Extubation in neurocritical care patients: the ENIO international prospective study.

PURPOSE: Neurocritical care patients receive prolonged invasive mechanical ventilation (IMV), but there is poor specific information in this high-risk population about the liberation strategies of invasive mechanical ventilation. METHODS: ENIO (NCT03400904) is an international, prospective observational study, in 73 intensive care units (ICUs) in 18 countries from 2018 to 2020. Neurocritical care patients with a Glasgow Coma Score (GCS) ≤ 12, receiving IMV ≥ 24 h, undergoing extubation attempt or tracheostomy were included. The primary endpoint was extubation failure by day 5. An extubation success prediction score was created, with 2/3 of patients randomly allocated to the training cohort and 1/3 to the validation cohort. Secondary endpoints were the duration of IMV and in-ICU mortality. RESULTS: 1512 patients were included. Among the 1193 (78.9%) patients who underwent an extubation attempt, 231 (19.4%) failures were recorded. The score for successful extubation prediction retained 20 variables as independent predictors. The area under the curve (AUC) in the training cohort was 0.79 95% confidence interval (CI95) [0.71-0.87] and 0.71 CI95 [0.61-0.81] in the validation cohort. Patients with extubation failure displayed a longer IMV duration (14 [7-21] vs 6 [3-11] days) and a higher in-ICU mortality rate (8.7% vs 2.4%). Three hundred and nineteen (21.1%) patients underwent tracheostomy without extubation attempt. Patients with direct tracheostomy displayed a longer duration of IMV and higher in-ICU mortality than patients with an extubation attempt (success and failure). CONCLUSIONS: In neurocritical care patients, extubation failure is high and is associated with unfavourable outcomes. A score could predict extubation success in multiple settings. However, it will be mandatory to validate our findings in another prospective independent cohort.

The Effect of Grapevine Age (Vitis vinifera L. cv. Zinfandel) on Phenology and Gas Exchange Parameters over Consecutive Growing Seasons.

Unlike most crop industries, there is a strongly held belief within the wine industry that increased vine age correlates with quality. Considering this perception could be explained by vine physiological differences, the purpose of this study was to evaluate the effect of vine age on phenology and gas exchange parameters. An interplanted, dry farmed, Zinfandel vineyard block under consistent management practices in the Central Coast of California was evaluated over two consecutive growing seasons. Treatments included Young vines (5 to 12 years old), Control (representative proportion of young to old vines in the block), and Old vines (40 to 60 years old). Phenology, leaf water potential, and gas exchange parameters were tracked. Results indicated a difference in phenological progression after berry set between Young and Old vines. Young vines progressed more slowly during berry formation and more rapidly during berry ripening, resulting in Young vines being harvested before Old vines due to variation in the timing of sugar accumulation. No differences in leaf water potential were found. Young vines had higher mid-day stomatal conductance and tended to have higher mid-day photosynthetic rates. The results of this study suggest vine age is a factor in phenological timing and growing season length.

Evaluation of association between Porphyromonas gingivalis and visfatin levels in chronic periodontitis patients.

BACKGROUND: Periodontal disease is one of the most common prevailing diseases, where the destruction occurs due to the direct effect of microorganisms and indirectly by the stimulation of host cells. The diverse inflammatory action of visfatin made this adipokine a potential periodontal biomarker of choice along with the periopathogen Porphyromonas gingivalis. AIM: Our study was carried out to evaluate the visfatin levels in gingival crevicular fluid (GCF) and P. gingivalis levels in subgingival plaque in periodontal health and disease. MATERIALS AND METHODS: A total of 60 participants were divided into two groups of thirty participants each as Group I - patients who have healthy periodontium and Group II - patients with generalized chronic periodontitis. The clinical parameters assessed for the participants were plaque index, probing pocket depth, papillary bleeding index, and clinical attachment loss. The subgingival plaque samples were obtained to estimate P. gingivalis levels and GCF was collected to check visfatin levels. RESULTS: The clinical parameters, P. gingivalis, and GCF visfatin levels between the two groups showed a notable significant difference. A significant positive correlation was noted on the correlation of GCF visfatin levels with clinical parameters. CONCLUSION: Our study outcomes propose that P. gingivalis can be the bonafide periopathogen which modulate the visfatin levels in individuals with periodontal disease and GCF visfatin can also be evaluated as a biomarker in periodontal disease.

Increased secretion of exopolysaccharide and virulence potential of a mucoid variant of Salmonella enterica serovar Montevideo under environmental stress.

