Miracle-dz/UniFAR-FTUs huggingface dataset:
Hypoglycemia is associated with intensive care unit mortality*

Objective:The implementation of intensive insulin therapy in the intensive care unit is accompanied by an increase in hypoglycemia. We studied the relation between hypoglycemia on intensive care unit mortality, because the evidence on this subject is conflicting. Design:Retrospective database cohort study. Setting:An 18-bed medical/surgical intensive care unit in a teaching hospital (Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands). Patients:A total of 5961 patients admitted to from 2004 to 2007 were analyzed. Readmissions and patients with a withholding care policy or with hypoglycemia on the first glucose measurement were excluded. Patients were treated with a computerized insulin algorithm (target glucose range, 72-126 mg/dL). Interventions:None. Measurements and Main Results:All first episodes of hypoglycemia (glucose ≤45 mg/dL) were derived from 154,015 glucose values. Using Poisson regression, the incidence rates for intensive care unit death and incidence rate ratio comparing exposure and nonexposure to hypoglycemia were calculated. Patients were considered to be exposed to hypoglycemia from the event until the end of intensive care unit admittance. We corrected for severity of disease using the daily Sequential Organ Failure Assessment score. Age, sex, cardiothoracic surgery, sepsis, and diabetes mellitus were also included as possible confounders. Two hundred eighty-eight (4.8%) patients experienced at least one episode of hypoglycemia. Median age was 68 yrs (range, 58-75 yrs), 66% were male, and 6.4% died in the intensive care unit. The incidence rate of death in patients exposed to hypoglycemia was 40 per 1000 intensive care unit days compared with 17 per 1000 intensive care unit days in patients without exposure. The adjusted incidence rate ratio for intensive care unit death was 2.1 (95% confidence interval, 1.6-2.8; p < .001). Conclusions:Hypoglycemia is related to intensive care unit mortality, also when adjusted for a daily adjudicated measure of disease severity, indicating the possibility of a causal relationship.
Preview : Published ahead of advance online publication Diet and exercise interventions for pediatric cancer patients during therapy : Tipping the scales for better outcomes

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Systematic review of physical and chemical compatibility of commonly used medications administered by continuous infusion in intensive care units

Objective:To quantify the physical and chemical stability data published for commonly used continuously infused medications in the intensive care unit and to evaluate the quality of the studies providing these data. Data Sources and Study Selection:We conducted a systematic electronic literature search of MEDLINE, EMBASE, and International Pharmaceutical Abstracts as well as the references of electronic drug compatibility textbooks for all English and French language research publications evaluating the physical compatibility or chemical stability of the 820 possible two-drug combinations of 41 commonly used drugs in an adult intensive care unit. Data Extraction and Synthesis:A total of 93 studies comprised of 86 (92%) studies evaluating physical compatibility and 35 (38%) studies evaluating chemical compatibility of at least one drug combination of interest were included. Physical and/or chemical compatibility data exist for only 441 of the possible 820 two-drug combinations (54%), whereas chemical compatibility data exist for only 75 (9%) of the possible combinations. Of the 441 combinations for which compatibility data are available, 67 (15%) represent incompatible combinations and 39 (9%) had conflicting data in which both compatible and incompatible data were identified. Conclusions:Physical compatibility studies that provide the basis for y-site compatibility are lacking for commonly used medications in intensive care unit patients and may contribute to unsafe medication practices. Furthermore, the heterogeneity in the methodology of these studies likely contributes to the common finding of conflicting data for specific combinations of drugs. Future studies should apply similar methodologic and reporting principles to be able to reproduce and compare outcomes both clinically and in the laboratory.
Evaluation of oxygen consumption during field exercise tests in Standardbred trotters

