Different Methods to Assess the Nutritional Status of Alzheimer Patients.

OBJECTIVE: To assess the body composition and nutritional state of patients with Alzheimer's (Global Deterioration Scale GDS-4) using different methods and to investigate the correlation among methods. METHODS: A total of 25 Alzheimer GDS-4 patients participated in this transversal descriptive observational study, which used anthropometry, Mini Nutritional Assessment (MNA), the Nutrition Screening Initiative Check List (NSI) and a 24-hour recall questionnaire (R24h). RESULTS: Anthropometric observations pointed to obesity in patients of both sexes. The MNA showed that 76% of the population was "at risk of malnutrition", and the NSI suggested that 32% had a high nutritional risk, 48% had an "average" nutritional risk, and the remaining 20% a low nutritional risk. The Bland-Alman concordance plot between the NSI and MNA tests pointed to a high degree of agreement, meaning that both tests provided similar results for the group of studied subjects. The nutritional analysis, based on the Kruskal-Wallis test, showed there were significant differences between R24h and MNA in the case of ascorbic acid, iron, zinc and potassium (p < 0.05), and between R24h and NSI in the case of the double unsaturation index and vitamin D3 (p < 0.05). These results suggest that both questionnaires are equally valid for evaluating the nutritional status of Alzheimer patients. CONCLUSION: Although the NSI and MNA tests provide similar results, we recommend an initial nutritional assessment using the NSI since it is short but provides information on any alteration in food intake as a result of restrictions and/or metabolic alterations.

Role of proteins and soluble peptides as limiting components during the co-composting of agro-industrial wastes.

The agri-food industry is at the centre of the circular economy, since the co-composting of its residual flows allows their management and adds value producing fertilisers. In this work, six composting piles were prepared combining agri-food sludge (AS), different fresh vegetable wastes (pepper waste (P), tomato waste (T), and leek waste (L), and, as bulking agents, vine shoot pruning (VS), garlic stalks (GS) and avocado leaves (AL)). Classical physico-chemical and chemical determinations and advanced instrumental methods (excitation-emission fluorescence (EEM) and gravimetric (TG, DTG and DTA) techniques) were used and compared to assess organic matter evolution and evaluate the quality of the composts obtained. The thermal profiles of the composting processes were viable to show the stabilization of the agri-food sludge with the different materials tested in the mixtures, reaching adequate levels of stabilization of organic matter. Preferential degradation of peptides and proteins was observed by fluorescence. This seemed to induce a limitation in the biodegradation of the remaining organic matter, indicating that these biomolecules are key in composting dynamics, acting as limiting components during the process. The results from thermogravimetric analysis indicated the degradation of labile compounds (e.g., carbohydrates and proteins), the most recalcitrant material becoming predominant at the maturity stage of the composting process. The rise in the thermogravimetric parameter R2 was associated with the increase in the concentration of more refracting compounds, which need more energy for their decomposition.

Use of Eye-Tracking Technology by Medical Students Taking the Objective Structured Clinical Examination: Descriptive Study.

BACKGROUND: The objective structured clinical examination (OSCE) is a test used throughout Spain to evaluate the clinical competencies, decision making, problem solving, and other skills of sixth-year medical students. OBJECTIVE: The main goal of this study is to explore the possible applications and utility of portable eye-tracking systems in the setting of the OSCE, particularly questions associated with attention and engagement. METHODS: We used a portable Tobii Glasses 2 eye tracker, which allows real-time monitoring of where the students were looking and records the voice and ambient sounds. We then performed a qualitative and a quantitative analysis of the fields of vision and gaze points attracting attention as well as the visual itinerary. RESULTS: Eye-tracking technology was used in the OSCE with no major issues. This portable system was of the greatest value in the patient simulators and mannequin stations, where interaction with the simulated patient or areas of interest in the mannequin can be quantified. This technology proved useful to better identify the areas of interest in the medical images provided. CONCLUSIONS: Portable eye trackers offer the opportunity to improve the objective evaluation of candidates and the self-evaluation of the stations used as well as medical simulations by examiners. We suggest that this technology has enough resolution to identify where a student is looking at and could be useful for developing new approaches for evaluating specific aspects of clinical competencies.

