bluuebunny/crossref_metadata_2025 huggingface dataset:
Percutaneous Coronary Intervention for Left Main and Multivessel Coronary Artery Disease – A Review of Strategies
Authors: Alli Oluseun , Holmes David ,   Mayo Clinic and Mayo Foundation, Rochester, US,   Mayo Clinic and Mayo Foundation, Rochester, Professor of Medicine, 200 First Street SW, Rochester, Minnesota, 55905, US. E: Holmes.david@mayo.edu
Published: August 2014

Patients with complex and multivessel disease present challenging clinical problems in defining treatment strategies. The Synergy between PCI with taxus and cardiac surgery (SYNTAX) trial, which included both a randomised as well as a registry experience has clarified many issues. These include the extent and severity of the disease, the clinical presentation, and the metrics used for comparison. The development, validation and application of the SYNTAX score has been of fundamental importance. In those patients with the least complex coronary anatomy, using hard endpoints such as death and myocardial infarction, the outcomes of treatment with either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) are similar although repeat revascularisation rates remain higher with PCI. In those patients with more extensive and complex disease, coronary artery bypass remains the standard of care. It must be remembered that the drug-eluting stent tested in SYNTAX was a first generation device and that newer generations are safer and more effective. Perhaps the most important guidance in the field of treatment of complex multivessel coronary disease is the attention paid to the Heart Team concept wherein both interventional cardiologists and cardiovascular surgeons are strongly encouraged to work together in these patients to identify the optimal approach consistent with the patients needs and objectives.
Dedicated Bifurcation Drug-eluting Stent BiOSS® – A Novel Device for Coronary Bifurcation Treatment
Authors: Gil Robert J , Vassilev Dobrin , Bil Jacek ,   Invasive Cardiology Department, Central Clinical Hospital of the Internal Affairs and Administration Ministry, 137 Woloska Street, 02-507 Warsaw, Poland. E: robert.gil@cskmswia.pl; Institute of Experimental and Clinical Medicine, Polish Academy of Science, Warsaw, Poland,   National Heart Hospital, Sofia, Bulgaria,   Invasive Cardiology Department, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
Published: August 2014

The Bifurcation Optimisation Stent System (BiOSS®) (Balton®, Poland) is a coronary, dedicated bifurcation, balloon-expandable stent made of 316 litre stainless steel tube with strut thickness of 120 micrometre (μm). It is covered with a mixture of a biodegradable polymer and an antiproliferative substance – paclitaxel (BiOSS Expert version) or sirolimus (BiOSS Lim version). The stent consists of two parts (the proximal with a larger diameter in relation to the distal one) connected with two connection struts (average 1.2 mm in length) at the step-up middle zone. The stent is crimped on a bottle-shaped semi-complaint balloon (Bottle®, Balton, Poland). Our intravascular ultrasound (IVUS) study revealed that the construction of the BiOSS stent assures an easy access to the side branch and is comparable to the classic stent lumen enlargement with less injury to the area adjacent to the most sensitive part of the bifurcation. A total number of 65 lesions in 63 consecutive patients were enrolled in the First-In-Man (FIM) registry for BiOSS Expert, where we achieved a 100 % device success rate. The long-term clinical results were satisfactory and closely related to the high-risk profile of the treated population. Our data demonstrated that simple and fast bifurcation treatment with a single dedicated bifurcation paclitaxel-eluting stent (BiOSS Expert) is feasible and highly successful. Based on the data collected in animal experiments and preliminary data in humans with BiOSS Lim, releasing sirolimus from the surface of the biodegradable coating, one may presume that this version will provide even better clinical results compared with the paclitaxel one.
Carotid Artery Stenting – Strategies to Improve Procedural Performance and Reduce the Learning Curve
Authors: Willaert Willem IM , Van Herzeele Isabelle ,   On behalf of the European Virtual reality Endovascular RESearch Team (EVEREST): Consultant Vascular Surgeon, Department of Thoracic and Vascular Surgery, AZ Maria Middelares Hospital, Ghent, Belgium,   On behalf of the European Virtual reality Endovascular RESearch Team (EVEREST): Consultant Vascular Surgeon, Department of Thoracic and Vascular Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E: Isabelle.vanherzeele@ugent.be; Honorary Senior Lecturer, Department of Biosurgery and Surgical Technology, Imperial College London, London, UK
Published: August 2014

