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Malonyl-CoA, a product of acetyl-CoA carboxylase is a metabolic intermediate in lipogenic tissues that include liver and adipose tissue, where it is involved in the de novo fatty acid synthesis and elongation. Malonyl-CoA decarboxylase (MLYCD, E.C.220.127.116.11), a 55-kDa enzyme catalyses the conversion of malonyl-CoA to acetyl-CoA and carbon dioxide, thus providing a route for disposal of malonyl-CoA from mitochondria and peroxisomes, whereas in the cytosol, the malonyl-CoA pool is regulated by the balance of MLYCD and acetyl-CoA carboxylase activities. So far, 34 cases with different MLYCD gene defects comprising point mutations, stop codons, and frameshift mutations have been reported in the literature. Here, we describe the follow-up of a patient affected by malonic aciduria upon neonatal onset. Molecular analysis showed novel homozygous mutations in the MLYCD gene. Our findings expand the number of reported cases and add a novel variant to the repertoire of MLYCD mutations.
Immobilization of the cervical spine by Emergency Medical Services (EMS) personnel is a standard procedure. In most EMS, multiple immobilization tools are available.
The aim of this study is the analysis of residual spine motion under different types of cervical spine immobilization.
In this explorative biomechanical study, different immobilization techniques were performed on three healthy subjects. The test subjects’ heads were then passively moved to cause standardized spinal motion. The primary endpoints were the remaining range of motion for flexion, extension, bending, and rotation measured with a wireless human motion detector.
In the case of immobilization of the test person (TP) on a straight (0°) vacuum mattress, the remaining rotation of the cervical spine could be reduced from 7° to 3° by additional headblocks. Also, the remaining flexion and extension were reduced from 14° to 3° and from 15° to 6°, respectively. The subjects’ immobilization was best on a spine board using a headlock system and the Spider Strap belt system (MIH-Medical; Georgsmarienhütte, Germany). However, the remaining cervical spine extension increased from 1° to 9° if a Speedclip belt system was used (Laerdal; Stavanger, Norway). The additional use of a cervical collar was not advantageous in reducing cervical spine movement with a spine board or vacuum mattress.
The remaining movement of the cervical spine is minimal when the patient is immobilized on a spine board with a headlock system and a Spider Strap harness system or on a vacuum mattress with additional headblocks. The remaining movement of the cervical spine could not be reduced by the additional use of a cervical collar.
Patient, 43 years old, with diagnoses of posttraumatic stress disorder and recurrent depressive disorder was hospitalized due to worsening of mental condition. At admission he was agitated, depressed, irritable, and presented problems with insomnia. He said that he decided to stop taking antidepressant without consulting his psychiatrist one month earlier because he felt better and he thought he did not need antidepressants any more. During that period he continued taking alprazolam. Soon after discontinuation of antidepressant, his condition worsened, he started feeling tensed, anxious, depressed, and problems with insomnia appeared. He decided to increase the daily dosage of alprazolam from 1,5 mg to 3 mg, but his mental condition deteriorated - he was feeling agitated, irritable, he was depressed and had insomnia. He increased the daily dosage of alprazolam to 4 mg, but his condition was getting worse. He decided to come to hospital because he could not bare such symptoms any longer. After admission, tianeptine was introduced (37,5 mg daily) with zolpidem 10 mg in the evening, and daily dosage of alprazolam was gradually decreased. After this changes in therapy agitation gradually decreased, as well as insomnia. His mood gradually improved. He was discharged after four weeks of hospital treatment.
To present a case of a patient with depression who stopped smoking during therapy with bupropion.
