Lupine Publishers | Chloride-Induced Highly Active Catalyst for Methyl Esterification of Alcohols

 Lupine Publishers | Journal of Organic and Inorganic Chemical Sciences

Abstract

In this work, a series of active Au/NiOx catalysts were successful to prepare by tracing the concentrations of chloride in the re-dispersed aqueous solutions. By characterizations, we found that the appropriate amount of residual chloride in Au catalyst would induce Au nanoparticles (Au NPs) to locate on the edges of NiOx particles, which resulted in the active Au/NiOx-9 sample. Fine control of chloride in the aqueous solution provides a new perspective to push for addressing the controllable preparation of active heterogeneous catalysts.

Keywords: Au catalyst, Preparation, Chloride, Esterification

Introduction

In recent decades, Au catalysts have received growing attentions and been widely applied in many important research fields [1], since good performance of Au catalysts was discovered [2]. However, the controllable preparation of highly active heterogeneous catalysts is still a longstanding challenge till now, especially Au catalysts. Many efforts have been devoted to this problem. The active site, structure and the quantum size effect of Au catalyst [3], active oxygen species of the support [4], suitable reducible oxide supports [5],and so on, have been extensively studied. Additionally, catalyst precursors, bases, pH value, aging time, and calcinations temperature are also crucial conditions [2,6]. Nevertheless, the controllable preparation of highly active Au catalyst is still difficult to realize even strictly following all above conditions. Chloride (usually as Cl-) is generally regarded as a poison for Au catalyst, Because of strong interaction of chloride and Au. We realized the reproducible preparation of Au/Fe2O3 catalyst for CO oxidation [7]. It is meaningful to explore whether this method can be applied to other catalysts and reactions or not. In this work, Methyl esterification of alcohols was chosen as model reaction. The controllable preparation of highly active Au/ NiOx catalyst was realized by tracing the concentrations of chloride in the re-dispersed aqueous solutions.

Experimental Details

Au/NiOx catalyst preparation

20ml Ni(NO3)36H2O (0.011 M) and 1.05 ml HAuCl4 (0.24M) were mixed together and were drop wise added into 60 ml Na2CO3 solution (0.31M) under vigorous stirring in 3h. The turbid liquid was divided into four sections and separation by centrifugation. Each section of the recovered precipitate was re-dispersed in different amount of deionised water and ultrasonically washed for 1h. The chloride concentration in the re-dispersed aqueous solution of each section was determined by CHI660D electrochemical workstation. Then, the solid was separated by centrifugation, dried at 80o C for 3h and calcined at 350 oC for 0.5 h to produce the catalyst sample, which was denoted as Au/NiOx-X, in which X suggested the chloride concentration in ppm.

Catalyst activity test

1mmol benzyl alcohol, 30 mg catalyst and 2 ml methanol were added into a glass tube. And then it was exchanged with oxygen and reacted at 60o C (1 atom, O2 balloon). After reaction, it was cooled to room temperature. Biphenyl was used as internal standard and a certain amount of ethanol were added into the reaction mixture up to 10mL for quantitative analysis by GC-FID (Agilent 7890A).

Results and Discussion

The catalytic activities of 15 Au/NiOx samples, which were prepared from the re-dispersed aqueous solutions with chloride concentrations in the range of 2 to 108 ppm, for esterification of benzyl alcohol were studied. According to the results shown in Figure 1, catalytic activity of Au/NiOx varied with the changing of chloride concentration. The yields of methyl benzoate were lower than 21% if the catalysts were prepared from aqueous solutions containing >22ppm chloride. More active catalysts were produced when the chloride concentrations were going down. The Au/ NiOx catalysts with the highest catalytic activity were prepared from aqueous solutions containing 8-13ppm chloride, the yield of methyl benzoate of catalyst Au/NiOx-9 was >99%. Surprisingly, the catalysts turned less active again when the chloride concentrations were < 8ppm. Typically, the yield of methyl benzoate was 20% with catalyst Au/NiOx-3.

Figure 1: The yield of methyl benzoatevs the chlorine concentration of the aqueous solution from which the catalyst samples were prepared.

Figure 2: HR-TEM (left) images and size distributions (right) of Au/NiOx-22 (a), Au/NiOx-9 (c), and Au/NiOx- 3(e).

TEM measurement results of Au/NiOx are shown in Figure 2. Their TEM images were similar and seemed amorphous. For the sample of Au/NiOx-22, the lattice of gold could be observed and wrapped in NiOx particle. For active Au/NiOx-9, the most of Au NPs connected with the edges of NiOx particles or the junctions of several NiOx particles [8]. In consideration of the best catalytic performance of this sample, this observation strongly supported the former results about active site in Au catalyst, i.e. the interface between Au and iron oxide [3]. It suggested that the appropriate amount of chloride might act as the linkage between Au NPs and the edges of NiOx particles to gain the active Au catalyst, For Au/ NiOx-22 and Au/NiOx-3, too much or less chloride was presented, the interaction of Au NPs and NiOx like Au/NiOx-9 decreased significantly. Accordingly, the catalytic activity lost sharply. By metering more than 150Au NPs, the mean diameters of Au NPs in samples Au/NiOx-3, Au/NiOx-9 and Au/NiOx-22were 4.1, 3.8 and 6.6 nm with 1.91, 1.84 and 3.06 standard deviations. The size distributions of Au NPs in Au/NiOx-3 and Au/NiOx-9 samples were extremely similar. The marked difference of catalytic activities of these two catalysts did not come from the size effect of Au particles, but the contact way of Au NPs and NiOx supports.

At present, there is still not sufficient evidence to explain the real role of chloride in the formation of Au catalysts. However, according to the known evidence, we can make some reasonable conjectures. Firstly, as pH value of the mother aqueous solution rises, chlorine in chloroauric acid is substituted by the hydroxyl. Au-Cl bond breaks and then small Au NPs form. Finally, chloride is adsorbed on the support NiOx as well as Au NPs. Due to the stronger interaction of chlorideon the edges than on planes of NiOx crystallites, after the ultrasonication and washing operations, chloride located on the edges of NiOx crystallites remains. As shown in Figure 3, it is this kind of residual chloride that induces Au NPs to anchor on the edges of NiOx crystallites.

Figure 3: The simple scheme of Au/NiOx catalysts.

Conclusion

In summary, by tracing the chloride concentrations in the re-dispersed aqueous solution, we successfully prepared active Au/NiOx catalyst for catalytic methyl esterification of alcohols. If the chloride concentration was not in the range of 8-13ppm, the catalytic activity dropped dramatically. These results indicated that the presence of appropriate amounts of residual chloride was beneficial to obtain highly active heterogeneous catalysts. This work can offer a new perspective to realize the controllable preparation of active heterogeneous catalysts.

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Lupine Publishers | Climate and Water

 Lupine Publishers | Journal of Environmental & Soil Science

Short Communication

It is established that the climate depends on greenhouse gases. Few people think that water evaporation is also gas. Their volumes exceed carbon dioxide emissions by 18,000 times [1]. There is a strong opinion that the evaporation of the oceans exceeds the evaporation from land because 3 times the area of the oceans exceeds the area of inhabited land. However, recently it was reported that the total area of leaves of vegetation increases the land area by 3 times. It follows that both the land and the oceans evaporate from the same area. Evaporated before the development of the industry.

Water evaporation into the atmosphere can be divided into two types. There is evaporation from the surface of water bodies, from hard surfaces, ice, snow. With the development of civilization, new nature of evaporation appeared - from boiling water, cooling equipment, plowed fields, new artificial reservoirs, landfills. All pairs raised from these surfaces make a direct or shortened path in the chain of circulation between atmosphere and soil. The second significant, for the time being, part of the vapor is organic discharges from animals and plants. This is a complete cycle of the circuit created by nature since the birth of life on the planet. The main function of water is to dissolve underground and riverbeds and the transfer of trace elements in food chains to the roots of plants and living consumers. Entering the bodies of organisms and the roots of plants with one structure, water is repeatedly transformed into blood, tissues, many other body organs, plant juices, and enters the atmosphere as an exhalation, drying excretions, transpiration in a completely different quality. The sum of all these, purely individual vapors, forms a substance in clouds with certain properties that have been polished for millions of years in each area, which along the beaten path with a given periodicity precipitates in the given places of the planet, supporting various areas from deserts to tropics. Perhaps, the information component plays some role here. It is known that clusters of molecules carry information about their source - maybe DNA. For example, it is known that the smell is formed by molecules inherent in everyone. And these molecules go into the atmosphere, filling up the clouds.

