Severe asthma care trajectories: the French RAMSES cohort

Background

The French RAMSES study is an observational prospective multicentre real-life cohort including severe asthmatic subjects. The objective of the study was to compare the characteristics of patients, in terms of phenotype and asthma care trajectories, between those managed by tertiary referral centres (TRCs) or secondary care centres (SCCs).

Methods

Patients were prospectively recruited and enrolled for a 5-year follow-up. Patients' characteristics were analysed at inclusion and compared between TRCs and SCCs.

Results

52 centres (24 TRCs and 28 SCCs) included 2046 patients: 1502 (73.4%) were included by a TRC and 544 (26.6%) by a SCC. Patients were mainly women (62%), 53±15 years old, 67% with Asthma Control Test <20; at inclusion, 14% received oral corticosteroids (OCS) and 66% biologics. Compared with the SCC group, the TRC group had more frequent comorbidities and lower blood eosinophil counts (262 versus 340 mm-3; p=0.0036). OCS and biologics use did not differ between groups, but patients in the TRC group benefited more frequently from an educational programme (26% versus 18%; p=0.0008) and received more frequently two or more sequential lines of biologics (33% versus 24%; p=0.0105). In-depth investigations were more frequently performed in the TRC group (allergy tests: 74% versus 62%; p<0.0001; exhaled nitric oxide fraction: 56% versus 21%; p<0.0001; induced sputum: 6% versus 3%; p=0.0390).

Conclusions

Phenotypes and care trajectories differed in the RAMSES cohort between SCCs and TRCs, probably related to different levels of asthma severity and differences in medical resources and practices among centres. This highlights the need for standardisation of severe asthma care.

Optimization of the Parameters Impacting the Direct Red 89 Degradation with Thermally Activated Persulfate Using a Full Factorial Design

A two-level full factorial design with interactions effectively used to screen for parameters impacting the degradation of Direct Red 89 (DR 89) by thermally activated persulfate. Four variables were identified as critical: reaction temperature (T), persulfate concentration ([PS]), initial pH of medium (pH) and initial DR 89 concentration ([DR89]i). The fit goodness of the reduced model tested by performing plots of descriptive statistic, residuals versus predicted responses, normal probability versus residuals and observed versus predicted values, as well as examining the ANOVA table. The observed and the predicted response values of the reduced model exhibited a good correlation, with R2, R2adj, Q2 and ‘p’ of 0.990, 0.983, 0.968 and 0.000, respectively. To determine optimal operating parameters, the desirability function utilized, and it determined to be 0.988 with a predicted response of 99.89% for an initial DR 89 concentration of 51.96 mg/L, a persulfate concentration of 12 mM, a reaction temperature of 60 °C and a pH of 3.

Enhanced reactivity of the CuO-Fe2O3 intimate heterojunction for the oxidation of quinoline yellow dye (E104)

This research work describes the degradation of quinoline yellow (QY) in aqueous solutions by the heterogeneous Fenton and photo-Fenton processes in the presence of CuO/Fe₂O₃ photocatalyst. CuO/Fe₂O₃ derived from LDH structure was synthesized by the co-precipitation method. The physiochemical characteristics of CuO/Fe₂O₃ were described by XRD, TEM/SEM, BET surface area, and FTIR techniques. The effects of pH, H₂O₂ concentration, dye concentration, catalyst dose, reaction temperature, and reusability of catalyst on the QY decolorization efficiency were studied. The results indicated that a complete removal of QY was achieved within 150 min, when the H₂O₂ and QY concentrations were 27.6 mM and 100 mg/L, respectively. The rate constants for QY removal by the heterogeneous Fenton system were calculated, and the experimental data were found to fit the pseudo-first order model. Under optimal conditions, the rate constants were, respectively, 0.02032 and 0.01715 min^-1 for the photo-Fenton and Fenton systems; this means that the addition of light has not a noticeable effect.

Sulfaquinoxaline oxidation by UV-C activated sodium persulfate: Degradation kinetics and toxicological evaluation

This study evaluates the efficiency of sulfate radicals used in advanced oxidation process in water treatment. The targeted pollutant is an antibiotic, sulfaquinoxaline (SQ-Na) sodium, widely used in the veterinary field. The results show a degradation of SQ-Na until 90% after 300 min of irradiation at optimal sodium persulfate (SPS) concentration (200 mg/L). Degradation of the antibiotic obeys a pseudo-first-order kinetics when the concentration of sulfate radicals ranging from 0 to 240 mg/L. The decomposition of SQ-Na via the UV/SPS method is favored significantly under acidic conditions but becomes slow at neutral pH and almost inhibited under alkaline conditions. The contribution of the sulfate radicals alone and of both radicals hydroxyl and sulfate on the SQ-Na degradation is evaluated at 69% and 80%, respectively. Toxicity tests with Sinapis alba and Daphnia magna on treated samples, before and after irradiation, indicate the formation of new by-products more toxic during the treatment process. PRACTITIONER POINTS: SQ-Na was significantly degraded (90%) under UV/SPS system. SQ-Na decay exhibited a pseudo-first-order kinetics. SQ-Na was completely degraded via UV/SPS process under acidic conditions. The shoot growth appears to be more sensitive to oxidation by-products toxicity than root growth. Ineffectiveness in eliminating the ecotoxicity.

