Corticosteroids influence the mortality and morbidity of acute critical illness

INTRODUCTION: Use of corticosteroids for adrenal supplementation and attenuation of the inflammatory and immune response is widespread in acute critical illness. The study hypothesis was that exposure to corticosteroids influences the mortality and morbidity in acute critical illness. METHODS: This case–control retrospective study was performed in a single multidisciplinary intensive care unit at a tertiary care institution and consisted of 10,285 critically ill patients admitted between 1 January 1999 and 31 December 2004. Demographics, comorbidities, acute illness characteristics including severity measured by Sequential Organ Failure Assessment, concurrent medications, therapeutic interventions and incidence of infections were obtained from electronic medical records, were examined with multiple regression analysis and were adjusted for propensity of corticosteroid exposure. The primary outcome was hospital death, and the secondary outcome was transfer to a care facility at hospital discharge. RESULTS: Corticosteroid exposure in 2,632 (26%) patients was characterized by younger age, more females, higher Charlson comorbidity and maximal daily Sequential Organ Failure Assessment scores compared with control patients. Corticosteroids potentiated metabolic and neuromuscular sequels of critical illness with increased requirements for diuretics, insulin, protracted weaning from mechanical ventilation, need for tracheostomy and discharge to a care facility. Early exposure to corticosteroids predisposed to recurrent and late onset of polymicrobial and fungal hospital-acquired infections. Corticosteroids increased the risk for death or disability after adjustments for comorbidities and acute illness characteristics. CONCLUSION: Corticosteroids increased the risk for death or disability in critical illness. Hospital-acquired infections and metabolic and neuromuscular sequels of critical illness were exacerbated by corticosteroids. Careful appraisal of the indications for use of corticosteroids is necessary to balance the benefits and risks from exposure in acute critical illness

Feasibility of utilizing color imaging and machine learning for adulteration detection in minced meat

peer-reviewedMeat products are popular foods and there is a need for cost-effective technologies for rapid quality assessment. In this study, RGB color imaging coupled with machine learning algorithms were investigated to detect plant and animal adulterants with ratios of from 1 to 50% in minced meat. First, samples were classified as either pure or adulterated, then adulterated samples were classified based on the adulterant's type. Finally, regression models were developed to predict the adulteration quantity. Linear discriminant classifier enhanced by bagging ensembling performed the best with overall classification accuracies for detecting pure or adulterated samples up to 99.1% using all features, and 100% using selected features. Classification accuracies for adulteration origin were 48.9–76.1% using all features and 63.8% for selected features. Regression trees were used for adulterant level quantification and the r (RPD) values were up to 98.0%(5.0) based on all features, and 94.5%(3.2) for selected features. Gray-level and co-occurrence features were more effective than other color channels in building classification and regression models. This study presents a non-invasive, and low-cost system for adulteration detection in minced meats

Inverse Agonist Action of Leu-Enkephalin at ␦ 2 -Opioid Receptors Mediates Spinal Antianalgesia

ABSTRACT Dynorphin A(1-17) given intrathecally releases spinal cholecystokinin to produce an antianalgesic action against spinal morphine in the tail-flick test in CD-1 mice. The present study showed that following the cholecystokinin step, a ␦ 2 -opioid inverse agonist action of Leu-enkephalin (LE), was involved. Pretreatment with intrathecal LE antiserum eliminated dynorphin and cholecystokinin-8s antianalgesia. A small dose of LE intrathecally produced antianalgesia that like that from dynorphin A(1-17) and cholecystokinin was eliminated by naltriben but not 7-benzylidenenaltrexone (␦ 2 -and ␦ 1 -opioid receptor antagonist, respectively). This ]-Leu-enkephalin-Thr analgesia was not attenuated by LE; thus, this ␦ 2 -analgesic agonist and LE inverse agonist action did not occur through competition at the same ␦ 2 -receptor in CD-1 mice. In CD-1 mice, a linear sequence of dynorphin A(1-17) 3 cholecystokinin 3 LE 3 NMDA receptors was indicated: cholecystokinin antiserum inhibited cholecystokinin but not LE; naltriben inhibited LE but not NMDA. The uniqueness of LE in linking dynorphin A(1-17), cholecystokinin, ␦ 2 -opioid, and NMDA receptor activation may unify the separate known mechanisms involved in the antiopioid actions of these components against morphine

Re A (A Child) and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society?

