Metabolic requirement of septic shock patients before and after liberation from mechanical ventilation

Objectives:Negative energy balance can impair regeneration of the respiratory epithelium and limit the functionality of respiratory muscles, which can prolong mechanical ventilation. The present study sought to quantify and identify the difference in energy expenditure of patients with septic shock during and upon liberation from mechanical ventilation. Methods:Patients admitted into intensive care with initial diagnosis of septic shock and mechanical ventilation-dependent were recruited. Their metabolic requirements before and after liberation from mechanical ventilation were measured by indirect calorimetry. A paired t-test was used to examine the variance between the two modes of breathing and a Spearman rho correlation coefficient to examine relationship of selected indicators.Results: Thirty-five patients, 20 males and 15 females mean age 69 ±10 years, body height of 1.58 ±0.08 meters, and ideal body mass 59.01 ±7.63 kg were recruited. Median APACHEII score was 22, length of stay in the intensive care was 45 ±65 days and duration on mechanical ventilation was 24 ±25 days. Measured energy expenditure during ventilation was 2090 ±489 kcal∙d-1 upon liberation from ventilation was 1910 ±579 kcal∙d-1 and actual caloric intake was 1148 ±495 kcal∙d-1. Measured energy expenditure (p=0.02), actual calories provision and energy expenditure with (p=0.00) and without (p=0.00) ventilator support were all significantly different. Mean carbohydrate oxidation was 0.17 ±0.09 g·min-1 when patients were on mechanical ventilation compared to 0.14 ±0.08 g·min-1 upon liberation, however, this difference was not statistically significant. Furthermore, mean lipid oxidation was 0.08 ±0.05 g·min-1 during mechanical ventilation and 0.09±0.07 g·min-1 upon liberation, which was also not statistically different. Comparison of carbohydrate utilization and lipid oxidation was not different during (0.7±0.36 vs 0.75±0.47 kcal·min-1) and upon liberation from mechanical ventilation (0.55±0.33 vs 0.78±0.59 kcal·min-1).Conclusions: This study examined energy expenditure and substrate oxidation within a single cohort of patients with and without mechanical ventilation. Measured energy expenditure was found to be higher during mechanical ventilation. The possible explanations were positive pressure support from ventilation, the repeated cycle of “rest” and “work” during weaning from ventilators and the asynchronization between self-initiated breathing effort and the ventilatory support. The change energy expenditure with and without ventilatory support should be monitored so that mismatch could be aligned. Future studies are important to examine whether matching energy expenditure with energy intake would promote positive outcomes.<br/

Solid-liquid extraction of betel leaves (Piper betle L.)

This work investigated the effects of extraction temperature on the quality of extract and the kinetics of solid-liquid extraction of betel leaves. In this study, the effects of extraction temperature on the quality of extract were evaluated by comparing the concentration of its active compounds, including hydroxychavicol (HC) and eugenol (EU). The results indicate that the increase of extraction temperature led to the increase of the concentration of HC. EU concentration was decreased when temperatures higher than 60C were used. The kinetics data show that the extraction process reached equilibrium in a short time – about 40 min. Two models, namely equilibrium-dependent solid-liquid extraction (EDSLE) model and diffusion-dependent solid-liquid extraction model were applied to describe the extraction process. By comparing the values of correlation coefficients, the EDSLE model was found to be more suitable in describing the extraction process as it provided a better fit to the experimental data

Drying of betel leaves (Piper betle L.): quality and drying kinetics

This work studied the effects of drying temperature on the quality and drying kinetics of betel leaves (Piper betle L.). As the drying process applies heat on the product, this might lead to the degradation and decomposition of valuable phytochemicals within the herbs. In this study, the effect of drying temperature on the quality of dried leaves was studied by analyzing the change of major phytochemicals found in the leaves, which are hydroxychavicol and eugenol. The results indicate that the content of major compounds increased with temperature from 40 to 70°C but underwent decomposition when the leaves dried at 80°C. Besides that, the drying kinetics for different drying temperatures also studied. The kinetics results show that the increase of drying temperature shortened the total drying time. Five thin-layer models were selected in describing the drying process of betel leaves. The logarithmic model was found to be the most suitable one

Modelling of freezing kinetics of extract of betel leaves (Piper betle L.)