During an investigation to increase the recovery of Salmonella enterica from Oregano, an increased expression of exopolysaccharide was induced in Salmonella serovar Montevideo. The atypical mucoid (SAL242S) and the non-mucoid (SAL242) strains of Montevideo were compared and characterized using various methods. Serotyping analysis demonstrated that both strains are the same serovar Montevideo. Electron microscopy (EM) of cultured SAL242S cells revealed the production of a prominent EPS-like structure enveloping aggregates of cells that are composed of cellulose. Mucoid cells possessed a higher binding affinity for Calcofluor than that of the non-mucoid strain. Genotypic analysis revealed no major genomic differences between these morphotypes, while expression analyses using a DNA microarray shows that the mucoid variant exhibited heightened expression of genes encoding proteins produced by the SPI-1 type III secretion system. This increased expression of SPI1 genes may play a role in protecting Salmonella from environmental stressors. Based on these observations, Salmonella serovar Montevideo mucoid variant under stressful or low-nutrient environments presented atypical growth patterns and phenotypic changes, as well as an upregulated expression of virulence factors. These findings are significant in the understanding of survival abilities of Salmonella in a various food matrices.

Antimicrobial activity of buttermilk and lactoferrin peptide extracts on poultry pathogens.

Antibiotics are commonly used in poultry feed as growth promoters. This practice is questioned given the arising importance of antibiotic resistance. Antimicrobial peptides can be used as food additives for a potent alternative to synthetic or semi-synthetic antibiotics. The objective of this study was to develop a peptide production method based on membrane adsorption chromatography in order to produce extracts with antimicrobial activity against avian pathogens (Salmonella enterica var. Enteritidis, Salmonella enterica var. Typhimurium, and two Escherichia coli strains, O78:H80 and TK3 O1:K1) as well as Staphylococcus aureus. To achieve this, buttermilk powder and purified lactoferrin were digested with pepsin. The peptide extracts (<10 kDa) were fractionated depending on their charges through high-capacity cation-exchange and anion-exchange adsorptive membranes. The yields of cationic peptide extracts were 6·3 and 15·4% from buttermilk and lactoferrin total peptide extracts, respectively. Antimicrobial activity was assessed using the microdilution technique on microplates. Our results indicate that the buttermilk cationic peptide extracts were bactericidal at less than 5 mg/ml against the selected avian strains, with losses of 1·7 log CFU/ml (Salm. Typhimurium) to 3 log CFU/ml (E. coli O78:H80); viability decreased by 1·5 log CFU/ml for Staph. aureus, a Gram-positive bacterium. Anionic and non-adsorbed peptide extracts were inactive at 5 mg/ml. These results demonstrate that membrane adsorption chromatography is an effective way to prepare a cationic peptide extract from buttermilk that is active against avian pathogens.

BECLA, a new assessment battery for acquired deficits of language: Normative data from Quebec-French healthy younger and older adults.

Compared to English, for which there exist numerous tests and batteries for the assessment of acquired deficits of language, the tools available to assess French-speaking individuals are much more limited. The Batterie d'Évaluation Cognitive du Langage (BECLA) was purposely developed to fulfill the need for French assessment tools based on theoretical models of cognitive psychology. It comprises 19 tasks, designed to assess each of the components and routes involved in single word processing in order to identify the functional locus/loci of impairment. In this article, we describe the BECLA and we present normative data for individuals 18-94 years of age (N=248). The sample was stratified by age, gender, and years of education, according to the Institut de la statistique du Québec, in order to be representative of the French-Quebec population. Percentile scores were provided for each BECLA task in order to show the relative rank of each raw score according to significant correlates. The BECLA is a new clinical, theoretically based assessment battery, useful for identifying and characterizing acquired deficits of language in younger and older adults.

Homozygous familial hypercholesterolemia and its management.

Mutations in the low-density lipoprotein (LDL) receptor gene cause familial hypercholesterolemia. In homozygous familial hypercholesterolemia, both genes for the LDL- receptor are mutated and LDL levels are markedly elevated. High-density lipoprotein cholesterol concentration is often reduced and lipoprotein(a) levels are high when corrected for apolipoprotein(a) isoforms. Cutaneous and tendinous xanthomata develop in childhood and are the most common reason for initial presentation. The diagnosis can be confirmed by analysis of LDL-receptor genes or studies of LDL receptor function in cultured cells. Severe aortic and coronary atherosclerosis usually occurs within the first or second decades of life. Left ventricular outflow tract obstruction may be at the level of the aortic valve or the supravalvar aorta. Treatment for the hyperlipidemia is with plasmapheresis, high-dose statins, and ezetimibe. Liver transplantation reverses the metabolic defect but requires chronic immunosupression, and rejection may still occur. Liver transplantation is indicated if cardiac transplantation becomes necessary. Portocaval shunt may still play a role in patients with coronary artery disease who do not have access to plasmapheresis. Gene therapy is currently not practicable but is being actively developed.

Familial hypercholesterolemia in South Africa.

South Africa, especially the Caucasian part of the population, has one of the highest incidences of familial hypercholesterolemia in the world. The founder effect in this region has led to this high incidence and to a limited number of mutations in the low-density lipoprotein-receptor gene. This chapter describes current situation concerning the management of familial hypercholesterolemia in South Africa.