Early prediction of blood stream infection in a prospectively collected cohort.

BACKGROUND: Blood stream infection (BSI) and sepsis are serious clinical conditions and identification of the disease-causing pathogen is important for patient management. The RISE (Rapid Identification of SEpsis) study was carried out to collect a cohort allowing high-quality studies on different aspects of BSI and sepsis. The aim of this study was to identify patients at high risk for BSI who might benefit most from new, faster, etiological testing using neutrophil to lymphocyte count ratio (NLCR) and Shapiro score. METHODS: Adult patients (≥ 18 years) presenting at the emergency department (ED) with suspected BSI were prospectively included between 2014 and 2016 at Örebro University Hospital. Besides extra blood sampling, all study patients were treated according to ED routines. Electronic patient charts were retrospectively reviewed. A modified Shapiro score (MSS) and NLCR were extracted and compiled. Continuous score variables were analysed with area under receiver operator characteristics curves (AUC) to evaluate the ability of BSI prediction. RESULTS: The final cohort consisted of 484 patients where 84 (17%) had positive blood culture judged clinically significant. At optimal cut-offs, MSS (≥3 points) and NLCR (> 12) showed equal ability to predict BSI in the whole cohort (AUC 0.71/0.74; sensitivity 69%/67%; specificity 64%/68% respectively) and in a subgroup of 155 patients fulfilling Sepsis-3 criteria (AUC 0.71/0.66; sensitivity 81%/65%; specificity 46%/57% respectively). In BSI cases only predicted by NLCR> 12 the abundance of Gram-negative to Gram-positive pathogens (n = 13 to n = 4) differed significantly from those only predicted by MSS ≥3 p (n = 7 to n = 12 respectively) (p < 0.05). CONCLUSIONS: MSS and NLCR predicted BSI in the RISE cohort with similar cut-offs as shown in previous studies. Combining the MSS and NLCR did not increase the predictive performance. Differences in BSI prediction between MSS and NLCR regarding etiology need further evaluation.

Plasma Exchange: An Effective Rescue Therapy in Critically Ill Patients With Coronavirus Disease 2019 Infection.

OBJECTIVES: Infection by severe acute respiratory syndrome coronavirus-2 can induce uncontrolled systemic inflammation and multiple organ failure. The aim of this study was to evaluate if plasma exchange, through the removal of circulating mediators, can be used as rescue therapy in these patients. DESIGN: Single center case series. SETTING: Local study. SUBJECTS: Four critically ill adults with coronavirus disease 19 pneumonia that failed conventional interventions. INTERVENTIONS: Plasma exchange. Two to six sessions (1.2 plasma volumes). Human albumin (5%) was used as the main replacement fluid. Fresh frozen plasma and immunoglobulins were administered after each session to avoid coagulopathy and hypogammaglobulinemia. MEASUREMENTS AND MAIN RESULTS: Serum markers of inflammation and macrophage activation. All patients showed a dramatic reduction in inflammatory markers, including the main cytokines, and improved severity scores after plasma exchange. All survived to ICU admission. CONCLUSIONS: Plasma exchange mitigates cytokine storm, reverses organ failure, and could improve survival in critically ill patients with coronavirus disease 2019 infection.

Cloning, Expression, Characterization and Immobilization of a Recombinant Carboxylesterase from the Halophilic Archaeon, Halobacterium salinarum NCR-1.

Only a few halophilic archaea producing carboxylesterases have been reported. The limited research on biocatalytic characteristics of archaeal esterases is primarily due to their very low production in native organisms. A gene encoding carboxylesterase from Halobacterium salinarum NRC-1 was cloned and successfully expressed in Haloferax volcanii. The recombinant carboxylesterase (rHsEst) was purified by affinity chromatography with a yield of 81%, and its molecular weight was estimated by SDS-PAGE (33 kDa). The best kinetic parameters of rHsEst were achieved using p-nitrophenyl valerate as substrate (KM = 78 µM, kcat = 0.67 s-1). rHsEst exhibited great stability to most metal ions tested and some solvents (diethyl ether, n-hexane, n-heptane). Purified rHsEst was effectively immobilized using Celite 545. Esterase activities of rHsEst were confirmed by substrate specificity studies. The presence of a serine residue in rHsEst active site was revealed through inhibition with PMSF. The pH for optimal activity of free rHsEst was 8, while for immobilized rHsEst, maximal activity was at a pH range between 8 to 10. Immobilization of rHsEst increased its thermostability, halophilicity and protection against inhibitors such as EDTA, BME and PMSF. Remarkably, immobilized rHsEst was stable and active in NaCl concentrations as high as 5M. These biochemical characteristics of immobilized rHsEst reveal its potential as a biocatalyst for industrial applications.

