Results from the ETHICUS-2 study

Background: End-of-life care is common in German intensive care units (ICUs) but little is known about daily practice. Objectives: To study the practice of end-of-life care. Methods: Prospectively planned, secondary analysis comprising the German subset of the worldwide Ethicus-2 Study (2015-2016) including consecutive ICU patients with limitation of life-sustaining therapy or who died. Results: Among 1092 (13.7%) of 7966 patients from 11 multidisciplinary ICUs, 967 (88.6%) had treatment limitations, 92 (8.4%) died with failed CPR, and 33 (3%) with brain death. Among patients with treatment limitations, 22.3% (216/967) patients were discharged alive from the ICU. More patients had treatments withdrawn than withheld (556 [57.5%] vs. 411 [42.5%], p < 0.001). Patients with treatment limitations were older (median 73 years [interquartile range (IQR) 61-80] vs. 68 years [IQR 54-77]) and more had mental decision-making capacity (12.9 vs. 0.8%), advance directives (28.6 vs. 11.2%), and information about treatment wishes (82.7 vs 33.3%, all p < 0.001). Physicians reported discussing treatment limitations with patients with mental decision-making capacity and families (91.3 and 82.6%, respectively). Patient wishes were unknown in 41.3% of patients. The major reason for decision-making was unresponsiveness to maximal therapy (34.6%). Conclusions: Treatment limitations are common, based on information about patients' wishes and discussion between stakeholders, patients and families. However, our findings suggest that treatment preferences of nearly half the patients remain unknown which affects guidance for treatment decisions

Elastic Scattering and Total Reaction Cross Section for the 6He + 27Al System

The elastic scattering of the radioactive halo nucleus 6He on 27Al target was measured at four energies close to the Coulomb barrier using the RIBRAS (Radioactive Ion Beams in Brazil) facility. The Sao Paulo Potential(SPP) was used and its diffuseness and imaginary strength were adjusted to fit the elastic scattering angular distributions. Reaction cross-sections were extracted from the optical model fits. The reduced reaction cross-sections of 6He on 27Al are similar to those for stable, weakly bound projectiles as {6,7}Li, 9Be and larger than stable, tightly bound projectile as 16O on 27Al.Comment: 7 pages, 1 table, 3 figure

Pre-germination treatments and storage of cassava seeds and their correlation with emergence of seedlings.

Apesar da propagação de mandioca ser efetuada vegetativamente para fins comerciais, a maioria dos acessos mantém ativo o sistema de propagação sexual, o que é fundamental para programas de melhoramento genético. Entretanto, as sementes de mandioca apresentam germinação baixa e desuniforme. Considerando este fato, o objetivo deste trabalho foi avaliar a eficiência do armazenamento, e de diferentes tratamentos pré-germinativos, na emergência de plântulas de mandioca. Para isso, foi conduzido um experimento com sementes originadas da polinização aberta entre plantas de quatro variedades de mandioca de mesa, nas quais foram testados 10 tratamentos pré-germinativos, mais a testemunha. A viabilidade das sementes submetidas aos tratamentos foi avaliada pelo teste do tetrazólio e a avaliação da emergência das plântulas foi realizada através da contagem diária do número de plântulas emersas. Os dados observados foram expressos em porcentagem de emergência, índice de velocidade de emergência e tempo médio de emergência das plântulas. Pelos resultados obtidos, pode-se concluir que o armazenamento, a 4 °C, durante um ano, aumenta a porcentagem de emergência das sementes e favorece a velocidade de emergência de plântulas; e que o calor seco (60 ºC), durante sete e 14 dias, também favorece a velocidade de emergência das plântulas

Engineering the Redox Potential over a Wide Range within a New Class of FeS Proteins

Abstract: MitoNEET is a newly discovered mitochondrial protein and a target of the TZD class of antidiabetes drugs. MitoNEET is homodimeric with each protomer binding a [2Fe-2S] center through a rare 3-Cys and 1-His coordination geometry. Both the fold and the coordination of the [2Fe-2S] centers suggest that it could have novel properties compared to other known [2Fe-2S] proteins. We tested the robustness of mitoNEET to mutation and the range over which the redox potential (EM) could be tuned. We found that the protein could tolerate an array of mutations that modified the EM of the [2Fe-2S] center over a range of ∼700 mV, which is the largest EM range engineered in an FeS protein and, importantly, spans the cellular redox range (+200 to-300 mV). These properties make mitoNEET potentially useful for both physiological studies and industrial applications as a stable, water-soluble, redox agent

Alcoholic beverages and risk of renal cell cancer

Using a mailed questionnaire, we investigated the risk of renal cell cancer in relation to different types of alcoholic beverages, and to total ethanol in a large population-based case–control study among Swedish adults, including 855 cases and 1204 controls. Compared to non-drinkers, a total ethanol intake of >620 g month−1 was significantly related to a decreased risk of renal cell cancer (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.4–0.9; P-value for trend=0.03). The risk decreased 30–40% with drinking more than two glasses per week of red wine (OR 0.6, 95% CI 0.4–0.9), white wine (OR 0.7, 95% CI 0.4–1.0), or strong beer (OR 0.6, 95% CI 0.4–1.0); there was a clear linear trend of decreasing risk with increasing consumption of these beverages (P-values for trends <0.05)

Effects of butter from mountain-pasture grazing cows on risk markers of the metabolic syndrome compared with conventional Danish butter: a randomized controlled study.