Reasons for performing the study : In human exercise physiology, the current gold standard for evaluating aerobic capacity is the measurement of oxygen consumption (VO 2 ) and maximal oxygen uptake (VO 2max ). The evaluation of VO 2 in horses is performed in some laboratories equipped with a treadmill but has only been exceptionally reported in field conditions because of the lack of adapted equipment. Objectives : The aim of this study was (1) to assess the feasibility of VO 2 measurement on the track using a recently validated portable breath-by-breath gas analyser system adapted to horses (Cosmed K4b 2® and Equimask ® ), (2) to compare these results with those obtained during a treadmill exercise test and (3) to study correlations between VO 2 and physiological parameters usually measured in field condition such as heart rate (HR), lactataemia (LA) and the speed at which HR equals 200 beats per minute (bpm) (V200) or LA 4 mmol l − 1 (VLA4). Methods : Five healthy Standardbred trotters in training were submitted to two stepwise incremental exercise tests, one driven on the racetrack and the other on a high-speed treadmill with a 4% incline. Speed (v), HR, ventilatory parameters and VO 2 were continuously recorded throughout the duration of the tests and LA was evaluated after each step. Results : All horses completed the test satisfactorily after an initial acclimatization to the mask. There were marked individual differences in ventilatory strategy, and breathing frequency (Rf) at the higher levels of exercise was noticeably low. The VCO 2 measurements were incoherent. There were no significant differences between track and treadmill maximal data obtained during the last step [VO 2peak (track: 139.9 ± 8.9 ml kg − 1 min − 1 ; treadmill: 139.9 ± 13.4 ml kg − 1 min − 1 ), LA max (track: 6.5 ± 1.6 mmol l − 1 ; treadmill: 7.3 ± 3.0 mmol l − 1 ), HR max (track: 229 ± 6.2 bpm; treadmill: 222 ± 13 bpm)], although the maximal speed required to reach similar workloads was significantly higher on the track (11.9 ± 0.6 m s − 1 vs. 9.7 ± 0.4 m s − 1 ). The correlation between VO 2 and HR ( r = 0.87; P 2 and LA ( r = 0.75; P 2peak and HR max , LA max , V200 or VLA4. Conclusions : This is the first report of a practical portable system to measure VO 2 and ventilation continuously during high-speed field exercise tests. However, current mask design markedly influences ventilation and could have prohibited the attainment of VO 2max . Furthermore, consistent VCO 2 measurements should be implemented by the manufacturers. Potential relevance : Continuous breath-by-breath ventilation and VO 2 measurements can be recorded in horses in the field at submaximal levels. With necessary adaptations to the system entailed, this study opens new perspectives in the analysis of physiological and metabolic mechanisms of exercise in the equine species in genuine track conditions.
Systematic review of reviews including animal studies addressing therapeutic interventions for sepsis*

Objective:Certain methodologic features of animal experiments such as random assignment have been found to reduce the risk of bias. Because animal research sometimes informs clinical practice, explicit acknowledgment of the risk of bias and clinical relevance cultivates realistic expectations on the part of clinicians reading preclinical studies. We assessed literature reviews of therapeutic interventions for sepsis that include animal experiments for explicit appraisals of the risk of bias and clinical relevance. Data Sources:MEDLINE and EMBASE. Study Selection:Systematic reviews or meta-analyses of animal experiments focusing on therapeutic interventions for sepsis. Data Extraction:In teams of two, reviewers independently screened citations and abstracted data. We determined whether the reviews systematically incorporated critical appraisals for the risk of bias and clinical relevance of the underlying studies as well as explicit extrapolations from preclinical research to human patients. Data Synthesis:From 164 citations, we retained 45 reviews. Chance-corrected agreement for inclusion was moderate (&kgr; 0.57). Three (7%) met our criteria for a systematic review and one (2%) systematically appraised the risk of bias and the clinical relevance of the primary animal experiments. Thirty-six (80%) were narrative reviews addressing issues related to diverse topics such as pathophysiology and diagnosis as well as multiple therapies and 40 of 45 (89%) included both clinical and animal studies. Twelve (27%) explicitly assumed that data from preclinical studies could apply to human patients. Conclusions:Although a significant proportion of reviews extrapolated preclinical study results to human patients, most did not systematically appraise the risk of bias or the clinical relevance of preclinical research. Because animal experiments may influence clinical practice, we propose a framework to enhance these features in future reviews of preclinical research.
Intracranial pressure following resuscitation with albumin or saline in a cat model of meningitis*