Assessment of quadriceps muscle mass by ultrasound in the postoperative period of cardiac surgery.

BACKGROUND: Patients undergoing cardiac surgery are exposed to many factors that activate catabolic and inflammatory pathways, which affect skeletal muscle and are, therefore, related to unfavorable hospital outcomes. Given the limited information on the behavior of muscle mass in critically ill patients, the objective of this study was to evaluate the impact on quantitative and qualitative measurements of quadriceps muscle mass using ultrasound after cardiac surgery. To accomplish this, a prospective, descriptive, and correlational study was conducted at a tertiary care hospital. Quadriceps muscle mass was evaluated via ultrasound in 31 adult patients in the postoperative period of cardiac surgery, with daily follow-up until postoperative day 7, as well as an assessment of associations with negative outcomes at 28 days. RESULTS: A 16% reduction in the cross-sectional area of the rectus femoris was found (95% CI 4.2-3.5 cm2; p 0.002), as well as a 24% reduction in the pennation angle of the rectus femoris (95% CI 11.1-8.4 degrees; p: 0.025). However, changes in the thickness of the rectus femoris, vastus internus, vastus lateralis, the length of the fascicle of the vastus lateralis, the pennation angle of the vastus lateralis, the sarcopenia index, and the Hekmat score were not statistically significant. There was no significant association between quadriceps muscle mass measurements and Intensive Care Unit (ICU) length stay or 28-day mortality. CONCLUSIONS: Patients in the postoperative period of cardiac surgery evaluated by ultrasound exhibit both quantitative and qualitative changes in quadriceps muscle mass. A significant reduction in muscle mass is observed but this is not associated with unfavorable outcomes.

Management of acute renal replacement therapy in critically ill cirrhotic patients.

Renal replacement therapy (RRT) in cirrhotic patients encompasses a number of issues related to the particular characteristics of this population, especially in the intensive care unit (ICU) setting. The short-term prognosis of cirrhotic patients with acute kidney injury is poor, with a mortality rate higher than 65% in patients with RRT requirement, raising questions about the futility of its initiation. Regarding the management of the RRT itself, there is still no consensus with respect to the modality (continuous versus intermittent) or the anticoagulation required to improve the circuit life, which is shorter than similar at-risk populations, despite the altered haemostasis in traditional coagulation tests frequently found in these patients. Furthermore, volume management is one of the most complex issues in this cohort, where tools used for ambulatory dialysis have not yet been successfully reproducible in the ICU setting. This review attempts to shed light on the management of acute RRT in the critically ill cirrhotic population based on the current evidence and the newly available tools. We will discuss the timing of RRT initiation and cessation, the modality, anticoagulation and fluid management, as well as the outcomes of the RRT in this population, and provide a brief review of the albumin extracorporeal dialysis from the point of view of a nephrologist.

Reducing self-shading effects in Botryococcus braunii cultures: effect of Mg2+ deficiency on optical and biochemical properties, photosynthesis and lipidomic profile.

Microalgae biomass exploitation as a carbon-neutral energy source is currently limited by several factors, productivity being one of the most relevant. Due to the high absorption properties of light-harvesting antenna, photosynthetic cells tend to capture an excessive amount of energy that cannot be entirely channeled through the electron transfer chain that ends up dissipated as heat and fluorescence, reducing the overall light use efficiency. Aiming to minimize this hurdle, in this work we studied the effect of decreasing concentrations of Magnesium (Mg2+) on the chlorophyll a content, photosynthetic performance, biomass and lipid production of autotrophic cultures of Botryococcus braunii LB 572. We also performed, for the first time, a comparative lipidomic analysis to identify the influence of limited Mg2+ supply on the lipid profile of this algae. The results indicated that a level of 0.0037 g L-1 MgSO4 caused a significant decline on chlorophyll a content with a concomitant 2.3-fold reduction in the biomass absorption coefficient. In addition, the Mg2+ limitation caused a decrease in the total carbohydrate content and triggered lipid accumulation, achieving levels of up to 53% DCW, whereas the biomass productivity remained similar for all tested conditions. The lipidome analysis revealed that the lowest Mg2+ concentrations also caused a differential lipid profile distribution, with an enrichment of neutral lipids and an increase of structural lipids. In that sense, we showed that Mg2+ limitation represents an alternative optimization approach that not only enhances accumulation of neutral lipids in B. braunii cells but also may potentially lead to a better areal biomass productivity due to the reduction in the cellular light absorption properties of the cells.

