Ageing kinetics of fern chlorophyllous spores during dry storage is determined by its antioxidant potential and likely induced by photosynthetic machinery

Ageing in dry chlorophyllous propagules is leaded by photooxidation through the photosynthetic machinery, but why species differ in longevity and the ageing mechanisms of when light and oxygen are absent are unknown. We hypothesize that the cellular antioxidant capacity is key for the inter- and intra-specific differences in the ageing process. We have tested this hypothesis in chlorophyllous spores of two ferns. They were subjected to four different storage regimes resulting from light/dark and normoxia/hypoxia combinations. Lipophilic and hydrophilic antioxidants, reactive oxygen species (ROS), and photosynthetic pigments were analysed in parallel to germination and the recovery of Fv/Fm over a storage period of up to 22-months. We show that light and oxygen accelerate the ageing process, but their mechanisms (ROS, increase, antioxidant capacity decrease, loss of efficiency of the photosystem II, pigment degradation) appear the same under all conditions tested. The end of the asymptomatic phase of longevity, when a sudden drop of germination occurs, seems to be determined by a threshold in the depletion of antioxidants. Our results support the hypothesis that ageing kinetics in dry plant propagules is determined by the antioxidant system, but also suggests an active role of the photosynthetic machinery during ageing, even in darkness and hypoxia.

ADENI-UCI study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments

OBJECTIVE

To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure.

DESIGN

Prospective, multicentrico.

SCOPE

62 ICU from Spain between February 2018 and March 2019.

PATIENTS

Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure.

INTERVENTIONS

None.

MAIN INTEREST VARIABLES

Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge.

RESULTS

A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99).

CONCLUSIONS

Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

ADENI-UCI Study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments

OBJECTIVE

To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure.

DESIGN

Prospective, multicentrico SCOPE: 62 ICU from Spain between February 2018 and March 2019.

PATIENTS

Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure.

INTERVENTIONS

None.

MAIN INTEREST VARIABLES

Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge.

RESULTS

A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99).

CONCLUSIONS

Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

Survival and death of seeds during liquid nitrogen storage: a case study on seeds with short lifespans

BACKGROUND

The low temperature of liquid nitrogen is assumed to stop ageing and preserve viability indefinitely, however there are few validating data sets. The use of seeds to test these assumptions is important because other cryopreserved systems lack quantitative measures of viability to allow comparisons among timed points.

OBJECTIVE

To evaluate survival of a collection of seeds with short lifespans stored 12-20 years in liquid nitrogen.

MATERIALS AND METHODS

Seeds from 11 species (26 accessions) were removed from cryostorage and evaluated for germination and normal growth.

RESULTS

Germination of Plantago cordata and Betula spp. seeds did not decrease significantly during cryostorage. However, Populus deltoides and most Salix spp. accessions showed a significant decrease in germination, with further loss observed when P. deltoides seedlings were followed to the young plant stage. Seeds of initial low quality showed greater deterioration during cryostorage.

CONCLUSION

Cryostorage maintained viability of Salix and Populus seeds longer than other temperatures. However, ageing was not completely stopped and seed longevity was shorter than that predicted for many other species. A high initial seed quality is important in order to obtain the maximum benefit of cryostorage.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Risk factors for candidemia in non-neutropenic critical patients in Colombia

OBJECTIVES

Due to the increase in isolation of Candida spp. in critically ill patients, and the high mortality and economic costs which this infection entails, a study was made of the risk factors associated to candidemia in critically ill patients from 7 intensive care units in Colombia.

MATERIALS AND METHODS

A multicenter matched case-control study was conducted in 7 intensive care units of 3 university hospitals. Data on overall length of hospital stay (including both general wards and the intensive care unit) were recorded.

RESULTS

A total of 243 subjects (81 cases and 162 controls) between January 2008 and December 2012 were included. In order of frequency, C. albicans, C. tropicalis and C. parapsilosis were isolated. The main identified risk factors were: overall length of hospital stay>25 days (OR 5.33, 95% CI 2.6-10.9), use of meropenem (OR 3.75, 95% CI 1.86-7.5), abdominal surgery (OR 2.9, 95% CI 1.39-6.06) and hemodialysis (OR 3.35, 95% CI 1.5-7.7). No differences in mortality between patients with candidemia and controls were found (39.5 vs. 36.5%, respectively, P=.66) were found.

CONCLUSIONS

In Colombia, a long hospital stay, abdominal surgery, the use of meropenem and hemodialysis were identified as risk factors for candidemia.