The determination of death by neurological criteria remains controversial scientifically, culturally, and legally, worldwide. In the United Kingdom, although the determination of death by neurological criteria is not legally codified, the Code of Practice of the Academy of Medical Royal Colleges is customarily used for neurological (brainstem) death determination and treatment withdrawal. Unlike some states in the US, however, there are no provisions under the law requiring accommodation of and respect for residents’ religious rights and commitments when secular conceptions of death based on medical codes and practices conflict with a traditional concept well-grounded in religious and cultural values and practices. In this article, we analyse the medical, ethical, and legal issues that were generated by the recent judgement of the High Court of England and Wales in Re: A (A Child) [2015] EWHC 443 (Fam). Mechanical ventilation was withdrawn in this case despite parental religious objection to a determination of death based on the code of practice. We outline contemporary evidence that has refuted the reliability of tests of brainstem function to ascertain the two conjunctive clinical criteria for the determination of death that are stipulated in the code of practice: irreversible loss of capacity for consciousness and somatic integration of bodily biological functions

Ultrasonic Measurements and Machine Learning for Monitoring the Removal of Surface Fouling during Clean-in-Place Processes

Cleaning is an essential operation in the food and drink manufacturing sector, although it comes with significant economic and environmental costs. Cleaning is generally performed using autonomous Clean-in-Place (CIP) processes, which often over-clean, as suitable technologies do not exist to determine when fouling has been removed from the internal surfaces of processing equipment. This research combines ultrasonic measurements and machine learning methods to determine when fouling has been removed from a test section of pipework for a range of different food materials. The results show that the proposed methodology is successful in predicting when fouling is present on the test section with accuracies up to 99% for the range of different machine learning algorithms studied. Various aspects relating to the training data set and input data selection were studied to determine their effect on the performance of the different machine learning methods studied. It was found that the classification models performed better when data points were extracted directly from the ultrasonic waves and when data sets were combined for different fouling materials

Association between antibodies to Coxiella burnetii in bulk tank milk and perinatal mortality of Danish dairy calves

<p>Abstract</p> <p>Background</p> <p><it>Coxiella burnetii </it>is a well-known cause of placentitis and subsequent abortion in ruminants, but there are no reports on the relationship with perinatal mortality. The study was performed to determine the influence of level and change of bulk tank milk (BTM) antibodies to <it>C. burnetii </it>on two outcomes associated with parturition in cattle: a) stillbirth; and b) stillbirth and neonatal mortality combined (perinatal death).</p> <p>Methods</p> <p>Twenty-four Danish dairy herds were tested repeatedly for antibodies to <it>C. burnetii </it>in BTM using a commercial ELISA. Samples were collected monthly from July 2008 to July 2009. Information on the 2,362 calvings occurring in the study period was obtained from the Danish Cattle Database. Two multilevel logistic regression models were created for the two outcomes stillbirth and perinatal mortality. One model included the level of BTM antibodies in a specified period before or after the outcome had occurred. The other model included the change in antibodies over time. These predictors were included both at herd and animal level. Furthermore, all models included parity and breed.</p> <p>Results</p> <p>The individual monthly BTM antibody levels were highly correlated within herds. Consequently, changes in BTM antibody levels were not found to be associated with neither risk of stillbirth nor the risk of perinatal mortality. However, the risk of stillborn calves and perinatal death was higher with high level of BTM antibodies 8 to 9 months after the incident, but not outside this period.</p> <p>Conclusion</p> <p>We conclude that the level of antibodies to <it>C. burnetii </it>in BTM may be associated with perinatal mortality, but the association was not persistent and should be investigated further.</p