The parameters of clouds are their saturation, physical and chemical composition, the size of clusters of molecules and droplets, specific gravity, location, volume, time spent in the atmosphere, temperature, pressure, electrical charges - all this together creates elements of the mechanism of weather and climate formation. For millions of years, the interaction of these parameters has formed a rigorous algorithm that determines where, how much and when it is necessary to give moisture to each place on the planet. With the development of civilization, we took away more than 70% of land from nature by cutting down forests, plowing the soil, flooding them with hydroelectric power plants, using unnatural water - turning it into a working reagent. We move it with pumps, with it we wash everything around us and ourselves. We boil, heat, compress, cool, fill the fields, destroy its molecules in the air with engines, furnaces and compressors.

Evaporation from all these processes must have lost the properties inherent in pairs from living organisms and plants. The physical, chemical elements and all other cloud parameters have changed. The mechanism of atmospheric transformations has changed, which produces new clouds in a new way, concentrates and distributes all the moisture in a different way, changes the places of precipitation.

The volume of artificial evaporation with the development of industry and human comfort equaled the volume of organic vapor. Mankind has destroyed the effect of organic vapor on most of the land. From these places, the waters that have not passed the path indicated by nature began to evaporate - to deliver nutrients to living organisms and plants. In total, we take 22 cubic kilometers of water from open and underground sources. All these waters lose their natural functions and evaporate without changing the structure [1]. The new quality of vapor has changed the structure of steam and has had an effect on its specific weight. The increased weight of gaseous water and its drops changed the height of the clouds. The quality of evaporation creates a new quality of atmospheric mechanisms. Heavy clouds cannot rise above, where the conditions of the precipitation, which was built in the pre-industrial era. Therefore, the clouds have changed their dynamics in terms of speed of movement and increased the concentration in volumes. Changed the time the water in the clouds. All this in the complex changed the places of precipitation, their volumes and schedule. From here, we observe floods in some areas, droughts in others, the extinction of insect species and animals. The decrease in transit in range and height of the movement of clouds led to a decrease in precipitation on the glaciers of the polar poles and mountain peaks. The precipitations on the way to these places do not accumulate in the glaciers but replenish the oceans with additional volumes. Therefore, the level of the oceans increases, and the ice layer of the glaciers decreases.

This hypothesis requires scientific evidence, which should lead to a new strategy, basically All of which should be the cessation of deforestation, the creation of man-made water reservoirs, deep plowing of fields, the elimination of landfills, the reduction of construction facilities and roads and the total water savings on all types of human activity. Nature urgently needs to return its natural mechanisms of atmospheric phenomena, processes of circulation. Opportunities are there, if you use the experiences of developed countries. It is known that in the Scandinavian countries there are no landfills, in Israel they grow plant products with minimal water consumption. Famous houses with vertical and roof gardening, in which water evaporates plants, and not from artificial surfaces. Known methods that allow to generate electricity without reservoirs. One of the significant water consumptions is the water consumption in toilets. At the same time, we are aware of ways to save water in the toilets of airplanes and trains. Simply transfer such savings to the devices of each toilet, and centralized sewage will disappear, with the need to maintain vast areas of lagoons. Such and many other measures of total water saving should be applied in all spheres of life of all cities of all countries. Considering each type of water consumption, it is possible to detect known and applied methods with minimal and even zero water consumption, for example, drip irrigation, dry cleaning of cars and asphalt. Only the return of its nature, millions of years of accumulated technology of the water cycle, can reduce natural disasters and stop climate change. To prove the hypothesis, it is necessary to study its basic elements. I call for the cooperation of all who can master and understand this hypothesis. A new team of new specialists is needed, which will bring the scientific base and turn the consciousness of the sleeping population in a new direction.

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Lupine Publishers| Antidiabetic Plant Extracts

 Lupine Publishers| Journal of Drug Designing & Intellectual Properties

Abstract

Diabetes mellitus is a chronic health problem with long term consequences that are potentially preventable. It is a heterogeneous group of disease, characterized by high blood glucose levels resulting from impaired insulin secretion, impaired insulin action, or both. There are several synthetic antidiabetic drugs. These include Insulin Secretagogues (Sulfonylureas), biguanides, Thiazolidinediones, α- Glucosidase, Glucagon. Although, antidiabetic agents such as insulin, biguanides, thiazolidinediones and α glucosidase inhibitors are available in Guyana to treat diabetes, a safe and effective treatment paradigm is yet to be achieved. This is due to that fact that these drugs fail to significantly reduce the course of diabetic complications and have limited use because of their undesirable pathological conditions and high secondary failure rates. Therefore, it is essential to discover more effective antidiabetic agents with few adverse effects, low costs and ease of accessibility. In recent years, there has been a resurgence of interest in medicinal plants for the treatment of diseases. A World Health Organization (WHO) study shows that 80% of the world’s population solely relies on medicinal plants for their primary health care needs. Medicinal plant extracts, having antidiabetic properties can be a useful source for the development of oral hypoglycemic agents in both animal models and human subjects. Over 350 plants are used in the treatment of diabetes mellitus, but only a small number of these plants had gained scientific and medical evaluation to assess their effectiveness and efficacy

Keywords: Diabetes; Chronic; Synthetic antidiabetic drugs; World Health Organisation; WHO

Introduction

Diabetes mellitus is a chronic health problem with long term consequences that are potentially preventable. It is a heterogeneous group of disease, characterized by high blood glucose levels resulting from impaired insulin secretion, impaired insulin action, or both [1-4]. In a hyperglycemic state, the body tries to remove excess glucose by excreting in the urine. This increases urine output, causing glycosuria and result in frequent thirst. In addition, the body is deprived of glucose energy and seeks alternative energy sources such as fats and muscle tissues, leading to weight loss [5]. A diminishing growth effect and increased predisposition to certain infections, may also be present with chronic hyperglycemia [1]. These combinations along with polyuria, polydipsia, polyphagia, and blurry vision produces the common symptoms of diabetes [6]. As this disease progresses, vascular damage ensues leading to severe diabetic microvascular and macrovascular complications [7]. Therefore, diabetes covers a wide range of diseases which are the major causes of chronic morbidity and death in diabetic subjects [8].

Being described as the “the perfect epidemic” this condition affects an estimated 387 million people worldwide. According to the WHO [9], the incidence of diabetes has risen dramatically over the past years with a current prevalence of 9% and it is expected to affect more than 500 million adults by 2030. North America and the Caribbean are the regions with a higher prevalence of 11%, having 37 million people affected. In 2012, an estimated 1.5 million deaths were directly caused by diabetes, with 80% deaths occurring in low and middle-income countries [9-11].

Table 1: IUPAC name for several synthetic antidiabetic drugs.

There are several synthetic antidiabetic drugs. These include Insulin Secretagogues (Sulfonylureas), biguanides, Thiazolidinediones, α- Glucosidase, Glucagon [12] etc. The structure of some of these drugs are shown in Figure 1. The scientific name is given in Table 1. Interestingly, most of these drugs seem to incorporate the urea linkage.

Figure 1:Antidiabetic drugs.

Although, antidiabetic agents such as insulin, biguanides, thiazolidinediones and α glucosidase inhibitors are available in Guyana to treat diabetes, a safe and effective treatment paradigm is yet to be achieved. This is due to that fact that these drugs fail to significantly reduce the course of diabetic complications and have limited use because of their undesirable pathological conditions and high secondary failure rates. Therefore, it is essential to discover more effective antidiabetic agents with few adverse effects, low costs and ease of accessibility [12]. Synthetic drugs currently in use for diabetic treatment have undesirable side effects, including weight gain, hypoglycemia, nausea and diarrhea. These contributes a great deal to non-compliance in patients which can lead to further deleterious progression of their condition and result inevitably, in the increased mortality rate of the disease. For this reason, natural hypoglycemic compounds found in plant extracts present an attractive alternative to synthetic drugs or as reinforcements for currently used treatments.

In recent years, there has been a resurgence of interest in medicinal plants for the treatment of diseases [12]. A World Health Organization (WHO) study shows that 80% of the world’s population solely relies on medicinal plants for their primary health care needs [13]. Medicinal plant extracts, having antidiabetic properties can be a useful source for the development of oral hypoglycemic agents in both animal models and human subjects [1]. Over 350 plants are used in the treatment of diabetes mellitus, but only a small number of these plants had gained scientific and medical evaluation to assess their effectiveness and efficacy [5]. For the management of diabetes, the World Health Organization (WHO) has recommended the evaluation of traditional plant treatments as they are effective, non-toxic, with little or no side effects and are considered to be excellent candidates for oral therapy [6].

The anti-diabetic activity of Psidium guajava have been reported [7,9]. For example, a study to evaluate the hypoglycemic potential of the aqueous extract of Psidium guajava unripe fruit peel on blood glucose level (BGL) of normal and streptozotocin induced mild and severely diabetic rats has been undertaken. This study revealed that the fruit peel of P. guajava had marked hypoglycemic effect [7].