Continuous tissue glucose monitoring correlates with measurement of intermittent capillary glucose in patients with distributive shock

BACKGROUND

Intermittent glycemic measurements in patients admitted to the intensive care unit (ICU) can result in episodes of severe hypoglycemia or in a poor control of glycemia range. We designed a study to assess accuracy and reliability of continuous monitoring of tissue glucose for patients with distributive shock.

METHODS

Consecutive patients admitted to the ICU with a diagnosis of distributive shock and the need of insulin infusion for glycemic control were included in the study. These patients were implanted a Continuous Glucose Control Monitoring System (CGMS) with the sensor inserted subcutaneously into the abdominal wall. CGMS values were recorded every 5min. Capillary glucose (CG) was monitored for adjusting insulin perfusion according to the ICU protocol. Correlation between both methods was assessed.

RESULTS

A total of 11,673 CGMS and 348 CG values were recorded. In five patients, CGMS failed to detect tissue glucose. A glucose value <3.33mmol/l (<60mg/dl) was observed in 3.6% of CGMS and in 0.29% CG values. 295 pairs of measurements were included in the statistical analysis for correlation assessment. The intraclass correlation coefficient was 0.706. The Pearson correlation coefficient was 0.71 (p<0.0001, 95% CI 0.65-0.76). The mean of differences between both measurement methods was 0.22mmol/l (3.98mg/dl) (95% CI 0.66-7.31).

CONCLUSIONS

When the Continuous Glucose Control Monitoring System (CGMS) is able to obtain data (75% of the patients), there is correlation between the values obtained by this method and capillary blood glucose in patients with distributive shock. CGMS can detect more episodes of glycemic excursions outside the normal range than intermittent capillary glucose monitoring. Variables that may impair glucose metabolism and peripheral soft tissues perfusion could impair CGMS measurements.

[Characteristics of deep sedation in gastrointestinal endoscopic procedures performed by intensivists]

OBJECTIVE

To determine tolerance, pain intensity, percentage of tests completed successfully and complications of deep sedation controlled by intensivists during gastrointestinal endoscopic procedures.

DESIGN

A one-year, prospective observational study was carried out.

SETTING

Department of Intensive Care intervention in the Endoscopy Unit of Hospital Universitario del Tajo (Spain).

PATIENTS

Subjects over 15 years of age subjected to endoscopic procedures under deep sedation.

RESULTS

A total of 868 patients were sedated during the study period, with the conduction of 1010 endoscopic procedures. The degree of tolerance was considered adequate («Very good»/«Good») in 96.9% of the patients (95%CI: 95.7-98.1%), with a median score of 0 on the pain visual analog scale. A total of 988 endoscopic procedures were successfully completed (97.8%; 95%CI: 96.9-98.8%): 675 colonoscopies (97.1%) and 305 endoscopies (99.7%). Complications were recorded in 106 patients (12.2%; 95%CI: 10.0-14.5%). The most frequent being desaturation (6.1%), rhythm disturbances (5.1%) and hypotension (2.4%).

CONCLUSION

Gastrointestinal endoscopic procedures under sedation controlled by intensivists are well tolerated and satisfactory for the patient, and are successfully completed in a very large percentage of cases. The procedures are associated with frequent minor complications that are resolved successfully.

Effect of storage temperature on green spore longevity for the ferns Equisetum ramosissimum and Osmunda regalis

Green spores of ferns lose viability quickly, and need specialized treatment for long-term conservation in germplasm banks. Dry storage at different temperatures was studied in green spores of Osmunda regalis and Equisetum ramosissimum. Changes in germination percentage, time to 50 percent of maximum germination (T50) and tendency for normal growth of the gametophyte were assayed during 24 months of storage. Spores stored at 25 degree C died within 1 month. Spores stored at 4 degree C maintained high viability for about 3 months, and then aging was evident by a decrease of final germination percentage, an increase in T50, and abnormal development of the gametophyte. Germination of spores stored at -25 degree C was highly variable during the storage period. Spores cryopreserved at -80 degree C and -196 degree C maintained high viability, rapid germination and normal growth throughout the study period. Cryopreservation of green spores is a feasible method to preserve viability and ensure normal gametophyte development for several years.

Percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangiopancreatography (ERCP) for malignant obstructive jaundice (OJ) in advanced digestive cancers

348

Background: OJ is a relatively frequent complication in patients with advanced malignancies that usually causes refractory symptoms and can make chemotherapy (CT) treatment difficult. In the last years, the use of different non-surgical techniques, such as PTBD or ERCP, is increasing.

