Comparison of patient characteristics and long‐term mortality between transferred and non‐transferred COVID‐19 patients in Dutch Intensive Care Units; A national cohort study

Background

COVID‐19 patients were often transferred to other intensive care units (ICUs) to prevent that ICUs would reach their maximum capacity. However, transferring ICU patients is not free of risk. We aim to compare the characteristics and outcomes of transferred versus non‐transferred COVID‐19 ICU patients in the Netherlands.

Methods

We included adult COVID‐19 patients admitted to Dutch ICUs between March 1, 2020 and July 1, 2021. We compared the patient characteristics and outcomes of non‐transferred and transferred patients and used a Directed Acyclic Graph to identify potential confounders in the relationship between transfer and mortality. We used these confounders in a Cox regression model with left truncation at the day of transfer to analyze the effect of transfers on mortality during the 180 days after ICU admission.

Results

We included 10,209 patients: 7395 non‐transferred and 2814 (27.6%) transferred patients. In both groups, the median age was 64 years. Transferred patients were mostly ventilated at ICU admission (83.7% vs. 56.2%) and included a larger proportion of low‐risk patients (70.3% vs. 66.5% with mortality risk <30%). After adjusting for age, APACHE IV mortality probability, BMI, mechanical ventilation, and vasoactive medication use, the hazard of mortality during the first 180 days was similar for transferred patients compared to non‐transferred patients (HR [95% CI] = 0.99 [0.91–1.08]).

Conclusions

Transferred COVID‐19 patients are more often mechanically ventilated and are less severely ill compared to non‐transferred patients. Furthermore, transferring critically ill COVID‐19 patients in the Netherlands is not associated with mortality during the first 180 days after ICU admission.

Attention deficit hyperactivity disorder (ADHD) and executive functioning in affected and unaffected adolescents and their parents: challenging the endophenotype construct

BACKGROUND

The results of twin and sibling studies suggest that executive functioning is a prime candidate endophenotype in attention deficit hyperactivity disorder (ADHD). However, studies have not assessed the co-segregation of executive function (EF) deficits from parents to offspring directly, and it is unclear whether executive functioning is an ADHD endophenotype in adolescents, given the substantial changes in prefrontal lobe functioning, EF and ADHD symptoms during adolescence.

METHOD

We recruited 259 ADHD and 98 control families with an offspring average age of 17.3 years. All participants were assessed for ADHD and EF [inhibition, verbal (VWM) and visuospatial working memory (VsWM)]. Data were analysed using generalized estimating equations (GEEs).

RESULTS

Parental ADHD was associated with offspring ADHD and parental EF was associated with offspring EF but there were no cross-associations (parental ADHD was not associated with offspring EF or vice versa). Similar results were found when siblings were compared. EF deficits were only found in affected adolescents and not in their unaffected siblings or (un)affected parents.

CONCLUSIONS

The core EFs proposed to be aetiologically related to ADHD, that is working memory and inhibition, seem to be aetiologically independent of ADHD in adolescence. EF deficits documented in childhood in unaffected siblings were no longer present in adolescence, suggesting that children 'grow out' of early EF deficits. This is the first study to document ADHD and EF in a large family sample with adolescent offspring. The results suggest that, after childhood, the majority of influences on ADHD are independent from those on EF. This has potential implications for current aetiological models of causality in ADHD.

Sodium iron (III) ethylenediaminetetraacetic acid synthesis to reduce iron deficiency globally

Despite major interest in sodium iron (III) ethylenediaminetetraacetic acid's (EDTA) potential use in food fortification programs in potentially curbing the global problem of iron deficiency and its anemia, synthesis methods of stable isotope-labeled sodium iron (III) EDTA for use in human bioavailability studies are incomplete, incorrect or totally lacking. Owing to a number of clinical research groups requiring this compound in bioavailability studies, in both developing and already developed countries, we simplified and optimized the synthesis of sodium iron (III) EDTA from a block of isotopically enriched iron metal, in order that it be easily reproduced, cheaply, using simple basic laboratory apparatus. The resulting product is of high purity (>99.0%), and may be used for human stable isotope bioavailability studies. The simplicity of this method allows for the many research groups, currently doing such studies, to perform their own syntheses. Additionally, more uniformity in this synthesis will reduce the variation observed between such studies.