A study to test for the hypoglycemic potential of the ethanolic extract of Psidium guajava leaves on normal and alloxan induced diabetic rats have been reported[8]. After 21 days of administering the ethanolic leaf extracts, blood glucose was found to attain normal levels in the plasma of the Psidium guajava treated rats. However, in this study, adequate results were not obtained to indicate sufficient evidence of anti-hyperglycemic activity of Psidium guajava . Nevertheless, the study confirmed that P. guajava has some form of hypoglycemic action, as is evident in prior research carried out on the species [9,10].

The antidiabetic activity of T. indica extract (100mg/kg and 200mg/kg) and standard compound glibenclamide were investigated [11]. A significant decrease of blood glucose level in treated diabetic rats compared to untreated diabetic rats (227.10mg/dL), p < 0.01 was observed. The glibenclamide produced a reduction in blood glucose to 127.32mg/dL which was lower than the 100mg/kg dose, resulting in a decrease in blood glucose to 133.27mg/dL [13].

The hypoglycemic and hypolipidemic activities of an ethanolic extract of Averrhoa bilimbi Linn. leaves Italised Oxalidaceae in streptozotocin (STZ)-diabetic rats have been reported. The beneficial effects of the ethyl acetate fraction of A. bilimbi fruit (ABAEE) on the antioxidant/oxidant status in diabetes mellitus rats have also been reported [14,15].

Antidiabetic effect of the ethanolic extract of Phyllanthus emblica fruits in evan rats has been reported and is dose dependent [16]. The anti-hyperglycemic effect of Quercetin, a major constituent of the methanolic extracts of Phyllanthus emblica fruit in Streptozotocin (STZ) induced diabetic rats were determined[17].

The hypoglycemic effect of the aqueous extract of the fruits of Psidium guajava, Averrhoa bilimbi and the peel of Tamarindus indica on normoglycemic guinea pigs have been reported by us [18]. The guinea pigs were divided into three groups of three: control group, aqueous fruit extract treatment group at a dose of 6ml/kg) and glibenclamide treatment group (with the dose 2.5mg/ kg). Guinea pigs received treatment twice daily for 12 days for each fruit and peel. Blood glucose and body weight were measured before treatment and between three days interval. Additionally, each plant extract at the dose of 6ml/kg was orally administered for glucose tolerance test during 120 minutes study in comparison to glibenclamide at the dose of 2.5mg/kg. Administration of extracts of Psidium guajava, Tamarindus indica and Averrhoa bilimbi resulted in a marked hypoglycemic (reduction) activity in blood glucose levels when compared to the control and Glibenclamide treated group on the 12th day: Psidium guajava (90±3.0 to 75.7±3.5mg/ dL), Tamarindus indica (89.0±5.6 to 70.7±2.1mg/dL) and Averrhoa bilimbi (110.0±9.2 to 86.7±10.0mg/dL). Glibenclamide also resulted in a reduction (88.0±2.0 to 67.3±3.5mg/dL) as compared to the control.

There are several herbs that are used to treat diabetes locally and internationally [19-23]. Locally Momordica charantia [19], an herbaceous, tendril-bearing vine contains a compound called charantin, which have hypoglycaemic effect. It has been found to increase insulin sensitivity. A daily dose of 100mg per kilogram of body weight is comparable to 2.5mg/kg of the anti-diabetes drug glibenclamide taken twice per day. Other compounds in M.charantia have been found to activate the AMPK, the protein that regulates glucose uptake. The whole plant is used as a decoction for diabetes. The dry leaf and stem are boiled and the water drunk as an anti diabetic. The fruit is cooked and eaten as an anti diabetic. Use with almond oil for a vulnerary. Tablets of M.charantia extract are sold in the United Kingdom.

Phyllanthus niruri [19] contains alkaloids, flavonoids and triterpenes. The whole plant is used as a blood purifier (bitter tonic) to reduce blood sugar level. It’s available as capsules. Cajanus cajan [19], Pigeon peas contain high levels of protein and the important amino acids methionine, lysine, and tryptophan. Leaves and flowers are boiled for a diuretic and diabetes remedy. The whole plant of Desmodium barbatum [19] is use to reduced blood sugar level. The wood of the plant, Telitoxium [19] is used for diabetes. The active adaptogenic constituents of Tinospora cordifolia [19] are diterpenoid compounds: polyphenols, and polysaccharides, including arabinogalactan polysaccharide. T. crispa and T. rumphii are used in Thailand and Philippines for treatment of diabetes. A decoction of the leaves of Azadirachta indica [19], Neem is used as a bitter tonic for treating diabetes and jaundice [20]. Internationally, the juice of the leaves of Abrus precatorius are given to diabetic patients. Achyranthes aspera [21-23] is used as a decoction in the treatment of diabetes mellitus. Likewise, the roots of Catharanthus roseus is used as decoction in the treatment of diabetes mellitus. The entire plant of Centella asiatica [21-23], is also used as a decoction in the treatment of diabetes mellitus [18- 23]. Curcuma longa is a rhizomatous herbaceous perennial plant which is used in the treatment of diabetes mellitus. Phyllanthus emblica [21-23], edible fruits are antidiabetic in nature. Piper bettle [21-23] leaf extract is used in the treatment for diabetes mellitus. Sphaeranthus indicus [21-23].

Conclusion

Diabetes mellitus is a serious disease worldwide and results in a wide range of ailments in humans. Synthetic treatments include the use of Insulin Secretagogues (Sulfonylureas), biguanides, Thiazolidinediones, α- Glucosidase, Glucagon etc. However, there is a need to continue with herbal treatments. Herbal treatments include plant parts from Momordica charantia , Phyllanthus niruri, Cajanus cajan, Desmodium barbatum , Tinospora cordifolia, Azadirachta indica, Abrus precatorius, Catharanthus roseus, Centella asiatica, Curcuma longa, Phyllanthus emblica , Piper betle and Sphaeranthus indicus. Type II diabetes is most likely to be developed in regions where there sedentary mode of life and lack of physical exercise and the diet is mainly of the Fast Food type. Stress is another factor that contributes to diabetes. Unless effective prevention strategies are implemented, the incidence of diabetes in the world will continue to rise, increasing the already high socioeconomic burden on families and the National Health Care System.

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Lupine Publishers| “Architecture and Fashion”: Something in Common

 Lupine Publishers| Journal of  Textile and Fashion Designing

Abstract

“Architecture and Fashion - Something in Common”, is exploring the parallels between one of the most two influential fields in the creative design industry; which are “Architecture” and “Fashion”. The purpose of the research work introduced in this paper is to find the common elements between architecture and fashion. “Design” and “Creativity” are major common elements between architecture and fashion, where both fields involves; imagination, art, visualization, creativity, and skill. On the other hand, architects develop a variety of creative design skills during their undergraduate studies in addition to learning their major in “Architecture”, such diversity of skills expands the realm of their job market, so that those who did not manage to find jobs in their field of major as architects may be able to find jobs in fields where they have developed creative design skills, during their undergraduate years of study2. The paper is aiming towards integrating learning fashion design principles as part of the undergraduate architecture syllabus, which in turn may facilitate numerous job opportunities for architects quitting their major field of study but still wish to work in the fashion industry which is a field where they can express and practice their creative design skills. Research introduced in this paper found that most famous and influential fashion designers were architects before they switched to fashion design, it was also found that there were many fashion designers who made architecture designs and great buildings, similarly, many famous and influential architects made great fashion designs.

Keywords: Fashion and Architecture; Fashion Architect; Fashion Designers; Architectural Fashion; Building Fashion

Problem

Job market statistics in USA and Europe found that salaries of fresh graduate architects are very low compared to other professional jobs that require creativity and design skills; also, it was found that finding a job opportunity for a fresh graduate to work as an architect in a design firm is scarce, which caused many fresh graduates to accept working as “Interim architects”1. in the beginning, without receiving any salary for a period of time that may; in many cases, extend to two or three years after graduation, in hope that they will be able to have a permanent employment in the firm at the end. For the above reasons; the concept of expanding the job market for architects have been adopted in many schools of architecture around USA and Europe. Since architects develop a variety of skills during their undergraduate studies in addition to learning their major in “Architecture”, they learn graphic design skills which allow them to work as graphic designers, and in the field of publication design, they also learn 3Dimensional visualization skills so that they can work as visualization specialists, rendering specialists, and animators.

And in some architecture schools; they learn interior design, theatre, and cinema plateau design, web design, multimedia design, and some industrial design principles. This diversity of skills expands the realm of their job market, so that those who did not manage to find jobs in their field of major as architects may be able to find jobs in fields where they have developed creative design skills, during their undergraduate years of study. Since “Design” and “Creativity” are major common elements between architecture and fashion, where both fields involves; imagination, art, visualization, creativity, and skill; integrating learning fashion design principles as part of the undergraduate architecture syllabus may facilitate numerous job opportunities for architects quitting their major field of study but still wish to work in the fashion industry which represents a field where they can express and practice their creative design skills.