Association of Thyroid Function Test Abnormalities and Thyroid Autoimmunity With Preterm Birth: A Systematic Review and Meta-analysis.

Importance: Maternal hypothyroidism and hyperthyroidism are risk factors for preterm birth. Milder thyroid function test abnormalities and thyroid autoimmunity are more prevalent, but it remains controversial if these are associated with preterm birth. Objective: To study if maternal thyroid function test abnormalities and thyroid autoimmunity are risk factors for preterm birth. Data Sources and Study Selection: Studies were identified through a search of the Ovid MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar databases from inception to March 18, 2018, and by publishing open invitations in relevant journals. Data sets from published and unpublished prospective cohort studies with data on thyroid function tests (thyrotropin [often referred to as thyroid-stimulating hormone or TSH] and free thyroxine [FT4] concentrations) or thyroid peroxidase (TPO) antibody measurements and gestational age at birth were screened for eligibility by 2 independent reviewers. Studies in which participants received treatment based on abnormal thyroid function tests were excluded. Data Extraction and Synthesis: The primary authors provided individual participant data that were analyzed using mixed-effects models. Main Outcomes and Measures: The primary outcome was preterm birth (<37 weeks' gestational age). Results: From 2526 published reports, 35 cohorts were invited to participate. After the addition of 5 unpublished data sets, a total of 19 cohorts were included. The study population included 47 045 pregnant women (mean age, 29 years; median gestational age at blood sampling, 12.9 weeks), of whom 1234 (3.1%) had subclinical hypothyroidism (increased thyrotropin concentration with normal FT4 concentration), 904 (2.2%) had isolated hypothyroxinemia (decreased FT4 concentration with normal thyrotropin concentration), and 3043 (7.5%) were TPO antibody positive; 2357 (5.0%) had a preterm birth. The risk of preterm birth was higher for women with subclinical hypothyroidism than euthyroid women (6.1% vs 5.0%, respectively; absolute risk difference, 1.4% [95% CI, 0%-3.2%]; odds ratio [OR], 1.29 [95% CI, 1.01-1.64]). Among women with isolated hypothyroxinemia, the risk of preterm birth was 7.1% vs 5.0% in euthyroid women (absolute risk difference, 2.3% [95% CI, 0.6%-4.5%]; OR, 1.46 [95% CI, 1.12-1.90]). In continuous analyses, each 1-SD higher maternal thyrotropin concentration was associated with a higher risk of preterm birth (absolute risk difference, 0.2% [95% CI, 0%-0.4%] per 1 SD; OR, 1.04 [95% CI, 1.00-1.09] per 1 SD). Thyroid peroxidase antibody-positive women had a higher risk of preterm birth vs TPO antibody-negative women (6.6% vs 4.9%, respectively; absolute risk difference, 1.6% [95% CI, 0.7%-2.8%]; OR, 1.33 [95% CI, 1.15-1.56]). Conclusions and Relevance: Among pregnant women without overt thyroid disease, subclinical hypothyroidism, isolated hypothyroxinemia, and TPO antibody positivity were significantly associated with higher risk of preterm birth. These results provide insights toward optimizing clinical decision-making strategies that should consider the potential harms and benefits of screening programs and levothyroxine treatment during pregnancy.

Comprehensive management of dog faeces: Composting versus anaerobic digestion.

