Association of lung recruitment and change in recruitment-to-inflation ratio from supine to prone position in acute respiratory distress syndrome.

Prone positioning is an evidence-based treatment for patients with moderate-to-severe acute respiratory distress syndrome. Lung recruitment has been proposed as one of the mechanisms by which prone positioning reduces mortality in this group of patients. Recruitment-to-inflation ratio (R/I) is a method to measure potential for lung recruitment induced by a change in positive end-expiratory pressure (PEEP) on the ventilator. The association between R/I and potential for lung recruitment in supine and prone position has not been studied with computed tomography (CT) scan imaging. In this secondary analysis, we sought to investigate the correlation between R/I measured in supine and prone position with CT and the potential for lung recruitment as measured by CT scan. Among 23 patients, the median R/I did not significantly change from supine (1.9 IQR 1.6-2.6) to prone position (1.7 IQR 1.3-2.8) (paired t test p = 0.051) but the individual changes correlated with the different response to PEEP. In supine and in prone position, R/I significantly correlated with the proportion of lung tissue recruitment induced by the change of PEEP. Lung tissue recruitment induced by a change of PEEP from 5 to 15 cmH2O was 16% (IQR 11-24%) in supine and 14.3% (IQR 8.4-22.6%) in prone position, as measured by CT scan analysis (paired t test p = 0.56). In this analysis, PEEP-induced recruitability as measured by R/I correlated with PEEP-induced lung recruitment as measured by CT scan, and could help to readjust PEEP in prone position.

Dynamic relative regional lung strain estimated by computed tomography and electrical impedance tomography in ARDS patients.

BACKGROUND: In the acute distress respiratory syndrome (ARDS), specific lung regions can be exposed to excessive strain due to heterogeneous disease, gravity-dependent lung collapse and injurious mechanical ventilation. Computed tomography (CT) is the gold standard for regional strain assessment. An alternative tool could be the electrical impedance tomography (EIT). We aimed to determine whether EIT-based methods can predict the dynamic relative regional strain (DRRS) between two levels of end-expiratory pressure (PEEP) in gravity-non-dependent and dependent lung regions. METHODS: Fourteen ARDS patients underwent CT and EIT acquisitions (at end-inspiratory and end-expiratory) at two levels of PEEP: a low-PEEP based on ARDS-net strategy and a high-PEEP titrated according to EIT. Three EIT-based methods for DRRS were compared to relative CT-based strain: (1) the change of the ratio between EIT ventilation and end-expiratory lung impedance in arbitrary units ([ΔZAU low-PEEP/EELIAU low-PEEP]/[ΔZAU high-PEEP/EELIAU high-PEEP]), (2) the change of ΔZ/EELI ratio calibrated to mL ([ΔZml low-PEEP/EELIml low-PEEP]/[ΔZml high-PEEP/EELIml high-PEEP]) using CT data, and (3) the relative change of ∆ZAU (∆ZAU low-PEEP/∆ZAU high-PEEP). We performed linear regressions analysis and calculated bias and limits of agreement to assess the performance of DRRS by EIT in comparison with CT. RESULTS: The DRRS assessed by (ΔZml low-PEEP/EELIml low-PEEP)/(ΔZml high-PEEP/EELIml high-PEEP) and ∆ZAU low-PEEP/∆ZAU high-PEEP showed good relationship and agreement with the CT method (R2 of 0.9050 and 0.8679, respectively, in non-dependent region; R2 of 0.8373 and 0.6588, respectively, in dependent region; biases ranging from - 0.11 to 0.51 and limits of agreement ranging from - 0.73 to 1.16 for both methods and lung regions). Conversely, DRRS based on EELIAU ([ΔZAU low-PEEP/EELIAU low-PEEP]/[ΔZAU high-PEEP/EELIAU high-PEEP]) exhibited a weak negative relationship and poor agreement with the CT method for both non-dependent and dependent regions (R2 ~ 0.3; bias of 3.11 and 2.08, and limits of agreement of - 2.13 to 8.34 and from - 1.49 to 5.64, respectively). CONCLUSION: Changes in DRRS during a PEEP trial in ARDS patients could be monitored using EIT, based on changes in ΔZmL/EELIml and ∆ZAU. The relative change ∆ZAU offers the advantage of not requiring CT data for calibration.

