AND CONCLUSIONS: These observations suggest that in some patients pancreatitis, a disorder that results in an intense systemic inflammatory response, may be a triggering event for acute episodes of TTP-HUS.

Investigation of using waste engine oil blended with reclaimed asphalt materials to improve pavement recyclability

With the increasing importance of conserving natural resources and moving toward sustainable practices, the aging transportation infrastructure can benefit from these ideas by improving their existing recycling practices. When an asphalt pavement needs to be replaced, the existing pavement is removed and ground up. This ground material, known as reclaimed asphalt pavement (RAP), is then added into new asphalt roads. However, since RAP was exposed to years of ultraviolet degradation and environmental weathering, the material has aged and cannot be used as a direct substitute for aggregate and binder in new asphalt pavements. One material that holds potential for restoring the aged asphalt binder to a usable state is waste engine oil. This research aims to study the feasibility of using waste engine oil as a recycling agent to improve the recyclability of pavements containing RAP. Testing was conducted in three phases, asphalt binder testing, advanced asphalt binder testing, and laboratory mixture testing. Asphalt binder testing consisted of dynamic shear rheometer and rotational viscometer testing on both unaged and aged binders containing waste engine oil and reclaimed asphalt binder (RAB). Fourier Transform Infrared Spectroscopy (FTIR) testing was carried out to on the asphalt binders blended with RAB and waste engine oil compare the structural indices indicative of aging. Lastly, sample asphalt samples containing waste engine oil and RAP were subjected to rutting testing and tensile strength ratio testing. These tests lend evidence to support the claim that waste engine oil can be used as a rejuvenating agent to chemically restore asphalt pavements containing RAP. Waste engine oil can reduce the stiffness and improve the low temperature properties of asphalt binders blended with RAB. Waste engine oil can also soften asphalt pavements without having a detrimental effect on the moisture susceptibility.

ISO 14001 in India: More than a certificate on the wall?

The growth of ISO 14001 certificates worldwide has led to much research on the role of voluntary standards in improving the environmental impacts of industry. Most of this research, however, has focused on industrialized countries, with very little research examining the effects of ISO 14001 and other voluntary initiatives in the developing world. This is especially unfortunate because it is in these very countries that proponents of ISO 14001 claim the largest benefits of the standard will occur, by helping polluting industries improve performance and by assisting environmental regulators in enforcing laws more effectively. Indian industries have begun adopting ISO 14001 at an accelerating pace, but there is little available information on what this means for the environmental performance of Indian firms. The research described here closes this gap by exploring the reasons for the increasing popularity of ISO 14001 in India, the ways in which firms use the standard and the benefits they obtain from it. Findings suggest that while the processoriented approach of ISO 14001 does offer important benefits, changing market demands towards cheaper certification and away from rigorous EMS implementation have devalued the standard for those interested in using it as an indicator of a firm’s environmental performance.

Investigation into the impact of grain boundaries, film interface, and crystallographic orientation on the ionic conductivity of thin film gadolinium-doped ceria

The research reported in this dissertation investigates the impact of grain boundaries, film interface, and crystallographic orientation on the ionic conductivity of thin film Gd-doped CeO2 (GDC). Chapter 2 of this work addresses claims in the literature that submicron grain boundaries have the potential to dramatically increase the ionic conductivity of GDC films. Unambiguous testing of this claim requires directly comparing the ionic conductivity of single-crystal GDC films to films that are identical except for the presence of submicron grain boundaries. In this work techniques have been developed to grow GDC films by RF magnetron sputtering from a GDC target on single crystal r plane sapphire substrates. These techniques allow the growth of films that are single crystals or polycrystalline with 80 nm diameter grains. The ionic conductivities of these films have been measured and the data shows that the ionic conductivity of single crystal GDC is greater than that of the polycrystalline films by more than a factor of 4 over the 400-700°C temperature range. Chapter 3 of this work investigates the ionic conductivity of surface and interface regions of thin film Gd-doped CeO2. In this study, single crystal GDC films have been grown to thicknesses varying from 20 to 500 nm and their conductivities have been measured in the 500-700°C temperature range. Decreasing conductivity with decreasing film thickness was observed. Analysis of the conductivity data is consistent with the presence of an approximately 50 nm layer of less conductive material in every film. This study concludes that the surface and interface regions of thin film GDC are less conductive than the bulk single crystal regions, rather than being highly conductive paths. Chapter 4 of this work investigates the ionic conductivity of thin film Gd-doped CeO2 (GDC) as a function of crystallographic orientation. A theoretical expression has been developed for the ionic conductivity of the [100] and [110] directions in single crystal GDC. This relationship is compared to experimental data collected from a single crystal GDC film. The film was grown to a thickness of _300 nm and its conductivity measured along the [100] and [110] orientations in the 500-700°C temperature range. The experimental data shows no statistically significant difference in the conductivities of the [100] and [110] directions in single crystal GDC. This result agrees with the theoretical model which predicts no difference between the conductivities of the two directions.