Removal of Cr(VI) from Aqueous Solutions Using Amino-Functionalized Carbon Nanospheres Adsorbents

  Carbon nanospheres were prepared and functionalized with carboxyl acid groups (CNS-CA), then reacted with 3-aminopropyltriethoxysilane to introduce amino groups onto the surface (CNS-NH₂) by post-synthesis grafting. CNS-NH₂ was acidified in order to convert the amino groups (-NH₂) into ammonium moieties (<inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="01925-ilm01.gif"/>). Various techniques such as N₂ physisorption, X-ray diffraction, Fourier transform infrared spectroscopy, Raman spectroscopy, thermogravimetry, X-ray photoelectron spectroscopy, and transmission electron microscopy were used to characterize the nanospheres. The removal of chromium ions from aqueous solution using <inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="01925-ilm12.gif"/> was investigated. Factors influencing the uptake of Cr(VI) ions such as solution pH, adsorbent dose, and initial Cr(VI) ion concentration were investigated. Equilibrium adsorption data fitted the Langmuir model very well. The adsorption maximum capacity of Cr(VI) was found to be 52.38 mg/g. The reusability of <inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="01925-ilm23.gif"/> results indicated that it can be reused five times successfully without loss of adsorption capacity.

Photodegradation of organic pollutants in water and green hydrogen production via methanol photoreforming of doped titanium oxide nanoparticles

Novel nanomaterials based on doped TiO2 nanoparticles with different morphological, textural and band-gap properties have been synthesized using scalable methods. The influence of synthetic parameters such as titanium source (titanium(IV) isopropoxide and titanium(IV) butoxide), doping quantity (0%, 2% or 5% Zn), acidic solution for the hydrolysis reaction (ascorbic acid, nitric acid) and calcination temperatures (500°C and 600°C) was simultaneously investigated. The obtained nanomaterials were characterized by different methods and photocatalytic tests of methylene blue (MB) degradation under UV-light were conducted to determine their activity. The results revealed that the synthesized nanomaterials are porous aggregates with very high crystallinity and are mainly composed of the anatase phase; although their physical properties vary depending on the different synthetic parameters employed. These changes are able to modify the apparent rate constant of the degradation of MB up to one order of magnitude, indicating, substantial changes in their photoactivity. Hybrid materials TiO2-Pd nanoparticles have also been prepared, characterized and tested for hydrogen production using photocatalytic methanol reforming where supported palladium nanoparticles acted as co-catalyst. Furthermore, the hybrid materials TiO2-Pd nanoparticles were studied in photocatalytic tests of methylene blue degradation under visible LED-light. The results obtained in the production of hydrogen from the photocatalytic reforming of methanol by hybrid materials suggest that the reported hybrid systems could be suitable photocatalysts for future sustainable hydrogen production upon tuning of the morphological, textural and band gap energy properties to allow processes to be carried out under visible light.

[Angiosarcoma mimicking recurrent pulmonary embolism]

INTRODUCTION

Pulmonary artery sarcoma is a rare disease with non-specific symptoms. The clinical and radiological presentation can mimic pulmonary embolism with chronic thromboembolic pulmonary hypertension. Management is essentially surgical but the prognosis remains poor.

CASE REPORT

A patient presented with symptoms of pulmonary embolism. Despite vitamin K antagonist therapy, he suffered from extension of the endovascular defects and his pulmonary hypertension increased. Suspicious results of positron emission tomography suggested the diagnosis of pulmonary artery sarcoma that was confirmed by surgery. However, the outcome was unfavourable, leading to death of the patient.

CONCLUSION

This case reinforces the idea that the clinical and tomodensitometric presentations of pulmonary arterial sarcoma and chronic thromboembolic pulmonary hypertension are similar. The positron emission tomography seems to be a key to distinguishing these two diagnoses.

Tuberculous osteomyelitis. A review of 125 cases

One hundred and twenty-five cases of tuberculous osteomyelitis have been observed by the authors since 1968. The site of the lesion and the clinical and radiological findings have been analysed. The importance of accurate diagnosis by bacteriological and histological investigation is emphasized. Pitfalls in the differential diagnosis with chronic haematogenous osteomyelitis are described. Treatment is by chemotherapy, and immobilization is useless. Operation was limited to the drainage of three large abscesses. A favourable response to chemotherapy was obtained in 92% of the 105 cases which were followed up. The role of a super-added pyogenic bone infection in 8 cases of persisting sinus after chemotherapy is discussed. Finally, the authors stress the importance of preventing the development of tuberculous arthritis by the correct diagnosis and treatment of juxta-articular tuberculous osteomyelitis.

Continuous ambulatory peritoneal dialysis in diabetic patients. The relationship of hypertension to retinopathy and cardiovascular complications

From August 1978 to December 1983, 51 insulin-dependent diabetic patients with end-stage renal disease were selected for treatment by continuous ambulatory peritoneal dialysis. There were 27 male and 24 female patients, with a mean age of 52.3 +/- 13.5 years. Forty-five patients dialyzed themselves by continuous ambulatory peritoneal dialysis and six were treated by continuous cyclic peritoneal dialysis. All patients were treated at home. The cumulative duration of treatment was 65.6 patient-years; 14 patients were dialyzed for at least 24 months. Extrarenal complications were frequent at start of continuous ambulatory peritoneal dialysis, including hypertension in 48 patients, proliferative retinopathy in 50, and cardiovascular complications in 30. Age appeared to be the major risk factor, with success rates at 2 years of 78% in patients under age 50 years and only 50% in patients over age 50. The main cause of death was vascular and the main cause of transfer to other therapeutic modalities was abdominal complications or malnutrition or both. Excellent control of blood pressure, uremia, and blood glucose levels was obtained on a daily program of four exchanges. Improvement in visual status was frequently observed, mainly in the young population. In patients with juvenile diabetes, continuous ambulatory peritoneal dialysis should be part of an integrated program with transplantation, while in the elderly, the method offers a unique opportunity for them to treat themselves at home.