Carotid artery stenting (CAS) remains an appealing intervention to reduce the stroke risk because of its minimal invasive nature. Nevertheless, landmark randomised controlled trials have not been able to resolve the controversies surrounding this complex procedure as the peri-operative stroke risk in a non-selected patient population still seems to be higher after CAS in comparison to carotid endarterectomy. What is more, these trials have highlighted that patient outcome after CAS is influenced by patient- and operator-dependant factors. The CAS procedure exhibits a definitive learning curve resulting in higher complication rates if the procedure is performed by inexperienced interventionists or in low-volume centres. This article will outline strategies to improve the performance of physicians carrying out the CAS procedure by means of proficiency-based training, credentialing, virtual reality rehearsal and optimal patient selection.
Catheter-based Renal Sympathetic Denervation – Long-term Symplicity™ Renal Denervation Clinical Evidence, New Data and Future Perspectives
Authors: Mahfoud Felix , Schmieder Roland , Davies Justin , Kandzari David E , Weil Joachim , Whitbourn Robert ,   Katrina Mountfort, Medical Writer, Radcliffe Cardiology: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany,   Katrina Mountfort, Medical Writer, Radcliffe Cardiology: Medizinische Klinik IV, Universitätsklinikum Erlangen, Erlangen, Germany,   Katrina Mountfort, Medical Writer, Radcliffe Cardiology: Consultant Cardiologist, Hammersmith Hospital, Imperial College London, London, UK,   Katrina Mountfort, Medical Writer, Radcliffe Cardiology: Chief Scientific Officer, Director, Interventional Cardiology, Piedmont Heart Institute, Atlanta, Georgia, US,   Katrina Mountfort, Medical Writer, Radcliffe Cardiology: CardioMed Herzzentrum Nord, Sana Klinikum Lübeck, Akademisches Lehrkrankenhaus der Universität zu Lübeck, Lübeck, Germany,   Katrina Mountfort, Medical Writer, Radcliffe Cardiology: Director, Cardiac Catheterization Labs and Coronary Intervention, The Cardiovascular Research Centre, University of Melbourne and Australian Catholic University, Melbourne, Australia
Published: August 2014

Hypertension is one of the most prevalent chronic diseases worldwide and the incidence of resistant hypertension is increasing. Catheter-based renal denervation (RDN) offers a new approach to reaching blood pressure goals by targeting the renal nerves. The technique has demonstrated significant and sustained reductions in blood pressure (BP) in the Symplicity HTN-1 and Symplicity HTN-2 clinical trials. The Global SYMPLICITY Registry aims to demonstrate safety and effectiveness in a ‘real-world’ patient population. Real-world RDN experience has emphasised that patient selection is crucial to successful outcomes; a multidisciplinary referral network is recommended to increase awareness of the procedure and identify patients who are likely to respond best to RDN. Further advances in catheter technology have led to the development of the multi-electrode Symplicity Spyral™ multi-electrode catheter; preliminary data from the feasibility study using the Symplicity Spyral catheter indicate clinical efficacy and procedural safety with reduced procedure times. The Symplicity Spyral catheter is not yet commercially available. The indications of RDN may also expand beyond resistant hypertension – encouraging data have been seen in patients with moderate treatment resistant hypertension. Furthermore, RDN may be beneficial in other clinical states characterised by sympathetic nervous system overactivation including heart failure and chronic kidney disease. Additional data are needed to evaluate the efficacy of RDN in these disease states.
Concurrent Coronary Artery and Valvular Heart Disease – Hybrid Treatment Strategies in 2013
Authors: Grubb Kendra J , Nazif Tamim , Williams Mathew R , George Isaac ,   Division of Cardiothoracic Surgery, College of Physicians and Surgeons,   Division of Cardiology, Columbia University Medical Center, New York, US,   Division of Cardiothoracic Surgery, College of Physicians and Surgeons; Division of Cardiology, Columbia University Medical Center, New York, US,   Division of Cardiothoracic Surgery, New York Presbyterian Hospital – College of Physicians and Surgeons, Columbia University, Milstein Hospital Building, 7GN-435, 177 Fort Washington Avenue, New York, NY 10032, US. E: ig2006@columbia.edu
Published: August 2014

Concomitant coronary artery disease (CAD) and valvular heart disease is an increasingly common problem in the ageing population. Hybrid procedures combine surgical and transcatheter approaches to facilitate minimally invasive surgery or to transform a single high-risk open surgery into two less risky procedures. In ideal circumstances, this strategy may decrease the surgical risk in elderly, high-risk and reoperative surgical candidates, while improving patient comfort, convenience and cost-effectiveness. Hybrid procedures can be performed in a staged fashion or as a ‘one-stop’ procedure in a hybrid operating suite. Increasing evidence supports the safety and short-term efficacy of hybrid valve repair or replacement and coronary revascularisation procedures. Nevertheless, important questions remain, including the optimal timing of the individual procedures and the optimal antiplatelet therapy after percutaneous coronary intervention. With ongoing advances in procedural techniques and anticoagulation strategies, as well as the accumulation of long-term outcomes data, hybrid approaches to concomitant CAD and valvular heart disease will likely become increasingly common.
Overcoming the Challenges of the Transfemoral Approach in Transcatheter Aortic Valve Implantation
Authors: Noble Stephane , Roffi Marco ,   Cardiology Division, Interventional Cardiology Unit, University Hospital of Geneva, Geneva, Switzerland. E: Stephane.noble@hcuge.ch,   Cardiology Division, University Hospital of Geneva, Geneva, Switzerland
Published: August 2014

