Predictive equations over-estimate the resting energy expenditure in amyotrophic lateral sclerosis patients who are dependent on invasive ventilation support

<p>Abstract</p> <p>Background</p> <p>Amyotrophic lateral sclerosis (ALS) is a form of degenerative motor neuron disease. At the end stage of the disease artificial feeding is often required. Nevertheless, very little is known about the energy demand of those ALS patients who are chronically dependent on tracheostomy intermittent positive pressure ventilation. The objective of our study was to clarify the resting energy expenditure (REE) in mechanically ventilated ALS patients.</p> <p>Methods</p> <p>We measured the REE of five ALS patients (four men, one female) twice during a 12 month-period using indirect calorimetry with two sampling flow settings (40 L/min and 80 L/min). The measured REEs (mREE) were compared with values calculated using five different predictive equations.</p> <p>Results</p> <p>The mean (± SD) of all mREEs was 1130 ± 170 kcal/d. The measurements with different flow settings and at different time instances provided similar results. The mean of mREEs was 33.6% lower, as compared to the mean calculated with five different predictive equations REE (p < 0.001). Each of the predictive equations over-estimated the REE.</p> <p>Conclusions</p> <p>The mREE values were significantly lower for every patient than all the predicted ones. Determination of daily nutrition with predictive equations may therefore lead in mis-estimation of energy requirements. Because ALS patients may live years with artificial ventilation their nutritional support should be based on individual measurements. However, further study is needed due to the small number of subjects.</p

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Estimation of optimal number of gates in dual gated ¹⁸F-FDG cardiac PET

Gating of positron emission tomography images has been shown to reduce the motion effects, especially when imaging small targets, such as coronary plaques. However, the selection of optimal number of gates for gating remains a challenge. Selecting too high number of gates results in a loss of signal-to-noise ratio, while too low number of gates does remove only part of the motion. Here, we introduce a respiratory-cardiac motion model to determine the optimal number of respiratory and cardiac gates. We evaluate the model using a realistic heart phantom and data from 12 cardiac patients (47–77 years, 64.5 on average). To demonstrate the benefits of our model, we compared it with an existing respiratory model. Based on our study, the optimal number of gates was determined to be five respiratory and four cardiac gates in the phantom and patient studies. In the phantom study, the diameter of the most active hot spot was reduced by 24% in the dual gated images compared to non-gated images. In the patient study, the thickness of myocardium wall was reduced on average by 21%. In conclusion, the motion model can be used for estimating the optimal number of respiratory and cardiac gates for dual gating

Predictive equations over-estimate the resting energy expenditure in amyotrophic lateral sclerosis patients who are dependent on invasive ventilation support

BackgroundAmyotrophic lateral sclerosis (ALS) is a form of degenerative motor neuron disease. At the end stage of the disease artificial feeding is often required. Nevertheless, very little is known about the energy demand of those ALS patients who are chronically dependent on tracheostomy intermittent positive pressure ventilation. The objective of our study was to clarify the resting energy expenditure (REE) in mechanically ventilated ALS patients.MethodsWe measured the REE of five ALS patients (four men, one female) twice during a 12 month-period using indirect calorimetry with two sampling flow settings (40 L/min and 80 L/min). The measured REEs (mREE) were compared with values calculated using five different predictive equations.ResultsThe mean (± SD) of all mREEs was 1130 ± 170 kcal/d. The measurements with different flow settings and at different time instances provided similar results. The mean of mREEs was 33.6% lower, as compared to the mean calculated with five different predictive equations REE (p ConclusionsThe mREE values were significantly lower for every patient than all the predicted ones. Determination of daily nutrition with predictive equations may therefore lead in mis-estimation of energy requirements. Because ALS patients may live years with artificial ventilation their nutritional support should be based on individual measurements. However, further study is needed due to the small number of subjects.</p