Methods: From Sep-05 to Aug-10, patients with OJ due to advanced digestive cancers who underwent ERCP or PTBD were included. Baseline characteristics, acute and late complications and outcome were retrospectively collected. Jaundice resolution was recognized if bilirubin value decreased to at least grade 1, after the procedure. Overall survival (OS) was calculated from the date of the technique to the date of death or last follow-up.

Results: Seventy-six consecutive patients were collected. Male/Female: 52p/24p; Mean age 63.5 y-o (range: 33-85); ECOG performance status 0/1/2/3: 1/37/27/11; Primary tumour: pancreas 30, biliary tract 18, colorectal 16, gastric 7, and gall bladder 5, and of them, 13% were unresectable locally advanced and 87% metastatic. ERCP was used in 59% of the patients and PTBD in 49% and the proportion of intrahepatic and extrahepatic causes were 1:1. Mean hospital stay was 11.3 days (95% CI 1-21). Twenty- six patients (32%) suffered a complication during the hospital stay: 9 cholangitis, 7 catheter obstruction, 2 bleeding, 2 acute pancreatitis and 6 other, and 8 died of procedure-related adverse event. After hospital discharge there were 34% infections, 17% catheter obstruction and 8% other. After the technique OJ was solved (bilirubin nadir) in 49% of the patients and 55% underwent palliative CT. Median OS was 30 weeks (95% CI: 17-42).

Conclusions: PTBD and ERCP are appropriate techniques in patients with malignant OJ and can resolve an absolute contraindication for palliative CT. However, major complications are frequent and a relatively high mortality rate should be expected. Therefore an adequate patient selection is crucial to prevent adverse events.

No significant financial relationships to disclose.

Gemcitabine (G) fixed-dose-rate infusion (FDR) plus erlotinib (E) in patients with advanced pancreatic cancer (APC)

304

Background: G (30-minute infusion) plus E improves survival in patients with APC compared with G alone. In a recent phase III trial, G-FDR showed a trend to better OS compared with standard G (6.2 vs. 4.9 months, HR 0.83, p=0.04), although the study was underpowered to detect great difference in OS. Based on our previous experience with G-FDR, we decided to evaluate the combination of G-FDR plus E, after E approval for APC.

Methods: Patients with previously untreated pathologically confirmed APC, locally advanced (LAPC) or metastatic (MPC), and ECOG PS 0-2 were included. G 1500 mg/m2 was given by 150-min infusion (10 mg/m2/min) on days 1, 8, and 15 every 28 days combined with E 100 mg/day orally. Treatment modifications for G-FDR were planned according with previously Tempero's phase II trial, and as described in prescribing information for E.

Results: 62 pts were included (36M/26F), with a median age of 63 y-o (range 37-78). ECOG PS 0/1/2: 19/40/3. LAPC/MPC: 16/46. All except one had measurable disease. ORR was 13% (8 PR), 95% CI: 4.7-21.3, and there were 34 (55%) SD. Mean relative dose intensity for G was 0.76 and 0.90 for E. Main hematologic toxicities 3/4 per pt: anaemia 12/0, thrombocytopenia 7/4, neutropenia 18/7. Acneiform rash 1/2/3 occurred in 16/16/3 pts. Other relevant adverse events were (grade 2/3/4): diarrhoea 18/3/0, mucositis 5/1/0, infection 9/8/1, thrombosis 1/4/1 and vomiting 6/4/0. There were three treatment-related deaths (septic shock, cholangitis, and bilateral pulmonary embolism). Ten pts (all LAPC) received RT after ≤ 6 cycles, all with concomitant capecitabine 825 mg/m2 bid. In 4 pts salvage surgery were performed: 2 R0, 1 R1 and 1 R2. Median PFS was 4.9 months (95% CI: 3-6.7), 7.9 m for LAPC and 2.5 m for MPC (p = 0.004). Median OS was 10 months (95% CI: 7.1-12.9), 17.5 m for LAPC and 7 m for MPC (p = 0.019). OS was significantly shorter in males (p = 0.01) and in pts taking major opioids (p = 0.027). There was a trend to better OS in pts who developed skin rash grade ≥ 2 (p = 0.078).

Conclusions: In this noncomparative study, G-FDR plus E is a feasible regimen in APC with an acceptable toxicity and notable activity. G-FDR seems to increase hematologic toxicity compared with standard infusion.

No significant financial relationships to disclose.

Patients on weaning trials from mechanical ventilation classified with neural networks and feature selection

One of the challenges in intensive care is the process of weaning from mechanical ventilation. We studied the differences in respiratory pattern variability between patients capable of maintaining spontaneous breathing during weaning trials and patients that fail to maintain spontaneous breathing. In this work, neural networks were applied to study these differences. 64 patients from mechanical ventilation are studied: Group S with 32 patients with Successful trials and Group F with 32 patients that Failed to maintain spontaneous breathing and were reconnected. A performance of 64.56% of well classified patients was obtained using a neural network trained with the whole set of 35 features. After the application of a feature selection procedure (backward selection) 84.56% was obtained using only 8 of the 35 features.

