Search

ObjectiveHematopoietic stem cell transplant (HSCT) survivors may show evidence of objective cognitive impairment; however, perceived cognitive problems and their impact on quality of life are less well-understood. The purpose of this study was to explore HSCT survivors’ perceptions of cognitive impairment and its effect on daily life functioning.MethodSixty-nine autologous and allogeneic HSCT survivors nine months to three years posttransplant experiencing mild survivorship problems completed a brief structured interview regarding perceived cognitive impairment since transplant. Data were coded and content analyzed. The frequency of participants reporting cognitive problems by domain and associations between reports of cognitive problems and age, depressed mood, anxiety, and health-related quality of life were examined.ResultOverall, 49 of the 69 participants (71%) reported cognitive impairments after transplant: 38 in memory (55%), 29 in attention and concentration (42%), and smaller numbers in other domains. There were no significant differences in problems reported by transplant type. Of the 50 participants who worked before transplant, 19 (38%) did not return to work following transplant, with 12 citing cognitive and health problems as being the reason. There were significant associations between reports of cognitive impairment and younger age (p = 0.02), depressed mood (p = 0.02), anxiety (p = 0.002), and health-related quality of life (p = 0.008).Significance of resultsA large proportion of survivors reported cognitive impairment following HSCT that impaired daily life functioning. Perceived cognitive impairment was associated with younger age, greater distress and reduced health-related quality of life.

Energy supply is a global hot topic. The social and political pressure forces a higher percentage of energy supplied by renewable resources. The production of renewable energy in form of biomethane can be increased by co-substrates such as municipal biowaste. However, a demand-driven energy production or its storage needs optimisation, the option to store the substrate with its inherent energy is investigated in this study. The calorific content of biowaste was found unchanged after 45 d of storage (19.9±0.19 kJ g(-1) total solids), and the methane yield obtained from stored biowaste was comparable to fresh biowaste or even higher (approx. 400 m(3) Mg(-1) volatile solids). Our results show that the storage supports the hydrolysis of the co-substrate via acidification and production of volatile fatty acids. The data indicate that storage of biowaste is an efficient way to produce bioenergy on demand. This could in strengthen the role of biomethane plants for electricity supply the future.

Moderne pathophysiologische Konzepte weisen auf eine Bedeutung des zentralen Nervensystems fur die Schmerzchronifizierung bei neuropathischen Schmerzen hin. Welche Bedeutung haben unter Berucksichtigung dieser Konzepte die bei chronischen Wurzelreizsyndromen vereinzelt angetroffenen halbseitigen Sensibilitatsstorungen? Anhand von 2 Kasuistiken werden die typischen klinischen Befunde demonstriert. Bei beiden Patientinnen fand sich neben einem neuropathischen Dauerschmerz eine halbseitige Sensibilitatsstorung der gesamten Korperhalfte ipsilateral zur radikularen Symptomatik. Auf der gesamten Korperhalfte wurde Beruhrungs-, Schmerz- sowie Temperaturempfindung vermindert im Vergleich zur Gegenseite wahrgenommen. Hemisensorische Storungen bei Patienten mit chronischen Wurzelreizsyndromen konnen als Hinweis auf eine funktionelle Verarbeitungsstorung noxischer Impulse im Nucleus ventralis posterior des Thalamus hinweisen. Sie stellen ein klinisches Korrelat einer subkortikalen Neuroplastizitat dar, die evtl. bei schweren chronischen Schmerzsyndromen die Therapieresistenz erklart.

A 71-year-old woman, with a history of light-chain amyloidosis, presented with a sudden onset dyspnoea. Echocardiography showed a large pericardial effusion with compression of the right atrium and the right ventricle. Right heart catheterisation demonstrated equalisation of her diastolic pressures consistent with cardiac tamponade. Pericardiocentesis revealed a haemmorrhagic exudative effusion with no evidence of malignancy. Bone marrow biopsy and other investigations showed no evidence of multiple myeloma. Her effusion recurred 2 weeks later and repeat pericardiocentesis demonstrated similar findings. She was started on chemotherapy with no further recurrence of pericardial effusion. The patient was unable to tolerate chemotherapy and died 1 year after initial presentation. This case represents a rare manifestation of cardiac amyloidosis and explores the reported aetiologies for cardiac tamponade in the setting of light-chain amyloidosis. Acute and definitive treatments are also discussed.

A young man from California presented with acute onset of cough, fevers, night sweats and pruritus with dark urine. Laboratory studies were notable for moderate transaminitis with elevated bilirubin and eosinophilia. Hepatitis panel, HIV screen and heterophile antibodies were negative. CT scan showed multiple bilateral focal opacities with hilar and mediastinal lymphadenopathy with no ductal dilation or gallbladder stones. The patient had positive coccidioidomycosis serologies and he was started on fluconazole with resolution of symptoms and improvement in transaminitis over the next month. This article highlights a rare manifestation of disseminated coccidioidomycosis with symptomatic hepatitis. Although an increasingly prevalent infection found in southwest USA, dissemination is rare in immunocompetent hosts. Postmortem studies suggest hepatic involvement is common in disseminated infection. However symptomatic hepatitis is rare, with only three cases of symptomatic hepatitis found in the literature.

This study was carried out to document the long-term results of postanal repair for idiopathic faecal incontinence. Thirty-one patients (mean age 65.6 years) were followed up for 2-7.5 years (median 4.2 years). Continence was improved in 16 (52%) patients, only 2 (6%) of whom regained normal continence. No significant change in resting and pressure, maximum squeeze pressure, pelvic descent or anorectal angle was seen postoperatively. The electromyographical signs, e.g. duration and amplitude of action potentials, average amplitude, and integrals of the curves did not change significantly after the operation. The mean right pudendal nerve terminal motor latency (PNTML) increased from 2.38 ms before to 2.59 ms after surgery (P > 0.05). No significant change in the continence and defaecation index was seen postoperatively.

Waste-activated sludge (WAS) may be considered a resource generated by wastewater treatment plants and used for biogas-generation but it requires pre-treatment (PT) for enhanced biogas-yields and reduced WAS disposal costs. To date, a number of studies on the optimization of such PT focused on improved biogas yields but neglected inferred energy and resource consumption. Here, we aimed to identify the most promising thermo-chemical PT-strategy in terms of net energy output and cost-efficiency by optimizing PT temperature and the amount and sort of the alkaline reagent used. We compared methane-potentials and disposal costs of untreated and treated WAS and conducted an annual cost-benefit calculation. We defined 70 °C and 0.04 M NaOH as ideal PT-conditions being both, low-energy demanding and efficient. Applying these conditions, enhanced biogas-yields and improved dewaterability led to reduced electricity and disposal costs of 22 and 27%, respectively, resulting in savings of approx. 28% of the yearly WAS-related expenditures of a wastewater treatment plant. Despite multiple benefits in running costs, the implementation of WAS-PT was not recommendable in the presented case study due to high investment costs.