Geometrical structure data of nanoporous carbon systems obtained from computer simulated pyrolysis.

This article contains data on nanoporous carbon materials coming from lignocellulosic components. Such data is directly related to the research paper "Insights into the design of carbon electrodes coming from lignocellulosic components pyrolysis with potential application in energy storage devices: A combined in silico and experimental study" [1]. In this work, the geometrical parameters of nanoporous carbon systems were found with Molecular Dynamics (MD) simulations at the ReaxFF level. The tridimensional structures of such carbon systems are given in Cartesian coordinates. They were computed at different heating rates, simulating the conditions observed in pyrolysis processes of Agave angustifolia leaves, which were carried out in a solar furnace. Nanoporous carbon systems are characterized with radial distribution functions (RDF) and ring distribution profiles.

Photoluminescence spectrum using DFT for double-walled carbon nanotubes with metallic constituents.

A theoretical study of the photoluminescence (PL) of double-walled carbon nanotubes (DWCNTs) using density functional theory (DFT) theory is reported in this work. The DWCNTs are of the armchair/armchair type and the structures studied have the arrangements (3,3)/(2,2), (8,8)/(4,4), (12,12)/(6,6), (16,16)/(8,8), (6,6)/(3,3), (10,10)/(5,5), (14,14)/(7,7), and (18,18)/(9,9). The PL spectra were obtained taking into account different DWCNT axial lengths ranging from 0.49 nm ≤ L ≤ 2.33 nm and their inner nanotube diameters in the range of 0.31 ≤ Dinn ≤ 1.22 nm; variations in their inter-wall separations were also considered, 0.18 ≤ Dinw ≤ 0.61 nm. Although the DWCNTs have metallic SWCNT constituents, such structures give rise to photoluminescence due mainly to both curvature effects and inter-wall interaction of the inner and outer nanotubes; these two factors modify significantly their electronic structure; besides, they also lead to these structures to exhibit the quenching effect. We realized calculations at a DFT level in which we used the generalized gradient approximation (GGA) to establish the molecular geometries and the fundamental state energies. To obtain the results of the PL spectra, the constituent SWCNTs were optimized in their ground state, with the hybrid function CAM-B3LYP, which is a mixed functional exchange and correlation, and the base set that was used is the 6-31G.

Impact of multiple sclerosis on quality of life: Comparison with systemic lupus erythematosus.

OBJECTIVE: To report the impact of multiple sclerosis (MS) on patients' quality of life (QoL) compared to systemic lupus erythematosus (SLE) using the 36-Item Short Form (SF-36) health questionnaire in Argentina. PATIENTS AND METHODS: Cross-sectional study. All consecutive MS patients, SLE and healthy controls (HC) were included. Demographics, clinical and radiological aspects, EDSS and SF-36 were assessed. RESULTS: A total of 191 subjects were included (MS=74, SLE=30 and HC=87). When we compared, using 2 standard deviations below the normal mean, the SF-36 subscales scores between MS and SLE, we found that MS patients experienced significant deterioration in general health (p<0.0001), vitality (p=0.009), current health (p<0.0001) and previous year health perception (p=0.003). Additional evaluated areas did not show significant differences. MS patients scored significantly lower in all categories compared to HC, except for bodily pain. An inverse correlation between EDSS and SF-36 total (R2=0.59, ß -11.08, p<0.0001) and subscale scores was observed after applying regression analysis. CONCLUSION: MS behaves as a systemic disease from the functional point of view. Patient-reported QoL scales scores provide comprehensive additional prognostic information beyond the EDSS score. Therefore, adding the SF-36 questionnaire in clinical practice might be useful for the assessment and follow-up of MS patients.

