Field Implementation of In-Depth Conformance Gel Treatment Prior to Starting an ASP Flooding Pilot

Mature carbonate reservoirs under waterflood in Kuwait suffer from relatively low oil recovery due to poor volumetric sweep efficiency, both areal, vertically, and microscopically. An Alkaline-Surfactant-Polymer (ASP) pilot using a regular five-spot well pattern is in progress targeting the Sabriyah Mauddud (SAMA) reservoir in pursuit of reserves growth and production sustainability. SAMA suffers from reservoir heterogeneities mainly associated with permeability contrast which may be improved with a conformance treatment to de-risk pre-mature breakthrough of water and chemical EOR agents in preparation for subsequent ASP injection and to improve reservoir contact by the injected fluids. Each of the four injection wells in the SAMA ASP pilot was treated with a chemical conformance improvement formulation. A high viscosity polymer solution (HVPS) of 200 cP was injected prior to a gelant formulation consisting of P300 polymer and X1050 crosslinker. After a shut-in period, wells were then returned to water injection. Injection of high viscosity polymer solution (HVPS) at the four injection wells showed no increase in injection pressure and occurred higher than expected injection rates. Early breakthrough of polymer was observed at SA-0561 production well from three of the four injection wells. No appreciable change in oil cut was observed. HVPS did not improve volumetric sweep efficiency based on the injection and production data. Gel treatment to improve the volumetric conformance of the four injection wells resulted in all the injection wells showing increased of injection pressure from approximately 3000 psi to 3600 psi while injecting at a constant rate of approximately 2,000 bb/day/well. Injection profiles from each of the injection well ILTs showed increased injection into lower-capacity zones and decreased injection into high-capacity zones. Inter-well tracer testing showed delayed tracer breakthrough at the center SA-0561 production well from each of the four injection wells after gel placement. SA-0561 produced average daily produced temperature increased from approximately 40°C to over 50°C. SA-0561 oil cuts increased up to almost 12% from negligible oil sheen prior to gel treatments. Gel treatment improved volumetric sweep efficiency in the SAMA SAP pilot area.

Retroperitoneal Liposarcoma: An Unusual Presentation of a Rare Cancer

Retroperitoneal liposarcomas (RLPS) are rare tumors that have variable clinical behavior and complex treatment strategies based on presentation, histopathology, and genomics. Early identification is critical, and complete surgical resection remains the primary treatment, although chemotherapy and radiation are used on individual bases. Presenting symptoms are often nonspecific; therefore, a high degree of suspicion is essential for early diagnosis. In this report, the management of a 37-year-old otherwise healthy male with a large RLPS causing right groin/testicular pain is presented. After three evaluations in the emergency department, the patient was diagnosed and received two cycles of doxorubicin/ifosfamide/mesna (AIM) neoadjuvant chemotherapy. His physical exam on presentation for second opinion demonstrated a large palpable abdominal mass and fullness around the right spermatic cord. There was no appreciable change in tumor size or distant metastases on repeat scanning. Given some obstructive symptoms, a multidisciplinary team advised neoadjuvant radiation followed by radical resection of RLPS. Final pathology demonstrated a 31-cm grade II well-differentiated (WD) liposarcoma with low-grade dedifferentiation. Scattered foci of microscopic positive WD margins were noted, and the remainder of margins were negative. Genomic evaluation showed amplification of CDK4, MDM2, and FRS2. A concise literature review of common presentations, histopathology, genomics, and treatment information is discussed herein. Thorough physical exams, attention to subtle findings, appropriate medical imaging studies, and a high index of suspicion when evaluating vague symptomatology can lead to earlier diagnosis and treatment of RLPS, and ultimately better patient outcomes.

