Recomendaciones para el tratamiento nutrometabólico especializado del paciente crítico: monitorización y seguridad. Grupo de Trabajo de Metabolismo y Nutrición de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) / Recommendations for specialized nutritional-metabolic management of the critical patient: Monitoring and safety. Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC)

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Biological characterization of a new silicon based coating developed for dental implants.

Taking into account the influence of Si in osteoblast cell proliferation, a series of sol-gel derived silicon based coating was prepared by controlling the process parameters and varying the different Si-alkoxide precursors molar rate in order to obtain materials able to release Si compounds. For this purpose, methyltrimethoxysilane (MTMOS) and tetraethyl orthosilicate (TEOS) were hydrolysed together and the sol obtained was used to dip-coat the different substrates. The silicon release ability of the coatings was tested finding that it was dependent on the TEOS precursor content, reaching a Si amount value around ninefolds higher for coatings with TEOS than for the pure MTMOS material. To test the effect of this released Si, the in vitro performance of developed coatings was tested with human adipose mesenchymal stem cells finding a significantly higher proliferation and mineralization on the coating with the higher TEOS content. For in vivo evaluation of the biocompatibility, coated implants were placed in the tibia of the rabbit and a histological analysis was performed. The evaluation of parameters such as the bone marrow state, the presence of giant cells and the fibrous capsule proved the biocompatibility of the developed coatings. Furthermore, coated implants seemed to produce a qualitatively higher osteoblastic activity and a higher number of bone spicules than the control (uncoated commercial SLA titanium dental implant).

Synthesis of hybrid sol-gel materials and their biological evaluation with human mesenchymal stem cells.

Surface engineering of biomaterials could promote the osseointegration of implants. In this work, two types of hybrid sol-gel materials were developed to stimulate cell attachment, proliferation and differentiation of osteogenic cells. One type was synthesised from vinyl triethoxysilane (VTES) and tetraethyl-orthosilicate (TEOS) at different molar ratios, while the other from VTES and hydroxyapatite particles (HAp). Hybrid materials were systematically investigated using nuclear magnetic resonance, Fourier transform infrared spectroscopy and contact angle metrology. The biocompatibility and osseoinduction of the coatings were evaluated by measuring mesenchymal stem cell proliferation using MTT assays and analysing the mineralised extracellular matrix production by quantifying calcium-rich deposits. The results highlighted the versatility of these coatings in obtaining different properties by changing the molar ratio of the VTES:TEOS precursors. Thus, mineralisation was stimulated by increasing TEOS content, while the addition of HAp improved cell proliferation but worsened mineralisation.

Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Hiperglucemia y diabetes mellitus / Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): Hyperglycemia and diabetes mellitus

La hiperglucemia es una de las alteraciones metabólicas predominantes en los pacientes críticos y se asocia con un aumento de la morbimortalidad. Por ello, es necesario realizar un control efectivo y a su vez seguro de la glucemia, esto es, mantener la normoglucemia en un rango que evite el riesgo de desarrollar hipoglucemia, por un lado, y las cifras elevadas de glucemia, por otro. Para conseguirlo, en la mayoría de los casos es necesario el tratamiento con insulina evitando protocolos dirigidos a conseguir cifras estrictas de glucemias. Con el fin de prevenir la hiperglucemia y sus complicaciones asociadas, el aporte energético debe adecuarse a los requerimientos de los pacientes, evitando la sobrenutrición y el aporte excesivo de glucosa. El aporte proteico se ajustará al nivel de estrés metabólico. Siempre que el enfermo requiera nutrición artificial y no esté contraindicada debe emplearse la vía enteral, ya que la nutrición parenteral se asocia a mayor frecuencia de hiperglucemia y mayores necesidades de insulina. La administración de la nutrición enteral debe ser precoz, preferiblemente dentro de las primeras 24 h de ingreso en UCI, tras la estabilización hemodinámica. Las dietas específicas para hiperglucemia que contienen hidratos de carbono de bajo índice glucémico, fibra y ricas en ácidos grasos monoinsaturados podrían conseguir un mejor control glucémico con menores necesidades de insulina (AU)

Hyperglycemia is one of the main metabolic disturbances in critically-ill patients and is associated with increased morbidity and mortality. Consequently, blood glucose levels must be safely and effectively controlled, that is, maintained within a normal range, avoiding hypoglycemia on the one hand and elevated glucose concentrations on the other. To accomplish this aim, insulin is often required, avoiding protocols designed to achieve tight glycemic control. To prevent hyperglycemia and its associated complications, energy intake should be adjusted to patients’ requirements, avoiding over nutrition and excessive glucose intake. Protein intake should be adjusted to the degree of metabolic stress. Whenever patients require artificial feeding, the enteral route , if not contraindicated, should be used since parenteral nutrition is associated with a higher frequency of hyperglycemia and greater insulin requirements. Enteral nutrition should be administered early, preferably within the first 24 hours of admission to the intensive care unit, after hemodynamic stabilization. Specific diets for hyperglycemia, containing low glycemic index carbohydrates and fibre and enriched with monounsaturated fatty acids, can achieve good glycemic control with lower insulin requirements (AU)

Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Hyperglycemia and diabetes mellitus / Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Hiperglucemia y diabetes mellitus

Hyperglycemia is one of the main metabolic disturbances in critically-ill patients and is associated within creased morbidity and mortality. Consequently, blood glucose levels must be safely and effectively controlled, that is, maintained within a normal range, avoiding hypoglycemia on the one hand and elevated glucose concentrations on the other. To accomplish this aim, insulin is often required, avoiding protocols designed to achieve tight glycemic control.To prevent hyperglycemia and its associated complications, energy intake should be adjusted to patients’ requirements, avoiding over nutrition and excessive glucose intake. Protein intake should be adjusted to the degree of metabolic stress. Whenever patients require artificial feeding, the enteral route , if not contraindicated, should be used since parenteral nutrition is associated with a higher frequency of hyperglycemia and greater insulin requirements. Enteral nutrition should be administered early, preferably within the first 24 hours of admission to the intensive care unit, after hemodynamic stabilization. Specific diets for hyperglycemia, containing low glycemic index carbohydrates and fibre and enriched with monounsaturated fatty acids, can achieve good glycemic control with lower insulin requirements (AU)

La hiperglucemia es una de las alteraciones metabólicas predominantes en los pacientes críticos y se asocia con un aumento de la morbimortalidad. por ello, es necesario realizar un control efectivo y a su vez seguro de la glucemia, esto es, mantener la normoglucemia en un rango que evite el riesgo de desarrollar hipoglucemia, por un lado, y las cifras elevadas de glucemia, por otro. Para conseguirlo, en la mayoría de los casos es necesario el tratamiento con insulina evitando protocolos dirigidos a conseguir cifras estrictas de glucemias. Con el fin de prevenir la hiperglucemia y sus complicaciones asociadas, el aporte energético debe adecuarse al os requerimientos de los pacientes, evitando la sobre nutrición y el aporte excesivo de glucosa. El aporte proteicos e ajustará al nivel de estrés metabólico. Siempre que el enfermo requiera nutrición artificial y no esté contraindicada debe emplearse la vía enteral, ya que la nutrición parenteral se asocia a mayor frecuencia de hiperglucemia y mayores necesidades de insulina. La administración de la nutrición enteral debe ser precoz, preferiblemente dentro de las primeras 24 h de ingreso en UCI, tras la estabilización hemodinámica. Las dietas específicas para hiperglucemia que contienen hidratos de carbono de bajo índice glucémico, fibra y ricas en ácidos grasos monoinsaturados podrían conseguir un mejor control glucémico con menores necesidades de insulina (AU)

[Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): hyperglycemia and diabetes mellitus]. / Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: hiperglucemia y diabetes mellitus.

Hyperglycemia is one of the main metabolic disturbances in critically-ill patients and is associated with increased morbidity and mortality. Consequently, blood glucose levels must be safely and effectively controlled, that is, maintained within a normal range, avoiding hypoglycemia on the one hand and elevated glucose concentrations on the other. To accomplish this aim, insulin is often required, avoiding protocols designed to achieve tight glycemic control. To prevent hyperglycemia and its associated complications, energy intake should be adjusted to patients' requirements, avoiding overnutrition and excessive glucose intake. Protein intake should be adjusted to the degree of metabolic stress. Whenever patients require artificial feeding, the enteral route, if not contraindicated, should be used since parenteral nutrition is associated with a higher frequency of hyperglycemia and greater insulin requirements. Enteral nutrition should be administered early, preferably within the first 24 hours of admission to the intensive care unit, after hemodynamic stabilization. Specific diets for hyperglycemia, containing low glycemic index carbohydrates and fibre and enriched with monounsaturated fatty acids, can achieve good glycemic control with lower insulin requirements.

Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: hyperglycemia and diabetes mellitus.

Hyperglycemia is one of the main metabolic disturbances in critically-ill patients and is associated with increased morbidity and mortality. Consequently, blood glucose levels must be safely and effectively controlled, that is, maintained within a normal range, avoiding hypoglycemia on the one hand and elevated glucose concentrations on the other. To accomplish this aim, insulin is often required, avoiding protocols designed to achieve tight glycemic control. To prevent hyperglycemia and its associated complications, energy intake should be adjusted to patients' requirements, avoiding overnutrition and excessive glucose intake. Protein intake should be adjusted to the degree of metabolic stress. Whenever patients require artificial feeding, the enteral route, if not contraindicated, should be used since parenteral nutrition is associated with a higher frequency of hyperglycemia and greater insulin requirements. Enteral nutrition should be administered early, preferably within the first 24 hours of admission to the intensive care unit, after hemodynamic stabilization. Specific diets for hyperglycemia, containing low glycemic index carbohydrates and fibre and enriched with monounsaturated fatty acids, can achieve good glycemic control with lower insulin requirements.