Transformation of Brewery Subproducts into Valuable Biomass Using Mixotrophic Culture of Chlorella pyrenoidosa and Associated Bacteria

Abstract To develop a biorefinery concept applied in the brewery industry, Chlorella pyrenoidosa and a consortium of associated bacteria were cultivated mixotrophically in a continuous photobioreactor using brewery low-value subproducts as an integrative process. Beer production residues were biochemically characterized to assess the most promising options to be used as a nutrient source for microalgal cultivation. Due to its physical and chemical properties, pre-treated weak wort was used to prepare an organic complex culture medium for microalgal biotransformation. Filtration and nitrogen supplementation were necessary to improve nutrient removal and biomass productivity. Maximal removal of nitrate and phosphate obtained were 90% and 100% respectively. Depending on operation conditions, total carbohydrates depuration ranged from 50 - 80%. The initial concentration of total carbohydrates of the weak wort must be adjusted to 2 - 4g/L to maintain a stable equilibrium between microalgal and bacterial growth. The biochemical composition of produced biomass varied depending on the cultivation conditions as well as on its final use. Upon continuous mixotrophic conditions evaluated in this study, C. pyrenoidosa was composed mainly of carbohydrates and protein.

Cladistic Analysis of the Briza Complex (Poaceae, Poeae).

The Briza complex comprises 23 species from South America, Mesoamerica and Europe. They constitute a monophyletic group because of the tendency of the spikelets to be dorsiventrally compressed. A cladistic analysis of the complex was performed using 32 characters from morphology. The terminal taxa were the species of the genera Briza, Calotheca, Microbriza, Poidium and Rhomboelytrum. Dactylis and Arrhenatherum were chosen to root the cladograms. Results of the cladistic analysis of the complex provide support for the ideas of Nicora and Rugolo (1981, Darwiniana 23(1), 279-309): Briza, Calotheca, Microbriza, Poidium and Rhomboelytrum are supported as monophyletic groups. Within Briza, only the Chascolytrum group appears monophyletic, while the Briza and Uniolae groups are paraphyletic. Poidium ambiguum, sometimes placed in Poa, is considered here as Poidium.

Técnicas de trasplante hepático usadas en el manejo del carcinoma renal de células claras con trombos en la cava inferior que ascienden hasta el diafragma: serie de casos / Liver transplant techniques used in the management of clear renal cell carcinoma with thrombi in the inferior vena cava that ascend to the diaphragm: case series

Introducción. El carcinoma de células renales corresponde al 3 % de todos los tumores sólidos y, de ellos, cerca del 10 % tiene compromiso de la vena cava inferior. La nefrectomía con trombectomía es la mejor alternativa con intención curativa. La mortalidad perioperatoria se encuentra entre el 2 y el 11 %. El objetivo del presente estudio fue presentar una serie de casos de carcinomas renales con trombos de tipo III según la clasificación de Neves-Zincke, en los cuales se usaron con éxito técnicas del trasplante hepático para su extracción.Materiales y métodos. Se presenta una serie de cinco casos, de pacientes sometidos a nefrectomía radical y que presentaban trombo de la vena cava inferior, atendidos en el periodo comprendido entre enero de 2012 y septiembre de 2018.Resultados. De 26 pacientes encontrados con cáncer de células renales, se seleccionaron cinco con trombos de tipo Neves III, cuatro de ellos de tipo IIIa y uno de tipo IIIc. El promedio de edad fue de 63,2 años, cuatro mujeres y un hombre. El promedio de tiempo operatorio fue de 274 minutos y el de pinzamiento de la vena cava inferior fue de 13,6 minutos. El tiempo promedio de estancia en la unidad de cuidados intensivos fue de 2,8 días y el de estancia hospitalaria fue de 9,6 días. Un paciente no presentó ninguna complicación, y los cuatro restantes presentaron complicaciones quirúrgicas menores, I y II de la clasificación de Clavien-Dindo.Conclusión. El uso de maniobras técnicas del trasplante hepático para extraer trombos de la vena cava inferior que no comprometen la aurícula derecha en pacientes con tumores renales, es una alternativa segura con baja morbimortalidad perioperatoria y que puede llegar a garantizar el control de la enfermedad a largo plazo

Introduction. Renal cell carcinoma corresponds to 3% of all solid tumors and about 10% have IVC thrombus. Nephrectomy with thrombectomy is the best choice for a curative treatment. Perioperative mortality may vary between 2 and 11%. The aim of this study is to describe a series of patients with renal tumors and IVC thrombus Neves III in treated succesfully with liver transplant techniques.Materials and methods. We conducted a descriptive case series of five patients who underwent nephrectomy and thrombectomy between January 2012 and September 2018.Results. Of 26 nephectomized patients who had any IVC thrombus, five cases had renal tumors and thrombus Neves III. The mean age was 63.2 years and 80% were women. Eighty percent were Neves IIIa. Mean operative time and IVC clamping were 274 and 13.6 minutes respectively. ICU and hospital stay were 2.8 and 9.6 days. Twenty percent of patients had no complications, the rest had minor complications (Clavien-Dindo I and II).Conclusion. IVC thrombus extraction with liver transplantion technique for renal tumors without right atrium involvement is a safe alternative for patients with low morbility and mortality. It is also a feasible alternative to ensure disease control in a long term