Objective:To compare the intracranial pressure after resuscitation to normovolemia by using 20% albumin or normal saline in a cat model of meningitis. Design:Prospective, randomized animal study. Setting:University hospital laboratory. Subjects:Twenty adult, male cats. Interventions:Meningitis was induced by intrathecal injection of Escherichia coli-derived lipopolysaccharide (0.8 × 106 units/kg). Four hours after the lipopolysaccharide injection, the animals were randomized to intravenous treatment with 0.4 mL/kg/hr of 20% albumin or 7.5 mL/kg/hr of 0.9% sodium chloride for 6 hrs (n = 7 per group). A control group receiving lipopolysaccharide but no fluid was also studied (n = 6). Measurements and Main Results:Effects on intracranial pressure, mean arterial pressure, plasma volume (125I-albumin technique), plasma oncotic pressure, and brain metabolism via cerebral interstitial lactate/pyruvate ratio and glycerol and glucose levels (microdialysis technique) were evaluated. Plasma volume decreased by approximately 20% and intracranial pressure increased from 10 to approximately 20 mm Hg at 4 hrs after the lipopolysaccharide injection. Six hours later, plasma volume had returned to baseline in both fluid groups while there was a further reduction in the control group. Intracranial pressure was higher in the saline group than in the albumin and control groups and was 25.8 ± 2.8 mm Hg, 18.3 ± 0.6 mm Hg, and 20.4 ± 1.7 mm Hg, respectively. Plasma oncotic pressure was higher in the albumin group than in the saline and control groups. Mean arterial pressure and microdialysis data were within normal range and did not differ among the groups. Conclusions:The results showed that the choice of resuscitation fluid may influence intracranial pressure in meningitis. The lower intracranial pressure in the colloid group may be explained by a higher plasma oncotic pressure and less fluid distribution to the brain interstitium.
Regional citrate anticoagulation in patients with liver failure supported by a molecular adsorbent recirculating system*

Objective:Regional citrate anticoagulation has emerged as a promising method in critically ill patients at high risk of bleeding. However, in patients with liver failure, citrate accumulation may lead to acid-base and electrolyte imbalances, notably of calcium. The aim of this study was to evaluate the feasibility and safety of regional citrate anticoagulation during liver support using a molecular adsorbent recirculating system as well as its effects on electrolyte and acid-base balance in patients with liver failure. Design:Prospective observational study. Setting:University hospital. Patients:Twenty critically ill patients supported by molecular adsorbent recirculating system resulting from liver failure between January 2007 and May 2009. Measurements and Main Results:The median duration of molecular adsorbent recirculating system treatment was 20 hrs (interquartile range, 18−22 hrs). Two of 77 molecular adsorbent recirculating system treatments (2%) were prematurely discontinued as a result of filter clotting and bleeding, respectively. The median citrate infusion rate, necessary to maintain the postfilter ionized calcium between 0.2 and 0.4 mmol/L, was 3.1 mmol/L (interquartile range, 2.3–4 mmol/L) blood flow. The median calcium chloride substitution rate was 0.9 mmol/L (0.3–1.7 mmol/L) dialysate. Total serum calcium remained stable during molecular adsorbent recirculating system treatments. There was a statistically significant increase of the ratio of total calcium to systemic ionized calcium (2.04 ± 0.32 mmol/L to 2.17 ± 0.35; p = .01), which reflected citrate accumulation resulting from liver failure. Under close monitoring, no clinically relevant electrolytes or acid-base disorders were observed. Conclusions:Our results suggest that regional citrate anticoagulation is a safe and feasible method to maintain adequate circuit lifespan without increasing the risk of hemorrhagic complications while maintaining a normal acid-base as well as electrolyte balance in patients with liver failure supported by molecular adsorbent recirculating system.
A tool for the educational study of manufacturing systems

In this article, a new application for teaching manufacturing systems is presented. A manufacturing system can be considered as a discrete‐event system constructed from devices that have a finite speed of operation. This application automatically simulates the manufacturing systems modelled by timed and stochastic Petri nets (PNs) with additional extensions that easily make possible to get specific information. The graphical model generated provides the necessary data to execute an event‐driven language programme that simulates the model and provides results. From the student's point of view, the problem is only to draw the PN accordingly with the characteristics of the system to be modelled and to get the information without noticing the underlying event‐driven language programme. © 2009 Wiley Periodicals, Inc. Comput Appl Eng Educ 18: 130–143, 2010; Published online in Wiley InterScience (www.interscience.wiley.com); DOI 10.1002/cae.20189
Bypassing The Cuffing Effect In Adult Hypospadias Surgery Diversion