Patient, 55 years old, diagnosed with depression, was in psychiatric treatment for two year before she discontined her treatment. She decided to discontinue psychiatric treatment and stopped taking antidepressants because she was feeling better and was functioning at work and in her social environment. For the past one year she was taking only lorazepam occasionally. She came again to our hospital when avolition and fatigue intensified, along with depressed mood. She was not able to function at work any more. She smoked about 20 cigarettes daily and tried to stop smoking on several occasions, but unsuccessfully. Because of worsening of symptoms of depression, treatment with bupropion was initiated in daily dosage of 150 mg. After five days of such treatment daily dosage of bupropion was elevated to 300 mg. The patient reported having headache for the first two days of treatment with bupropion, but after the headache stopped. After ten days of treatment she reported feeling better and was smoking less cigarettes (five per day). She said that didn’t have such pleasurable feeling any more when smoking. Also, after smoking she felt mild nausea. At control examination, after one month of treatment with bupropion, the patient reported feeling well, without symptoms of depression and that she stopped smoking. She continued outpatient treatment regularly and was functioning well again at work and in her social environment.
To present a case of a patient with depression who recovered during treatment with duloxetine.
Patient, 68 years old, was treated for the past 20 years because of depression. The patients described that worsening in mental condition usually started with depressed mood, followed by prostration and loss of motivation. So far, she was treated with different antidepressants, with partial therapeutic response. On the control examination, depressed mood, anxiety, fatigue, prostration, insomnia and loss in motivation were noticed. The patient reported spending most of the time in bed, with lack of interest for daily activities. Also, she reported indistinct pain in the back. She was afraid that there was no adequate cure for her condition. Treatment with duloxetine was initiated, in daily dosage of 60 mg. The patient was advised to take the medication along with the richest meal, so she started taking duloxetine after lunch. Also, the patient started taking zolpidem 10 mg in the evening because of insomnia. On the next control examination, ten days later, improvement in her mental condition was observed, and she said that she felt better. Her mood improved, as well as motivation, and anxiety was reduced. The patient continued taking duloxetine in daily dosage of 60 mg and on the following control examinations her condition remained stable, pain in the back was reduced, and she reported that she was able to function socially and was satisfied with her condition.
Patient N-V, with diagnose of PTSD according to DSM-IV-TR, was hospitalized in Vrapce Psychiatric Hospital, Zagreb, during 2008. At admission he reported tension, anxiety, irritability, need for isolation form other people, insomnia and nightmares. He said he was waking up almost every night because of nightmares.
In the beginning of hospital treatment lamotrigine was introduced in therapy, in daily dosage of 25 mg, along with diazepam 10 mg daily and zolpidem 10 mg in the evening. After three days the daily dosage of lamotrigine was elevated to 50 mg. No side effects of treatment were observed and the daily dosage of lamotrigine was elevated to 100 mg after six days and again on 200 mg after ten days of continuous therapy with lamotrigine. The patient reported improvement of sleep - he said he the nightmares were less frequent and he did not wake up as often as before. Also, during second week of treatment he became less tensed. After three weeks of treatment he became even more relaxed and less irritable. Also, he became more active and able to endure conversation. Initial insomnia was reduced, and he was waking up only occasionally during night. The patient was discharged from hospital after six weeks of treatment. Recommended therapy at discharge was lamotrigine in daily dosage of 200 mg, 10 mg of zolpidem in the evening, and diazepam 5 mg in case of tension.
To report about occurence of side effects of different antidepressants during treatment of a patient with depressive disorder.
Patient, 42 years old, was admitted to our Clinic for psychiatry due to worsening in her mental condition. At admission, the patient was anxious, depressed, and members of her family said that she stopped eating and isolated herself from her family and other people. Also, she spent most of the time in bed. After admission to the hospital the laboratory examination was performed and results were in referent ranges. Also, EEG and brain MRI were performed (normal findings). The patient was diagnosed with depressive disorder. The treatment with duloxetine in daily dosage of 30 mg, along with lorazepam in daily dosage of 2,5 mg was initiated, but vomiting occured and the treatment with duloxetine was discontinued. After that velafaxine was introduced in therapy. Soon after that headache occured and treatment with venlafaxine was discontinued. The therapy with tianeptine in daily dosage of 37,5 mg was initiated and after two weeks the symptoms of depression and anxiety were reduced. Also, the patient started communicating more with other people and showed interest in the environment. Gradually, daily dosage of lorazepam was reduced and treatment with lorazepam was discontinued. The patient was discharged from the hospital after six weeks of treatment. At control examinations that followed her mental condition remained stable and she started work again.