Transcatheter aortic valve implantation (TAVI) is performed through a retrograde transfemoral approach in approximately 80–90 % of cases thanks to the improvements in delivery catheter profile, size and steerability compared with the first generation devices. The aim of this review article is to describe the challenges of transfemoral TAVI and the options to overcome them. The difficulties may be related to the access itself or the placement of the valve using the transfemoral route. Comprehensive patient screening using multislice computed tomography and crossover techniques to prevent bleeding should result in low complication rates even for fully percutaneous procedures. Horizontal ascending aorta and severely calcified aortic valves remain a challenge for retrograde valve crossing, device advancement and accurate positioning during deployment. The buddy balloon technique is a simple option in the case of difficult aortic valve crossing with a delivery catheter, whereas an antegrade approach using the transapical route is a reasonable alternative in such anatomy.
No Racial Disparities in the Treatment of ST Elevation Myocardial Infarction – A Community-based Experience
Authors: Basoor Abhijeet , Randhawa Gagan , Cotant John F , Choksi Nishit , Halabi Abdul R , Patel Kiritkumar C , DeGregorio Michele ,   Division of Cardiology, Department of Internal Medicine, St. Joseph Mercy Oakland Hospital, Medical Education – Fourth Floor, St. Joseph Mercy Oakland, 44405 Woodward Avenue, Pontiac, Michigan 48341, Michigan, US. E: drasbasoor@hotmail.com,   Division of Cardiology, Department of Internal Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, Michigan, US,   Division of Cardiology, Department of Internal Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, Michigan, US,   Division of Cardiology, Department of Internal Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, Michigan, US,   Division of Cardiology, Department of Internal Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, Michigan, US,   Division of Cardiology, Department of Internal Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, Michigan, US,   Division of Cardiology, Department of Internal Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, Michigan, US
Published: August 2014

Whether racial disparities exist in the treatment of ST elevation myocardial infarction (STEMI) is not exactly known. We report a retrospective chart review of patients with first event of STEMI, in two groups separated by one decade. Results revealed that hospital mortality in the 2007 and 1997 groups for African Americans versus Caucasians was one of 22 versus 21 of 170, 95 % confidence interval (CI) -0.178 to 0.022, p=0.48 and four of 41 versus 39 of 402, 95 % CI -0.095 to 0.096, p=1.00, respectively. The mean length of stay (LOS) for African Americans and Caucasians in the 2007 and 1997 groups was 5.7 versus 4.1 days (p=0.09) and 7.3 versus 6.6 days (p=0.42), respectively. During follow-up, a total of 40 patients needed re-intervention in the 2007 group. The re-intervention rate in African American patients being 13.6 % (three of 22) versus 21.2 % (36 of 170) in Caucasians, 95 % CI -0.231 to 0.081, with p=0.57. In conclusion, there was no evidence of racial disparity in the treatment of STEMI in terms of hospital mortality, length of hospital stay and re-intervention rate.
How to Select the Most Appropriate Patient and Lesion to be Treated with a Coronary Bioresorbable Vascular Scaffold
Authors: Costopoulos Charis , Latib Azeem , Colombo Antonio ,   Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO GVM Centro Cuore Columbus, Milan, Italy; Department of Cardiology, Imperial College University, London, UK,   Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO GVM Centro Cuore Columbus, Milan, Italy;,   Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO GVM Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy. E: info@emocolumbus.it
Published: August 2014

Bioresorbable vascular scaffolds (BVS) are an exciting novel treatment for coronary artery disease (CAD) as their eventual resorption renders the artery free from a permanent metallic cage. Clinical trials regarding these novel devices have demonstrated promising results, although their use in this context has largely been restricted to simple lesions. More recently, BVS use has expanded to patients with more complex lesions including those with long diffuse disease, and results from several registries are awaited with regard to their efficacy in ‘real-world’ patients. Although any patient who requires percutaneous treatment for CAD could benefit from BVS implantation, there are certain cohorts of patients and lesions in whom BVS could be of particular benefit. In this review, we attempt to identify which patient and lesion cohort is most suitable for treatment with these novel devices.
Start-up of horizontal anaerobic reactors with sludge blanket and fixed bed for wastewater treatment from coffee processing by wet method
Authors: Oliveira Roberto A. de , Bruno Natani M. N.
Published: August 2014

In this study it was evaluated the start-up procedures of anaerobic treatment system with three horizontal anaerobic reactors (R1, R2 and R3), installed in series, with volume of 1.2 L each. R1 had sludge blanket, and R2 and R3 had half supporter of bamboo and coconut fiber, respectively. As an affluent, it was synthesized wastewater from mechanical pulping of the coffee fruit by wet method, with a mean value of total chemical oxygen demand (CODtotal) of 16,003 mg L-1. The hydraulic retention time (HRT) in each reactor was 30 h. The volumetric organic loading (VOL) applied in R1 varied from 8.9 to 25.0 g of CODtotal (L d)-1. The mean removal efficiencies of CODtotal varied from 43 to 97% in the treatment system (R1+R2+R3), stabilizing above 80% after 30 days of operation. The mean content of methane in the biogas were of 70 to 76%, the mean volumetric production was 1.7 L CH4 (L reactor d)-1 in the system, and the higher conversions were around at 0.20 L CH4 (g CODremoved)-1 in R1 and R2. The mean values of pH in the effluents ranged from 6.8 to 8.3 and the mean values of total volatile acids remained below 200 mg L-1 in the effluent of R3. The concentrations of total phenols of the affluent ranged from 45 to 278 mg L-1, and the mean removal efficiency was of 52%. The start-up of the anaerobic treatment system occurred after 30 days of operation as a result of inoculation with anaerobic sludge with active microbiota.
Estrutura arbórea da Floresta Ombrófila Densa Altomontana de serras do Sul do Brasil
Authors: Scheer Maurício Bergamini , Mocochinski Alan Yukio , Roderjan Carlos Vellozo
Published: August 2014