Literature Review

The literature introduced in this research paper is exploring the common elements between architecture and fashion, through introducing examples of fashion designs influenced by architectural buildings, and vice versa. It also introduces some of the most famous fashion designers whose background study was architecture, and architects who worked as both architects and fashion designers.

An “Interim job” is a temporary occupation where a worker is employed for a specific period of time, and without the notion for changing such working status into a permanent employment. “Interim architects” are usually fresh graduates who are temporary hired by design firms, as the later prefers those fresh graduates above experienced, or intermediate, and senior architects due to their higher salary rates. However, in some cases the word “Interim architect” is used for describing undergraduate students of architecture who spend some time receiving a “Training opportunity” in a design firm, where the time they spent has been calculated as part of the completion of their credits in order to be eligible for graduation. In general, “Interim employment opportunities” are characterized by its no, or very small compensation.

One of the major working issues that aroused in USA and Europe since 2000 is that major architecture firms started to heavily depend on “Interim architects” as the main back office workforce in order to minimize their major running expenses represented in salaries. Instead, the firm in many cases gives the “Interim architect” a certificate of experience with a little compensation. This situation caused many fresh graduate architects to quit the field and start using skills they learned during their undergraduate years of study to work in the creative design industry, as free lancers, or finding better job opportunities as employees.

Research Goal

The goal of this research is to find the common elements between architecture and fashion, for the purpose of integrating learning fashion design skills in architecture syllabus, especially at the under graduate level, where architecture students developed various creative design skills.

Research Scope

The research work introduced in this paper is focusing on exploring attributes that may be common between architecture design and fashion design. Subjects like “Fashion Cycles” and/or “Fashion Trends” are not within the scope of work introduced in this research paper.

Methodology

In order for the research paper to fulfill its goals; the paper started with an overview about the nature of fashion design, then the paper discussed the following topics:

a) Fashion Designers with Architectural Background

b) Examples of Fashion Designers who Make Architectural Designs

c) Examples of Architects who Make Fashion Designs

d) Examples of Fashion Designs Influenced by Architecture

e) Examples of Architectural Designs Influenced by Fashion

Discussion

Overview

Fashion designs are inspired from all sources; Fine arts, society, culture, nature, architecture, etc. There is a great synergy between architecture and fashion. While architecture provides spaces for living, work, entertainment, learning, health, etc. Fashion provides wearable art. Many Fashion designers use their materials as building blocks, constructing all types of dresses and garments in the same way architects utilize concrete, cement, and glass to build up their structures Stewart Jessica [1].

Fashion Designers with Architectural Background

Fashion giants such as the late “Pierre Balmain”, “Gianfranco Ferré”, “Fernando Garcia”, and “Coco Chanel”; they all came from an architectural background. Also, famous classic fashion designers like “Versace, “Cardin”, and many others studied architecture before switching to fashion.

Balmain: “Pierre Alexandre Claudius Balmain”, or “Balmain” [May 1914–June 1982], was a famous French fashion designer and founder of the leading post-war fashion house “Balmain”, he was known for his sophisticated and elegance fashion designs. “Balmain” studied architecture at the “École des Beaux-Arts” in Paris, France. While in 1934, he switched from architecture to fashion when he was offered a job at the “Edward Molyneux” fashion studio Elle- Balmain [2]. “Balmain” was clear in his words for incorporating architectural elements into his designs, stating that: “Dressmaking is the Architecture of Movement”.

Gianfranco Ferré: “Gianfranco Ferré’s”, [August 1944 – June 2007], was a famous Italian fashion designer who studied architecture at the “Milan Polytechnic Institute” in Milan, Italy. He was also known as “The architect of fashion” for his background study as an architect, and his original attitude towards creating fashion design. BBC News [3]. “Ferré” began his fashion career in 1970 by designing accessories, and then worked as a raincoat designer from 1972 to 1974. Afterwards, he started his own company “Baila” in 1974 and launched his signature collection for women in 1978. His first men’s collection appeared in 1982, followed by his first couture collection in Rome in 1986. Then in 1989, “Ferré” was chosen by “Bernard Arnault” the owner of “Christian Dior”3 to replace its director “Marc Bohan”. (Blanchard Tamsin [4].

Fernando Garcia: “Fernando Garcia” is a famous fashion designer, who grew up traveling between the “Dominican Republic” and “Northern Spain”. His love for drawing on napkins led him to study architecture at the University of “Notre Dame” in USA. Being a creative artist and architect made him switch into fashion design. He found the opportunity to work at “Oscar de la Renta” fashion studio in New York where he built his reputation as a recognized fashion designer; he won with Laura Kim the “Swarovski Award for Emerging Talent for Monse” fashion design award. In his opinion about the interrelation between fashion and architecture he said: CFDA [5]. “I Find A Building’s Façade, For Example, To Be Similar to When I’m Trying to Find A Balance in Designing Any Garment “

Coco Chanel: “Coco Chanel”, or “Gabrielle Bonheur Chanel”, [August 1883 –January 1971] was a famous French fashion designer and businesswoman. She was the founder of the famous “Chanel brand”. “Chanel” was nominated on “TIME” magazine’s list of the 100 most influential people of the 20th century. Her fashion design for females was recognized as the feminine standard of style of the post-World War I era. In her opinion about the interrelation between fashion and architecture she said: (Horton, R. Simmons, and Sally [6]. “Fashion Is Architecture: It Is A Matter of Proportions”.

Versace: “Gianni Versace” [1946-1997] one of the most innovative fashion designers of the 20th century, being inspired by studying architectural drafting and the ancient Greek and Roman architecture in his early age; Versace entered the world of fashion with his clothes designed using architectural materials like metals, plastics, and leathers. He was awarded the best fashion designer of the year [1982-83] for his fall/winter collection called the “L’Occhio d’Oro”, or the “Golden Eye”, for designing women garments made of metals cut by laser technology. (Encyclopedia of World Biography [7] (Figure 1).

Figure 1: Showing the “ Selena White Laser Cut Cross- Body Bag” introduced by “Versace” in his Spring 2008 Collection, the bag is made of: White Faux Leather, Silver Hardware, a Popper Snap Closer, with a Detachable Chain Strap, the design was cut by laser and came under the “Versace Jeans” Branding in 2008, Source: Daniel Footware [38].

Cardin

“Pietro Cardin”, also known as “Pierre Cardin”, is a famous Italian-French fashion designer who moved with his wealthy parents from Italy escaping “Fascism”4 to settle in France. In 1945, and after the end of World War II, he studied architecture in Paris. Yet with a great passion for fashion design; he worked with many famous fashion houses like “Paquin”5 “Elsa Schiaparelli”6 and also became the head of design department at “Christian Dior’s” atelier in 1947. “Cardin” founded his fashion house in 1950. United Nations Educational, Scientific and Cultural Organization [8]. Being influenced by his architectural background study; “Cardin” was known for his inclination towards applying geometrical shapes and motifs in his fashion design and often ignoring the female form. He was also known by his “Avant-Garde” style [7]and “Space Age” designs 8. In 1954, he introduced his famous “Bubble Dress” design inspired by the geometrical shapes of ellipsoids and spheres. Pierre Cardin [9] (Figure 2).

Figure 2: Showing “Cardin’s” 1954 Bubble Dress design that was inspired by the geometrical shapes of the ellipsoids and spheres Source: Pierre Cardin [9].

“Christian Dior” is one of the most famous and biggest fashion houses of the twentieth century, founded by the French fashion designer “Christian Dior”, who lived between [January 1905 and 24 October 1957]

“Fascism” is a political ideology that was developed after World War I in Italy and Germany, it was characterized by its extreme nature, almost classifying human beings as superior nations and others that should be dominated by military invasion, “Fascism” was a very oppressive political form of dictatorship that was against “Liberalism” and “Socialism”. The ideology was adopted by “Benito Amilcare Andrea Mussolini” who was the leader and Prime Minister of Italy from 1922 to 1943, “Fascism” was one of the major political ideologies that influenced the beginning of world war II in 1939, (Grimsley Shawn [10]

“Paquin” is a leading French fashion design house founded in Paris by “Jeanne Paquin”. She lived between [1869 and 1936], and she was considered one of the female pioneers in the fashion industry, (Brenda Polan, Roger Tredre [11].

“Schiaparelli” Designs, was a famous fashion house founded by the Italian fashion designer “Elsa Schiaparelli” [1890–1973], she was also considered as one of the most female pioneers in fashion design between world war I and II. Her clients included many prominent figures and celebrities like “Heiress Daisy Fellowes” and actress “Mae West” Bradley Laura, Watt Judith [12].