[Development of mechanical ventilators in Chile. Chronicle of the initiative "Un Respiro para Chile"]. / Desarrollo de ventiladores mecánicos en Chile. Crónica de la iniciativa "Un Respiro para Chile", durante la primera ola de la pandemia COVID-19.

At the beginning of the COVID-19 pandemic in Chile, in March 2020, a projection indicated that a significant group of patients with pneumonia would require admission to an Intensive Care Unit and connection to a mechanical ventilator. Therefore, a paucity of these devices and other supplies was predicted. The initiative "Un respiro para Chile" brought together many people and institutions, public and private. In the course of three months, it allowed the design and building of several ventilatory assistance devices, which could be used in critically ill patients.

Estimation of changes in cyclic lung strain by electrical impedance tomography: Proof-of-concept study.

RATIONALE: Cyclic strain may be a determinant of ventilator-induced lung injury. The standard for strain assessment is the computed tomography (CT), which does not allow continuous monitoring and exposes to radiation. Electrical impedance tomography (EIT) is able to monitor changes in regional lung ventilation. In addition, there is a correlation between mechanical deformation of materials and detectable changes in its electrical impedance, making EIT a potential surrogate for cyclic lung strain measured by CT (StrainCT ). OBJECTIVES: To compare the global StrainCT with the change in electrical impedance (ΔZ). METHODS: Acute respiratory distress syndrome patients under mechanical ventilation (VT 6 mL/kg ideal body weight with positive end-expiratory pressure 5 [PEEP 5] and best PEEP according to EIT) underwent whole-lung CT at end-inspiration and end-expiration. Biomechanical analysis was used to construct 3D maps and determine StrainCT at different levels of PEEP. CT and EIT acquisitions were performed simultaneously. Multilevel analysis was employed to determine the causal association between StrainCT and ΔZ. Linear regression models were used to predict the change in lung StrainCT between different PEEP levels based on the change in ΔZ. MAIN RESULTS: StrainCT was positively and independently associated with ΔZ at global level (P < .01). Furthermore, the change in StrainCT (between PEEP 5 and Best PEEP) was accurately predicted by the change in ΔZ (R2 0.855, P < .001 at global level) with a high agreement between predicted and measured StrainCT . CONCLUSIONS: The change in electrical impedance may provide a noninvasive assessment of global cyclic strain, without radiation at bedside.

Food quality and authenticity screening via easy ambient sonic-spray ionization mass spectrometry.

This review is the first to summarize a decade of studies testing the use of easy ambient sonic-spray ionization mass spectrometry (EASI-MS) and its several sister techniques, Venturi (V-EASI), thermal imprinting (TI-EASI) and Spartan (S-EASI) mass spectrometry in food quality control and authentication. Since minimal or no sample preparation is required, such ambient desorption/ionization techniques have been shown to provide direct, fast and selective fingerprinting characterization at the molecular level based on the pools of the most typical components. They have also been found to be applicable on intact, undisturbed samples or on simple solvent extracts. Fundamentals of EASI-MS and its sister techniques, including mechanisms, devices, parameters and strategies, as well as the many applications reported for food analysis, are summarized and discussed.

Preschoolers' mutualistic conception of seeing is related to their knowledge of the pronoun "each other".

Previous research has shown that young children deny being able to see an agent whose eyes are covered. The current study explored this phenomenon further. In Experiment 1, 3-year-olds denied that they could "see," but affirmed that they could "look at," a doll whose eyes were covered--indicating that they demand mutuality for seeing another but not for looking at another. In Experiment 2, 3.5-year-olds drew the same distinction between "see" and "look at" when facing a doll or a human. A strong correlation between children's knowledge of the reciprocal pronoun "each other" and their adherence to the mutuality demand was found. The results are discussed with respect to children's bias for second personal encounters and children's relational concept of persons.

Effects of prone positioning on lung protection in patients with acute respiratory distress syndrome.