Support vector machine classification applied on weaning trials patients

One of the most frequent reasons for instituting mechanical ventilation is to decrease patient's work of breathing. Many attempts have been made to increase the effectiveness of the evaluation of the respiratory pattern with the analysis of the respiratory signals. This work proposes a method for the study of the differences in respiratory pattern variability in patients on weaning trials. The proposed method is based on a support vector machine using 35 features extracted from the respiratory flow signal. In this paper, a group of 146 patients with mechanical ventilation were studied: group S of 79 patients with successful weaning trials and group F of 67 patients that failed to maintain spontaneous breathing and were reconnected. Applying a feature selection procedure based on the use of the support vector machine with a leave-one-out cross-validation, it was obtained 86.67% of well classified patients on group S and 73.34% on group F, using only 8 of the 35 features. Therefore, support vector machine can be a classification method of the respiratory pattern variability useful in the study of patients on weaning trials.

Study of the respiratory pattern variability in patients during weaning trials

Mechanical ventilators are used to provide life support in patients with respiratory failure. One of the challenges in intensive care is the process of weaning from mechanical ventilation. We studied the differences in respiratory pattern variability between patients capable of maintaining spontaneous breathing during weaning trials and patients that fail to maintain spontaneous breathing. The respiratory pattern was characterized by the following time series: inspiratory time (T(I)), expiratory time (T(E)), breath duration (T(Tot)), tidal volume (V(T)), fractional inspiratory time (T(I)/T(Tot)), mean inspiratory flow (V(T)/T(I)), respiratory frequency (f), and rapid shallow breathing index (f/V(T)). The variational activity of breathing was partitioned into autoregressive, periodic and white noise fractions. Patients with unsuccessful trial presented a tendency to higher values of gross variability of V(T)/T(I) and f/V(T), and lower values of T(I). The autocorrelation coefficients tended to present higher values for T(I), T(I)/T(Tot) and V(T)/T(I). During both successful and unsuccessful T-tube test uncorrelated random behavior constituted > 75% of the variance of each time breath components and represented 50 to 70% in the breath component related to V(T). Correlated behavior represented 6 to 21% in time components and 28 to 50% in component related to V(T).

Joint symbolic dynamic analysis of cardiorespiratory interactions in patients on weaning trials

Assessing autonomic control provides information about patho-physiological imbalances. Measures of variability of the cardiac interbeat duration RR(n) and the variability of the breath duration T<inf>Tot</inf>(n) are sensitive to those changes. The interactions between RR(n) and T<inf>Tot</inf>(n) are complex and strongly non-linear. A study of joint symbolic dynamics is presented as a new short-term non-linear analysis method to investigate these interactions in patients on weaning trials. 78 patients from mechanical ventilation are studied: Group A (patients that failed to maintain spontaneous breathing and were reconnected) and Group B (patients with successful trials). Using the concept of joint symbolic dynamics, cardiac and respiratory changes were transformed into a word series, and the probability of occurrence of each word type was calculated and compared between both groups. Significant differences were found in 13 words, and the most significant p<inf>n</inf>(W<inf>c010, r010</inf>): 0.0041 &#177; 0.0036 (group A) against 0.0012 &#177; 0.0024 (group B), p-value = 0.00001. The number of seldom occurring word types (forbidden words) also presents significant differences fw<inf>cr</inf>: 6.9 &#177; 6.6 against 13.5 &#177; 5.3, p-value = 0.00004. Joint symbolic dynamics provides an efficient non-linear representation of cardiorespiratory interactions that offers simple physiological interpretations.

Effectiveness and safety of enteral vancomycin to control endemicity of methicillin-resistant Staphylococcus aureus in a medical/surgical intensive care unit