Evaluación financiera de la industria de fabricación de papel, cartón y derivados en Colombia 2010-2015 / Financial evaluation of the paper, cardboard and derivative manufacturing industry in Colombia 2010-2015 / Avaliação financeira da Indústria de fabricação de papel, cartão e produtos em Colombia 2010-2015

RESUMEN Este artículo tiene como propósito evaluar el desempeño financiero de la industria de fabricación de papel, cartón y derivados en Colombia en el período 2010-2015, mediante un análisis de los indicadores contables y de gestión del valor que miden su crecimiento, eficiencia, eficacia y efectividad. Se encuentra que esta industria genera rentabilidades contables en casi todos los años, menos en el 2014; y que el comportamiento de su efectividad depende en orden de importancia a la eficacia en el control de costos y gastos, a la eficiencia del uso de los recursos, quedando como tercer factor el apalancamiento financiero; no obstante, en cada año se destruye valor económico agregado (EVA), y su valor de mercado agregado (VMA) es negativo. Esta industria es destructora de valor porque la rentabilidad del activo neto operacional es inferior al costo de capital, donde la rentabilidad es creciente, con una caída considerable en el 2014, y el costo de capital oscilante. Esto contrasta con el sector homólogo en Estados Unidos de América donde se crea valor en cinco años, con rentabilidades del activo neto operacional superior y costo de capital inferior a la de Colombia. Los resultados encontrados podrían complementarse con estudios similares para grupos de empresas más homogéneos en cuanto a la edad, tamaño y ubicación geográfica. CÓDIGOS JEL G10, M40, L73

ABSTRACT The purpose of this paper is to evaluate the financial performance of the paper paperboard and derivatives industry in Colombia in the period 2010-2015, through an analysis of accounting and value management indicators that measure growth, efficiency, efficacy and effectiveness. It is found that this industry generates accounting returns in almost every year less in 2014; and that the behavior of its effectiveness depends in order of importance to the efficacy in the control of costs and expenses, to the efficiency of the use of resources, leaving as a third factor the financial leverage; however aggregate economic value (EVA) is destroyed each year and its aggregate market value (VMA) is negative. This industry is a value-destroyer because the profitability of net operating assets is lower than the cost of capital, where profitability is increasing, with a considerable drop in 20l4, and the cost of oscillating capital. This contrasts with the counterpart sector in the United States of America where value is created in five years, with higher net operating income and lower capital cost than Colombia. The results found could be complemented with similar studies for groups of companies more homogeneous in age, size and geographical location. JEL CLASSIFICATION G10, M40, L73

RESUMO O objetivo deste artigo é avaliar o desempenho financeiro da indústria de papel, papelão e derivados na Colômbia no período 2010-2015, através de uma análise dos indicadores contábeis e de gestão de valor que medem seu crescimento, eficiência, eficácia e efetividade Verifica-se que esta indústria gera retornos contábeis quase todos os anos, exceto em 2014; e que o comportamento de sua efetividade depende, por ordem de importância, da eficácia no controle de custos e despesas, na eficiência do uso de recursos, com alavancagem financeira como terceiro fator; no entanto, em cada ano, o valor econômico agregado (EVA) é destruído e seu valor agregado de mercado (VMA) é negativo. Essa indústria é uma destruidora de valor porque o retorno sobre os ativos operacionais líquidos é menor do que o custo de capital, onde a lucratividade está aumentando, com uma queda considerável em 2014, e o custo do capital flutua. Isso contrasta com o setor de contrapartida nos Estados Unidos da América, onde o valor é criado em cinco anos, com retornos sobre ativos operacionais líquidos e custos de capital inferiores aos da Colômbia. Os resultados encontrados poderiam ser complementados por estudos semelhantes para grupos de empresas que são mais homogêneas em termos de idade, tamanho e localização geográfica. CLASSIFICAÇÕES JEL G10, M40, L73