“Avant-Garde” is an intellectual, artistic, and cultural movement lead by many writers, critiques, artists, and social activists who challenged the main stream of thinking in both their societies and their professional fields. The “Avant-Garde” movement dates back to early 1850’s. And it had great influence on art, writing, architecture, and many other social related fields. Gongini Barbara [13].

“Space Age” is a term defining the time period where the space science technologies began to evolve and introduced to the main stream media, the space age is marked by the launch of “Sputnik” space ship in 1957” Garber Steve [14]

Examples of Fashion Designers Who Make Architectural Designs

What follows are some examples of famous fashion designers who make architectural designs

Versace: “Versace” inc. was commissioned by “ENSHAA PSC”; a major real estate developer in UAE to design a luxury 130,000 square meters [1,400,000 sqft] seven stars “Palazzo Versace Dubai” hotel in Dubai, the United Arab Emirates, the hotel consists of 215 hotel rooms and suites, and 169 residencies, together with main entrance, high ceilings, multipurpose halls, restaurants, spa, landscaped gardens with promenades, terraces, water features, reflection pools, and other amenities. The hotel was aimed to reflect the “Versace” lifestyle. Its public spaces and hallways were designed to showcase the artwork, sculpture, featured sketches, and artifacts of the atelier “Versace” gowns, while every interior detail in the hotel including furniture in the hotel rooms and other hotel spaces were exclusively designed by “Versace” to create an immersive experience of his lifestyle Marcellous Jones [15] (Figure 3).

Figure 3: Showing the “Palazzo Versace Dubai” hotel in Dubai, the United Arab Emirates, designed by “Versace”, Source: (Marcellous Jones [15].

Virgil Abloh: “Virgil Abloh” is an American creative fashion designer, and founder of the Milan-based fashion label “Off- White” [9] “Abloh” also studied architecture at the Illinois Institute of Technology. In addition to running a famous fashion line, he collaborated with “IKEA”, to create a capsule furniture collection, and planned to publish a series of books that showcase his clothes alongside iconic structures by “Le Corbusier” and “Mies Van Der Rohe”. (Figure 4). “Abloh” quoted in an interview with the “Architectural Digest”, Maria Bobila [16], Mathew Taylor [17]. “The Idea Is to Teach My Demographic — The Younger Generation Who’s Immersed in Fashion — About Architecture Through These Sites.” Moreover, the style director at the “Architectural Digest” “Jane Keltner De Valle”, an established longtime fashion editor in both the “Women’s Wear Daily”, and “Elle” magazines, after moving to work in the “Architectural digest”; She interviewed “Abloh” and cited him as: “The Brains Behind Off-White and another Designer Who Heavily References Architecture in His Work”. In her personal opinion about the interrelation between fashion and architecture she stated that: Tyler Mccallnov [18]. “I think we’re going through such a seismic Cultural shift right now”.

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Lupine Publishers | The Optimal Pain Management Methods Post Thoracic Surgery: A Literature Review

 Lupine Publishers | Journal of Surgery & Case Studies

Abstract

Post-operative pain control is one of the key factors that can aid in fast and safe recovery after any surgical interventions. Thoracic surgery can cause significant postoperative pain which can lead to delayed recovery, delayed hospital discharge and possibly increased risk of chest complications in the form of atelectasis and even lower respiratory infections. Therefore, appropriate pain management following thoracic surgery is mandatory to prevent development of such morbidities including chronic pain.

Keywords:Thoracic Surgery, Analgesia, VATS, Robotics, Thoracotomy

Introduction

Thoracic surgical procedures can result in severe pain which can present as a challenge to be appropriately managed postoperatively. In particular, thoracotomies are well known for their severity of pain due to the incision, manipulation of muscles and ligaments, retraction of the ribs with compression, stretching of the intercostal nerves, possible rib fractures, pleural irritation, and postoperative tube thoracotomy [1]. Recognition of this has contributed to the development of minimally invasive techniques such as video assisted thoracoscopic surgeries (VATS) and lately robotic surgery [1]. These techniques not only aim to produce better aesthetic results, but also reduce post-operative pain and enhance recovery without compromising the quality of treatment offered. Poor pain management can lead to several and serious complications such as lung atelectasis, hypostatic pneumonia due to avoidance of deep breathing in these patients as a result of pain and superimposed infection [1]. Pain management as a result, does not only lead to greater patient satisfaction, but it also reduces morbidity and mortality in patients undergoing thoracic surgery [2]. Historically, post-operative pain management for thoracic surgery involved the use of narcotics alongside parenteral or oral anti-inflammatory agents [2]. Post chest tube removal patients typically are transitioned to oral analgesia. Multiple additional pain control adjuncts were also implemented with differing levels of success [1]. Over time, intra-operative techniques have been developed which aims to target pain reduction postoperatively [2]. As our understanding of both pain management and the factors that play a role in the development of pain has increased, we have been able to target these and improve postoperative pulmonary morbidity and pain scores [1,2]. We aim to review different means of pain control in this paper in order to assess their effectiveness in achieving optimum results.

Thoracotomy

The mechanism of pain in thoracotomy involves the innervation of the intercostal, sympathetic, vagus and phrenic nerves [3]. Additionally, shoulder pain may result from stretching of the joints during the operation.

After a thoracotomy, pain can persist for two months or more, and in certain incidences it recurs after a period of cessation. The incidence of chronic pain post thoracotomy is reported to be 22-67% in the population [4]. Good surgical technique and effective acute post-operative pain treatment are evident means of preventing post-thoracotomy pain and consequent pulmonary complications [4]. Due to the multifactorial character of the pain, a multimodal approach to target pain is advised. Typically, both regional and systemic anaesthesia are administered. A combination of opioids such as fentanyl or morphine are typically used [5]. A variety of techniques for the administration of local anaesthetics are available at present, and the effectiveness of each is assessed in this paper.

a) Thoracic Epidural Analgesia (TEA)

TEA was the most widely used method of means of analgesia. It was the gold standard means of pain relief [6,7]. It is typically inserted prior to general anaesthesia, at the level of T5-T6, midway along the dermatomal distribution of the thoracotomy incision. A study by Tiippana et al. [8] measured the visual analogue scale (VAS) in order to assess the presence of pain during rest and at the time at which they coughed in 114 patients of whom 89 had TEA and 22 who had other methods of pain control. TEA was effective in alleviating pain at rest and during coughing. In TEA patients, the incidence of chronic pain of at least moderate severity was 11% and 12% at 3 and 6 months, respectively. The study found that at one week after discharge, 92% of all patients needed daily pain medication. The study advised for extended postoperative analgesia for up to the week post-discharge to be administered in order to manage this. The study however concluded overall, that TEA was effective in controlling evoked post-operative pain. However, the study did encounter problems of technical form in 24% of the epidural catheters. The incidence of chronic pain, however, was lower compared with previous studies where TEA was not used. Several other studies support that TEA is superior to less invasive methods. According to Shelley B. et al. [9] TEA was preferred by 62% of the respondents over paravertebral block (PVB) with 30% and other analgesic techniques with 8%. Limitations of this technique included hypotension and urinary retention. Certain patients with active infection and on anticoagulation are excluded from epidural placement.

b) Paravertebral Block (PVB)

PVB is considered an effective method for pain management and its use has been increased in the recent years. This technique involves injecting local anaesthetic into the paravertebral space and it is able to block unilateral multi-segmental spinal and sympathetic nerves. Previous studies have shown that it is effective in achieving analgesia and is associated with a lower incidence of side effects such as nausea, vomiting, hypotension and urinary retention [10,11]. As the lungs are collapsed, it is associated with a lower risk of pneumothorax.

In a study by Davies R.G. et al. [10] there was no significant difference in pain scores, morphine consumption and supplementary use of analgesia between TEA and PVB. The rate of failed technique was lower in PVB (OR =0.28, p=0.007). Respiratory function was improved at both 24 and 48 hours with PVB but only significantly improved at 24 hours.

c) Intercostal Nerve Block (ICNB)

ICNBs are generally administered as single injections at least two dermatomes above and below the thoracotomy incision [12]. It is performed percutaneously or under direct vision, using single injections or through placement of an intercostal catheter. It can also be formed using cryotherapy. It is associated with reduced post-operative pain scores; however, it is less effective than TEA in controlling chronic pain [12]. This was illustrated by a study by Sanjay et al. [12] which found that patients that underwent ICNB had higher pain scores 4 hours post-operatively, than those who received epidural anaesthesia using 0.25% bupivacaine (p<0.05). The study concluded that in the early post-operative period there was significant impact in pain relief for both techniques, but thereafter, epidural anaesthesia was proven to significantly reduce post thoracotomy pain over ICNB. Due to the multifactorial nature of post-thoracotomy pain, various approaches are required in order to target pain. ICNBs are useful in the blockade of intercostal nerves, whilst PVB and TEA appear to block the intercostal and sympathetic nerves. Due to the inability of regional anaesthesia to block the vagus and phrenic nerves which are implicated in the pathophysiology of pain, NSAIDs and opioids are required as adjuncts. TEA is proven to be the most effective means of treating pain alongside PVB; however, it is associated with more side effects than PVB. At present, there are a limited number of studies directly comparing pain control and post-operative outcomes between PVB and TEA. There is no conclusive evidence that either method is superior to the other regarding pain control.