Bioefficacy of beta-carotene dissolved in oil studied in children in Indonesia

BACKGROUND

More information on the bioefficacy of carotenoids in foods ingested by humans is needed.

OBJECTIVE

We aimed to measure the time required for isotopic enrichment of beta-carotene and retinol in serum to reach a plateau, the extent of conversion of beta-carotene dissolved in oil with use of beta-carotene and retinol specifically labeled with 10 (13)C atoms, and the intraindividual variation in response.

DESIGN

Indonesian children aged 8--11 y (n = 35) consumed 2 capsules/d, 7 d/wk, for < or =10 wk. Each capsule contained 80 microg [12,13,14,15,20,12',13',14',15',20'-(13)C(10)]beta-carotene and 80 microg [8,9,10,11,12,13,14,15,19,20-(13)C(10)]retinyl palmitate. Three blood samples were drawn per child over a period of < or =10 wk. HPLC coupled with atmospheric pressure chemical ionization liquid chromatography-mass spectrometry was used to measure the isotopic enrichment in serum of retinol with [(13)C(5)]retinol and [(13)C(10)]retinol and of beta-carotene with [(13)C(10)]beta-carotene. The beta-carotene in the capsules used had a cis-trans ratio of 3:1.

RESULTS

Plateau isotopic enrichment was reached by day 21. The amount of beta-carotene in oil required to form 1 microg retinol was 2.4 microg (95% CI: 2.1, 2.7). The amount of all-trans-beta-carotene required to form 1 microg retinol may be lower.

CONCLUSIONS

The efficiency of conversion of this beta-carotene in oil was 27% better than that estimated previously (1.0 microg retinol from 3.3 microg beta-carotene with an unknown cis-trans ratio). The method described can be extended to measure the bioefficacy of carotenoids in foods with high precision, requiring fewer subjects than other methods.

A liquid chromatography-mass spectrometry method for the quantification of bioavailability and bioconversion of beta-carotene to retinol in humans

A method based on high-performance liquid chromatography-atmospheric pressure chemical ionization mass spectrometry (APCI LC-MS) was developed for the quantification of the bioavailability of retinyl palmitate and beta-carotene and the bioconversion of beta-carotene to retinol in humans. Following oral administration of [8,9,10,11,12,13,14,15,19,20-13C10]-retinyl palmitate and [12,13,14,15,20,12',13',14',15',20'-13C10]-beta-carotene at physiological doses to children between 8 and 11 years of age, blood samples were drawn and serum was prepared. Retinol and beta-carotene were extracted from 0.2- and 1.0-mL serum samples, respectively, and analyzed using reversed-phase HPLC with a C30 column interfaced to an APCI mass spectrometer. Unlike other LC-MS assays for carotenoids, no additional purification steps were necessary, nor was any derivatization of retinol or beta-carotene required. APCI LC-MS showed a linear detector response for beta-carotene over 4 orders of magnitude. Using selected ion monitoring to record the elution profile of protonated circulating beta-carotene at m/z 537 and [13C10]-beta-carotene at m/z 547, the limit of detection was determined to be 0.5 pmol injected on-column. To assess the ratio of labeled to unlabeled retinol, selected ion monitoring was carried out at m/z 269, 274, and 279. These abundant fragment ions corresponded to the loss of water from the protonated molecule of circulating retinol, [13C5]-retinol (metabolically formed from orally administered [13C10]-beta-carotene), and [13C10]-retinol (formed by hydrolysis of [13C10]-retinyl palmitate). The ratios of labeled to unlabeled retinol and the ratio of labeled to unlabeled beta-carotene were calculated. Combined with standard HPLC measurement of beta-carotene and retinol concentration and a mathematical model, these results showed that this simple LC-MS method can be used to quantify beta-carotene bioavailability and its bioconversion to retinol at physiologically relevant doses.

Determination of phenolic derivatives of antipyrine in plasma with solid-phase extraction and high-performance liquid chromatography-atmospheric-pressure chemical ionization mass spectrometry

This manuscript describes a method to determine antipyrine and its phenolic derivatives in plasma by reversed-phase high-performance liquid chromatography-mass spectrometry (RP-HPLC-MS). The sample pretreatment consisted of a C18 solid-phase extraction (SPE), to remove the salts and proteins. The retention behavior of antipyrine and its phenolic derivatives in the SPE procedure was estimated by the k values determined on a C18 HPLC column at different pH values and with different buffer compositions. Recoveries of antipyrine and its phenolic products were 90% in water and 100% in plasma. Atmospheric pressure chemical ionization (APCI) was used to introduce the components into the mass spectrometer. The mass spectrometer was operated in the single ion monitoring mode (SIM mode) as well as in the selective reaction (SR) mode. The SR mode or tandem MS resulted in the best signal-to-noise ratio, with a detection limit for antipyrine of 6 pg in 20 microl. For the different phenolic antipyrines, different target ions were used and conditions were optimized for each.