Intelligent Sensors for Sustainable Food and Drink Manufacturing

Food and drink is the largest manufacturing sector worldwide and has significant environmental impact in terms of resource use, emissions, and waste. However, food and drink manufacturers are restricted in addressing these issues due to the tight profit margins they operate within. The advances of two industrial digital technologies, sensors and machine learning, present manufacturers with affordable methods to collect and analyse manufacturing data and enable enhanced, evidence-based decision making. These technologies will enable manufacturers to reduce their environmental impact by making processes more flexible and efficient in terms of how they manage their resources. In this article, a methodology is proposed that combines online sensors and machine learning to provide a unified framework for the development of intelligent sensors that work to improve food and drink manufacturers' resource efficiency problems. The methodology is then applied to four food and drink manufacturing case studies to demonstrate its capabilities for a diverse range of applications within the sector. The case studies included the monitoring of mixing, cleaning and fermentation processes in addition to predicting key quality parameter of crops. For all case studies, the methodology was successfully applied and predictive models with accuracies ranging from 95 to 100% were achieved. The case studies also highlight challenges and considerations which still remain when applying the methodology, including efficient data acquisition and labelling, feature engineering, and model selection. This paper concludes by discussing the future work necessary around the topics of new online sensors, infrastructure, data acquisition and trust to enable the widespread adoption of intelligent sensors within the food and drink sector

Sinteza i biološko djelovanje novih 1-benzil i 1-benzoil 3-heterocikličkih derivata indola

Starting from 1-benzyl- (2a) and 1-benzoyl-3-bromoacetyl indoles (2b) new heterocyclic, 2-thioxoimidazolidine (4a,b), imidazolidine-2,4-dione (5a,b), pyrano(2,3-d)imidazole (8a,b and 9a,b), 2-substituted quinoxaline (11a,b–17a,b) and triazolo(4,3-a)quinoxaline derivatives (18a,b and 19a,b) were synthesized and evaluated for their antimicrobial and anticancer activities. Antimicrobial activity screening performed with concentrations of 0.88, 0.44 and 0.22 g mm2 showed that 3-(1-substituted indol-3-yl)quinoxalin-2(1H)ones (11a,b) and 2-(4-methyl piperazin-1-yl)-3-(1-substituted indol-3-yl) quinoxalines (15a,b) were the most active of all the tested compounds towards P. aeruginosa, B. cereus and S. aureus compared to the reference drugs cefotaxime and piperacillin, while 2-chloro-3-(1-substituted indol-3-yl)quinoxalines (12a,b) were the most active against C. albicans compared to the reference drug nystatin. On the other hand, 2-chloro-3-(1-benzyl indol-3-yl) quinoxaline (12a) display potent efficacy against ovarian cancer xenografts in nude mice with tumor growth suppression of 100 0.3 %.U radu je opisana sinteza, antimikrobno i antitumorsko djelovanje heterocikličkih derivata indola. Polazeći iz 1-benzil- i 1-benzoil-3-bromacetil indola (2a i 2b) sintetizirani su novi heterociklički spojevi 2-tioksoimidazolidini (4a,b), imidazolidin-2,4-dioni (5a,b), pirano(2,3-d)imidazoli (8a,b i 9a,b), 2-supstituirani kinoksalini (11a,b–17a,b) i triazolo(4,3-a)kinoksalini (18a,b i 19a,b). Sintetizirani spojevi testirani su na antimikrobno i antitumorsko djelovanje. Ispitivanje antimikrobnog djelovanja provedeno je s koncentracijama otopina 0,88, 0,44 i 0,22 g mm2 i uspoređeno s referentnim lijekovima cefotaksimom i piperacilinom. Rezultati pokazuju da su 3-(1-supstituirani indol-3-il)kinoksalin-2(1H)oni (11a,b) i 2-(4-metil piperazin-1-il)-3-(1-supstituirani indol-3-il) kinoksalini (15a,b) najaktivniji spojevi na sojeve P. aeruginosa, B. cereus i S. aureus, dok su 2-klor-3-(1-supstituirani indol-3-il)kinoksalini (12a,b) najaktivniji na C. albicans (usporedba s nistatinom). Osim toga, 2-klor-3-(1-benzil indol-3-il) kinoksalin (12a) pokazuje veliku učinkovitost na tumore ovarija miševa (supresija rasta tumora 100 0,3 %)