To report about treatment of a patient with schizophrenia who had depressive symptoms after establishing diagnosis of breast cancer.
The patient, 35 years old, was diagnosed with schizophrenia in the age of 20. Since then she was in regular psychiatric treatment and was taking different antipsychotics in therapy. She was hospitalized six times in our hospital. About one year ago, the diagnosis of breast cancer was established. Before that, the patient had quetiapine in daily dosage of 300 mg in therapy. When the patient found out about the diagnosis of breast cancer she was afraid and after some time developed depressive symptoms. For that reason, tianeptine was administered in therapy, in daily dosage of 37,5 mg, and treatment with quetiapine in daily dosage of 300 mg was continued. Before initiation of antidepressant the patient refused all suggested treatment for breast cancer. Two weeks after initiation of treatment with tianeptine, and along with supportive psychotherapy, the symptoms of depression were reduced and the patient accepted surgical treatment (mastectomy), and after that chemotherapy and radiotherapy. During such treatment the patient continued taking tianeptine and quetiapine as described, and her mental condition remained stable. Also, for the past six months the patient has been attending meetings of women with diagnosis of breast cancer in the Clinic where she was treated.
A 9-year-old African-American girl presented with sudden cardiac arrest a few hours after adenotonsillectomy. She received anaesthesia which included propofol during the procedure. Her electrocardiogram (EKG) showed type 1 Brugada pattern, and genetic testing revealed a variant of unknown significance in desmoplakin (DSP) gene. We discuss the association between propofol, Brugada EKG pattern, and malignant ventricular arrhythmias.
New guidelines aimed to minimize restraint in psychiatry clinics due to ethical reasons.
Further studies investigating factors affecting the decision of restraint and its potential benefits and harms are needed.
We aimed to determine current rates of restraint in psychiatric clinics and sociodemographic/clinical variables which may be related with restraint practices.
The study was conducted in 64-bed male and 28-bed female psychiatric inpatient units, between March 1–May 31 2015. Sociodemographic and clinical data forms were completed using case files and restraint records.
In a total number of 481 inpatients (351 males, 130 females), number of restrained patients was 98 (20.3%) (90 (25.7%) males, 8 (6.2%) females). There was no significant difference in sociodemographic characteristics between restrained and unrestrained patients, but duration of the illness and electroconvulsive therapy rates were significantly different. Substance abuse (44.4%) was higher in restrained male patients. Also, restraint rates were higher in patients having a diagnosis of substance-related disorder compared to other diagnoses. Restraints occurred most commonly in the first day (48%) of hospitalization.
The studies carried out in psychiatric hospitals suggested major differences in the rates and types of restraints among different countries and institutions. In our study, a higher restraint rate is obtained compared to other studies. Consistently with the literature, substance abuse was higher in restrained patients, and restraints occurred most commonly in the first day of hospitalization. Many factors including substance abuse should be considered to reduce restraint rates, which are still quite high in mental health hospitals in Turkey.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
To investigate the changes in the provision of preventive health services in
terms of woman and child health after reorganization of the primary health
The primary care system in Turkey has undergone fundamental changes as a part
of Health Transformation Program during last decade. But there was no
community-based study to evaluate these changes.
This community-based and cross-sectional study was conducted in 2010, just
before the reorganization of primary care services and in 2015, five year
after the reforms. The 30×7 cluster sampling method was used in
Zümrütevler quarter of Maltepe District. The socio-demographic
characteristics of the participants, the presence of the physician who can
be consulted for any health problem, the presence of smokers at home were
questioned. The women aged 18 years or older and gave consent provided
information about history of pregnancy and birth, the number of follow-ups
during pregnancy, family planning method usage, cervical and breast cancer
screening, breastfeeding duration, vaccinations, and prophylactic iron and
vitamin D supplementation for their children.