A prospective trial was undertaken to assess the effectiveness and safety of enteral vancomycin in controlling methicillin-resistant Staphylococcus aureus (MRSA) in an endemic setting. Over the 49 month period patients aged >14 years were enrolled, following admission to a medical/surgical intensive care unit (ICU) and expected to require ventilation for three days or more. A total of 799 patients were included in the trial. Period one, 1 July 1996-30 April 1997, (N=140), was observational. During period two, 1 May 1997-30 September 1998, (N=258), surveillance samples were obtained. MRSA carriers were isolated and received enteral vancomycin. During period three, 1 October 1998-31 July 2000, (N=400), all ventilated patients were given selective digestive decontamination (SDD) with polymyxin E, tobramycin, amphotericin B and vancomycin and four days of intravenous cefotaxime. The primary endpoints were: (1) incidence of patients with diagnostic samples positive for MRSA acquired on the ICU; (2) incidence of patients with vancomycin-resistant enterococci (VRE) in surveillance or diagnostic samples; (3) incidence of patients with samples positive for S. aureus with intermediate sensitivity to glycopeptides (GISA). The incidence of patients with MRSA in diagnostic samples were 31%, 14%, and 2% in periods one, two and three, respectively (P<0.001). There was a VRE outbreak involving 13 patients during period three. VRE disappeared with no change in policy. GISA was not detected. These findings support the effectiveness and safety of enteral vancomycin in the control of MRSA.

Evaluation of a hospital-wide resuscitation team: does it increase survival for in-hospital cardiopulmonary arrest?

OBJECTIVE

To assess the impact (defined not only with regard to patient outcome but also to record keeping for evaluation of care) of a formal, structured resuscitation team for in-hospital cardiopulmonary resuscitation over the year following its creation.

METHODS

This is a "before and after" study in which charts of all patients needing resuscitation during the two-year period were reviewed and data arranged in the Utstein Style of in-hospital reporting of cardiac arrests. The review was limited to adults (> or = 18 years of age) in nonICU settings.

RESULTS

A total of 220 events were identified. Demographics and presenting rhythms for the two periods under review were similar. For the period of August 1996-August 1997 (group 1), there were 70 resuscitation events recorded with a return of spontaneous circulation (ROSC) rate of 21/70 (30%). For the period of August 1997-August 1998 (group 2), 150 events were recorded and the ROSC rate was significantly higher 87/150 (58%)) (P=0.0002). ROSC after ventricular fibrillation and ventricular tachycardia was similar in both groups (50 vs 57%) (P = 1.00) but an improvement in survival was seen in group 2 from events of bradycardia perfusing rhythm (25% vs 84%) (P = 0.0003). Survival from PEA/Asystole was also improved during period 2 (18 vs 48%) (P = 0.013). Survival to discharge was seen in 3/50 (6%) of patients in period 1 and 18/102 (18%) of patients in period 2 (P = 0.09).

CONCLUSIONS

The formation of a structured, formalized hospital resuscitation team was associated with an increase in the number of recorded events, in the number of patients experiencing ROSC and in the percentage of patients who were discharged from the hospital. Facilities with no formal resuscitation team or with no skilled, practiced resuscitator on their current team should consider implementation of a similar strategy.

Survival of patients with colorectal carcinoma: possible prognostic value of tissular carbohydrate antigen 19.9 determination

BACKGROUND

An important goal of serum tumor marker research is to provide a test for detecting cancer in early stages. Expression of carbohydrate antigen (CA) 19.9 has been described in various malignancies.

METHODS

The possible prognostic value measuring cytosol CA 19.9 expression in tumors was evaluated in a study of 63 colorectal carcinoma (CRC) patients who were followed for at least 2 years. CA 19.9 expression in cytosol was determined by enzyme-linked immunoadsorbant assay, and measurement of this protein achieved by quantitative assay.

RESULTS

Mean levels of cytosol CA 19.9 found in tumor samples were significantly higher than those in nontumoral areas in CRC patients (P<0.0005). Patients with more than 3 positive lymph nodes had a higher expression of the marker (P<0.05). Univariate and multivariate analyses revealed that cytosol CA 19.9 concentration was an independent prognostic variable for relapse. Furthermore, the probability of relapse increased 4.2 times for every increase in cytosol tumor marker of 5000 U/mg, and tumors located in the rectum had a probability of relapse 9.5 times greater.

CONCLUSIONS

Cystol CA 19.9 expression in CRC can be an independent prognostic factor for relapse. Patients with high levels of CA 19.9 have worse prognosis than those with lower values. Therefore, this group of patients should receive special management with regard to their follow-up and treatment. Moreover, quantitative cytosol tumor marker measurement is an easy and highly effective method for determining the prognoses of CRC patients.

Conn's syndrome in a patient with acromegaly

The renin-angiotensin-aldosterone system (RAAS) in a female patient suffering from acromegaly and severe hypertension was studied and a suppressed plasma renin activity could be found. A catheterisation of both adrenal veins, a bilateral adrenal gammagraphy and an abdominal CT scan confirmed the diagnosis of an aldosterone-producing right adrenal adenoma (Conn's Syndrome). We greatly emphasized the need of investigating the RAAS in acromegalic patients suffering from hypertension.