Betel is a native medicinal plant from central and eastern parts of Peninsular Malaysia. It is now an important commercial crop in India and Sri Lanka. There are various beneficial bioactivities discovered in this herb including anti-carcinogenic, anti-inflammatory, antioxidant, and antimicrobial properties. Freeze drying is one of the common methods used to dehydrate the herbal aqueous extract. This work studied the freezing process of aqueous extract of betel leaves (Piper betle L.). The effects of different freezing temperatures on the freezing kinetics were investigated. Freezing temperatures of -20, -25, -30°C were selected for the study. The freezing time which was taken as the time required for the temperature of the sample to reach the freezing temperature was determined from the kinetics data. The freezing point of betel leaves extract was determined as -4°C. The freezing process was described with numerical model. The predicted data showed good agreement with the experimental results

Metabolic requirement of septic shock patients before and after liberation from mechanical ventilation

Objectives:Negative energy balance can impair regeneration of the respiratory epithelium and limit the functionality of respiratory muscles, which can prolong mechanical ventilation. The present study sought to quantify and identify the difference in energy expenditure of patients with septic shock during and upon liberation from mechanical ventilation. Methods:Patients admitted into intensive care with initial diagnosis of septic shock and mechanical ventilation-dependent were recruited. Their metabolic requirements before and after liberation from mechanical ventilation were measured by indirect calorimetry. A paired t-test was used to examine the variance between the two modes of breathing and a Spearman rho correlation coefficient to examine relationship of selected indicators.Results: Thirty-five patients, 20 males and 15 females mean age 69 ±10 years, body height of 1.58 ±0.08 meters, and ideal body mass 59.01 ±7.63 kg were recruited. Median APACHEII score was 22, length of stay in the intensive care was 45 ±65 days and duration on mechanical ventilation was 24 ±25 days. Measured energy expenditure during ventilation was 2090 ±489 kcal∙d-1 upon liberation from ventilation was 1910 ±579 kcal∙d-1 and actual caloric intake was 1148 ±495 kcal∙d-1. Measured energy expenditure (p=0.02), actual calories provision and energy expenditure with (p=0.00) and without (p=0.00) ventilator support were all significantly different. Mean carbohydrate oxidation was 0.17 ±0.09 g·min-1 when patients were on mechanical ventilation compared to 0.14 ±0.08 g·min-1 upon liberation, however, this difference was not statistically significant. Furthermore, mean lipid oxidation was 0.08 ±0.05 g·min-1 during mechanical ventilation and 0.09±0.07 g·min-1 upon liberation, which was also not statistically different. Comparison of carbohydrate utilization and lipid oxidation was not different during (0.7±0.36 vs 0.75±0.47 kcal·min-1) and upon liberation from mechanical ventilation (0.55±0.33 vs 0.78±0.59 kcal·min-1).Conclusions: This study examined energy expenditure and substrate oxidation within a single cohort of patients with and without mechanical ventilation. Measured energy expenditure was found to be higher during mechanical ventilation. The possible explanations were positive pressure support from ventilation, the repeated cycle of “rest” and “work” during weaning from ventilators and the asynchronization between self-initiated breathing effort and the ventilatory support. The change energy expenditure with and without ventilatory support should be monitored so that mismatch could be aligned. Future studies are important to examine whether matching energy expenditure with energy intake would promote positive outcomes.<br/

Is the relationship between financial development and economic growth monotonic? evidence from a sample of middle income countries

We revisit the relationship between financial development and economic growth in a panel of 52 middle-income countries over the 1980-2008 period. Using pooled mean group estimations in a dynamic heterogeneous panel setting, we show that there is an inverted U-shaped relationship between finance and growth in the long-run. In the short run, the relationship is insignificant. This suggests that too much finance can exert a negative influence on growth in middle-income countries. The finding of a non-monotonic effect of financial development on growth is confirmed by estimating a threshold model

Shape-Controlled Synthesis of ZnS Nanostructures: A Simple and Rapid Method for One-Dimensional Materials by Plasma

In this paper, ZnS one-dimensional (1D) nanostructures including tetrapods, nanorods, nanobelts, and nanoslices were selectively synthesized by using RF thermal plasma in a wall-free way. The feeding rate and the cooling flow rate were the critical experimental parameters for defining the morphology of the final products. The detailed structures of synthesized ZnS nanostructures were studied through transmission electron microscope, X-ray diffraction, and high-resolution transmission electron microscope. A collision-controlled growth mechanism was proposed to explain the growth process that occurred exclusively in the gas current by a flowing way, and the whole process was completed in several seconds. In conclusion, the present synthetic route provides a facile way to synthesize ZnS and other hexagonal-structured 1D nanostructures in a rapid and scalable way

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London