Implementation of the Mental Capacity Act: a national observational study of changes in place of death for older heart failure patients with or without comorbid dementia

Background: Heart failure is increasingly prevalent in the growing elderly population and commonly associated with cognitive impairment. This study compared trends in place of death (PoD) of heart failure patients with / without comorbid dementia over the period of implementation of the Mental Capacity Act (MCA) in October 2007, this legislation supporting patient-centred decision making for those with reduced agency.Methods: Analyses of death certification data for England between January 2001 and December 2018, describing the PoD and sociodemographic characteristics of all people ≥ 65 years registered with heart failure as the underlying cause of death, with / without a mention of comorbid dementia. Multiple Poisson regression modelling was used to determine the prevalence ratio (PR) of dying at home or in care homes compared to dying in hospital. Covariates included year of death, age, gender, marital status, comorbidity burden, index of multiple deprivation and urban / rural settings.Results:120,068 heart failure-related death records were included of which 8199 mentioned dementia as a contributory cause. The overall prevalence of dementia was 6.8%, the trend significantly increasing from 5.6% to 8.0% pre- and post-MCA (p<0.0001). Dementia was coded as unspecified (78.2%), Alzheimer’s disease (13.5%) and vascular (8.3%). Those with dementia were more commonly older, female, widowed, and had more comorbidities. Pre-MCA, PoD for heart failure patients without dementia was hospital 68.2%, care homes 20.2%, 10.7% dying at home. The corresponding figures for those with comorbid dementia were 47.6%, 48.0% and 4.2%, respectively. Following MCA enforcement, PoD for those without dementia shifted from hospital to home, PR: 1.026 [95%CI: 1.024-1.029]. This trend was not significant for those with dementia, PR: 1.001 [0.988-1.015], hospital deaths increasing. Care home deaths reduced for all, with or without dementia, PR: 0.959 [0.949-0.969], and PR: 0.996 [0.993-0.998], respectively. Hospice as PoD was rare for both groups (≤0.5%) with no appreciable change over the study period.Conclusions: Our analyses suggest the MCA did not materially affect the PoD of heart failure decedents with comorbid dementia, likely reflecting difficulties implementing this legislation in real-life clinical practice.

A pancreas tumor derived organoid study: from drug screen to precision medicine

Pancreatic ductal adenocarcinoma (PDAC) one of the deadliest malignant tumor. Despite considerable progress in pancreatic cancer treatment in the past 10 years, PDAC mortality has shown no appreciable change, and systemic therapies for PDAC generally lack efficacy. Thus, developing biomarkers for treatment guidance is urgently required. This review focuses on pancreatic tumor organoids (PTOs), which can mimic the characteristics of the original tumor in vitro. As a powerful tool with several applications, PTOs represent a new strategy for targeted therapy in pancreatic cancer and contribute to the advancement of the field of personalized medicine.

Astrocyte GluN2C NMDA receptors control basal synaptic strengths of hippocampal CA1 pyramidal neurons in the stratum radiatum

Experience-dependent plasticity is a key feature of brain synapses for which neuronal N-Methyl-D-Aspartate receptors (NMDARs) play a major role, from developmental circuit refinement to learning and memory. Astrocytes also express NMDARs although their exact function has remained controversial. Here we identify a circuit function for GluN2C NMDAR, a subtype highly expressed in astrocytes, in layer-specific tuning of synaptic strengths in mouse hippocampal CA1 pyramidal neurons. Interfering with astrocyte NMDAR or GluN2C NMDAR activity reduces the range of presynaptic strength distribution specifically in the stratum radiatum inputs without an appreciable change in the mean presynaptic strength. Mathematical modeling shows that narrowing of the width of presynaptic release probability distribution compromises the expression of long-term synaptic plasticity. Our findings suggest a novel feedback signaling system that uses astrocyte GluN2C NMDARs to adjust basal synaptic weight distribution of Schaffer collateral inputs, which in turn impacts computations performed by the CA1 pyramidal neuron.

Effects of pH and temperature on the genotoxicity of halogenated disinfection by-products in chlorinated water

Disinfection by-products (DBPs) are important environmental chemicals and the objective of this study was to assess the effects of pH, temperature and bromide concentration on the genotoxicity of DBPs in chlorinated water. Cells were exposed to humic acid samples and genotoxicity was assessed by chromosomal aberration assay using Chinese hamster lung (CHL) cells in vitro. A strong positive correlation between bromide concentration and the number of chromosomal aberrations formed was observed. Higher temperature values resulted in more chromosomal aberrations (14.6%) and a greater percentage of aberrant cells (24.6)% at pH 9 and, at higher bromide concentrations, more aberrations were formed at 25°C than 5°C for all pH values. There is some evidence that the number of aberrant cells is higher at 5°C at pH 7 than pH 5 or 9, however there does not appear to be any appreciable change in genotoxicity over the pH range tested.

