Both overfeeding and underfeeding of intensive care unit (ICU) patients are associated with worse outcomes. A reliable estimation of the energy expenditure (EE) of ICU patients may help to avoid ...these phenomena. Several factors that influence EE have been studied previously. However, the effect of neuromuscular blocking agents on EE, which conceptually would lower EE, has not been extensively investigated.
We studied a cohort of adult critically ill patients requiring invasive mechanical ventilation and treatment with continuous infusion of cisatracurium for at least 12 h. The study aimed to quantify the effect of cisatracurium infusion on EE (primary endpoint). EE was estimated based on ventilator-derived VCO
(EE in kcal/day = VCO
× 8.19). A subgroup analysis of septic and non-septic patients was performed. Furthermore, the effects of body temperature and sepsis on EE were evaluated. A secondary endpoint was hypercaloric feeding (> 110% of EE) after cisatracurium infusion.
In total, 122 patients were included. Mean EE before cisatracurium infusion was 1974 kcal/day and 1888 kcal/day after cisatracurium infusion. Multivariable analysis showed a significantly lower EE after cisatracurium infusion (MD - 132.0 kcal (95% CI - 212.0 to - 52.0; p = 0.001) in all patients. This difference was statistically significant in both sepsis and non-sepsis patients (p = 0.036 and p = 0.011). Non-sepsis patients had lower EE than sepsis patients (MD - 120.6 kcal; 95% CI - 200.5 to - 40.8, p = 0.003). Body temperature and EE were positively correlated (Spearman's rho = 0.486, p < 0.001). Hypercaloric feeding was observed in 7 patients.
Our data suggest that continuous infusion of cisatracurium in mechanically ventilated ICU patients is associated with a significant reduction in EE, although the magnitude of the effect is small. Sepsis and higher body temperature are associated with increased EE. Cisatracurium infusion is associated with overfeeding in only a minority of patients and therefore, in most patients, no reductions in caloric prescription are necessary.
Objective
Robot‐assisted surgery is a recognised treatment for pelvic‐organ prolapse. Many of the surgical subgroup outcomes for apical prolapse are reported together, leading to a paucity of ...homogenous data.
Design
Prospective observational cohort study (NCT01598467, clinicaltrials.gov) assessing outcomes for homogeneous subgroups of robot‐assisted apical prolapse surgery.
Setting
Two European tertiary referral hospitals.
Population
Consecutive patients undergoing robot‐assisted sacrocolpopexy (RASC) and supracervical hysterectomy with sacrocervicopexy (RSHS).
Methods
Anatomical cure (simplified Pelvic Organ Prolapse Quantification, sPOPQ, stage 1), subjective cure (symptoms of bulge), and quality of life (Pelvic Floor Impact Questionnaire, PFIQ‐7).
Main outcome measures
Primary outcome: anatomical and subjective cure. Secondary outcomes: surgical safety and intraoperative variables.
Results
A total of 305 patients were included (RASC n = 188; RSHS n = 117). Twelve months follow‐up was available for 144 (RASC 76.6%) and 109 (RSHS 93.2%) women. Anatomical success of the apical compartment occurred for 91% (RASC) and in 99% (RSHS) of the women. In all compartments, the success percentages were 67 and 65%, respectively. Most recurrences were in the anterior compartment 15.7% RASC (symptomatic 12.1%); 22.9% RSHS (symptomatic 4.8%). Symptoms of bulge improved from 97.4 to 17.4% (P < 0.0005). PFIQ‐7 scores improved from 76.7 ± 62.3 to 13.5 ± 31.1 (P < 0.0005). The duration of surgery increased significantly for RSHS 183.1 ± 38.2 versus 145.3 ± 29.8 (P < 0.0005). Intraoperative complications and conversion rates were low (RASC, 5.3 and 4.3%; RSHS, 0.0 and 0.0%). Four severe postoperative complications occurred after RASC (2.1%) and one occurred after RSHS (1.6%).
Conclusions
This is the largest reported prospective cohort study on robot‐assisted apical prolapse surgery. Both procedures are safe, with durable results.
Tweetable
European bi‐centre trial concludes that robot‐assisted surgery is a viable approach to managing apical prolapse.
Tweetable
European bi‐centre trial concludes that robot‐assisted surgery is a viable approach to managing apical prolapse.