O presente trabalho teve os objetivos de agrupar informações sobre a estrutura arbórea da floresta altomontana da Serra do Mar paranaense e de compará-las com as de florestas altomontanas de outras serras do Sul e Sudeste do Brasil. Foram realizados levantamentos fitossociológicos em diversas montanhas de quatro importantes serras (ou subserras) do Paraná. Nas quatro subserras foram amostrados 2294 indivíduos (PAP > 10 cm) pertencentes a 28 famílias, 43 gêneros e 78 espécies. Foi observada maior riqueza de espécies na amostragem da Serra Gigante (41 espécies), seguida pelas serras da Prata (37), da Igreja (34) e do Ibitiraquire (26). A altura média obtida para os indivíduos foi de 4,8 m, o PAP médio de 22,9 cm, a densidade média de 4779 ind/ha, a área basal média de 33,5 m²/ha e o índice de diversidade de Shannon total de 2,68 nat/ind. Agrupando informações de estudos realizados em outras subserras paranaenses, totalizando 11 levantamentos e 204 parcelas (10200 m²), obteve-se uma matriz com 75 espécies determinadas, onde as cinco com maior porcentagem de importância estrutural foram Ilex microdonta, Siphoneugena reitzii, Drimys angustifolia, Ocotea porosa e Ilex chamaedrifolia. Os trechos amostrados na Serra do Mar do Paraná, apresentaram menor riqueza e diversidade que os da Serra da Mantiqueira (MG) e maior que os dos Aparados da Serra Geral (SC). Tais diferenças, possivelmente, estão relacionadas às influências antrópicas, das distâncias geográficas, dos diferentes centros de endemismo, dos entornos tropicais ou subtropicais dominantes, das feições geomorfológicas, entre outros fatores.
Local and regional processes determine plant species richness in a river‐network metacommunity
Authors: Kuglerová Lenka , Jansson Roland , Sponseller Ryan A. , Laudon Hjalmar , Malm-Renöfält Birgitta
Published: August 2014

River systems form dendritic ecological networks that influence the spatial structure of riverine communities. Few empirical studies have evaluated how regional, dispersal‐related processes and local habitat factors interact to govern network patterns of species composition. We explore such interactions in a boreal watershed and show that riparian plant species richness increases strongly with drainage size, i.e., with downstream position in the network. Assemblage composition was nested, with new species successively added downstream. These spatial patterns in species composition were related to a combination of local and regional processes. Breadth in local habitat conditions increased downstream in the network, resulting in higher habitat heterogeneity and reduced niche overlap among species, which together with similar trends in disturbance, allows more species to coexist. Riparian edaphic conditions were also increasingly favorable to more species within the regional pool along larger streams, with greater nitrogen availability (manifested as lower C:N) and more rapid mineralization of C and N (as indicated by ratios of stable isotopes) observed with downstream position in the network. The number of species with the capacity for water dispersal increased with stream size, providing a mechanistic link between plant traits and the downstream accumulation of species as more propagules arrive from upstream sites. Similarity in species composition between sites was related to both geographical and environmental distance. Our results provide the first empirical evidence that position in the river network drives spatial patterns in riparian plant diversity and composition by the joint influence of local (disturbance, habitat conditions, and habitat breadth) and regional (dispersal) forces.
Additional Organizations That Address Health Inequities Within the African American Community
Authors: Kendall-Tackett Kathleen
Published: August 2014

The increase in breastfeeding rates in the African American community is largely due to the efforts of several grassroots organizations. This article briefly describes some of these organizations, highlighting their objectives, mission, founders, and beginnings.
Implementation of the waste discharge charge system
Authors: Pegram G. C. , Weston D. , Reddy S. T.
Published: August 2014

The waste discharge charge system (WDCS) is being developed by the Department of Water Affairs to promote waste reduction and water conservation. It forms part of the Pricing Strategy, which is being established under the National Water Act (Act 36 of 1998). The WDCS is based on the polluter-pays principle and aims to:promote the sustainable development and efficient use of water resourcespromote the internalisation of environmental costs by impactorscreate financial incentives for dischargers to reduce waste and use water resources in a more optimal way.

The WDCS is premised on resource quality objectives (RQOs) as the measure of acceptable risk, and seeks to achieve RQOs at lowest total cost to the catchment. Where RQOs are exceeded or are threatened, impact on the resource is unacceptable and the WDCS may be deployed to achieve RQOs. The system will be applied at a catchment scale where the catchment is defined as those areas that have a significant impact on water quality, or are impacted by the specific water quality problem such as salinity, nutrients, heavy metals and organics. This paper aims to provide a summary of the WDCS Strategy.
Sectorisation of looped water networks with electromagnetic water meters
Authors: Wojciech Koral
Published: August 2014

This paper describes the sectorisation of a water network, as operated by the water and sewage utility (PWiK Gliwice, Poland) with electromagnetic water-meters (battery powered). This solution allows supply of District Metered Areas (DMA) by a few points without ‘dead-end’ pipework and shows that the main problems of the Utility are small, hidden leaks. Additionally the paper describes a water balance for the town of Pyskowice (part of the Gliwice water network) where all water meters are read by radio (automatic meter reading – AMR).
Commissioning and operation experience of the largest flat sheet membrane bio-reactors in the world
Authors: Alhakawati M. S. , Cooper N. B. , Al Asmi S. , Abu El Soud M. , Abdulhussain H.
Published: August 2014