The objective of this work was to study the possibilities to manage and recycle dog faeces (DF) using biological processes, using two approaches: composting (C) and anaerobic digestion (AD). Thus, different experiments have been carried out: i) two laboratory/pilot scale experiments (self-heating and composting tests) and one, on a commercial scale; ii) two AD experiments. In both approaches, municipal waste such as the organic fraction of municipal solid waste (OMSW) and urban pruning waste (GW) were used as co-substrates. The results obtained regarding the optimization of the composting process indicated that the best strategy was the use of a 1:2 ratio of DF, a 1:4 ratio of OMSW, and a 1:4 ratio of GW, according to the thermal parameters studied (temperature and cumulative quadratic exothermic index (EXI2)), and the quality of the compost obtained. A potentially limiting factor of the process was the high salinity of the DF waste. In addition, AD experiments were performed on DF, OMSW, and GW wastes in controlled anaerobic systems at a laboratory scale. In these experiments, the biogas production obtained was 229 mL biogas/g total solids for the DF residue, 248 mL biogas/g total solids for GW, and 263 mL biogas/g total solids for OMSW. The co-digestion yields a clear improvement in the efficiency of the process against the use of a single residue, increasing the production of biogas by up to 27% with respect to that of the DF waste alone during the first 25 days of AD. The results obtained with these procedures have shown the possibilities to add value to this waste in an urban context where the circular economy represents an increasingly favourable scenario, including the generation of fertilisers and/or energy at a local scale, provided that the collection of dog faeces is optimized.

Maternal and fetal genetic contribution to gestational weight gain.

BACKGROUND: Clinical recommendations to limit gestational weight gain (GWG) imply high GWG is causally related to adverse outcomes in mother or offspring, but GWG is the sum of several inter-related complex phenotypes (maternal fat deposition and vascular expansion, placenta, amniotic fluid and fetal growth). Understanding the genetic contribution to GWG could help clarify the potential effect of its different components on maternal and offspring health. Here we explore the genetic contribution to total, early and late GWG. PARTICIPANTS AND METHODS: A genome-wide association study was used to identify maternal and fetal variants contributing to GWG in up to 10 543 mothers and 16 317 offspring of European origin, with replication in 10 660 mothers and 7561 offspring. Additional analyses determined the proportion of variability in GWG from maternal and fetal common genetic variants and the overlap of established genome-wide significant variants for phenotypes relevant to GWG (for example, maternal body mass index (BMI) and glucose, birth weight). RESULTS: Approximately 20% of the variability in GWG was tagged by common maternal genetic variants, and the fetal genome made a surprisingly minor contribution to explain variation in GWG. Variants near the pregnancy-specific beta-1 glycoprotein 5 (PSG5) gene reached genome-wide significance (P=1.71 × 10-8) for total GWG in the offspring genome, but did not replicate. Some established variants associated with increased BMI, fasting glucose and type 2 diabetes were associated with lower early, and higher later GWG. Maternal variants related to higher systolic blood pressure were related to lower late GWG. Established maternal and fetal birth weight variants were largely unrelated to GWG. CONCLUSIONS: We found a modest contribution of maternal common variants to GWG and some overlap of maternal BMI, glucose and type 2 diabetes variants with GWG. These findings suggest that associations between GWG and later offspring/maternal outcomes may be due to the relationship of maternal BMI and diabetes with GWG.

Dietary administration effects of fenugreek seeds on skin mucosal antioxidant and immunity status of gilthead seabream (Sparus aurata L.).

Improving fish defense through the preventive administration of immunostimulants has an important role in controlling the outbreak of the disease in aquaculture. As a continuity of our previous studies, this paper describes the effects of dietary fenugreek (Trigonella foenum graecum) seeds on the skin mucosal antioxidant status and immune response of gilthead seabream (Sparus aurata L.). Fish were fed with four experimental diets: one a basal diet (control) and three diets with powdered fenugreek seeds incorporated in the fish feed at 1%, 5%, and 10%. After eight weeks of feeding, free radicals scavenging and antioxidant assays were assessed in skin mucus by measuring the peroxidation of phospholipid liposomes, hydroxyl radical and hydrogen peroxide scavenging, measurement of total antioxidant activity and the determination of antioxidant activity in a linoleic acid system. The skin mucosal immune response was evaluated by measuring the IgM levels and some enzymatic activities (peroxidase, antiprotease, protease, esterase, and ceruloplasmin). Our results demonstrated that fenugreek inclusion improved the hydroxyl radical scavenging capacity and conferred very high antioxidant activity. Besides, only the highest supplementation level (10%) was able to augment the peroxidase and protease activities confronted by a general decrement in the antiprotease activity in the experimental fed groups with 1% and 10%. These results suggest that the dietary administration of fenugreek at the higher inclusion dose enhances the skin mucosal immunity response and the antioxidant status of gilthead seabream a species with one of the highest rates of production in marine aquaculture.