Home-Applied Dual-Light Photodynamic Therapy in the Treatment of Stable Chronic Periodontitis (HOPE-CP)—Three-Month Interim Results

A single-site, randomized clinical trial was designed to determine the efficacy of regular home use of Lumoral® dual-light antibacterial aPDT in periodontitis patients. For the study, 200 patients were randomized to receive non-surgical periodontal treatment (NSPT), including standardized hygiene instructions and electric toothbrush, scaling and root planing, or NSPT with adjunctive Lumoral® treatment. A complete clinical intraoral examination was conducted in the beginning, at three months, and at six months. This report presents the three-month results of the first 59 consecutive randomized subjects. At three months, bleeding on probing (BOP) was lower in the NSPT + Lumoral®-group than in the NSPT group (p = 0.045), and more patients in the NSPT + Lumoral®-group had their BOP below 10% (54% vs. 22%, respectively, p = 0.008). In addition, patients in the NSPT + Lumoral®-group improved their oral hygiene by visible-plaque-index (p = 0.0003), while the NSPT group showed no statistical improvement compared to the baseline. Both groups significantly reduced the number of deep periodontal pockets, but more patients with a reduction in their deep pocket number were found in the NSPT + Lumoral® group (92% vs. 63%, p = 0.02). Patients whose number of deep pockets was reduced by 50% or more were also more frequent in the NSPT + Lumoral®-group (71% vs. 33%, p = 0.01). Patients with initially less than ten deep pockets had fewer deep pockets at the three-month follow-up in the Lumoral® group (p = 0.01). In conclusion, adjunctive use of Lumoral® in NSPT results in improved treatment outcomes at three months post-therapy

Validation of indirect calorimetry for measurement of energy expenditure in healthy volunteers undergoing pressure controlled non-invasive ventilation support

The aim of this validation study was to assess the reliability of gas exchange measurement with indirect calorimetry among subjects who undergo non-invasive ventilation (NIV). Oxygen consumption (VO2) and carbon dioxide production (VCO2) were measured in twelve healthy volunteers. Respiratory quotient (RQ) and resting energy expenditure (REE) were then calculated from the measured VO2 and VCO2 values. During the measurement period the subjects were breathing spontaneously and ventilated using NIV. Two different sampling air flow values 40 and 80 l/min were used. The gas leakage from the measurement setup was assessed with a separate capnograph. The mean weight of the subjects was 93 kg. Their mean body mass index was 29 (range 22-40) kg/m(2). There was no statistically significant difference in the measured values for VO2, VCO2, RQ and REE during NIV-supported breathing and spontaneous breathing. The change of sampling air flow had no statistically significant effect on any of the above parameters. We found that REE can be accurately measured with an indirect calorimeter also during NIV-supported breathing and the change of sampling air flow does not distort the gas exchange measurement. A higher sampling air flow in indirect calorimetry decreases the possibility for air leakages in the measurement system and increases the reliability of REE measurement

Estimation of optimal number of gates in dual gated F-18-FDG cardiac PET

Gating of positron emission tomography images has been shown to reduce the motion effects, especially when imaging small targets, such as coronary plaques. However, the selection of optimal number of gates for gating remains a challenge. Selecting too high number of gates results in a loss of signal-to-noise ratio, while too low number of gates does remove only part of the motion. Here, we introduce a respiratory-cardiac motion model to determine the optimal number of respiratory and cardiac gates. We evaluate the model using a realistic heart phantom and data from 12 cardiac patients (47-77 years, 64.5 on average). To demonstrate the benefits of our model, we compared it with an existing respiratory model. Based on our study, the optimal number of gates was determined to be five respiratory and four cardiac gates in the phantom and patient studies. In the phantom study, the diameter of the most active hot spot was reduced by 24% in the dual gated images compared to non-gated images. In the patient study, the thickness of myocardium wall was reduced on average by 21%. In conclusion, the motion model can be used for estimating the optimal number of respiratory and cardiac gates for dual gating