After the reorganization of primary care, more people stated that they had
physicians to whom they could consult for all kinds of health problems (27.8
versus 44.7%; P<0.001) and that physician was
the primary care physician (30.2 versus 64.7%;
P<0.001). The reported frequency of at least one
smoker at home was decreased after reorganization of primary care (63.6
versus 53.1%; P=0.034). There were no
significant differences in terms unplanned pregnancy, the use of family
planning method, the number of pregnancy follow-ups and the frequency of Pap
smears and mammography. There are no significant differences in terms of
healthy children follow-ups, vaccination, vitamin D and iron supplementation
(P>0.05). It was found that the duration of
total breastfeeding increased after reorganization of primary care
We examine disturbances leading to optimal energy growth in a spatially developing, zero-pressure-gradient turbulent boundary layer. The slow development of the turbulent mean flow in the streamwise direction is modelled through a parabolized formulation to enable a spatial marching procedure. In the present framework, conventional spatial optimal disturbances arise naturally as the homogeneous solution to the linearized equations subject to a turbulent forcing at particular wavenumber combinations. A wave-like decomposition for the disturbance is considered to incorporate both conventional stationary modes as well as propagating modes formed by non-zero frequency/streamwise wavenumber and representative of convective structures naturally observed in wall turbulence. The optimal streamwise wavenumber, which varies with the spatial development of the turbulent mean flow, is computed locally via an auxiliary optimization constraint. The present approach can then be considered, in part, as an extension of the resolvent-based analyses for slowly developing flows. Optimization results reveal highly amplified disturbances for both stationary and propagating modes. Stationary modes identify peak amplification of structures residing near the centre of the logarithmic layer of the turbulent mean flow. Inner-scaled disturbances reminiscent of near wall streaks, and amplified over short streamwise distances, are identified in the computed streamwise energy spectra. In all cases, however, propagating modes surpass their stationary counterpart in both energy amplification and relative contribution to total fluctuation energy. We identify two classes of large-scale energetic modes associated with the logarithmic and wake layers of the turbulent mean flow. The outer-scaled wake modes agree well with the large-scale motions that populate the wake layer. For high Reynolds numbers, the log modes increasingly dominate the energy spectra with the predicted streamwise and wall-normal scales in agreement with superstructures observed in turbulent boundary layers.
Two studies were carried out to assess the effects of seed inoculation by arbuscular mycorrhizal fungi (AMF) coupled to a reduced fertilizer supply on yield, economic benefit and energy balance of maize and sorghum forage cropping. The effect of dietary inclusion of mycorrhizal forages on milk yield was also examined. The control treatments (control maize and control sorghum) were non-mycorrhizal seeds fertilized with recommended doses of nitrogen (N) and phosphorus (P). The inoculated treatments (inoculated maize and inoculated sorghum) were the mycorrhizal seeds fertilized with a half dose of N. For each treatment, two plots, 1.5 ha each, were used. The forages were ensiled and fed to lactating buffaloes (maize) and dairy cows (sorghum). Plant traits and yield parameters were generally found to be higher in inoculated compared to the control plants. Inoculation positively influenced the chemical composition of sorghum silage that resulted in less fibre and more protein and presented higher dry matter degradability. No differences between the control and inoculated maize silages were found. For both inoculated crops, higher profitability (+670 and 732€ for maize and sorghum, respectively), as well as an increment of net energy (+0.24 and 0.60, respectively), and energy use efficiency (+0.53 and 0.85, respectively) were observed. The use of the inoculated silages did not affect milk yield. Results suggest that seed inoculation with mycorrhizal fungi combined with the low rate of fertilizers could be a viable solution to increase the eco-efficiency and profitability in forage production without affecting forage quality and lactating cow productivity.
Climate change poses a fundamental threat to humanity, and thus solutions for both mitigation and adaptation strategies are becoming increasingly necessary. Biochar can offer a range of environmental services, such as reclamation of degraded land, improvement of soil fertility and carbon sequestration. However, it also raises questions, regarding sustainable feedstock provision, biomass pyrolysis, and soil amendment. These questions, among various others, are addressed in this state-of-the-art compendium. Covering a broad geographical range, with regional assessments from North America, Europe, the Near East, and Southeast Asia, this interdisciplinary volume focuses on the entire biochar supply chain, from the availability and economics of biomass resources, to pyrolysis, and ultimately to the impacts on soil properties. The combination of theory with practical examples makes this a valuable book for researchers, policymakers, and graduate students alike, in fields such as soil science, sustainable development, climate change mitigation, biomass and bioenergy, forestry, and environmental engineering.