Valorization of date palm (Phoenix dactylifera L.) pruning biomass by co-composting with urban and agri-food sludge.

In the Mediterranean countries, there is an increasing production of date palm wastes (Phoenix dactylifera L.), not only due to the raising production of date palm fruits, but also derived from the maintenance of urban and peri-urban green areas, especially in those affected by red palm weevil (Rhynchophorus ferrugineus). The management of this increasing volume of green wastes usually concludes with a controlled disposal that implies an important loss of resources, in terms of organic matter, nutrients and energy. In addition, the rise of wastewater generation and the incentive of the wastewater treatment processes have derived in an increase of the amount of the sludge produced, which makes difficult its management. This work studies the feasibility of co-composting palm wastes with sludge from the urban and agri-food sectors as alternative treatment to manage these organic waste streams and to obtain added-value compost. For this, four mixtures (P1, P2, P3 and P4) were prepared using as main component palm leave waste (PL) mixed with different types of sludge. In the piles P1, P2 and P3, sewage sludge (SS) was used as co-composting agent, while agri-food sludge (AS) was used in P4. Throughout composting, the thermal profile of the composting piles was assessed, as were physical, chemical, physico-chemical and maturity parameters. In addition, the changes in water-soluble organic matter were assessed using chemical analytical methods and the excitation-emission matrix (EEM) fluorescence spectroscopy. The results obtained showed the viability of the co-composting process to obtain end-products with adequate maturity degree and physical characteristics for their potential use as substrates, except for the salt contents that can limit their use in some agricultural sectors.

Behaviour of polysulfone ultrafiltration membrane for dyes removal.

Although ultrafiltration membranes have been used for the separation of macromolecules and colloids from solutions, this process has a limited application in the removal of dyes present in coloured discharges of textile industry, as these typically have much lower molecular weight than the molecular cut-off of the membranes (MWCO). In the present work, we have evaluated the behaviour of a polysulfone ultrafiltration membrane in the removal of different dyes from aqueous solutions (Congo red, methyl green and amaranth). Different variables (tangential flow rate, concentration of dye and pH of the feed) were studied to determine their influence on the separation processes (permeate flux and rejection coefficient). The results show that Congo red is easily removed with a GR60PP membrane (MWCO = 25 kDa), whereas methyl green and amaranth show rejection coefficient values of approximately 25.78% and 13.85%, respectively, at neutral pH. Also, an interesting effect is observed for the rejection coefficient for methyl green at different pH values. In addition, several treatments were performed to the membrane so as to modify its surface, trying to improve the values obtained for permeate flux and rejection rate.

Application of electroencephalographic techniques to the study of visual impact of renewable energies.

Much is currently being studied on the negative visual impact associated to the installation of large wind turbines or photovoltaic farms. However, methodologies for quantitatively assessing landscape impact are scarce. In this work we used electroencephalographic (EEG) recordings to investigate the brain activity of 14 human volunteers when looking at the same landscapes with and without wind turbines, solar panels and nuclear power plants. Our results showed no significant differences for landscapes with solar power systems or without them, and the same happened for wind turbines, what was in agreement with their subjective scores. However, there were clear and significant differences when looking at landscapes with and without nuclear power plants. These differences were more pronounced around a time window of 376-407 msec and showed a clear right lateralization for the pictures containing nuclear power plants. Although more studies are still needed, these results suggest that EEG recordings can be a useful procedure for measuring visual impact.

