Comparison of first-line and second-line terlipressin versus sole norepinephrine in fulminant ovine septic shock

The Surviving Sepsis Guidelines suggest the use of vasopressin in case of catecholamine-refractory septic shock. Terlipressin (TP) as a V-1-selective AVP analogue is a potential alternative, though data regarding the first-line administration in septic shock are scarce. The present study explored and compared the effects of first-line vs. second-line infusion of TP or sole norepinephrine regarding organ function, fluid and norepinephrine requirements and survival in fulminant ovine septic shock. Peritoneal sepsis was induced in 23 ewes after laparotomy and faecal withdrawal from the caecum. After onset of shock, causal and supportive sepsis therapy (antibiotics, peritoneal lavage, fluids and open-label norepinephrine) was performed in all animals. Concurrently, animals were randomized to receive 0.9% sodium chloride (control group) or TP (2 mu g.kg(-1).h(-1), first-line group) after shock onset. In the second-line TP group, TP (2 mu g.kg(-1).h(-1)) was started once norepinephrine requirements exceeded 0.5 mu g.kg(-1).min(-1). No significant differences were found between groups regarding survival, haemodynamics as well as fluid-and catecholamine-requirements. Kidney function and electron microscopic kidney injury were comparable between groups. In the present model of fulminant ovine septic shock, first-line TP infusion had no significant effect on fluid and norepinephrine requirements or organ dysfunction as compared to second-line TP infusion or placebo

A new complimentary web-based tool for manual analysis of microcirculation videos: validation of the capillary mapper against the current gold standard AVA 3.2

OBJECTIVE: The aim of the current study was to compare a newly developed web-based freely accessible software program for manual analysis of the microcirculation, the Capillary Mapper (CM), with AVA 3.2 software (AVA; MicroVision Medical B.V., Amsterdam, The Netherlands), which is the current gold standard for analysis of microcirculation videos. METHODS: A web-based software program was developed, which enables manual analysis of videos of the microcirculation to be carried out according to recommendations of the 2018 consensus conference. A set of 50 high quality microcirculation videos was analyzed with AVA and CM with respect to total vessel density, perfused vessel density, proportion of perfused vessels, and the microvascular flow index. RESULTS: Comparison of the mean values derived from manual analysis with CM and AVA revealed no significant differences in microcirculatory variables. Analysis according to Bland and Altman revealed an acceptable bias between manual analysis with the CM and AVA for all variables tested with sufficient limits of agreement. The analysis of intraclass correlation showed "excellent" agreement for all microcirculatory variables analyzed. CONCLUSIONS: The newly developed CM was successfully validated for manual analyses of microcirculation videos against the current gold standard, the software AVA 3.2

DESENVOLVIMENTO DE UMA BARRA DE CEREAL COM ALTO TEOR DE FIBRAS

A barra de cereal é um alimento nutritivo de fácil consumo, obtida a partir da mistura de cereais, com ou sem adição de frutas e outros ingredientes, possuindo um sabor adocicado e agradável, a qual é uma fonte de vitaminas, sais minerais, fibras, proteínas e carboidratos. O objetivo deste projeto foi elaborar uma barra de cereal com alto teor de fibras, e analisar suas características químicas, microbiológicas e sensórias, utilizando cereais como aveia em flocos, farelo de aveia e flocos de arroz. Foram elaboradas três formulações de barra de cereal que diferiram entre si pelas quantidades de ingredientes utilizados. Foram realizadas análises físico-químicas, microbiológicas e sensórias para as três formulações. Para as análises físico-químicas, em geral, os resultados foram satisfatórios, obtendo bons valores para fibras totais, para as três formulações, sendo a média de 38,72%. As análises microbiológicas apresentaram resultados de acordo com a legislação vigente, com exceção para os valores encontrados de Bacillus cereus para as amostras A e B, visando a importância do controle do crescimento microbiano pelo ácido cítrico e da procedência da matéria-prima. Na análise sensorial, as três formulações obtiveram boa aceitação, principalmente a barra de formulação C, que foi definida pelos provadores como sendo a menos doce, e a barra comprariam

