TaReCa – Cascade utilization of horticultural biomass for a resource efficient production of valuable bioactive substances

Viele pflanzliche Sekundärmetabolite haben antioxidative oder andere bioaktive Eigenschaften, weshalb sie einerseits wichtige Bestandteile der menschlichen Ernährung sind, andererseits aber auch als pharmazeutische Verbindungen oder als Substrat für die chemische Synthese von bioaktiven Substanzen verwendet werden. Pflanzen induzieren die Produktion solcher nutzbaren Sekundärmetabolite wie z.B. Flavonoiden als Reaktion auf abiotischen Stress. Die Produktion von Gemüse und Früchten in Gewächshäusern hinterlässt große Mengen an ungenutzter pflanzlicher Biomasse, welche eine potentielle Ressource für die Gewinnung wertvoller Metabolite darstellt. Durch eine kaskadenartige Verwendung von Gartenbaukulturen zur Produktion von Früchten und Gemüse mit einer anschließenden Gewinnung hochwertiger Substanzen aus der verbleibenden Restbiomasse würde ein erheblicher Mehrwert generiert. Das Projekt TaReCa bearbeitet die Entwicklung einer maßgeschneiderten Kaskadenverwertung von Paprikapflanzen-Restbiomasse aus dem Gartenbau. Dabei soll der pflanzliche Sekundärmetabolismus durch spezifische abiotische Stressbedingungen nach der Fruchternte gezielt induziert werden, um die Konzentrationen der Zielmetaboliten zu steigern. Durch umweltfreundliche und wirtschaftliche Extraktionsprozesse und eine anschließende Verwertung des verbleibenden Pflanzenmaterials in einer Bioraffinerie wird die Wertschöpfungskette erweitert. Eine Analyse der Anwendungsgebiete sowie Untersuchungen zur Akzeptanz der induzierten Inhaltsstoffe, Prozesse und Technologien werden helfen, das Marktpotenzial der Restbiomasse für die Nutzung in Kaskaden zu evaluieren. Die maßgeschneiderte Nutzung von Gartenbaubiomasse durch Lebensmittelproduktion, Extraktion bioaktiver Sekundärmetabolite und Bioraffinerien kann wirtschaftlich relevante, biobasierte Produkte für industrielle Anwendungen erzeugen und somit zur Entwicklung einer nachhaltigen, effizienten und integrierten Bioökonomie beitragen, ohne mit der Lebensmittelproduktion zu konkurrieren.Many plant secondary metabolites have antioxidant or pharmaceutically relevant properties, which makes them important components of the human diet, but also as pharmaceutical compounds or for the chemical synthesis of bioactive substances. Plants induce the production of secondary metabolites, e.g. flavonoids in response to environmental stress stimuli. The production of vegetables and fruits in greenhouses leaves huge amounts of so far under-utilized biomass after fruit harvest, which is a potential source for production of valuable metabolites. A cascade utilization of horticultural crops to produce fruits and vegetables with subsequent extraction of high quality compounds would generate significant added value. The project TaReCa is working on the development of a tailored cascade utilization of bell pepper plant residues from horticulture. The secondary metabolism will be induced by specific abiotic stress treatments after the last fruit harvest, in order to increase the concentrations of the target metabolites. Eco-friendly and economical extraction processes and subsequent utilization of the remaining plant material in a biorefinery will expand the value chain. An analysis of the application areas as well as studies on the acceptance of the induced ingredients, processes and technologies will help to evaluate the market potential of the residual biomass for the proposed cascaded use. The tailored utilization of horticultural biomass in food production, extraction of bioactive secondary metabolites and biorefineries can produce economically relevant bio-based products for industrial applications and thus contribute to the development of a sustainable, efficient and integrated bioeconomy without competing with food production

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Color for Life: Biosynthesis and Distribution of Phenolic Compounds in Pepper (<i>Capsicum annuum</i>)

Fruits and vegetables are an important supplier of biological active substances, such as vitamins and secondary metabolites (SM) for human nutrition, but also for further industrial applications. Pepper (Capsicum annuum) is grown and consumed all over the world as a fresh vegetable or dried as a spice. It is also used as a coloring agent, as well for medical purposes. Pepper fruits are considered as an attractive source of health-related compounds, but other organs like the leaves and stem also contain considerable amounts of antioxidants, e.g., phenolic compounds. This indicates potential for valorization of residual biomass from horticultural production by using innovative bioeconomic concepts. Herein, we present an overview about the biosynthesis of phenolic compounds, with a special focus on flavonoids and their regulation in pepper, the current knowledge of amounts and distribution of these valuable substances, as well as possible strategies for: (1) increasing flavonoid contents in pepper, (2) improving the nutritional value of fruits, and (3) new concepts for utilization of residual biomass from horticultural production