RATIONALE: Positive end-expiratory pressure (PEEP) and prone positioning may induce lung recruitment and affect alveolar dynamics in acute respiratory distress syndrome (ARDS). Whether there is interdependence between the effects of PEEP and prone positioning on these variables is unknown. OBJECTIVES: To determine the effects of high PEEP and prone positioning on lung recruitment, cyclic recruitment/derecruitment, and tidal hyperinflation and how these effects are influenced by lung recruitability. METHODS: Mechanically ventilated patients (Vt 6 ml/kg ideal body weight) underwent whole-lung computed tomography (CT) during breath-holding sessions at airway pressures of 5, 15, and 45 cm H2O and Cine-CTs on a fixed thoracic transverse slice at PEEP 5 and 15 cm H2O. CT images were repeated in supine and prone positioning. A recruitment maneuver at 45 cm H2O was performed before each PEEP change. Lung recruitability was defined as the difference in percentage of nonaerated tissue between 5 and 45 cm H2O. Cyclic recruitment/de-recruitment and tidal hyperinflation were determined as tidal changes in percentage of nonaerated and hyperinflated tissue, respectively. MEASUREMENTS AND MAIN RESULTS: Twenty-four patients with ARDS were included. Increasing PEEP from 5 to 15 cm H2O decreased nonaerated tissue (501 ± 201 to 322 ± 132 grams; P < 0.001) and increased tidal-hyperinflation (0.41 ± 0.26 to 0.57 ± 0.30%; P = 0.004) in supine. Prone positioning further decreased nonaerated tissue (322 ± 132 to 290 ± 141 grams; P = 0.028) and reduced tidal hyperinflation observed at PEEP 15 in supine patients (0.57 ± 0.30 to 0.41 ± 0.22%). Cyclic recruitment/de-recruitment only decreased when high PEEP and prone positioning were applied together (4.1 ± 1.9 to 2.9 ± 0.9%; P = 0.003), particularly in patients with high lung recruitability. CONCLUSIONS: Prone positioning enhances lung recruitment and decreases alveolar instability and hyperinflation observed at high PEEP in patients with ARDS.

Specific Training Improves the Detection and Management of Patient-Ventilator Asynchrony.

BACKGROUND: Patient-ventilator asynchrony is common in patients undergoing mechanical ventilation. The proportion of health-care professionals capable of identifying and effectively managing different types of patient-ventilator asynchronies is limited. A few studies have developed specific training programs, but they mainly focused on improving patient-ventilator asynchrony detection without assessing the ability of health-care professionals to determine the possible causes. METHODS: We conducted a 36-h training program focused on patient-ventilator asynchrony detection and management for health-care professionals from 20 hospitals in Latin America and Spain. The training program included 6 h of a live online lesson during which 120 patient-ventilator asynchrony cases were presented. After the 6-h training lesson, health-care professionals were required to complete a 1-h training session per day for the subsequent 30 d. A 30-question assessment tool was developed and used to assess health-care professionals before training, immediately after the 6-h training lecture, and after the 30 d of training (1-month follow-up). RESULTS: One hundred sixteen health-care professionals participated in the study. The median (interquartile range) of the total number of correct answers in the pre-training, post-training, and 1-month follow-up were significantly different (12 [8.75-15], 18 [13.75-22], and 18.5 [14-23], respectively). The percentages of correct answers also differed significantly between the time assessments. Study participants significantly improved their performance between pre-training and post-training (P < .001). This performance was maintained after a 1-month follow-up (P = .95) for the questions related to the detection, determination of cause, and management of patient-ventilator asynchrony. CONCLUSIONS: A specific 36-h training program significantly improved the ability of health-care professionals to detect patient-ventilator asynchrony, determine the possible causes of patient-ventilator asynchrony, and properly manage different types of patient-ventilator asynchrony.

Pendelluft in hypoxemic patients resuming spontaneous breathing: proportional modes versus pressure support ventilation.