The independent role of prenatal and postnatal exposure to active and passive smoking on the development of early wheeze in children.

Maternal smoking during pregnancy increases childhood asthma risk, but health effects in children of nonsmoking mothers passively exposed to tobacco smoke during pregnancy are unclear. We examined the association of maternal passive smoking during pregnancy and wheeze in children aged ≤2 years.Individual data of 27 993 mother-child pairs from 15 European birth cohorts were combined in pooled analyses taking into consideration potential confounders.Children with maternal exposure to passive smoking during pregnancy and no other smoking exposure were more likely to develop wheeze up to the age of 2 years (OR 1.11, 95% CI 1.03-1.20) compared with unexposed children. Risk of wheeze was further increased by children's postnatal passive smoke exposure in addition to their mothers' passive exposure during pregnancy (OR 1.29, 95% CI 1.19-1.40) and highest in children with both sources of passive exposure and mothers who smoked actively during pregnancy (OR 1.73, 95% CI 1.59-1.88). Risk of wheeze associated with tobacco smoke exposure was higher in children with an allergic versus nonallergic family history.Maternal passive smoking exposure during pregnancy is an independent risk factor for wheeze in children up to the age of 2 years. Pregnant females should avoid active and passive exposure to tobacco smoke for the benefit of their children's health.

Modelling and experimental checking of the influence of substrate concentration on the first order kinetic constant in photo-processes.

Most photoprocesses follow a pseudo first order kinetic law and, commonly, the kinetic parameter depends on the initial concentration of the substrate. In this work, a kinetic model, which explains this dependence on the substrate concentration and on the other operational variables, has been developed. In the model, mass transfer of substrate from the bulk solution to the wall of the photoreactor was assumed as the step determining the rate of the process. To check the model, methylene blue (MB) has been used as model substrate and photodegradation experiments have been carried out in an exciplex KrCl flow-through photoreactor, It was observed that the methylene blue conversion improved with a decrease in its initial concentration, in good agreement with the model. Also, by fitting the experimental data to the model, high correlation coefficients and a high degree of agreement between experimental and calculated conversion was obtained, which validates the model.

Metabolomics of the aqueous humor in the rat glaucoma model induced by a series of intracamerular sodium hyaluronate injection.

Glaucoma models are helpful to study disease characteristics and to design new therapeutic options. Metabolomic profiling approach have been used to elucidating the molecular characteristics of the aqueous humor. Juvenile male Wistar rats experimental (n = 15) and controls (n = 6) were used for these studies. Experimental rats received weekly intracamerular injection of 25 µl of sodium hyaluronate in the left eye and sterile saline solution in the right eye, consecutively for ten weeks. Rats were subjected to anterior/posterior eye segment examinations, intraocular pressure (IOP), and flash electroretinograms (ERG). The aqueous humor was collected at endpoints and analyzed by Nuclear Magnetic Resonance. Elevated IOP and significant reduction of a, b waves and amplitude of oscillatory potential was observed in the left eyes compared to control eyes. The aqueous humor metabolomic profile from control and the experimental eyes were compared. Concentrations of metabolites (amino acids, lipids and carbohydrates) significantly changed after the sodium hyaluronate injections series, compared to the sham-operated eyes. Metabolic changes in the hypertensive eyes correlated with the impaired retinal function. Observed metabolomic changes in aqueous humor in hypertensive state may play a significant role in glaucoma pathogenesis.

Pre- and postnatal exposure to tobacco smoke and respiratory outcomes during the first year.

