A Deviation in BG dynamics during liver transplantation comparing ICU patients: a model-based approach

A proper glycemic control would beneficial affect on the outcomes of the liver-transplantation. Model based validated tight glycemic control protocol, STAR exists for ICU treatments. The validated metabolic model ICING for STAR differ in the blood glucose dynamics. By localizing the places of the extraordinary LT patients dynamics we can specify modifications on the ICU patient model. Based on the analyzes of ICING model, these dynamics mainly occurs in the 1) pre-anhepatic phase at the beginning of the surgery, 2) at the portal vein reperfusion and 3) in the post-anhepatic phase before 500 minutes from the reperfusion

Matrix effect in the hydroxyl radical induced degradation of ß-lactam and tetracycline type antibiotics

Due to the spread of antibiotic resistant bacteria, elimination of antibiotics from purified wastewater is a highly important task. Purified wastewater contains large variety of organic/inorganic compounds that strongly influence the efficiency of advanced oxidation processes (AOP). In this work, we investigate the radiation-induced degradation of selected antibiotic contaminants (oxacillin and cloxacillin from the beta-lactams; tetracycline and chlortetracycline from the tetracyclines) in four matrices: pure water, tap water, synthetic wastewater and purified wastewater received from a wastewater treatment plant. Changes in technically important parameters, such as COD, TOC, BOD, OUR, acute toxicity and antibacterial activity, were investigated at 0.1 mmol dm(-3) (40-48 mg dm(-3)) antibiotic concentration. None of the four antibiotics were biodegradable in any of the four matrices, however, after irradiation with relatively low doses the obtained products were biodegradable. Oxacillin and cloxacillin were not toxic in Vibrio fischeri test, while tetracycline and chlortetracycline showed toxicity that was strongly reduced by the irradiation treatment. Both COD and TOC decreased after irradiation, their ratio shifted towards TOC indicating an increase in the average oxidation state (AOS). The increase in AOS was lower in purified wastewater matrices: this matrix may contain various small, highly oxidized molecules in high concentration, which degrade very slowly in AOP. The antibacterial activity in most of matrices was greatly reduced or completely disappeared at around 2-4 kGy. However, in purified wastewater matrices some antibiotic activity remained even at 4 kGy. Here the degradation of antibiotic is slow (small delta COD/dose value) because a large fraction of the reactive radicals is scavenged presumably by small, highly oxidized molecules in the solution. Although the water radiolysis product H2O2 affected some of the bioassays, this phenomenon was absent in purified wastewater. The purified wastewater after ionizing radiation treatment can be safely released into the receiving lakes or rivers

Altered blood glucose dynamics during and after anhepatic phase of liver transplantation: a model-based approach

“© © 2013 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.”During liver transplantation (LT) the glucose metabolism is effected by a crucial disturbance. The blood glucose level is extremely hard to control by conventional clinical protocols during this phase. Model based approach can enhance the blood glucose control during the anhepatic phase and postanhepatic phase. The physiological constants of validated clinical metabolic model were slightly modified based on previous studies. The model fitting errors and the sufficient capture of the blood glucose (BG) dynamic evincived the applicability of the model. However the particular/sufficient per-patient estimation of endogenous production could more enhance the performance of the model based BG prediction

Comparison of model based and clinical blood glucose evolution during and after anhepatic status

Blood glucose (BG) control is a major difficulty during liver transplantation (LT). A model-based approach to analysis and control can enhance the efficiency of BG management during LT surgery. An existing clinically validated metabolic model was fitted to data from 8 LT patients. The reperfusion part of the post-anhepatic phase of LT shows a clear consistent dynamic rise in blood glucose (BG) level that would enable better prediction of future BG in this phase. Model fitting errors showed that the fundamental model captured all primary dynamics but parameter adjustment to reflect known conditions during LT surgery in specific phases would improve model quality

Advanced feeding regime combined with STAR protocol on ICU patients

Controlling stress-induced hyper blood glucose (BG) levels and variation is a critical task in the intensive care unit (ICU). The STAR protocol combined with an advanced feeding regime was used at an independent ICU to assess the impact of systematically increased energy input versus the basic STAR insulin and nutrition control approach

Intenzív osztályon ápolt betegek szoros vércukorszabályozása

Invited presentation, abstract made of presentation notes by organisers - Thus, the presentation IS the abstrac

Safety, efficacy and clinical generalization of the STAR protocol: a retrospective analysis

Background: The changes in metabolic pathways and metabolites due to critical illness result in a highly complex and dynamic metabolic state, making safe, effective management of hyperglycemia and hypoglycemia difficult. In addition, clinical practices can vary significantly, thus making GC protocols difficult to generalize across units.The aim of this study was to provide a retrospective analysis of the safety, performance and workload of the stochastic targeted (STAR) glycemic control (GC) protocol to demonstrate that patient-specific, safe, effective GC is possible with the STAR protocol and that it is also generalizable across/over different units and clinical practices. Methods: Retrospective analysis of STAR GC in the Christchurch Hospital Intensive Care Unit (ICU), New Zealand (267 patients), and the Gyula Hospital, Hungary (47 patients), is analyzed (2011–2015). STAR Christchurch (BG target 4.4–8.0 mmol/L) is also compared to the Specialized Relative Insulin and Nutrition Tables (SPRINT) protocol (BG target 4.4–6.1 mmol/L) implemented in the Christchurch Hospital ICU, New Zealand (292 patients, 2005–2007). Cohort mortality, effectiveness and safety of glycemic control and nutrition delivered are compared using nonparametric statistics. Results: Both STAR implementations and SPRINT resulted in over 86 % of time per episode in the blood glucose (BG) band of 4.4–8.0 mmol/L. Patients treated using STAR in Christchurch ICU spent 36.7 % less time on protocol and were fed significantly more than those treated with SPRINT (73 vs. 86 % of caloric target). The results from STAR in both Christchurch and Gyula were very similar, with the BG distributions being almost identical. STAR provided safe GC with very few patients experiencing severe hypoglycemia (BG < 2.2 mmol/L, <5 patients, 1.5 %). Conclusions: STAR outperformed its predecessor, SPRINT, by providing higher nutrition and equally safe, effective control for all the days of patient stay, while lowering the number of measurements and interventions required. The STAR protocol has the ability to deliver high performance and high safety across patient types, time, clinical practice culture (Christchurch and Gyula) and clinical resources. © 2016, Stewart et al