High frequency of SEN virus infection in thalassemic patients and healthy blood donors in Iran

<p>Abstract</p> <p>Background</p> <p>SEN virus is a blood-borne, circular ssDNA virus and possessing nine genotypes (A to I). Among nine genotypes, SENV-D and SENV-H genotypes have the strong link with patients with unknown (none-A to E) hepatitis infections. Infection with blood-borne viruses is the second important cause of death in thalassemic patients. The aim of this study was to determine the frequency of SENV-D and SENV-H genotypes viremia by performing nested-PCR in 120 and 100 sera from healthy blood donors and thalassemic patients in Guilan Province, North of Iran respectively. Also, to explicate a possible role of SEN virus in liver disease and established changes in blood factors, the serum aminotransferases (ALT and AST) and some of the blood factors were measured.</p> <p>Results</p> <p>Frequency of SENV-D, SENV (SENV-H or SENV-D) and co-infection (both SENV-D and SENV-H) viremia was significantly higher among thalassemic patients than healthy individuals. Frequency of SENV-H viremia was significantly higher than SENV-D among healthy individuals. In comparison to SENV-D negative patients, the mean of mean corpuscular hemoglobin was significantly higher in SENV-D positive and co-infection cases (<it>P </it>< 0.05). The means of AST and ALT were significantly higher in thalassemic patients than healthy blood donors, but there were not any significant differences in the means of the liver levels between SENV-positive and -negative individuals in healthy blood donors and thalassemic patients. High nucleotide homology observed among PCR amplicon's sequences in healthy blood donors and thalassemic patients.</p> <p>Conclusions</p> <p>The high rate of co-infection shows that different genotypes of SENV have no negative effects on each other. The high frequency of SENV infection among thalassemic patients suggests blood transfusion as main route of transmission. High frequency of SENV infection in healthy individuals indicates that other routes rather than blood transfusion also are important. Frequency of 90.8% of SENV infection among healthy blood donors as well as high nucleotide homology of sequenced amplicons between two groups can probably suggest that healthy blood donors infected by SENV act partly as a source of SENV transmission to the thalassemic patients. In conclusion, SENV-D isolate in Guilan Province may be having a pathogenic agent for thalassemic patients.</p

Proteomic Profile of Reversible Protein Oxidation Using PROP, Purification of Reversibly Oxidized Proteins

Signal transduction pathways that are modulated by thiol oxidation events are beginning to be uncovered, but these discoveries are limited by the availability of relatively few analytical methods to examine protein oxidation compared to other signaling events such as protein phosphorylation. We report here the coupling of PROP, a method to purify reversibly oxidized proteins, with the proteomic identification of the purified mixture using mass spectrometry. A gene ontology (GO), KEGG enrichment and Wikipathways analysis of the identified proteins indicated a significant enrichment in proteins associated with both translation and mRNA splicing. This methodology also enabled the identification of some of the specific cysteine residue targets within identified proteins that are reversibly oxidized by hydrogen peroxide treatment of intact cells. From these identifications, we determined a potential consensus sequence motif associated with oxidized cysteine residues. Furthermore, because we identified proteins and specific sites of oxidation from both abundant proteins and from far less abundant signaling proteins (e.g. hepatoma derived growth factor, prostaglandin E synthase 3), the results suggest that the PROP procedure was efficient. Thus, this PROP-proteomics methodology offers a sensitive means to identify biologically relevant redox signaling events that occur within intact cells