BACKGROUND: Internal redistribution of gas, referred to as pendelluft, is a new potential mechanism of effort-dependent lung injury. Neurally-adjusted ventilatory assist (NAVA) and proportional assist ventilation (PAV +) follow the patient's respiratory effort and improve synchrony compared with pressure support ventilation (PSV). Whether these modes could prevent the development of pendelluft compared with PSV is unknown. We aimed to compare pendelluft magnitude during PAV + and NAVA versus PSV in patients with resolving acute respiratory distress syndrome (ARDS). METHODS: Patients received either NAVA, PAV + , or PSV in a crossover trial for 20-min using comparable assistance levels after controlled ventilation (> 72 h). We assessed pendelluft (the percentage of lost volume from the non-dependent lung region displaced to the dependent region during inspiration), drive (as the delta esophageal swing of the first 100 ms [ΔPes 100 ms]) and inspiratory effort (as the esophageal pressure-time product per minute [PTPmin]). We performed repeated measures analysis with post-hoc tests and mixed-effects models. RESULTS: Twenty patients mechanically ventilated for 9 [5-14] days were monitored. Despite matching for a similar tidal volume, respiratory drive and inspiratory effort were slightly higher with NAVA and PAV + compared with PSV (ΔPes 100 ms of -2.8 [-3.8--1.9] cm H2O, -3.6 [-3.9--2.4] cm H2O and -2.1 [-2.5--1.1] cm H2O, respectively, p < 0.001 for both comparisons; PTPmin of 155 [118-209] cm H2O s/min, 197 [145-269] cm H2O s/min, and 134 [93-169] cm H2O s/min, respectively, p < 0.001 for both comparisons). Pendelluft magnitude was higher in NAVA (12 ± 7%) and PAV + (13 ± 7%) compared with PSV (8 ± 6%), p < 0.001. Pendelluft magnitude was strongly associated with respiratory drive (ß = -2.771, p-value < 0.001) and inspiratory effort (ß = 0.026, p < 0.001), independent of the ventilatory mode. A higher magnitude of pendelluft in proportional modes compared with PSV existed after adjusting for PTPmin (ß = 2.606, p = 0.010 for NAVA, and ß = 3.360, p = 0.004 for PAV +), and only for PAV + when adjusted for respiratory drive (ß = 2.643, p = 0.009 for PAV +). CONCLUSIONS: Pendelluft magnitude is associated with respiratory drive and inspiratory effort. Proportional modes do not prevent its occurrence in resolving ARDS compared with PSV.

Soybean oil organogelled emulsions as oral delivery systems of hydroxytyrosol and hydroxytyrosol alkyl esters.

Water-in-soybean oil organogelled emulsions (OGEs) were formulated as fat replacers and evaluated as delivery systems of hydroxytyrosol (HT, hydrophilic compound), hydroxytyrosol octanoate (HTC18, hydrophobic compound) and hydroxytyrosol decanoate (HTC10, with intermediate hydrophobicity and the highest antioxidant activity measured by conjugated autoxidizable triene assay). OGEs formulated with 55% of water and a ternary blend of candelilla wax, fully hydrogenated palm oil and monoacylglycerols showed mechanical properties similar to lard and solid-like behavior. The increase in the water content, together with a higher concentration of structuring agents in the oil phase, led to an increase in oil retention capacity and texture parameters. A slight desesterification of HTC10 and HTC18 was found during in vitro gastrointestinal digestion. The three bioactive compounds loaded in OGEs showed high bioaccessibility values (∼84%) at the end of digestion, regardless their chain length and hydrophobicity. These OGEs designed as fat replacers showed a great potential for vehiculation of both hydrophilic and lipophilic compounds.

Inflammatory biomarkers and pendelluft magnitude in ards patients transitioning from controlled to partial support ventilation.

The transition from controlled to partial support ventilation is a challenge in acute respiratory distress syndrome (ARDS) patients due to the risks of patient-self-inflicted lung injury. The magnitude of tidal volume (VT) and intrapulmonary dyssynchrony (pendelluft) are suggested mechanisms of lung injury. We conducted a prospective, observational, physiological study in a tertiary academic intensive care unit. ARDS patients transitioning from controlled to partial support ventilation were included. On these, we evaluated the association between changes in inflammatory biomarkers and esophageal pressure swing (ΔPes), transpulmonary driving pressure (ΔPL), VT, and pendelluft. Pendelluft was defined as the percentage of the tidal volume that moves from the non-dependent to the dependent lung region during inspiration, and its frequency at different thresholds (- 15, - 20 and - 25%) was also registered. Blood concentrations of inflammatory biomarkers (IL-6, IL-8, TNF-α, ANGPT2, RAGE, IL-18, Caspase-1) were measured before (T0) and after 4-h (T4) of partial support ventilation. Pendelluft, ΔPes, ΔPL and VT were recorded. Nine out of twenty-four patients (37.5%) showed a pendelluft mean ≥ 10%. The mean values of ΔPes, ΔPL, and VT were - 8.4 [- 6.7; - 10.2] cmH2O, 15.2 [12.3-16.5] cmH2O and 8.1 [7.3-8.9] m/kg PBW, respectively. Significant associations were observed between the frequency of high-magnitude pendelluft and IL-8, IL-18, and Caspase-1 changes (T0/T4 ratio). These results suggest that the frequency of high magnitude pendelluft may be a potential determinant of inflammatory response related to inspiratory efforts in ARDS patients transitioning to partial support ventilation. Future studies are needed to confirm these results.