The different role of prenatal and postnatal exposure to tobacco smoke in respiratory outcomes in infants has not yet been clearly established. Our objective is to assess the effects of these exposures on the risk of respiratory outcomes during the first year of life of infants from a Spanish multicenter cohort study. A total of 2506 women were monitored until delivery. About 2039 infants made up the final population. The outcomes were caused by the occurrence of the following: otitis, cough persisting for more than 3 weeks, lower respiratory tract symptoms (wheezing or chestiness), and lower respiratory tract infections (bronchitis, bronchiolitis, or pneumonia). The relationship between prenatal and postnatal exposure and health outcomes was explored using logistic regression analysis. Maternal smoking during pregnancy increased the odds for wheezing (OR: 1.41, 95% CI: 0.99-2.01) and chestiness (OR: 1.46, 95% CI: 1.03-2.01). Postnatal exposure from fathers was associated with otitis (OR: 1.25, 95% CI: 1.01-1.54). Passive exposure at work of non-smoking mothers during pregnancy was related to cough (OR: 1.62, 95% CI: 1.05-2.51). Exposure to tobacco smoke was related to a higher risk of experiencing respiratory outcomes in young infants. Prenatal exposure was that most clearly associated with the respiratory outcomes analyzed.

Evaluation of antioxidant activity and nutritional composition of flavoured dehydrated soups packaged in different formats. Reducing the sodium content.

The antioxidant activity and nutritional composition of four dehydrated soups (vegetables, meat, chicken and fish) packaged in four formats - carton, plastic, and aluminium bags (the last with and without modified atmosphere) - were evaluated during 12 months' storage. The results showed that all four soups had a good or very good antioxidant capacity as tested by the lipid peroxidation, deoxyribose, and Trolox equivalent antioxidant capacity (TEAC) tests. Of interest from a nutritional point of view was the finding that the lipid fraction of all the soups was below 1 %. The sodium content of the four soups and their ingredients was also analysed. By modifying some of the ingredients, a 25 % reduction in the sodium content of the soups was obtained, permitting them to be labelled as "sodium reduced". The monosodium glutamate (MSG) content of the reformulated soups (lower sodium content) was below levels permitted by European legislation.

Polyamide nanofiltration membranes to remove aniline in aqueous solutions.

Aniline is commonly used in a number of industrial processes. It is known to be a harmful and persistent pollutant and its presence in wastewater requires treatment before disposal. In this paper, the effectiveness of nanofiltration (NF) to remove aniline from aqueous solutions is studied in a flat membrane test module using two thin-layer composite membranes of polyamide (NF97 and NF99HF). The influence of different operational variables (applied pressure, feed concentration and pH) on the removal of aniline from synthetic aqueous solutions was analysed. The experimental NF results are compared with results previously obtained by reverse osmosis. Based on this comparative study, the effective order for aniline rejection is: HR98PP > NF97 > DESAL3B > SEPA-MS05 > NF99HF.

Application of a diffusion-reaction kinetic model for the removal of 4-chlorophenol in continuous tank reactors.

A continuous tank reactor was used to remove 4-chlorophenol from aqueous solutions, using immobilized soybean peroxidase and hydrogen peroxide. The influence of operational variables (enzyme and substrate concentrations and spatial time) on the removal efficiency was studied. By using the kinetic law and the intrinsic kinetic parameters obtained in a previous work with a discontinuous tank reactor, the mass-balance differential equations of the transient state reactor model were solved and the theoretical conversion values were calculated. Several experimental series were used to obtain the values of the remaining model parameters by numerical calculation and using an error minimization algorithm. The model was checked by comparing the results obtained in some experiments (not used for the determination of the parameters) and the theoretical ones. The good concordance between the experimental and calculated conversion values confirmed that the design model can be used to predict the transient behaviour of the reactor.

Oral supplementation with postbiotics modulates the immune response produced by myxomatosis vaccination in wild rabbits.

