1,721,018 research outputs found
Probiotics, prebiotics and synbiotics in critical illness
No full textThe interest in human intestinal microbiota in health and critical illness has increased in recent years. In critically ill patients, the gut ecology can be negatively affected by malnutrition, intestinal ischemia, impaired intestinal motility, and bacterial adherence. Trauma, surgical stress, surgical injury, antibiotic treatment, severe sepsis, vasoactive agents, hypovolemia, hypoxia, hypercarbia, electrolyte disorders and deep sedation can cause these conditions. Most clinical trials conducted to date focused on the effects of pre- and probiotic therapy in critical illness but there were potential confounders (single-center studies, small size, variable design, variable inclusion and endpoint criteria, variable pre- and probiotic treatment). The available meta-analyses suggest that probiotics were associated with lower rates of infection (including ventilator-associated pneumonia) and reduced Intensive Care Unit mortality, but no effect on hospital mortality, Intensive Care Unit or hospital stay were found. However, their use should be avoided in immunocompromised hosts and in patients with prosthetic vascular grafts or heart valves. In particular, Saccharomyces boulardii should not to be used in patients with indwelling central-line catheters
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Validation of a glucose control protocol in septic patients with continuous venous glucose measurement
No full textIntroduction: Blood glucose control in critically-ill patients is still on debate. A protocolized approach and a tight control limiting wasting of patient's blood are useful to correctly manage glycaemia (1).
Objective: Validation of glucose protocol (2) with a continuous blood glucose measurement (OptiScannerTM 5000).
Materials/Methods: OptiScannerTM was used in 6 patients providing glucose measurement every 15 minutes from a CVC dedicated line, net drawing 9.6 ml blood/24h. 330 ml of saline/24h were reinfused.
Target level was 80-160 mg/dL. Insulin infusion and kcal with nutritional support (NS) were recorded. Data are presented as median [interquartile range] (Sigmaplot11).
Results: 6 septic patients, SAPSII 28 [26-34], were studied for 319 hours (1277 measurements); 58 [40-69] hours for each patient (measurements/patient: 231 [172-265]). Blood glucose was at target for 96.6% of study time (120 [113-131] mg/dL). Overall only 3 measurements showed hypoglycemic episodes (78, 78, 69 mg/dL). Blood glucose was >160 mg/dL in 44 measurements (3%:168 [163-173] mg/dL). Insulin infusion rate was 2.2 [1.2-2.9] UI/h; kcal/day uptake was 1436 [649-1761].
Conclusion: The local glucose control protocol mantained euglycaemia in septic patients with high safeness (blood glucose <80 mg/dL, 0.2%).
Key points of the protocol are (2):
1. Lower blood glucose if >160 mg/dl before starting NS.
2. At the start of NS, provide insulin according to predicted stress status.
3. Targeting insulin need according to CHO/UI insulin observed.
OptiScannerTM 5000 seemed useful to validate the protocol.
References:
1) Dellinger RP Intensive Care Med. 2013;39(2):165-228.
2) Iapichino G Minerva Anestesiol. 2010;76(12):982-5
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Insulin and glycemia control in critically ill patients
No full textIntensive insulin therapy for glycemic control may be beneficial to critically ill patients, even if many studies have reported an increased risk of severe hypoglycemia. The objective of effective therapy is to avoid severe hypoglycemia and the adverse outcomes associated with hyperglycemia. Various protocols to guide intensive insulin therapy have been described but it is difficult to establish which is the best. All protocols address the problem by taking into account only the glucose plasma concentration, with no mention of insulin resistance or glucose supply. We analyze the key issues for a safe protocol of intensive insulin therapy with a glycemia target not exceeding 150-140 mg/dL
2-(tert-Butyldimethylsiloxy)thiophene: Application to Total Syntheses of Both Enantiomers of 2’,3’-Dideoxy-4’-thiocytidine
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