Video-Assisted Thoracoscopic Surgery (VATS)

Existing evidence supports the noninferiority of thoracic PVB when compared to TEA for postoperative analgesia [13]. PVB is versatile and may be applied both unilaterally or bilaterally. It can be used to avoid contralateral sympathectomy, consequently minimising hypotension. This is an apparent advantage it has over thoracic epidural. Furthermore, it offers a more favourable side effect profile when compared to epidural anaesthesia. At present, the factors taken into consideration when selecting a regional technique include tolerance of side effects associated with TEA, consensus on best practice/technique, and operator experience [13]. A randomised controlled trial by Kosiński et al. [14] compared the analgesic efficacy of continuous thoracic epidural block and percutaneous continuous PVB in 51 patients undergoing VATS lobectomy. The primary outcome measures were postoperative static (at rest) and dynamic (coughing) visual analogue pain scores (VAS), patient-controlled morphine use and side-effect profile. The study found that pain control (VAS) was superior in the PVB group at 24 hours, both at rest (1.7 vs3.3, p=0.01) and on coughing (5.8 vs 6.6, p=0.023), and control of pain at rest was also superior in the PVB group at 36 hours (3.0 vs 3.7 (p=0.025) and at 48 hours (1.2 vs 2.0, p=0.026). There were no significant differences in the postoperative morphine requirements. In regard to side-effect profile, the study showed that the incidence of postoperative urinary retention (defined as no spontaneous micturition for 8 hours or ultrasound-assessed volume of the urinary bladder >500ml) was greater in the epidural group (64.0% vs 34.6%, p=0.0036), as was the incidence of hypotension (32.0% vs 7.7%, p=0.0031). There was no significant difference in the incidence of atelectasis (4.0% vs 7.7%, p=0.0542). However, the incidence of pneumonia was significantly more frequent in the PVB group (3.8% vs 0%, p=0/0331). Kosiński et al. concluded that PVB is as effective as thoracic epidural block in regard to pain management as it offers a superior safety profile with minimal postoperative complications. A further randomised controlled trial by Okajima et al. [15] compared the requirements for postoperative supplemental analgesia in 90 patients who received wither a PVB or thoracic epidural infusion for VATS lobectomy, segmentectomy or wedge resection. The main outcome measures were pain scores at rest (verbal rating scale 0= none and 10=maximum pain), blood pressure, side effects and overall satisfaction scores relating to pain control (1=dissatisfied and 5=satisfied). The study found a similar frequency of supplemental analgesia (50mg diclofenac sodium suppository or 15mg pentazocine intramuscularly) for moderate pain in both groups, with 56% of those in the PVB group requiring ≥2 doses, compared to 48% in the epidural group (p=0.26). Hypotension, defined as a systolic blood pressure <90mmHg, occurred more frequently in the epidural group (21.2% vs 2.8%, p=0.02). There was no difference in the incidence of pruritus (3.0% vs 0%, p=0.29) and post-operative nausea and vomiting (30.3% vs 25.0%, p=0.62) between both groups. The study found no statistical difference between patient-reported satisfaction in pain control between epidural and PVB using the verbal rating scale (5.0 vs 4.5, p=0.36). The study concluded that PVB offered additional to equivalent analgesia to epidural, a lower incidence of haemodynamic instability postoperatively. A further study by Khoshbin et al. [16] performed an analysis on 81 patients undergoing VATS for pleural aspiration +/- pleurodesis, lung biopsies or bullectomy. The main outcome was postoperative pain levels, documented every 6 hours and scored against the Visual analogue Scale (0= no pain, 10= worst possible pain). In both PVB and epidural groups, bupivacaine 0.125% was the local anaesthetic of choice, with clonidine added to the epidural infusion at 300μg in 500ml. The study showed that there was no significant difference in mean pain scores between PVB or EP (2.1 vs 2.9, p=0.899), therefore concluding that PVB is as effective as epidural in controlling pain post-VATS.

Robotic Lung Surgery

Minimally invasive techniques are considered advantageous over open surgical approaches due to their shorter recovery times, reduced perceived levels of pain post-operatively and shorter postoperative length of stay in hospital [17-19]. Robotic surgery has become a popular method in recent years. Debate remains regarding whether robotic surgery is superior to VATS in regard with pain reduction. A case control study by Louie et al. [19] compared 45 robotic assisted lobectomies (RAL) to 34 VATS lobectomies. The study showed that both groups had a similar mean ICU stay (0.9 vs 0.6 days) and a mean total length of stay (4.0 vs 4.5 days). The study showed that patients that underwent robotic lobectomies had a shorter duration of analgesic use post-operatively (p=0.039) and a shorter time resuming to normal everyday activities (p=0.001). A limitation in this study was an inaccurate record of the amount of pain relief used by the patients, ultimately working as a confounding factor when interpreting the results. In a separate study by Jang et al. [18] 40 patients undergoing RAL were compared retrospectively to 80 VATS patients (40 initial patients and 40 most recent patients), all with resectable non-small cell lung cancer. The study showed that the post-operative median length of stay was significantly shorter in RAL patients compared to the initial VATS patients. The rate of post-operative complications was significantly lower in the RAL group (10%) compared to the initial VATS group (32.5%) and similar to the recent VATS group (17.5%). Post-operative recovery was easier for patients in both the RAL and VATS group due to earlier mobilisation, allowing them to return to their everyday activities quicker. In a retrospective review by Kwon et al. [17] 74 patients undergoing robotic surgery, 227 patients undergoing VATS and 201 patients undergoing anatomical pulmonary resection were assessed and compared with regard to acute (visual pain score) and chronic pain (Pain DETECT questionnaire). The study showed that there was no significant difference in acute or chronic pain between patients undergoing robotic assisted surgery and VATS. Despite no significant difference in pain scores, 69.2% of patients who underwent robotic-assisted surgery felt the approach affected their pain versus 44.2% of the patients who underwent VATS (p=0.0330). These results all support the superiority of robotic surgery over VATS and open approaches with regard to pain, length of hospital stay and recovery times. Both robotic surgery and VATS have their benefits i.e. two-versus three-dimensional view, instrument manoeuvrability, and reduced post-operative pain.

Conclusion

Since post-thoracotomy pain is multifactorial, a multimodal approach is required. In particular, ICNB blocks the intercostal nerves, and PVB and TEA appear to block the intercostal and sympathetic nerves. NSAIDs and opioids are required as valgus and phrenic nerve cannot be blocked by regional anaesthesia. TEA is evident to be the most effective in treating pain alongside with PVB. It is however associated with more side effects than PVB.

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Lupine Publishers | Can Dimple on Face is Affected by Blood Group?

 Lupine Publishers | Journal of Research & Reviews

Abstract

The objective of the present study was to correlate dimples on face with blood group system in humans. Total 180 subjects were participated in this activity. The subjects were student at Bahauddin Zakariya University Multan, Pakistan. Blood is to be checked against three types of antibodies, antibody A antibody B and –Rh serum. I took the blood group of the subjects and checked their blood type. Then we made list of subjects with their blood group types and asked them do they have dimple on their face or not one by one. Then we mentioned whether they have dimples or not after their blood group type in the list. It was concluded from the present study that O+ blood group people have maximum chance of having dimples and AB- have minimum chance of having dimples.

Keywords: ABO blood group system; Face dimples; Dimples and Blood grouping

Introduction

The most important blood group system in human blood transfusion is ABO blood group system. It is also present in some other animals like chimpanzees, bonobos and gorillas. ABO blood group system is discovered by Karl Landsteiner who discovered three different blood types in 1900. Our blood contains white blood cells, red blood cells, platelets and plasma. A person with blood group A, he have antigen A on red blood cells surface and antibodies B on his blood plasma. On the otherhand a person with blood group B have B antigen on red blood cells surface and A antibodies in his plasma. If he have blood type AB, then he have both antigen A and B on his red blood cells surface and no antibodies. If he has O blood group than neither he have antigen A nor B on red blood cells and both A and B antibodies present in plasma. A person having blood group A can donate blood to the person having blood group A. B blood group can only be donates to a person having blood group B and so on. If a person receive another type of blood or donate blood to a person with another type of blood than antibodies will match to the donors blood antigen. Red blood cells will clump in donated blood. Antibodies bind with the foreign red blood cells which cause agglutination.