This chapter gives an overview of the key technologies to produce biochar. First, an introduction will be given to the different thermochemical conversion techniques of dry biomass (including pyrolysis) which result in char as one of the product fractions. A second part of this chapter is devoted to the discussion on how the biochar physicochemical properties result from the type of biomass feedstock used, as well as from the prevailing process conditions applied during thermochemical conversion – as some of these physicochemical properties in biochar have a major impact on the functionality and stability of biochar in soil. A major challenge for the successful deployment of biochar systems is to render its production economically profitable. Hence, this chapter concludes with an economic assessment of biochar. This last part of the chapter also emphasizes the potential increase in value creation in the biochar production process by identifying potential economic uses of co-products, including bio-oil and producer gas.
Forests are important for providing wood for products and energy, and the demand for wood is expected to increase over the next decades. The potential woody biomass supply was estimated for the period 2000–2020 for stem wood as well as residues, taking into account economic, environmental and technical restrictions. Constraints reducing the availability of forest biomass were defined and quantified for three mobilisation scenarios and five wood price scenarios in order to estimate the realisable potentials. The theoretical biomass potential was estimated from Austrian forest inventory data and applying the PROGNAUS forest growth simulator. It lies between 32.7 and 38.4 million m3 equivalents yr-1 over bark for the period 2000–2020. The realisable potential in Austria was estimated in a range between 23.9 and 31.1 million m3 equivalents yr-1 over bark for the period 2000–2020. These potentials represent 73–84% of the theoretical potential. Nutrient sustainability in the context of whole-tree harvesting appeared to be an important constraint when considering how much biomass is realisable from forests. The attitude of private forest owners towards increased harvest of forest biomass is also of major importance for the realisable potential, given the small-scale structure of forest ownership in Austria.
Biomass provides 14% of the world’s primary energy production, but it is largely wasted by inefficient and unsustainable use. To exploit the full potential of this energy source, new approaches and modern technologies such as pyrolysis and gasification are needed. Pyrolysis is the most promising thermal decomposition method for the conversion of biomass into valuable bio-products. The process produces a solid fraction (biochar), a liquid fraction (bio-oil) and a mixture of gases. Depending on pyrolysis conditions, biochar for soil amendment, activated carbon, carbon fibers, bio-fuels, value-added chemicals (PF type adhesives, phenolics, levoglucosan, octane enhancers, fertilizers) and gas products (hydrogen, methane, ethane and propane) could be achieved. The ratio of the products varies with the chemical composition of the biomass and operating conditions such as pyrolysis temperature, heating rate, reactor configuration, pyrolysis atmosphere, reaction time, particle size and so on. In the scope of this issue, this chapter covers the definition and sources of biomass, thermal behavior of biomass and its components, fundamentals of the pyrolysis process, and effects of the process parameters on yields and composition of products. Moreover, properties of bio-oil and biochar are explained according to their utilization areas.
Biochar systems are designed to meet four related primary objectives: improve soils, manage waste, generate renewable energy, and mitigate climate change. Supply chain models provide a holistic framework for examining biochar systems with an emphasis on product life cycle and end use. Drawing on concepts in supply chain management and engineering, this chapter presents biochar as a manufactured product with a wide range of feedstocks, production technologies, and end use options. Supply chain segments are discussed in detail using diverse examples from agriculture, forestry and other sectors that cut across different scales of production and socioeconomic environments. Particular attention is focused on the environmental impacts of different production and logistics functions, and the relationship between supply chain management and life cycle assessment. The connections between biochar supply chains and those of various co-products, substitute products, and final products are examined from economic and environmental perspectives. For individuals, organizations, and broad associations connected by biochar supply and demand, achieving biochar’s potential benefits efficiently will hinge on understanding, organizing, and managing information, resources and materials across the supply chain, moving biochar from a nascent to an established industry.