Effects of pH and temperature on the genotoxicity of halogenated disinfection by-products in chlorinated water

Disinfection by-products (DBPs) are important environmental chemicals and the objective of this study was to assess the effects of pH, temperature and bromide concentration on the genotoxicity of DBPs in chlorinated water. Cells were exposed to humic acid samples and genotoxicity was assessed by chromosomal aberration assay using Chinese hamster lung (CHL) cells in vitro. A strong positive correlation between bromide concentration and the number of chromosomal aberrations formed was observed. Higher temperature values resulted in more chromosomal aberrations (14.6%) and a greater percentage of aberrant cells (24.6)% at pH 9 and, at higher bromide concentrations, more aberrations were formed at 25°C than 5°C for all pH values. There is some evidence that the number of aberrant cells is higher at 5°C at pH 7 than pH 5 or 9, however there does not appear to be any appreciable change in genotoxicity over the pH range tested.

FC 034SAFETY AND EFFICACY OF INTRAVENOUS BELIMUMAB IN PATIENTS WITH LUPUS NEPHRITIS: A 6-MONTH OPEN-LABEL EXTENSION

Background and Aims Lupus nephritis (LN) is the most common severe manifestation of systemic lupus erythematosus (SLE), occurring in up to 40% of patients (pts) with SLE over their disease course, and resulting in 10–20% of pts progressing to end-stage kidney disease.1-3 The BLISS-LN (GSK Study BEL114054; NCT01639339) study demonstrated that the addition of intravenous (IV) belimumab (BEL) to standard therapy (ST) in pts with active LN significantly improved renal responses over 2 years compared with ST alone.4 Here we present additional safety and efficacy data from the 6-month open-label (OL) extension phase of BLISS-LN. Method In this OL phase, eligible completers of the Phase 3 BLISS-LN study (those who received BEL or placebo [PBO] through Week 100 and completed Week 104 assessments) received BEL 10 mg/kg IV plus ST every 28 days for 24 weeks. Endpoints at OL Week 28 included: safety; Primary Efficacy Renal Response (PERR; defined as urine protein:creatinine ratio [uPCR] ≤0.7; eGFR no more than 20% below OL baseline value or ≥60 ml/min/1.73m2; no rescue therapy); Complete Renal Response (CRR; defined as uPCR &lt;0.5; eGFR no more than 10% below OL baseline value or ≥90 ml/min/1.73m2; no rescue therapy); uPCR; eGFR; the proportion of pts with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score &lt;4; Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI); and corticosteroid use. Analyses were based on observed data and summarised relative to the OL baseline (last available value measured prior to dosing on or before the date of the first OL treatment dose). Results Of 257 pts (57.4 % of pts in BLISS-LN double-blind [DB] study) screened and enrolled, 255 pts were treated (safety population: 123 pts switched from PBO to BEL; 132 pts remained on BEL). In total, 254 pts were included in the efficacy analyses (PBO to BEL: 122 pts; BEL to BEL: 132 pts). Mean (standard deviation) age was 35.9 (10.3) years. In total, 3.5% of pts withdrew from the OL phase, mainly due to adverse events (AE; 2.0%). Overall, 168/255 (65.9%) pts experienced ≥1 AE (76/123 [61.8%] PBO to BEL pts; 92/132 [69.7%] BEL to BEL pts); 49/255 (19.2%) pts had ≥1 treatment-related AE (25/123 [20.3%] PBO to BEL pts; 24/132 [18.2% ] BEL to BEL pts); 15/255 (5.9%) pts had ≥1 serious AE (5/123 [4.1%] PBO to BEL pts; 10/132 [7.6%] BEL to BEL pts); and 1 death was reported in the PBO to BEL group. The proportion of patients achieving PERR and CRR increased from OL baseline to OL Week 28 in both groups (Table). The median (interquartile range [IQR]) for uPCR and eGFR were maintained from OL baseline through to OL Week 28 (Table). The proportion of SLEDAI score &lt;4 responders in BEL to BEL group tended to increase from OL baseline to OL Week 28, and decrease in the PBO to BEL group (Table). SDI worsening (change &gt;0) was experienced by 7 (2.9%) pts (4 [3.3%] PBO to BEL; 3 [2.5%] BEL to BEL) compared with OL baseline. There was no appreciable change in the number of patients receiving average daily prednisone-equivalent doses of ≤5 mg or ≤7.5 mg from OL baseline to OL Week 28 (Table). Conclusion BEL was well tolerated as an add-on to ST, with no new safety signals. Efficacy among pts with LN randomised to BEL during the DB phase was maintained during the OL phase. Study funding GSK. Editorial assistance (GSK-funded): Olga Conn, PhD, Fishawack Indicia Ltd., part of Fishawack Health, UK.