Oleogel-based emulsions: Concepts, structuring agents, and applications in food.

This review discusses the application of oleogel technology in emulsified systems. In these systems of mimetic fats, water-in-oil or oil-in-water emulsions can be obtained, but, here, we cover emulsions with an oil continuous phase in detail. Depending on the percentage of water added to the oleogels, systems with different textures and rheological properties can be developed. These properties are affected by the characteristics and concentration of the added components and emulsion preparation methods. In addition, some gelators exhibit interfacial properties, resulting in more stable emulsions than those of conventional emulsions. Oleogel-based emulsion are differentiated by continuous and dispersed phases and the structuring/emulsification components. Crucially, these emulsions could be applied by the food industry for preparing, for example, meat products and margarines, as well as by the cosmetics industry. We present the different processes of emulsion elaboration, the main gelators used, the influence of the water content on the structuring of water-in-oleogel emulsions, and the structuring mechanisms (Pickering, network, and combined Pickering and network stabilization). Finally, we highlight the applications of these systems as alternatives for reducing processed food lipid content and saturated fat levels.

Margarines: Historical approach, technological aspects, nutritional profile, and global trends.

Margarines are an expanding market worldwide due to large-scale commercial, lower cost, growth of bakery and confectionery markets, and seasonal independence. The fatty acid composition, solid fat content, consistency, and melting point of the fats used in margarine determine their functional properties. Due to its proven association with increased risk of cardiovascular diseases, the recommendations of the World Health Organization and the enactment of laws in several countries to eliminate industrially produced trans fatty acids (TFA) have resulted in the prohibition or progressive reduction in the use of partially hydrogenated fat. However, issues related to high levels of TFA and saturated fatty acids still constitute a challenge in the formulation of this product category. Current trends on margarine production addition of phytosterols, non-lipid components, organogels, and new interesterified fat bases are reviewed. This review aims to present a historical view and the technological evolution of margarines, including their production processes, formulations, and physical and nutritional characteristics, as well as legislation, and main trends.

Organogels in low-fat and high-fat margarine: A study of physical properties and shelf life.

This study aimed to investigate the effect of the addition of organogels in low-fat and high-fat margarines during storage. Margarine formulations were made using water: oil ratios of 65:35 and 40:60 (w/w), and a lipid phase composed of organogel made with soybean oil, candelilla wax, fully hydrogenated palm oil, and mononoacylglycerols. The thermal stability, particle size, consistency, peroxide index, oil exudation, and microstructure of the margarines were evaluated for six months of storage. All margarines showed thermal stability at 35 °C, with no physical destabilization during the period studied. Both low-fat and high-fat margarines presented similar particle size distribution, with d3.3 around units of 5 µm. The peroxide index of the margarines ranged from 1.27 to 5.97 meq O2/Kg after six months of storage. High-fat margarines showed greater hardness and lower spreadability. The amount of water added to the formulations affected the stability, particle size, and texture of the margarines. It was possible to produce margarines with different fat contents and greater health appeal. The margarines with 60% and 35% fat exhibited 12.00 and 8.03% SFA; 32.63 and 18.20% PUFA; and 14.37 and 8.20% MUFA, respectively.

Survey of Nurses' Experiences Applying The Joint Commission's Medication Management Titration Standards.

BACKGROUND: Critical care nurses titrate continuous infusions of medications to achieve clinical end points. In 2017, The Joint Commission (TJC) placed restrictions on titration practice, decreasing nurses' autonomous decision-making. OBJECTIVES: To describe the practice and perceptions of nurses regarding the 2017 TJC accreditation/regulatory standards for titration of continuous medication infusions. METHODS: A survey of nurses' experiences titrating continuous medication infusions was developed, validated, and distributed electronically to members of the American Association of Critical-Care Nurses. RESULTS: The content validity index for the survey was 1.0 for relevance and 0.95 for clarity. A total of 781 nurses completed the survey; 625 (80%) perceived titration standards to cause delays in patient care, and 726 (93%) experienced moral distress (mean [SD], 4.97 [2.67]; scale, 0-10). Among respondents, 33% could not comply with titration orders, 68% reported suboptimal care resulting from pressure to comply with orders, 70% deviated from orders to meet patient needs, and 84% requested revised orders to ensure compliance. Suboptimal care and delays in care significantly and strongly (regression coefficients ≥0.69) predicted moral distress. CONCLUSIONS: Critical care nurses perceive TJC medication titration standards to adversely impact patient care and contribute to moral distress. The improved 2020 updates to the standards do not address delays and inability to comply with orders, leading to moral distress. Advocacy is indicated in order to mitigate unintended consequences of TJC medication management titration standards.