Development of a method for quantitation of retinol and retinyl palmitate in human serum using high-performance liquid chromatography-atmospheric pressure chemical ionization-mass spectrometry

A method for the quantitative analysis of the vitamin A compounds all-trans-retinol and all-trans-retinyl palmitate was developed using high-performance liquid chromatography-atmospheric pressure chemical ionization-mass spectrometry (APCI-LC-MS). Unlike previous quantitative mass spectrometric methods for vitamin A, HPLC separations were carried out using a C30 reversed-phase column instead of GC separation. Because no sample hydrolysis or derivatization was necessary, retinyl palmitate was preserved for analysis instead of being hydrolyzed to retinol. Human serum was analyzed following simple hexane extraction without saponification or any additional purification. A comparison of APCI and electrospray ionization showed that only APCI produced a linear response over all four orders of magnitude of retinol and three orders of magnitude of retinyl palmitate concentrations. Selected ion monitoring of the fragment ion of m/z 269 was used for APCI quantitation of both retinol and retinyl palmitate, since it was the base peak and the only abundant ion in the mass spectra of both compounds and the internal standard, retinyl acetate. The ion of m/z 269 corresponded to loss of water, loss of palmitic acid, or elimination of acetic acid from the protonated molecules of retinol, retinyl palmitate and retinyl acetate, respectively. The limit of detection of APCI-LC-MS for all-trans-retinol and all-trans-retinyl palmitate was determined to be approximately 34 fmol/microliter and 36 fmol/microliter (0.670 pmol all-trans-retinol and 0.720 pmol all-trans-retinyl palmitate injected in 20 microliters on-column), respectively. The limit of quantitation was approximately 500 fmol/microliter and 250 fmol/microliter (10 pmol and 5 pmol injected in 20 microliters on-column) for retinol and retinyl palmitate, respectively.

Leather nights in the woods: homosexual encounters in a Dutch highway rest area

This article describes a small-scale research on homosexual encounters in a Dutch highway rest area called "the Mollebos." Research was carried out on Monday evenings and nights, the so-called "leather nights," which attracted a specific group of patrons: men into leathersexuality and sadomasochism (S&M). Participant observation, informal conversations, and in-depth interviews made it possible to analyze spatial strategy as used by cruising men and the individual meanings patrons attach to outdoor leather cruising. It was found that in the Netherlands cruisers are no longer members of "a silent community." The leather nights in the woods proved to be an important supplement for the Dutch gay leather and S&M scene. For many visitors they served as an erotic space to realize sexual fantasies.

Pregnancy diagnosis in pigs: a field study comparing linear-array real-time ultrasound scanning and amplitude depth analysis

Between days 24 and 32 after mating/insemination, 881 pigs (785 pregnant and 96 not-pregnant) were tested for pregnancy on a commercial farm with a linear-array real-time ultrasound scanner. 5-7 Days later, 785 of these animals (708 pregnant and 77 not-pregnant) were tested again with A-mode equipment by farm employees. Confirmation of pregnancy was based on recorded farrowings or abortions; confirmation of non-pregnancy was based on return to oestrus and rebreeding, recorded non-farrowing, or inspection of the uterus of culled animals at the slaughterhouse. From the number of correct positive (a), incorrect positive (b), correct negative (c) and incorrect negative (d) diagnoses, a sensitivity (a/a + d) of 100% versus 97.5%, a specificity (c/c + b) of 90.6 versus 55.8%, a positive predictive value (a:a + b) of 98.9% versus 95.3% and a negative predictive value (c:c + d) of 100% versus 70.5% were calculated for the real-time ultrasound technique versus A-mode technique. It was concluded that real-time ultrasound scanning provides a very accurate technique for pregnancy diagnosis in pigs, enabling immediate decision making on treatment or culling of animals diagnosed as non-pregnant.