The Al Ansab sewage treatment plant (STP) serves the central area of Muscat, the capital of Oman. When commissioned in 2010, the plant was the largest flat-plate membrane bioreactor facility in the world, with an initial capacity of 55,000 m3/day. Expansion to 125,000 m3/day is under design and when operational in 2016 the plant will once again be one of the largest MBRs of its kind in the world. With limited space available, and a desire for consistent high quality effluent for full public access applications, the membrane bio-reactor (MBR) process was selected as the treatment technology for the plant. The plant equipment and tankage installed under the first phase was sized to serve a maximum month average flow rate of 55,000 m3/day, while buildings, hydraulics, interconnecting piping and electrical power supply were sized to serve the second phase total capacity of 84,000 m3/day.

Kubota EK400 flat sheet membranes of 0.4 μm pore size were selected for the MBR. Eight membrane tanks were provided in the first phase, each having 40 double stacked membrane units. Each double stacked unit has 400 membrane panels making the total membranes sheets installed in the first phase over 120,000 panels. Al Ansab MBR plant expansion to the second phase is currently under detailed design and the new Kubota membranes module RW400 will be used in this phase.

The plant was designed to accept sewage delivered by sewer networks. Due to delay in completing the sewer network the new plant was commissioned using trucked sewage diverted from the old plant. This is a non-standard condition for the MBR plant, and Haya implemented several modifications in anticipation of this situation. The high volume of trucked wastewater was addressed with flow and load equalization systems to dampen the impact of shock loading. The Al Ansab STP is performing very well and complying with all the required effluent standards. Many lessons have been learned in both the design and operation of such a large MBR plant.
Application of bootstrap-based neural networks for monthly rainfall forecasting in Western Jilin Province, China
Authors: Chu Haibo , Lu Wenxi , Sun Xiaoqing
Published: August 2014

Rainfall forecasting is an important pre-requisite for effectively managing and planning water resources. This study developed a generalized regression neural network (GRNN) combined with a bootstrap approach for rainfall forecasting, and the forecasting results were compared with the autoregressive model and single GRNN model. The test was performed in western Jilin Province, China with a 53-year (1957–2010) monthly rainfall time series. To obtain the good performance of GRNN model, the number of input neurons was decided by the analysis of Bayesian information criterion, and the appropriate spread was selected considering the performance of the training and testing phases. mean absolute error, root mean square error, coefﬁcient of efﬁciency and R2 are employed to evaluate the performances of the forecasting models. The results showed that the bootstrap-based GRNN model performed better than single GRNN and AR models in forecasting monthly rainfall and the proposed method can improve the prediction accuracy of monthly rainfall time series, while generating uncertainty estimates of the rainfall forecasting.
Increased nitrogen removal in existing volumes at Sundet wastewater treatment plant, Växjö
Authors: Andersson Chan Anneli , Johansson Niklas , Christensson Magnus
Published: August 2014

Many wastewater treatment plants need to improve their nitrogen removal due to stricter requirements and increasing loads. This often means larger bioreactor volumes, which can be very expensive and is sometimes impossible if space is limited. Therefore, there is a need for compact hybrid solutions that can increase capacity within existing volumes. Two full-scale demonstration projects using moving bed biofilm reactor (MBBR) technology has proven to be an efficient way to treat nitrogen in existing volumes at Sundet wastewater treatment plant in Växjö. Increased nitrification and denitrification capacity in parts of the main stream were demonstrated through the Hybas™ process, a combination of MBBR and activated sludge using the integrated fixed-film activated sludge technology. The ANITA™ Mox process, using autotrophic N-removal through anaerobic ammonium oxidation (anammox), provided high nitrogen removal for the sludge liquor. Data collected on-site for over a year are analyzed and compared with the performance of conventional treatment systems. These two full-scale demonstration projects have been a successful learning experience in identifying and correcting both process and operational issues, which may not have arisen at pilot scale. The set objectives in terms of nitrogen removal were met for both processes and design modifications have been identified that will improve future operation at Sundet WWTP.
Plugrisost: a model for design, economic cost and environmental analysis of rainwater harvesting in urban systems
Authors: Gabarrell X. , Morales-Pinzón T. , Rieradevall J. , Rovira M. R. , Villalba G. , Josa A. , Martínez-Gasol y C. , Dias A. C. , Martínez-Aceves D. X.
Published: August 2014