Feasibility, Impact on Symptoms and Mentalising Capacity

This pilot study aimed to evaluate the feasibility of an assessor-blind, randomised controlled trial of psychodynamic art therapy for the treatment of patients with schizophrenia, and to generate preliminary data on the efficacy of this intervention during acute psychotic episodes. Fifty-eight inpatients with DSM-diagnoses of schizophrenia were randomised to either 12 twice-weekly sessions of psychodynamic group art therapy plus treatment as usual or to standard treatment alone. Primary outcome criteria were positive and negative psychotic and depressive symptoms as well as global assessment of functioning. Secondary outcomes were mentalising function, estimated with the Reading the mind in the eyes test and the Levels of emotional awareness scale, self- efficacy, locus of control, quality of life and satisfaction with care. Assessments were made at baseline, at post-treatment and at 12 weeks' follow- up. At 12 weeks, 55% of patients randomised to art therapy, and 66% of patients receiving treatment as usual were examined. In the per-protocol sample, art therapy was associated with a significantly greater mean reduction of positive symptoms and improved psychosocial functioning at post-treatment and follow-up, and with a greater mean reduction of negative symptoms at follow-up compared to standard treatment. The significant reduction of positive symptoms at post-treatment was maintained in an attempted intention- to-treat analysis. There were no group differences regarding depressive symptoms. Of secondary outcome parameters, patients in the art therapy group showed a significant improvement in levels of emotional awareness, and particularly in their ability to reflect about others' emotional mental states. This is one of the first randomised controlled trials on psychodynamic group art therapy for patients with acute psychotic episodes receiving hospital treatment. Results prove the feasibility of trials on art therapy during acute psychotic episodes and justify further research to substantiate preliminary positive results regarding symptom reduction and the recovery of mentalising function

Elaboração de produtos panificados livres de glúten

A doença celíaca é uma doença autoimune desencadeada pela ingestão de glúten, presente em alimentos como trigo, aveia, centeio e cevada, por indivíduos geneticamente predispostos. Estudos realizados sobre essa doença visam garantir uma alternativa alimentar para os indivíduos celíacos. O objetivo com este trabalho foi elaborar panificados isentos de glúten, de boa aceitação sensorial, utilizando amido de mandioca e adicionados de derivados de soja. Foram produzidos pão e muffin sem glúten, elaborados por meio de duas formulações que diferem entre si pelas quantidades utilizadas dos ingredientes. Análises centesimais, microbiológicas e sensoriais foram realizadas tanto no pão quanto no muffin. Para a análise centesimal do pão sem glúten os resultados de umidade e do resíduo mineral apresentaram valores de acordo com a legislação vigente, e em relação ao teor de lipídios, foi alto em razão da utilização da manteiga que possui um valor calórico elevado; a quantidade de fibras alimentares e de proteínas foram altas, o que torna o produto desenvolvido mais nutritivo. A análise centesimal do muffin apresentou ótimas quantidades de fibras, proteína e gordura; a quantidade de proteínas elevada foi decorrente da utilização de ovos e extrato de soja, e a quantidade maior de fibras é em decorrência da utilização do extrato de soja, o qual foi utilizado para suprir a escassez desses nutrientes no amido de mandioca e nos demais amidos utilizados. As análises microbiológicas tanto do pão quanto do muffin apresentaram resultados de acordo com a legislação. Na análise sensorial, ambos tiveram uma boa aceitação.Palavras-chave: Doença celíaca. Glúten. Pão. Muffin

Quantifying interactions between accommodation and vergence in a binocularly normal population

AbstractStimulation of the accommodation system results in a response in the vergence system via accommodative vergence cross-link interactions, and stimulation of the vergence system results in an accommodation response via vergence accommodation cross-link interactions. Cross-link interactions are necessary in order to ensure simultaneous responses in the accommodation and vergence systems. The crosslink interactions are represented most comprehensively by the response AC/A (accommodative vergence) and CA/C (vergence accommodation) ratios, although the stimulus AC/A ratio is measured clinically, and the stimulus CA/C ratio is seldom measured in clinical practice. The present study aims to quantify both stimulus and response AC/A and CA/C ratios in a binocularly normal population, and determine the relationship between them. 25 Subjects (mean±SD age 21.0±1.9years) were recruited from the university population. A significant linear relationship was found between the stimulus and response ratios, for both AC/A (r2=0.96, p<0.001) and CA/C ratios (r2=0.40, p<0.05). Good agreement was found between the stimulus and response AC/A ratios (95% CI −0.06 to 0.24MA/D). Stimulus and response CA/C ratios are linearly related. Stimulus CA/C ratios were higher than response ratios at low values, and lower than response ratios at high values (95% CI −0.46 to 0.42D/MA). Agreement between stimulus and response CA/C ratios is poorer than that found for AC/A ratios due to increased variability in vergence responses when viewing the Gaussian blurred target. This study has shown that more work is needed to refine the methodology of CA/C ratio measurement

long term treatment outcome in ipex syndrome patients an international multicenter retrospective study

n/