Agglutinated red blood cells will break after a while and their content will leak out. Persons having AB blood are universal receivers and they receive blood from all blood groups. Persons with O blood group are universal donors and they donate blood to all types of blood groups. Rh blood group system is another and important blood group system after ABO [1]. Term Rh is abbreviation of “Rhesus factor” discovered in 1937 in rhesus monkey red blood cells. Rh blood group system related with many antigens, one of which is antigen D. Rh+ blood type have antigen but Rh- do not have antigen. Those individuals who lack antigen D do not make it naturally. Rh+ antigen lack the antigen and pose a danger for Rh- persons. Adverse effects may not be occur the after first time when blood with Rh+ is given to the person having Rhblood group. But the immune system produces anti Rh antibodies by responding to the foreign Rh antigen. If we give again Rh+ blood then after forming antibodies they cause agglutination because foreign red blood cells cause them to clump together. Hemolysis occur which cause destruction of red blood cells and also cause serious illness [2].

Dimple is a small hollow area on a part of human body mostly noticed on the cheek or on chin. There are two kinds of dimples, chin and cheek dimples. Cheek dimples shown when a person make a face expression. But in the case of chin dimple there is a small line on the chin that stays without making any face expression. Dimples may be appear or disappear for an extended period of time. Some researchers conclude that dimples are genetically inherited and as a dominant trait. But some said that they are irregular dominant trait controlled by one gene that may be influenced by some other genes. It is a genetic defect that cause irregular growth of certain facial muscles during embryonic development. They are formed by structural variation in facial muscle which is zygomaticus major. Presence of double zygomaticus major muscle form cheek dimples. The muscle that is shortened is responsible for stretching or pulling our lips behind into corners when we smile. They occur in those persons having dominant dimple gene. If both parents have dimples than there would be 50% chance that this deformity passed into next generation. Dimples are incredibly attractive and so many people wish that they could have dimples. If a person feels uncomfortable with their dimples than there are some ways to help them. They can never be removed but there are procedures that can reduce dimple size. The objective of present study was to correlate dimple on face with blood group system in humans.

Materials and Methods

Blood Grouping

In order to check blood group of any person, a blood sample is needed. First of all sterilize finger with alcohol wipes then take blood from fingertip by pricking it. Blood is checked by mixing it with three types of antibodies in test tube against Antibody A, Antibody B and anti-Rh serum. Cells clumps, or blood clotting tells about the type of Blood group. Then I Put blood group sample in test tube then add antibodies in it. After adding antibodies to blood sample wait for few seconds to observe precipitates formation. If blood is clot it means one of the antibody will react to the blood. If blood cells do not clot on antibodies A or Antibodies B then it is blood group O, If it clots on both antibodies A and B then Blood group is AB. If blood cells clot against Antibodies A then it is Blood Group B and if blood cells clot against Antibodies B then it is Blood Group A. After this blood sample is checked against anti-Rh serum which confirms the positivity and negativity of that blood group. Drop anti-Rh serum on blood sample if blood cells clot on Rh antibodies then blood group type is positive and if do not clot then it is negative blood group type.

Project Designing

Firstly, we took consent from each subject to take their blood sample and collected information by making questionnaire that do they have dimples on their face or not? Then we took blood sample of each subject and checked their blood group type by the procedure mentioned above. Then we made list of subjects with their blood group types and asked them do they have dimple on their face or not one by one. Then we mentioned whether they have dimples or not after their blood group type in the list. Total 180 subjects were participated in this activity. The subjects were students in Bahauddin Zkariya University Multan, Pakistan.

Statistical Analysis

MS Excel is used to perform statical analysis.

Results and Discussion

Table 1: Dimple on face with respect to blood group.

Following Table 1 shows the percentage of dimples in A+ males is 11.76% while in A+ females is 20%. Percentage of dimples in both A- males and females is 0%. B+ males have 10% and B+ females 21.81% dimples. B- males and females both have 0% dimples. AB+ males have 0% dimples while AB+ females have 12.50%. ABboth males and females have 0% dimples. O+ males have 16.66% and females have 26.83% dimples. O- males have 0% and females have 40% dimples on their face. Questionnaire based studies have given an important advancement in recent studies. Four scientists in 2015 work on five different Genetic Traits in Association with the Distribution Pattern of ABO and Rhesus Phenotypes among Families in Calabar and Nigeria one of which was dimples [3-10].

Conclusion

It was concluded from the present study that O+ blood group people have maximum chance of having dimples and AB- have minimum chance of having dimples.

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Lupine Publishers | Therapeutic Effect of Barley Grains powder (Hordeum vulgare L.) Among Sudanese Patients with Proteinuria Admitted at Ibn Sina Hospital in Khartoum State - Pilot study 2018

 Lupine Publishers | Journal of Urology & Nephrology

Abstract

Objectives: There are well recognised differences in health outcomes generally in society due to a range of socio-economic factors. We have compared survival outcomes in patients undergoing radical cystectomy for aggressive bladder cancer in the national health service (NHS) and compared this with those with private health insurance (PHI).

Methods: This is retrospective study of 225 NHS and 32 PHI patients operated over 14 years by one surgeon. ASA scores were compared to approximate comorbidity status.

Results: There were significantly worse outcomes for all cause and disease specific mortality in the NHS group. There was no difference in ASA scores.

Conclusions: NHS patients fare worse than those with PHI. The reasons for this difference remain unclear. PHI patients have a more extensive lymphadenectomy and have fewer overall complications.

Keywords: NHS private insurance outcomes radical cystectomy bladder cancer

Introduction

We studied the outcome of patients with private health insurance (PHI) compared to national health service (NHS) patients. These patients had the same operation for muscle invasive cancer of the bladder, and we looked to see whether there were significant differences in both all-cause mortality and disease specific mortality. We have attempted to see whether we can propose any explanatory cause for such differences.
There are barriers in society that delay detection and the treatment of cancers for those people with various social and economic disadvantages [1]. This imbalance creates health disparities such as differences in survival [2]. There are racial, gender, ethnic and socioeconomic components which are reflected in their insurance status [3].
Previous studies, mostly in the United States, although with some English and Danish studies, have looked at the effect of insurance status on outcomes of treatment for various cancers, including urological cancers of the prostate, kidney and bladder [4]. In the USA, the uninsured and those on Medicaid, have a worse stage at presentation [3-7]and a lower all cause survival than those with private insurance [2,1,8]. Worse disease specific mortality has also been shown to be an independent risk factor with worse outcomes for lower socio-economic status groups [9]. This finding, however, was not confirmed by a British study specifically looking at social deprivation [10]. Definitions of what constitutes adverse social groups are complex and may affect robustness of data [11]. A shift in classification of groups, pathological definitions and coding of cause of death may explain the lack of improvement in survival but not socioeconomic inequalities [11].
Many factors, including socio-demographic and clinical entities, form a complex network influencing survival. In the USA Insurance and socioeconomic status are predictors of mortality [1,8]. Uninsured patients are often treated at low volume centres[3]. Race and gender can also affect survival [12,13] as can communal poverty [14,15].
It has been suggested that poorer health generally, as demonstrated by more comorbidities and unhealthy lifestyle behaviours account for this phenomenon [2,15]. The affordable care act in the USA is an attempt to address the problem of the uninsured presenting with more advanced disease and their subsequent lower survival rates [16]. In addition, a negative association between income and prevalence of physicians for bladder and renal cancer mortality was found [17]. Those on Medicaid were less likely to receive definitive treatment [18]. Similar effects of socioeconomic status have been found in England [19]and Denmark [20].
These studies have all looked at the effect of all the range of treatments, both curative and palliative, for all types of cancer, including low- and high-grade disease which is of particular importance when discussing bladder cancer.
For differences in outcomes after specific surgical treatments, research has focused on radical prostatectomy. Insurance status is associated with stage and cancer control [21]. Higher surgery rates and lower radiotherapy rates were observed in private patients who were more affluent [22]. We have shown previously that insurance status is a protective risk factor with radical prostatectomy, but wealth itself is not protective which may be due to different adverse lifestyle behaviour[23].
There are few published studies pertaining to insurance status and survival after a specific treatment for bladder cancer, particularly radical cystectomy [24].