Due to the ongoing component miniaturization and integration in the electronics industry, there is a need for asymmetric lay-ups for printed circuit boards (PCBs), especially in the case of complex ...boards that house both analog and digital circuits. This paper focuses on the contribution of the constituent layers that make up the PCB to the board’s macroscopic multilayer properties in terms of stiffness and coefficient of thermal expansion (CTE). The thermoelastic material properties for constituents, like cured prepreg and laminate layers, have been determined. Using classical laminate theory, individual layer properties are assembled to the macroscopic level and compared to fabricated multilayer boards. Following this approach, the contribution of various copper features on constituent layers can de deduced. The experiments show that properties of cured prepreg, taking
z
-direction expansion into account, and laminate layers are dependent on the type of fiberglass reinforcement and the fiber volume fraction. Depending on these properties, the Young’s modulus and CTE varies from 11 to 31 GPa and from 10 to 28 ppm/K, respectively. Datasheet values deviate significantly from these results as they do not take the fiber volume fraction into account. By alternating the measurement directions, the experiments have also shown that the fiberglass reinforcement plays a dominant role in determining macroscopic multilayer board properties. The multilayer board follows iso-strain conditions. Therefore, the material properties depend linearly on the copper volume fraction and follow the rule of mixtures independent of the type of copper patterning. Overall, the presented model and method to determine material properties increase the accuracy for predicting multilayer board behavior and offers the possibility to design and predict bow and twist behavior of PCBs with asymmetric lay-ups.
It is well established that elite football referees possess superior anticipatory skills in specific game scenarios such as when assessing foul situations. Referees might also have better ...anticipatory skills in other important scenarios such as when observing a long pass. In these often-occurring situations, a referee has to use visual information to anticipate the outcome of the pass, in particular to foresee any potential infringements that might occur when players battle for ball possession. However, little is known about if and how football referees might anticipate outcomes in these scenarios. The aim of the current study was therefore to analyse the visual anticipatory behaviour of football referees when long passes occur during actual football matches. Elite (N = 4) and sub-elite referees (N = 12) officiated an actual football match while wearing a mobile eye-tracker to analyse their gaze behaviour when long passes occurred (N = 196). The results revealed differences in the way that the elite and sub-elite referees tracked the ball and anticipated the outcome of the ball trajectories. The elite referees used a lower search rate (1.3 vs 1.8 fix/s; p < .05) and were more likely to direct their gaze towards the ball during the moment of kick (77 vs 52%; p < .05) and the early flight-phase of the pass (68 vs 45%; p < .05), and subsequently produced earlier anticipatory eye movements to the player(s) receiving the ball (at 50% vs 60% of the ball flight; p < .05). This earlier anticipation may help the elite referees to better pick-up relevant information about the receivers that could be vital in making adjudications about any potential infringement when the ball does arrive. Referee education programs can use the current study to highlight the importance of visual search behaviour and help referees to adapt a strategy that is beneficial for long-pass situations.
Persistent physical impairment is frequently encountered after critical illness. Recent data point towards mitochondrial dysfunction as an important determinant of this phenomenon. This narrative ...review provides a comprehensive overview of the present knowledge of mitochondrial function during and after critical illness and the role and potential therapeutic applications of specific micronutrients to restore mitochondrial function.
Increased lactate levels and decreased mitochondrial ATP-production are common findings during critical illness and considered to be associated with decreased activity of muscle mitochondrial complexes in the electron transfer system.
Adequate nutrient levels are essential for mitochondrial function as several specific micronutrients play crucial roles in energy metabolism and ATP-production. We have addressed the role of B vitamins, ascorbic acid, α-tocopherol, selenium, zinc, coenzyme Q10, caffeine, melatonin, carnitine, nitrate, lipoic acid and taurine in mitochondrial function. B vitamins and lipoic acid are essential in the tricarboxylic acid cycle, while selenium, α-tocopherol, Coenzyme Q10, caffeine, and melatonin are suggested to boost the electron transfer system function. Carnitine is essential for fatty acid beta-oxidation. Selenium is involved in mitochondrial biogenesis. Notwithstanding the documented importance of several nutritional components for optimal mitochondrial function, at present, there are no studies providing directions for optimal requirements during or after critical illness although deficiencies of these specific micronutrients involved in mitochondrial metabolism are common. Considering the interplay between these specific micronutrients, future research should pay more attention to their combined supply to provide guidance for use in clinical practise.