A STUDY OF THE IMPACTS OF FREEZE-THAW ON CLIFF RECESSION AT THE CALVERT CLIFFS IN CALVERT COUNTY, MARYLAND

The Calvert Cliffs, which form much of the western coastline of the Chesapeake Bay in Calvert County, Maryland, are actively eroding and destabilizing, resulting in a critical situation for many homes in close proximity to the slope's crest. Past studies have identified that where waves directly interact with the toe of the slope, wave action controls cliff recession; however, where waves do not regularly interact with the slope toe, the past work identified that freeze-thaw controls recession. This study investigated the validity of this second claim by analyzing the recession rate and freeze-thaw behavior of six study sites along the Calvert Cliffs that are not directly affected by waves. While waves do remove failed material from the toe, in these regions freeze-thaw is believed to be the dominant factor driving recession at the Calvert Cliffs. Past recession rates were calculated using historical aerial photographs and were analyzed together with a number of other variables selected to represent the freeze-thaw behavior of the Calvert Cliffs. The investigation studied sixteen independent variables and found that over 65% of recession at these study sites can be represented by the following five variables: (1) cliff face direction, (2 and 3) the percent of total cliff height composed of soil with freeze-thaw susceptibility F4 and F2, (4) the number of freeze-thaw cycles, and (5) the weighted shear strength. Future mitigation techniques at these sites should focus on addressing these variables and might include vegetation or addressing the presence of water along the face of the slope. Unmitigated, the Calvert Cliffs will continue to recede until a stable slope angle is reached and maintained.

[Role of coronary artery bypass grafting in the treatment of coronary artery disease - a well-balanced information of the patients and objective decision making are welcome]

Most recently discussion about the optimal treatment for different subsets of patients suffering from coronary artery disease has re-emerged, mainly because of the uncertainty caused by doctors and patients regarding the phenomenon of unpredictable early and late stent thrombosis. Surgical revascularization using multiple arterial bypass grafts has repeatedly proven its superiority compared to percutaneous intervention techniques, especially in patients suffering from left main stem disease and coronary 3-vessels disease. Several prospective randomized multicenter studies comparing early and mid-term results following PCI and CABG have been really restrictive, with respect to patient enrollment, with less than 5% of all patients treated during the same time period been enrolled. Coronary artery bypass grafting allows the most complete revascularization in one session, because all target coronary vessels larger than 1 mm can be bypassed in their distal segments. Once the patient has been turn-off for surgery, surgeons have to consider the most complete arterial revascularization in order to decrease the long-term necessity for re-revascularization; for instance patency rate of the left internal thoracic artery grafted to the distal part left anterior descending artery may be as high as 90-95% after 10 to 15 years. Early mortality following isolated CABG operation has been as low as 0.6 to 1% in the most recent period (reports from the University Hospital Berne and the University Hospital of Zurich); beside these excellent results, the CABG option seems to be less expensive than PCI with time, since the necessity for additional PCI is rather high following initial PCI, and the price of stent devices is still very high, particularly in Switzerland. Patients, insurance and experts in health care should be better and more honestly informed concerning the risk and costs of PCI and CABG procedures as well as about the much higher rate of subsequent interventions following PCI. Team approach for all patients in whom both options could be offered seems mandatory to avoid unbalanced information of the patients. Looking at the recent developments in transcatheter valve treatments, the revival of cardiological-cardiosurgical conferences seems to a good option to optimize the cooperation between the two medical specialties: cardiology and cardiac surgery.