In the context of transition to sustainability, one of the main challenges facing societies today is the supply of water. By integrating different methodological tools and studies we developed the innovative software program Plugrisost® (rainwater, greys and sustainability), a simulation model, that facilitates the economic evaluation and the potential environmental impact of alternative water supplies (rainwater harvesting [RWH] and greywater systems) at different scales of urban planning. This modelling tool contributes to urban water planning for smart cities development. Plugrisost® analyses the optimal design variables, cost and environmental performance of RWH and greywater systems, using tap water production as a reference system for comparison. The use of economic and environmental indicators can make the optimal size of a rainwater tank more restrictive when it is compared to the results regarding the satisfaction of the demand for rainwater. Economic and environmental analysis can help avoid oversizing tanks for rainwater and thus obtain greater benefits. Plugrisost includes estimated cost and Global Warming Potential, as well as other life cycle impact indicators for this purpose. A case study analyzing the implementation of a RWH system in a single-family house in Aveiro, Portugal is included, showing the importance of rainwater availability and demand for the successful operation of simulated systems.
Early-Lethal Costello Syndrome Due to Rare HRAS Tandem Base Substitution (c.35_36GC>AA; p.G12E)–Associated Pulmonary Vascular Disease
Authors: Weaver K. Nicole , Wang Dehua , Cnota James , Gardner Nicholas , Stabley Deborah , Sol-Church Katia , Gripp Karen W. , Witte David P. , Bove Kevin E. , Hopkin Robert J.
Published: August 2014

Costello syndrome is a rare, autosomal-dominant syndrome caused by activating missense mutations in the Harvey rat sarcoma viral oncogene homolog ( HRAS), most often p.G12S. Several rare mutations have consistently been associated with a more severe phenotype that is often lethal in infancy. Cause of death is most often respiratory failure, with hypertrophic cardiomyopathy playing a significant role in morbidity. Impaired fibroblast elastogenesis is thought to contribute to the Costello phenotype, but reports of histologic evidence of disordered elastogenesis at autopsy are limited. We report a patient with Costello syndrome due to a rare tandem base substitution (c.35_36GC>AA) resulting in the p.G12E missense change. The proband died at the age of 3 months from respiratory failure, with minimal evidence of cardiomyopathy. The autopsy disclosed pulmonary vascular dysplasia affecting small arteries and veins associated with abnormal elastin distribution in tortuous dilated arteries and veins, with nonuniform wall thickness and semiobstructive lesions at artery branch points typical of early pulmonary hypertensive vascular disease. Elastic fibers in the dermis were abnormally short and fragmented. This case suggests that disordered elastogenesis in the pulmonary vasculature and undiagnosed (or underdiagnosed) pulmonary hypertension may contribute to morbidity in patients with Costello syndrome.
Actinomycotic Mastoiditis Complicated by Sigmoid Sinus Thrombosis and Labyrinthine Fistula
Authors: Lezcano Cecilia , Simons Jeffrey P. , Colman Kathryn L. , Cohen Michael S. , Lin Philana L. , Reyes-Múgica Miguel
Published: August 2014

Actinomyces is a rare pathogen that can be the cause of infections in the digestive and urinary tracts, skin, genitalia, and lungs, which generally have an indolent clinical course. However, in some cases these can be locally destructive and become generalized infections. Actinomyces has been previously implicated in infections of the middle ear, nasopharynx, and sinuses, occasionally causing complications such as chronic mastoiditis. Here we describe the case of a 10-year-old-male presenting with nausea, vomiting, and headache who developed intracranial complications of actinomycotic mastoiditis.
Effects of Wheatgrass (Triticum aestivum) Juice on Serum Cholesterol of Experimentally Induced Hypercholesterolaemic Male Long Evans Rat
Authors: Afroz Rokhsana Dil , Nurunabbi Abu Sadat Mohammad , Khan Md Ismail
Published: August 2014

An experimental study was designed to observe the hypocholesterolaemic effect of wheatgrass (Triticum aestivum) juice on experimentally induced hypercholesterolaemic rats, which was carried out in the Department of Pharmacology & Therapeutics, Dhaka Medical College, Dhaka, from July, 2009 to June, 2010. A total number of 48 healthy adult male Long Evans rats (Norwegian strain), age ranging from 2-3 months, and weighing from 140-200 grams were used for the present study. 6 rats were taken in each group of total 8 groups treated differently with 1 control group. Rats of the first 5 groups were sacrificed at 29th day and their serum total cholesterol levels were measured. Rest of the rats were sacrificed at 57th day and their serum total cholesterol levels were measured. The mean serum concentration of total cholesterol of 10ml/kg grass juice fed normal rats was decreased by 11.64% than that of the laboratory diet fed control group (P<0.01). The total cholesterol of the group of rats treated with 10ml/kg grass juice and1% cholesterol diet were decreased by 36.59% than that of the hypercholesterolaemic control group (P<0.001). The mean total cholesterol of the hypercholesterolaemic rats treated with 10ml/kg grass juice for 28 days were decreased by 29.10%, and in hypercholesterolaemic rats treated with 20ml/kg grass juice for 28 days were decreased by 39.46% (P<0.001). The mean total cholesterol of the hypercholesterolaemic rats treated with 0.14mg/kg atorvastatin for 28 days were found to be decreased by 38.86% than that of hypercholesterolemic control group, which was statistically significant (P<0.001). DOI: http://dx.doi.org/10.3329/bjpp.v27i1-2.20070 Bangladesh J Physiol Pharmacol 2011; 27(1&2):21-27
Patterns of Drug Utilization in Cardiology Department of a Tertiary Level Hospital in Bangladesh
Authors: Afroj Farhana , Parveen Feroza , Ara Ferdous , Iqbal Md Jalal Uddin , Saha Rekha Rani , Rozario Rini Juliet
Published: August 2014