BACKGROUND: There is considerable interest in dairy products from low-input systems, such as mountain-pasture grazing cows, because these products are believed to be healthier than products from high-input conventional systems. This may be due to a higher content of bioactive components, such as phytanic acid, a PPAR-agonist derived from chlorophyll. However, the effects of such products on human health have been poorly investigated. OBJECTIVE: To compare the effect of milk-fat from mountain-pasture grazing cows (G) and conventionally fed cows (C) on risk markers of the metabolic syndrome. DESIGN: In a double-blind, randomized, 12-week, parallel intervention study, 38 healthy subjects replaced part of their habitual dietary fat intake with 39 g fat from test butter made from milk from mountain-pasture grazing cows or from cows fed conventional winter fodder. Glucose-tolerance and circulating risk markers were analysed before and after the intervention. RESULTS: No differences in blood lipids, lipoproteins, hsCRP, insulin, glucose or glucose-tolerance were observed. Interestingly, strong correlations between phytanic acid at baseline and total (P<0.0001) and LDL cholesterol (P=0.0001) were observed. CONCLUSIONS: Lack of effects on blood lipids and inflammation indicates that dairy products from mountain-pasture grazing cows are not healthier than products from high-input conventional systems. Considering the strong correlation between LDL cholesterol and phytanic acid at baseline, it may be suggested that phytanic acid increases total and LDL cholesterol. TRIAL REGISTRATION: ClinicalTrials.gov, NCT0134358

Prevalence, Features and Risk Factors for Malaria Co-Infections amongst Visceral Leishmaniasis Patients from Amudat Hospital, Uganda

Visceral leishmaniasis (VL) and malaria are two major parasitic diseases sharing a similar demographic and geographical distribution. In areas where both diseases are endemic, such as Sudan, Uganda, India and Bangladesh, co-infection cases have been reported, but features and risk factors associated with these co-morbidities remain poorly characterized. In the present study, routinely collected data of VL patients admitted to Amudat Hospital, Uganda, were used to investigate the magnitude of VL-malaria co-infections and identify possible risk factors. Nearly 20% of the patients included in this study were found to be co-infected with VL and malaria, indicating that this is a common condition among VL patients living in malaria endemic areas. Young age (≤9 years) was identified as an important risk factor for contracting the VL-malaria co-infection, while being anemic or carrying a skin infection appeared to negatively correlate with the co-morbidity. Co-infected patients presented with slightly more severe symptoms compared to mono-infected patients, but had a similar prognosis, possibly due to early diagnosis of malaria as a result of systematic testing. In conclusion, these results emphasize the importance of performing malaria screening amongst VL patients living in malaria-endemic areas and suggest that close monitoring of co-infected patients should be implemented

Prevalence of the metabolic syndrome in Pudong New Area of Shanghai using three proposed definitions among Chinese adults

<p>Abstract</p> <p>Background</p> <p>The prevalence of metabolic syndrome (MS) has been increasing in China in recent years. The aim of this study is to estimate and compare the prevalence of MS among Chinese adults in Shanghai, one of the most economic developed areas in China, using definitions proposed by World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel (modified ATP III) and International Diabetes Federation (IDF).</p> <p>Methods</p> <p>This cross-sectional study included 5,584 adults at age 20-79 randomly selected from Pudong New Area of Shanghai, China, through a three-stage sampling. All participants were interviewed in-person between April and July of 2008 to collect information on demographic and lifestyle characteristics. At the interview, anthropometry and blood pressure were measured and bio-specimens were collected.</p> <p>Results</p> <p>The prevalence estimates for the MS increased with age for each definition in men and women, but the estimates varied greatly between the definitions and by sex. The prevalence of the MS was higher in men (20.2%) than in women (18.7%) using WHO definition but this sex difference was reversed when using the modified ATP III (28.4% for men vs. 35.1% for women) and the IDF (15.9% for men vs. 26.7% for women) criteria. The most common metabolic disorder in this population was dyslipidaemia, regardless of the definition used. Substantial agreement, estimated using the kappa statistic, was found between the modified ATP III and IDF definition, whereas the lowest agreement was observed between the WHO and ATP III criteria.</p> <p>Conclusions</p> <p>The MS is highly prevalent among Chinese adults in Pudong New Area of Shanghai and the most prevalent component was dyslipidemia. These findings underscore the importance of prevention and control efforts for the MS in this area and the need for a unified predictive definition for the syndrome for use by clinical practitioners and public health agencies.</p