A Comparative 68Ga-Citrate and 68Ga-Chloride PET/CT Imaging of Staphylococcus aureus Osteomyelitis in the Rat Tibia

There may be some differences in the in vivo behavior of Ga-68-chloride and Ga-68-citrate leading to different accumulation profiles. This study compared Ga-68-citrate and Ga-68-chloride PET/CT imaging under standardized experimental models. Methods. Diffuse Staphylococcus aureus tibial osteomyelitis and uncomplicated bone healing rat models were used (n = 32). Two weeks after surgery, PET/CT imaging was performed on consecutive days using Ga-68-citrate or Ga-68-chloride, and tissue accumulation was confirmed by ex vivo analysis. In addition, peripheral quantitative computed tomography and conventional radiography were performed. Osteomyelitis was verified by microbiological analysis and specimens were also processed for histomorphometry. Results. In PET/CT imaging, the SUVmax of Ga-68-chloride and Ga-68-citrate in the osteomyelitic tibias (3.6 +/- 1.4 and 4.7 +/- 1.5, resp.) were significantly higher (P = 0.0019 and P = 0.0020, resp.) than in the uncomplicated bone healing (2.7 +/- 0.44 and 2.5 +/- 0.49, resp.). In osteomyelitic tibias, the SUVmax of Ga-68-citrate was significantly higher than the uptake of Ga-68-chloride (P = 0.0017). In animals with uncomplicated bone healing, no difference in the SUVmax of Ga-68-chloride or Ga-68-citrate was seen in the operated tibias. Conclusions. This study further corroborates the use of Ga-68-citrate for PET imaging of osteomyelitis

Life cycle assessment of the environmental performance of conventional and organic methods of open field pepper cultivation

Summarization: As the scale of the organic cultivation sector keeps increasing, there is growing demand for reliable data on organic agriculture and its effect on the environment. Conventional agriculture uses chemical fertilizers and pesticides, whilst organic cultivation mainly relies on crop rotation and organic fertilizers. The aim of this work is to quantify and compare the environmental sustainability of typical conventional and organic pepper cultivation systems. Methods: Two open field pepper cultivations, both located in the Anthemountas basin, Northern Greece, are selected as case studies. Life cycle assessment (LCA) is used to quantify the overall environmental footprint and identify particular environmental weaknesses (i.e. unsustainable practices) of each cultivation system. Results are analysed at both midpoint and endpoint levels in order to obtain a comprehensive overview of the environmental sustainability of each system. Attributional LCA (ALCA) is employed to identify emissions associated with the life cycles of the two systems. Results are presented for problem-oriented (midpoint) and damage-oriented (endpoint) approaches, using ReCiPe impact assessment. Results and discussion: At midpoint level, conventional cultivation exhibits about threefold higher environmental impact on freshwater eutrophication, than organic cultivation. This arises from the extensive use of nitrogen and phosphorus-based fertilizers, with consequent direct emissions to the environment. The remaining impact categories are mainly affected by irrigation, with associated indirect emissions linked to electricity production. At endpoint level, the main hotspots identified for conventional cultivation are irrigation and fertilizing, due to intensive use of chemical fertilizers and (to a lesser degree) pesticides. For organic pepper cultivation, the main environmental hotspots are irrigation, machinery use, and manure loading and spreading processes. Of these, the highest score for irrigation derives from the heavy electricity consumption required for groundwater pumping associated with the fossil-fuel-dependent Greek electricity mix. Conclusions: Organic and conventional cultivation systems have similar total environmental impacts per unit of product, with organic cultivation achieving lower environmental impacts in ‘freshwater eutrophication’, ‘climate change’, ‘terrestrial acidification’ and ‘marine eutrophication’ categories. Conventional cultivation has a significantly greater effect on the freshwater eutrophication impact category, due to phosphate emissions arising from application of chemical fertilizers.Presented on: International Journal of Life Cycle Assessmen