A cross-sectional descriptive study was carried out among patients admitted in cardiology department from 1st January to 31st March 2011 in Sir Salimullah Medical College & Mitford Hospital, Dhaka to see the patterns of prescriptions and use of drug by using WHO core drug use indicators and some additional indices. A total of 300 patients were included in this study. The average number of drugs per encounter was 8.8 and 11.43% drugs were prescribed by generic name. Percentage of encounters with cardiovascular drugs were 64%,other drugs were 36% and 25% injection were prescribed.70.45% drugs were prescribed from EDL of Bangladesh, the availability of copy of essential drug list was present and availability of key drugs was 74%.So the results of the present study may contribute to identify essential drug prescribing patterns in our country. DOI: http://dx.doi.org/10.3329/bjpp.v28i1-2.20072 Bangladesh J Physiol Pharmacol 2012; 28(1&2):1-4
HMG-COA Reductase Inhibition by Simvastatin Reduces Neointimal Inflammation in a Rat Model of Atherosclerosis
Authors: Sultana Rezina , Rahman Md Sayedur , Akhter Nargis
Published: August 2014

Background: Inhibitors of HMG-CoA-reductase reduce cardiovascular mortality through the mechanisms yet elucidated. Most ischemic events are secondary to disruption of atherosclerotic plaques highly infiltrated by macrophages.Objectives: To study the effect of the 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG-CoA)-reductase inhibitor simvastatin on the potential mechanisms involved in the recruitment of monocytic cells into the vessel wall.Methodology: This experimental study was carried out in the Laboratory of the Department of Pharmacology & Therapeutics, BSMMU, Shahbag, Dhaka, during the period from 1st July 2008 to 30th June 2009. Fifty healthy Long-Evans Norwegian male rats aged between 3-4 months and weighing between 180-200gm were randomly selected and divided into 3 groups (A, B & C). Control group A (n=10) were fed on standard rat diet for 8 weeks, Vehicle fed group B (n=10) were fed soybean oil at a dose of 1ml once daily for 8 weeks and 2% cholesterol fed group C (n=30) were fed a 2% cholesterol enriched diet (suspension of cholesterol powder in soybean oil) at a dose of 100mg/ml of 2ml once daily for 8 weeks. After 8 weeks 10 rats of each group were sacrificed and remaining 20 rats of group C were continued to the part II of the experiment and divided into two groups. Group-I (cholesterol fed control group, n=10) and Group-II (simvastatin treated group). Group-I fed 0.5ml of o.1% cholesterol enriched diet once daily to maintain atherosclerotic state & Group-II treated with 1ml of 60mg/ml simvastatin at a dose of 300mg/Kg/day along with 0.5ml of 0.1% cholesterol enriched diet. After 8 weeks all the rats of two group were sacrified. Blood collected from each rats for estimation of serum lipid profile by enzymatic methods and aorta was preserved for histopathological examination and Intima-media ratio was measured using Image-proplus software (Silva et al, 2000).Results: Simvastatin induced a significant reduction in serum lipids (p<0.001) and in atherosclerotic lesion size (p<0.001). Aortic macrophage infiltration was abolished by the treatment.Conclusions: In a rat atherosclerosis model, simvastatin diminished the neointimal inflammation and this could contribute to the stabilization of the atherosclerotic plaque. This may be an additional explanation for the reduction of acute ischemic events in patients treated with statins. DOI: http://dx.doi.org/10.3329/bjpp.v28i1-2.20073 Bangladesh J Physiol Pharmacol 2012; 28(1&2):5-9
Effect of Ruellia Praetermissa Extracts on Erythropoiesis in Pregnant Women
Authors: Martin Salah A , Anna Njunda L
Published: August 2014

The effect of the extracts of Ruellia Praetermissa on hemoglobin (Hb), Hematocrit (Ht), mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV). mean corpuscular hemoglobin concentration (MCHC), red blood cell count (RBC), was investigated in 50 Pregnant women attending prenatal clinic in Belo maternity. The women were assigned to 5 groups of 10 women per group. The first group was the control and the other 4 were the experimental groups. The control was administered daily, 0.5 ml of saline solution while the experimental groups were administered daily oral doses of the plant extract in concentrations of 200mg/kg, 400mg/kg, 800mg/kg and 1,600mg/kg respectively for 16 days. Blood samples were collected on the 17th day and analyzed. The extracts contain flavonoids aglycons (luteolin and apigenin) and their respective, glycosides and a high concentration of triterpens (campesterol, stigmasterol, -sitosterol, lupeol) and iridoid glycosides. It is also rich in vitamins and minerals. The extracts increased the values in a dose dependent manner Hb (P < 0.05), RBC (P < 0.05), hematocrit (P < 0.05). It however showed no remarkable effect on the values of MCH and MCHC (P > 0.05) but with a dose depending decreasing effect on MCV (P < 0.05). The active principles of this plant drug stimulate erythropoiesis which leads to increase in circulating RBCs with slightly microcytic sizes (MCV), normochromic weight,(MCH) normochromic hemoglobin contents (MCHC). The result of this study thus supports the traditional use of Ruellia Praetermissa in pregnancies threatened with miscarriage and as a remedy for anemia. DOI: http://dx.doi.org/10.3329/bjpp.v28i1-2.20075 Bangladesh J Physiol Pharmacol 2012; 28(1&2):15-18
Patterns of Prescription in a Psychiatry Out Patient Department in a Teaching Hospital in Bangladesh
Authors: Any Omma Hafsa , Parveen Feroza , Ara Ferdous , Iqbal Mohammad Ju , Saha Rekha Rani
Published: August 2014