YCLNU-D-17-01092R2.
The metabolic course during and after critical illness is unclear. We performed repeated indirect calorimetry (IC) measurements during ICU- and post-ICU hospitalization to determine resting energy ...expenditure (REE).
Prospective observational design. In ventilated ICU patients, IC measurements were performed every three days until hospital discharge. Measured REE as predicted by the Harris-Benedict equation (HBE-REE) and 25 kcal/adjusted body weight/day (25-REE) were compared.
In 56 patients (38% females, 7113years, BMI 29(27;31)kg/m2), 189 ICU IC measurements were performed. Measured REE did not differ from HBE-REE at ICU admission, but was lower than 25-REE. Measured REE was increased compared to baseline on ICU-admission-day four (29(29–30)kcal/kg/day; mean difference 3.1(1.4–4.9)kcal/kg/day, p < 0.001) and thereafter during ICU admission. During post-ICU ward stay, 44 measurements were performed in 23 patients, showing a higher mean REE than during ICU stay (33(31–35)kcal/kg/day; mean difference 2.6(1.2–3.9)kcal/kg/day, p < 0.001). The REE in the ICU and ward was >110% of HBE-REE from day four onwards.
Critically ill mechanically ventilated patients were shown to have a resting energy expenditure (REE) > 110% of predicted REE on ICU admission day four and thereafter. Indirect calorimetry measurements suggest that the mean energy requirements during post-ICU hospitalization are higher than those in the ICU.
Display omitted
•Resting energy expenditure measured within 24 h of ICU admission was not higher than predicted.•Patients were hypermetabolic on ICU admission day four and thereafter.•Energy requirements increased when patients were discharged from the ICU to the ward.
Single-molecule fluorescence techniques are key for a number of applications, including DNA sequencing, molecular and cell biology and early diagnosis. Unfortunately, observation of single molecules ...by diffraction-limited optics is restricted to detection volumes in the femtolitre range and requires pico- or nanomolar concentrations, far below the micromolar range where most biological reactions occur. This limitation can be overcome using plasmonic nanostructures, which enable the confinement of light down to nanoscale volumes. Although these nanoantennas enhance fluorescence brightness, large background signals and/or unspecific binding to the metallic surface have hampered the detection of individual fluorescent molecules in solution at high concentrations. Here we introduce a novel 'antenna-in-box' platform that is based on a gap-antenna inside a nanoaperture. This design combines fluorescent signal enhancement and background screening, offering high single-molecule sensitivity (fluorescence enhancement up to 1,100-fold and microsecond transit times) at micromolar sample concentrations and zeptolitre-range detection volumes. The antenna-in-box device can be optimized for single-molecule fluorescence studies at physiologically relevant concentrations, as we demonstrate using various biomolecules.
To assess whether preterm infants with postnatal cytomegalovirus infection develop neurologic sequelae in early childhood.
Infants <32 weeks' gestation were prospectively screened for cytomegalovirus ...(CMV) at term-equivalent age. Neurodevelopment was compared between CMV-positive and CMV-negative infants by using the Griffiths Mental Development Scales (GMDS) at 16 months' corrected age (CA); the Bayley Scales of Infant and Toddler Development, Third Edition or the GMDS at 24 to 30 months' CA; and the Wechsler Preschool and Primary Scale of Intelligence, Third Edition and Movement Assessment Battery for Children, Second Edition at 6 years of age. At 6 years old, hearing was assessed in CMV-positive children.
Neurodevelopment was assessed in 356 infants at 16 months' CA, of whom 49 (14%) were infected and 307 (86%) were noninfected. Infected infants performed significantly better on the GMDS locomotor scale. There were no differences at 24 to 30 months' CA on the Bayley Scales of Infant and Toddler Development, Third Edition or GMDS. At 6 years of age, infected children scored lower on the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, but mean scores were within normal range, reaching significance only in verbal IQ (96 SD 17 vs 103 SD 15 points;
= .046). Multiple regression indicated no impact of CMV status but significant influence of maternal education and ethnicity on verbal IQ. No significant differences in motor development were found and none of the infected children developed sensorineural hearing loss.
In this cohort study, postnatal cytomegalovirus infection in preterm children did not have an adverse effect on neurodevelopment within the first 6 years of life.
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