Instantaneous characterization of vegetable oils via TAG and FFA profiles by easy ambient sonic-spray ionization mass spectrometry.

A fast and reliable method is presented for the analysis of vegetable oils. Easy ambient sonic-spray ionization mass spectrometry (EASI-MS) is shown to efficiently desorb and ionize the main oil constituents from an inert surface under ambient conditions and to provide comprehensive triacylglyceride (TAG) and free fatty acid (FFA) profiles detected mainly as either [TAG + Na](+) or [FFA-H](-) ions. EASI(+/-)-MS analysis is simple, easily implemented, requires just a tiny droplet of the oil and is performed without any pre-separation or chemical manipulation. It also causes no fragmentation of TAG ions hence diacylglyceride (DAG) and monoacylglyceride (MAG) profiles and contents can also be measured. The EASI(+/-)-MS profiles of TAG and FFA permit authentication and quality control and can be used, for instance, to access levels of adulteration, acidity, oxidation or hydrolysis of vegetable oils in general.

A Model of Queer STEM Identity in the Workplace.

Science, technology, engineering, and mathematics (STEM) fields are often stereotyped as spaces in which personal identity is subsumed in the pursuit of a single-minded focus on objective scientific truths, and correspondingly rigid expectations of gender and sexuality are widespread. This paper describes findings from a grounded theory inquiry of how queer individuals working in STEM fields develop and navigate personal and professional identities. Through our analysis, we identified three distinct but related processes of Defining a queer gender and/or sexual identity, Forming an identity as a STEM professional, and Navigating identities at work. We found that heteronormative assumptions frequently silence conversations about gender and sexuality in STEM workplaces and result in complicated negotiations of self for queer professionals. This analysis of the personal accounts of queer students, faculty, and staff in STEM reveals unique processes of identity negotiation and elucidates how different social positioning creates challenges and opportunities for inclusivity.

[Lipid composition of marine shellfish berbigão Anomalocardia brasiliana (Gmelin, 1791) raw and cooked]. / Composição lipídica do molusco marinho berbigão Anomalocardia brasiliana (Gmelin, 1791) "in natura" e cozido.

The berbigão Anomalocardia brasiliana is a marine shellfish which is commoning consumed in the coastal region of Santa Catarina. However, there are limited available data on the composition of their fatty acids and sterols. The objetive of this study was to determine the lipid composition of the berbigão from Reserva Extrativista Marinha de Pirajubaé (REMAPI), Florianópolis/SC, Brasil, during the autumn and spring. The total lipid content was 1.21g% and 0.72g% in the autumn and spring, respectively. Several fatty acids were identified and quantified, including 20 fatty acids, 6 saturated (14:0, 15:0, 16:0, 17:0, 18:0, 20:0), 4 monounsaturated (16:1, 17:1, 18:1, 20:1) and 10 polyunsaturated (18:2, 18:3, 18:4, 20:2, 20:3, 20:4, 20:5, 22:4, 22:5, 22:6). There was a higher proportion of polyunsaturated fatty acids in total than saturated and monounsaturated, regardless of season: 40.7% of polyunsaturated, 30.8% of saturated, 17.2% of monounsaturated in the autumn and 39.7% of polyunsaturated, 27.7% of saturated, 13.7% of monounsaturated in the spring. The cholesterol corresponded to a value of 94.38 mg% in the autumn and 76.75 mg% in the spring. Among the sterols were found campesterol, estigmasterol and beta-sitosterol, but in lower quantities than cholesterol. These results showed that the berbigão was not a significant source of lipids, revealing low levels of saturated fatty acids and cholesterol. Berbigão is recommended for daily consumption as part of a healthy diet due to it is safe levels of fats and cholesterol.

Acute Kidney Injury Following Cardiothoracic Surgery.

This article reviews acute kidney injury following cardiothoracic surgery, addressing the full spectrum of the perioperative environment including preoperative, intraoperative, and postoperative factors for acute kidney injury. Topics discussed include pathophysiology, risk prediction scoring, diagnosis, prevention, treatment, and new directions for research.