Effect of comorbidity and ASA score

Greater comorbidities as assessed by the ASA score, increase the likelihood of complications after radical cystectomy [25]. Patients with an ASA score of three or more have a greater complication rate [25]. Severe comorbidity is also associated with increased mortality [26,27]. The ASA score has been used to predict outcomes [28] and should be used for counselling and risk stratification [29,30]. In younger patients the ASA score can be useful despite EAU guidelines suggesting otherwise [31,32]. Neglect of comorbidities can cause misleading impressions of results [33] but the ASA score can be useful at to ascertain complication risk particularly with the type of urinary diversion and the time taken to do more complex surgery [34]. Comorbidity assessed using the Charlson score is useful for younger and older patients to predict toxicity of treatment and outcomes [35,36]. All-cause mortality has a stronger relation to comorbidity than disease specific mortality does [37].

Urinarydiversion

In general, the neobladder has a higher complication rate and longer stay in hospital [38] although it may be offered to most patients [39-41]. However, in practice, it still tends to be reserved for younger and fitter patients and thus may serve as a proxy for generally better health [42].

Methods

This is a retrospective study. The 257 radical cystectomy with bilateral lymphadenectomy (with ileal conduit or neobladder) operations were performed by one surgeon in both NHS and the private sector in the same county of the UK, operated from 1999 to 2013 and followed up to the present day. There were 225 patients from the NHS and 32 patients with private health insurance. These were sequential patients who underwent potentially curative operative and neoadjuvant/adjuvant treatments.
We compared various patient characteristics from health records using Iqutopia for operation details, ICE, Bostwick laboratories and Masterlab for pathology and PACS for imaging.
Medical statistics were done using Medcalc software for logistic regression analysis to determine significant predictors of mortality and progression. Fishers, Mann-Whitney, t tests and log rank tests to compare Kaplan Meier. P values less than 0.05 were considered significant.
The ASA score was documented by the attending anaesthetist and retrieved from Iqutopia where available.

Results

(Table 1-4) (Graph1-6)

Table 1: Patient characteristics.

Table 2:Significant predictors of mortality on logistic regression.

Table 3: 1 year, 5 year and 10-year comparisons of mortality rates.

Table 4: ASA score and log rank tests.

Graph 1:

Graph 2:

Graph 3:

Graph 4:

Graph 5:

Graph 6:

There is a significant difference between the ages of the two populations with NHS patients being older by four years. Private patients had a greater degree of nodal dissection and fewer complications. However, there was no difference in tumour volume, positive surgical margin status, advanced stage, carcinoma in situ, nodal involvement, nodal extracapsular extension. Further, there was no difference in rates of neo adjuvant or adjuvant treatment or the use of a neobladder. Logistic regression showed private health status to have highly significant negative coefficients which are protective in all cause and disease specific mortality as well as lower progression rates.
All-cause mortality was associated with negative coefficients for neobladder and PHI. Locally advanced stage was predictive of a deleterious outcome.
Disease specific mortality also showed adverse coefficients for additional treatments (adjuvant and neoadjuvant), complications and nodal density involvement.
Progression was adversely affected by additional treatment and increasing stage.
The ASA score was available in 169 of the 257 patients (66%). There was no difference in the distributions of healthy and unhealthy patients as measured by this score. (ASA1 and 2 were summated).
Log rank tests showed significant differences between the two groups for mortality.

Discussion

This study has supported generally what is known about bladder cancer and the negative impact of lower socio-economic status. However former studies have looked at bladder cancer as a whole, which includes low grade and non-muscle invasive disease as well as advanced muscle invasive disease, inoperable cases, cases treated with radiotherapy and palliative cases all grouped together. This study looks at a subsection of these, those deemed appropriate for radical cystectomy. We have seen significant differences in both all-cause mortality and disease specific mortality. These differences have not been previously demonstrated. There are many gross and subtle differences that are difficult to detect with such a heterogenous disease in a heterogenous population. We propose that looking at a subgroup like this will decrease some of the obfuscating factors, by limiting geographical variation and the operation being performed by one surgeon only.

All-causemortality

We have detected a significant difference in all-cause mortality (Graph 5) with NHS patients (Graph 2)faring far worse (log rank P = 0.025) and with an odds ratio 0.24 in favour of PP (Graph 1, Table 2). Overall survival at one year is 0.75 for NHS and 0.84 for PHI, and at five years it is 0.45 for NHS and 0.74 for PHI. Similarly, at ten years for NHS patients it is 0.34 compared to 0.53 for PP (Table 3). Numerous explanations have been proposed for the worse prognosis overall for bladder cancer in the uninsured [1- 12]. Overall worse health is the proposed principal reason for a worse all cause survival. We have tried to reflect potentially worse comorbidities with the ASA score as an approximation to overall health. There was, surprisingly, no significant difference detected between the two groups (P = 0.56) (Table 4). Private patients were four years younger on average and any chronic disease may not have reached a critical point to effect outcome (P =0.026) (Table 1). This was not a significant factor on regression analysis.
We do see that having a neobladder is a significant (P = 0.0154) protective (negative coefficient -0.8) factor, perhaps standing as a proxy for overall health [38,39], but there was no significant difference in the use of this between the two groups (P=0.16) (Table 1). Locally advanced stage 3 and 4 were both significant as expected [43, 44] with increasingly worse odds ratios (Table 2). The five-year gold standard for radical cystectomy is about 50% [43-49], and our population in the NHS reflects this. The patients with PHI fare much better with a 5-year survival of 0.74.

Diseasespecificmortality

We found a significant protective coefficient and odds ratio of 0.33 in favour of private patients (Table2). There was a DSM of 0.87, 0.84 and 0.75 for PHI at one, five and ten years (Graph 3). This was superior to NHS patients with DSM of 0.82, 0.81 and 0.58 (Table 3, Graph 4). This compares favourably with other series (49). The log rank test comparing the two was significant (Graph 6, Table5). Interestingly, the NHS mass of tumour was twice that of PHI, yet there was no significant difference in tumour volume which one might expect if there were a longer time to diagnosis in NHS patients (11cc v 23cc P=0.18). Further, we did not detect a worse stage (NHS 56% localised, PHI 62% localised P=0.84) or a significantly greater positive surgical margin rate in NHS patients (14% NHS v 6% PHI P = 0.27). However, the trend was worse with all of these parameters for NHS patients. There was no difference in rates of CIS between the two.
The use of neobladder was, once again, a protective risk factor (Table 2) which was used in 38% of PHI patients compared to 18% in NHS patients, however this did not reach significance (P=0.16) (Table 1).
Additional treatments, neo-adjuvant and adjuvant therapies, were a significant detrimental risk factor (Table 2) but with no significant difference between the two groups (NHS 17% and PHI 13% P=0.79).
The role of lymphadenectomy revealed no difference in severity of extracapsular invasion (Table 1)(P=1.0) or in nodal involvement with 19% of NHS patients having involved metastatic deposits within at least one node, compared to 22% of PHI patients (P=0.811). However, there was a significant difference in the number of nodes retrieved at lymphadenectomy, with an average of 9 for NHS and 13 for PHI patients (P=0.006). Node density is a significant predictor of DSM with an odds ratio of 9.67 (Table2).
Complications, of all types, are a significant adverse predictor for DSM. With a significantly worse rate in NHS, 40% compared to PHI patients, 13% (P=0.002).

Progression

This also revealed PHI status to be protective and worse outcomes were associated with need for additional treatment and advancing stage.
Time to diagnosis and time to treatment from diagnosis may be a factor, although studies are conflicting [50,51]. There is no lead time bias (perceived increased survival with no effect on course of cancer) as there is no screening protocol.

Conclusion

American studies have shown that insurance is important and that even Medicaid patients do worse than private patients. We concur that in the UK the NHS does not provide equal outcomes compared with PHI when comparing radical cystectomy. There may be social infrastructure issues involving hospital building capacity, education, prevention, detection and treatment. Assistance to patients to access and navigate healthcare systems and workplace policies to encourage overall better health is needed. National policies have been implemented to tackle this complex problem. The NHS cancer plan 2000 in the United Kingdom (http.//www.doh. gov.uk/cancer/pdfs/cancerplan.pdf) aims to reduce inequalities in survival between rich and poor with a 62-day target to treatment. The affordable care act in the USA highlights benefits of extending health coverage to the uninsured [1].
We have found significant differences in outcomes for all cause and disease specific mortality, yet the cause is elusive. We have shown a direct comparison of NHS and PHI to reveal these outcomes which can remain hidden in American studies as the SEER datebase does not include uninsured patients by definition. There is no difference in tumour volume, carcinoma in situ, advanced stage or not, nodal involvement, extracapsular involvement of nodes, rates of adjuvant and neo-adjuvant treatment. There are, however, differences in complication rates and extent of lymphadenectomy with favourable features pertaining to PHI.
We need to look for other ways to measure overall health that include medical and lifestyle with socioeconomic components.

Limitations

The PHI cohort is small. We have not measured the time to diagnosis and to treatment. We have not been able to document the Charlson comorbidity score. We have not documented types of complications.

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