Rabbits (Oryctolagus cuniculus) are vitally important species in the Iberian Peninsula ecosystem. However, since 1950, there has been a significant population decline, with major repercussions. This situation is mainly due to the presence of infectious diseases, such as myxomatosis, which is expanding and is characterized by severe and fatal clinical manifestations. Current control measures, mainly those based on vaccinations, are ineffective. Therefore, new strategies need to be developed and implemented. This study aimed to evaluate whether supplementation with postbiotic products modulates the immune response in wild rabbits vaccinated against myxomatosis. For this purpose, two groups of rabbits were established: a control group fed with standard feed ad libitum from weaning (28 days) until two months of age, and a treated group, which was fed under the same conditions but supplemented with postbiotics (3 kg/Tm). All the studied rabbits were vaccinated against this disease during weaning. In addition, a blood samples were obtained from all animals immediately before vaccination and 30 days later, which allowed us to evaluate the level of antibodies against myxomatosis virus (ELISA detection) and the relative expression of gene encoding to cytokines related to the immune response (IL6, TNFα and IFNγ), at both times of the experience. Weight and length measurements were also taken at both times to calculate body index and mean daily gain (MDG). No statistically significant differences in growth parameters were observed. There were also no differences in the serological response among groups. However, a relative underexpression of gene codifying to TNFα (p-value = 0.03683) and a higher expression on IFNγ (p-value = 0.045) were observed in the treated group. This modulation in cytokines could lead to less severe lesions in wild rabbit naturally infected with myxomatosis virus.

Guidelines for inhaled sedation in the ICU.

INTRODUCTION AND OBJECTIVES: Sedation is used in intensive care units (ICU) to improve comfort and tolerance during mechanical ventilation, invasive interventions, and nursing care. In recent years, the use of inhalation anaesthetics for this purpose has increased. Our objective was to obtain and summarise the best evidence on inhaled sedation in adult patients in the ICU, and use this to help physicians choose the most appropriate approach in terms of the impact of sedation on clinical outcomes and the risk-benefit of the chosen strategy. METHODOLOGY: Given the overall lack of literature and scientific evidence on various aspects of inhaled sedation in the ICU, we decided to use a Delphi method to achieve consensus among a group of 17 expert panellists. The processes was conducted over a 12-month period between 2022 and 2023, and followed the recommendations of the CREDES guidelines. RESULTS: The results of the Delphi survey form the basis of these 39 recommendations - 23 with a strong consensus and 15 with a weak consensus. CONCLUSION: The use of inhaled sedation in the ICU is a reliable and appropriate option in a wide variety of clinical scenarios. However, there are numerous aspects of the technique that require further study.

Esterification of polyglycerol with polycondensed ricinoleic acid catalysed by immobilised Rhizopus oryzae lipase.

The enzymatic method for synthesising polyglycerol polyricinoleate (PGPR), a food additive named E-476, was successfully carried out in the presence of immobilised Rhizopus oryzae lipase in a solvent-free medium. The great advantage of using the commercial preparation of R. oryzae lipase is that it is ten times cheaper than the commercial preparation of R. arrhizus lipase, the biocatalyst used in previous studies. The reaction, which is really a reversal of hydrolysis, takes place in the presence of a very limited amount of aqueous phase. Immobilisation of the lipase by physical adsorption onto an anion exchange resin provided good results in terms of activity, enzyme stability and reuse of the immobilised derivative. It has been established that the adsorption of R. oryzae lipase on Lewatit MonoPlus MP 64 follows a pseudo-second order kinetics, which means that immobilisation is a process of chemisorption, while the equilibrium adsorption follows a Langmuir isotherm. The use of this immobilised derivative as catalyst for obtaining PGPR under a controlled atmosphere in a vacuum reactor, with a dry nitrogen flow intake, allowed the synthesis of a product with an acid value lower than 6 mg KOH/g, which complies with the value established by the European Commission Directive. This product also fulfils the European specifications regarding the hydroxyl value and refractive index given for this food additive, one of whose benefits, as proved in our experiments, is that it causes a drastic decrease in the viscosity (by 50 %) and yield stress (by 82 %) of chocolate, comparable to the impact of customary synthesised PGPR.