Introduction Urethral stents are frequently used for urinary diversion after hypospadias surgery. The foley catheter is not generally preferred, for the formation of a ‘cuff ’ on deflation of the balloon of all foley catheters that causes difficulty in removal (cuffing effect of balloon). In the literature, there is not comprehensive study on the usage of foley catheter for adult hypospadias surgery. We have recently been using the modified foley catheter that we designed in our patients. In this study, we aim to compare the results of no-balloon catheter (nelaton catheter) and modified foley catheter usage after TIPU operations in adults. Patients and methods The medical records of 53 adult patients who applied TIPU for subcoronal or midpenile hypospadias between November 2008 and September 2012 were evaluated retrospectively. Patients were evaluated in two groups based on the performed urinary diversion. Group 1 was composed of 29 patients to whom 16 F nelaton catheter was used for urinary diversion between November 2008-December 2010, whereas Group 2 consisted of 24 patients to whom 12 F foley catheter coated by 16 F nelaton catheter by half was used for urinary diversion between February 2011 – September 2012. Results There was no statistically significant difference between Group 1 and Group 2 in terms of age, the location of the mea, the number of secondary cases, the length of the neourethra, fistula and urethral stricture (p>0.05). Surgery success rate was 79.3% in Group 1 and 79.1% in Group 2 (p>0.05). At the 6th month follow-up, no statistically significant difference was found between two groups regarding fistula and urethral stricture. In terms of postoperative patient comfort, Group 2 were better than Group 1 (p
Stretching: Acute and Chronic? The Potential Consequences

summary Stretching is commonly used by many athletes in different sports. Although acute stretching, as part of a warm-up, can enhance range of motion, it may also reduce performance. Acute stretching can reduce peak force, rate of force production, and power output. Chronic stretching may enhance performance, although the mechanism is unclear. Acute stretching has little effect on injury. However, chronic stretching (not part of warm-up) may have some injury reduction potential.
The evaluation of the ability of closed-loop glycemic control device to maintain the blood glucose concentration in intensive care unit patients*

Objectives:Reduction in the variability of blood glucose concentration might be an important aspect of blood glucose management. A closed-loop glycemic control device (STG-22; NIKKISO, Tokyo, Japan) has been developed to maintain blood glucose levels within the target range through automatic infusion of insulin and glucose. We hypothesized that the STG-22 system could provide optimal blood glucose management without causing hypoglycemic events in patients admitted to intensive care units. In this study, we investigated the feasibility of glycemic control with the STG-22 system. Furthermore, we evaluated the variability in blood glucose concentration associated with the use of the STG-22 system. Design:Retrospective analysis. Setting:A five-bed medical/surgical intensive care unit in a university hospital. Patients:Two hundred eight patients admitted to the intensive care unit between August 2006 and July 2009. Interventions:None. Measurements and Main Results:We calculated the mean and sd of blood glucose concentrations in each patient during intensive insulin therapy (target range, 90–110 mg/dL) administered using STG-22. In addition, to evaluate the blood glucose control achieved using STG-22, the durations for which the blood glucose level was maintained at 70–110 mg/dL, 110–150 mg/dL, 150–180 mg/dL, and >180 mg/dL were calculated. The average operation time of STG-22 was 33.9 ± 42.4 hrs. The blood glucose level was maintained at 70–110 mg/dL for 49.5% of the study period; the corresponding values for 110–150 mg/dL, 150–180 mg/dL, and >180 mg/dL were 31.4%, 7.0%, and 6.9%, respectively. No hypoglycemic events occurred. The sd of blood glucose levels was 19.9 ± 10.9 mg/dL. After a level of 150 mg/dL was achieved, the sd of blood glucose was 12.6 ± 3.1 mg/dL. Conclusions:STG-22 can help maintain optimal blood glucose levels without causing hypoglycemia in patients admitted to the intensive care unit. In addition, the use of this device might help decrease the variability in blood glucose concentration. Further randomized clinical trials are required to elucidate whether the low glucose variability maintained using STG-22 can contribute to improving the outcomes of patients admitted to the intensive care unit.
THE RISK OF PROSTATE CANCER AMONGST SOUTH ASIAN MEN IN SOUTHERN ENGLAND: THE PROCESS COHORT STUDY