A cross-sectional descriptive study was carried out among individuals attending the psychiatry out-patient department from February 1st 2010 to April 30th 2010 in Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh to see the patterns of prescription and drug use in psychiatry out-patient department of teaching hospital in Bangladesh.A total of 300 patient were included in this study. The average number of drugs per encounter was 2.44 drugs were prescribed by generic name. The commonest clinical indication were schizophrenia and other psychotic disorder (40%) and use of psychotropic drug (36%) frequently but injection use(8.33%) was very low, additional (anticholinergic) drugs were prescribed 76% of prescription. Average cost of drugs per prescription was 181 taka. So, the study will help to understand the trends in prescribing psychotropic drugs and will provide guidelines for designing appropriate future intervention strategies in order to promote rational prescribing and improve the quality of health care. DOI: http://dx.doi.org/10.3329/bjpp.v28i1-2.20076 Bangladesh J Physiol Pharmacol 2012; 28(1&2):19-22
Study on expression of cytokine genes in peripheral blood mononuclear cells (PBMCs) following Hepatitis B vaccination
Authors: Hossain Marufa , Any Omma Hafsa , Sultana Rezina , Majid Farjana , Khan Nashid Tabassum
Published: August 2014

Vaccination with surface protein of Hepatitis B Virus (HBsAg) is considered the main strategy for effective control of the infection and viral transmission. The present study was designed to determine the expression of Interferon (INF-?) in peripheral blood mononuclear cells (PBMCs) by RT-PCR method. In the present study, PBMCs from responders expressed INF-? gene in response to HBsAg, while nonresponders expressed low levels of this cytokines. Most humoral non responders to HBV thus develop specific cellular immune responses, eventually liable to protect them against viral infection. http://dx.doi.org/10.3329/bjpp.v29i1-2.20064 Bangladesh J Physiol Pharmacol 2013; 29(1&2) : 25-28
The silent geriatric giant- anxiety disorders in late life
Authors: Nowshin Iffat , Kabir Farhana
Published: August 2014

Late-life anxiety can often be silent, missed or difficult to diagnose as older adults tend to somatize psychiatric problems. Yet late-life anxiety disorders are a "geriatric giant," being twice as prevalent as dementia among older adults and four to eight times more prevalent than major depressive disorders, causing significant impact on the quality of life, morbidity, and mortality of older adults. Bangladesh is one of the twenty countries in the world with the largest elderly population and by 2025, along with four other Asian countries, will account for 44% of world's total elderly population. Demographic and epidemiological transitions reveal geriatric problems as burning public health issue. So more emphasis should be given on geriatric health problems in order to ensure physical, mental and socially sound health. http://dx.doi.org/10.3329/bjpp.v29i1-2.20065 Bangladesh J Physiol Pharmacol 2013; 29(1&2) : 29-31
Heterospin Junctions in Zigzag-Edged Graphene Nanoribbons
Authors: Girão Eduardo , Liang Liangbo , Meunier Vincent
Published: August 2014

We propose a graphene nanoribbon-based heterojunction, where a defect-free interface separates two zigzag graphene nanoribbons prepared in opposite antiferromagnetic spin configurations. This heterospin junction is found to allow the redirecting of low-energy electrons from one edge to the other. The basic scattering mechanisms and their relation to the system’s geometry are investigated through a combination of Landauer–Green’s function and the S-matrix and eigen-channel methods within a tight-binding + Hubbard model validated with density functional theory. The findings demonstrate the possibility of using zigzag-edged graphene nanoribbons (zGNRs) in complex networks where current can be transmitted across the entire system, instead of following the shortest paths along connected edges belonging to the same sub-lattice.
The Art of Interconnected Thinking: Starting with the Young
Authors: Nguyen Nam , Bosch Ockie
Published: August 2014

Despite many efforts to deal with the various complex issues facing our societies, plans and problem solutions are seldom long lasting, because we, as individuals, and our leaders are most likely to fall into the trap of using traditional linear thinking. It is natural and easy, but does not usually deliver long-term solutions in the context of highly complex modern communities. There is an urgent need for innovative ways of thinking and a fresh approach to dealing with the unprecedented and complex challenges facing our world. It is essential for future leaders and citizens to be prepared for “interconnected” thinking to deal with complex problems in a systemic, integrated and collaborative fashion; working together to deal with issues holistically, rather than simplistically focusing on isolated features. An educational tool (Ecopolicy) is used as the main mechanism to achieve this aim. The Ecopolicy cybernetic simulation “game” is a challenging, but playful, method by which students are introduced to the idea of thinking in terms of relations, in feedback cycles, in networks and in systems. Participation in this stimulating simulation enhances the capacity of young people to change their way of thinking. This would be expected to prepare them to develop into leaders or citizens who can effectively deal with a complex and challenging future.