Evaluating Immediate and Short-Term Postoperative Clinical Outcomes of Patients Undergoing Ulnar Shortening for Ulnar Impaction Syndrome Using PROMIS

Background The early recovery trajectory of patients undergoing ulnar shortening for ulnar impaction syndrome using the Patient-Reported Outcomes Measurement Information System (PROMIS) is unknown. Questions/Purposes Using PROMIS Upper Extremity (UE), Physical Function (PF), Pain Interference (PI), and Depression, we asked (1) do patients undergoing operative management for ulnar impaction syndrome present at their preoperative visit with notable impairment?; (2) At immediate follow-up, do patients present with a clinically appreciable change in symptom severity?; and (3) At short-term follow-up, do patients present with a clinically appreciable change in symptom severity? Patients and Methods We identified patients from 01/2017 to 12/2019 at our institution undergoing ulnar shortening for ulnar impaction syndrome who completed all PROMIS domains at a preoperative visit and at least one postoperative time point (i.e., less than 4 weeks and/or greater than 12 weeks). Distribution- and anchor-based minimal clinically important difference estimates were used to evaluate clinically appreciable changes in symptoms over time. Results A total of 38 patients met our inclusion criteria. The average change in PROMIS UE, PF, PI, and Depression scores from preoperative to immediate postoperative follow-up were –3.8, –4.3, 3.2, and 0.5, respectively. However, by short-term follow-up, the average change in PROMIS UE, PF, PI, and Depression scores were 3.7, 3.2, –4.7, and –3.9, respectively. Conclusions Patients have worsening function at the immediate postoperative follow-up. By short-term postoperative follow-up, functional status and PI levels improve. Our findings can help hand surgeons provide evidence-based guidance on expected initial recovery following operative management for ulnar impaction syndrome. Level of Evidence This is a level II, prognostic study.

A Highly Efficient and Stable Photocatalyst; N-Doped ZnO/CNT Composite Thin Film Synthesized via Simple Sol-Gel Drop Coating Method

The thin film of N-doped ZnO/CNT nanocomposite was successfully fabricated on soda lime glass substrate by a simple sol-gel drop-coating method. The structural, morphological, chemical, and optical properties of as prepared samples were characterized by a variety of tools such as X-ray Diffraction (XRD), Field Emission Scanning Electron Microscopy (FE-SEM), Fourier Transform Infrared spectroscopy (FT-IR), and UV-visible spectroscopy. The hexagonal crystalline structure was confirmed from XRD measurement without any other impurity phase detection in samples. The N-doped ZnO/CNT composite showed excellent photo-catalytic activity towards cationic methylene blue (MB) dye degradation with 100% removal rate under UV light irradiation as compared to N-doped ZnO (65%) and pure ZnO (47.36%). The convincing performance has also been observed for the case of visible light irradiation. The enhancement of that photocatalytic activity might be due to narrowing the band gap as well as the reduction of electron–hole pair recombination in ZnO matrix with the incorporation of dopant nitrogen and CNT. It is assumed from the obtained results that N-doped ZnO/CNT nanocomposite thin film can be employed as an economically achievable and ecofriendly method to degrade dye with UV and visible light irradiation. Additionally, density functional theory (DFT) calculations were applied to explore the effect of N-doping on electronic structure of ZnO. The computational study has supported the experimental results of significant band gap contraction, which leads to the maximum absorption towards higher wavelength and no appreciable change of lattice parameters after doping. A conceivable photocatalytic mechanism of N-doped ZnO/CNT nanocomposite has been proposed as well.