J O U R N A L C O M P I L A T I O N © 2 0 0 9 B J U I N T E R N A T I O N A L | 1 0 3 , 5 5 3 – 5 5 5 | doi:10.1111/j.1464-410X.2009. 08395.x 5 5 3 Asian men in southern England: the PROCESS cohort study. BJU Int 2008; 102 : 1407–12 2 Rastogi T, Devesa S, Mangtani P et al. Cancer incidence rates among South Asians in four geographic regions: India, Singapore, UK US. Int J Epidemiol 2008; 37 : 147–60 3 Stewart BW and Kleihues P, eds. World Cancer Report . Lyon: IARC Press, 2003 4 Martin FL, Grover PL. The initiation of breast and prostate cancer. Carcinogenesis 2002; 23 : 1095–102 5 Ben-Shlomo Y, Evans S, Ibrahim F et al. The risk of prostate cancer amongst Black Men in the United Kingdom: The PROCESS cohort study. Eur Urol 2008; 53 : 99–105
A modular virtual reality system for engineering laboratory education

The globalization trend has affected the tertiary education sector, resulting in an increased flow of both students and academics across borders. Economic pressures on universities and the emergence of new technologies have spurred the creation of new systems in engineering education. The recent advances in computer graphics have exposed great potential in education at all levels. The Virtual Reality (VR) is a promising technology which aims to assist the students in the visualization of concepts and to provide immediate graphical feedback during the learning process. This article presents a modular interactive teaching package, called Virtual Learning System (VLS), which can be used by people with little prior computer experience. VLS provides a comprehensive and conductive yet dynamic and interactive environment that can be incorporated into various courses in the field of Mechanical and Manufacturing Engineering. The evaluation of the learning process with the developed system has been done through laboratory reports, lab quizzes and questionnaires implemented with a tutorial monitoring application. © 2009 Wiley Periodicals, Inc. Comput Appl Eng Educ 19: 305–314, 2011
Preclinical evaluation of epinephrine nebulization to reduce airway hyperemia and improve oxygenation after smoke inhalation injury*

Objective:Acute lung injury secondary to smoke inhalation is a major source of morbidity and mortality in burn patients. We tested the hypothesis that nebulized epinephrine would ameliorate pulmonary dysfunction secondary to acute lung injury by reducing airway hyperemia and edema formation and mediating bronchodilatation in an established, large animal model of inhalation injury. Design:Prospective, controlled, randomized trial. Setting:University research laboratory. Subjects:Twenty-four chronically instrumented, adult, female sheep. Interventions:Following baseline measurements, the animals were allocated to a sham-injured group (n = 5), an injured and saline-treated group (n = 6), or an injured group treated with 4 mg of nebulized epinephrine every 4 hrs (n = 6). Inhalation injury was induced by 48 breaths of cotton smoke. The dose of epinephrine was derived from dose finding experiments (n = 7 sheep). Measurements and Main Results:The injury induced significant increases in airway blood flows, bronchial wet/dry weight ratio, airway obstruction scores, ventilatory pressures, and lung malondialdehyde content, and contributed to severe pulmonary dysfunction as evidenced by a significant decline in Pao2/Fio2 ratio and increase in pulmonary shunt fraction. Nebulization of epinephrine significantly reduced tracheal and main bronchial blood flows, ventilatory pressures, and lung malondialdehyde content. The treatment was further associated with significant improvements of Pao2/Fio2 ratio and pulmonary shunting. Conclusions:Nebulization of epinephrine reduces airway blood flow and attenuates pulmonary dysfunction in sheep subjected to severe smoke inhalation injury. Future studies will have to improve the understanding of the underlying pathomechanisms and identify the optimal dosing for the treatment of patients with this injury.