24-h Period Research Articles

Interleukin-12 modulates sleep–wake activity and improves performance in a memory task

Abstract Background Cytokines, known for their pro- and anti-inflammatory roles, are also key regulators of sleep–wake cycles. Classical pro-inflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α), are associated with increased sleep, particularly slow-wave sleep (SWS), while anti-inflammatory cytokines, like interleukin-10 (IL-10), generally reduce sleep duration. Given the essential role of sleep in memory consolidation, this study aimed to investigate whether interleukin-12 (IL-12), a pro-inflammatory cytokine, could increase sleep duration following a memory acquisition task and subsequently improve memory performance. Male Swiss mice were surgically implanted with electrodes for electrocorticogram (ECoG) and electromyogram (EMG) recordings to track their sleep–wake cycles. After a recovery period, baseline sleep–wake activity was recorded. The mice were then randomly assigned to two groups and treated with either IL-12 (0.5 µg, i.p.) or a phosphate-buffered saline (PBS, i.p.) control, administered immediately before the multiple-trial inhibitory avoidance (MTIA) task, a behavioral test used to assess memory performance. Following the memory acquisition session, sleep–wake activity was immediately recorded for a continuous 24-h period. Results Mice treated with IL-12 exhibited longer latency to cross into the dark compartment during the MTIA test, indicating improved memory retention compared to the control group. Interestingly, this improved performance was associated with prolonged wakefulness, particularly in the first three hours after task acquisition. Conclusion The study shows that IL-12 can improve memory retention through prolonged wake episodes rather than increased sleep. This finding challenges the conventional understanding that sleep is the primary state for memory consolidation, suggesting that under specific conditions, wakefulness may also play a key role in supporting memory processes. Further research is needed to explore the underlying mechanisms of IL-12's cognitive effects.

Appropriateness of intravenous fluid prescriptions in hospitalised patients: a point prevalence study.

Inappropriate use of intravenous (IV) fluids results in fluid overload, electrolyte disturbances, and increased costs. To describe IV fluid prescribing and its appropriateness in hospitalised patients. A point prevalence study was conducted at two sites (academic and general) of a tertiary care hospital in Belgium. All inpatients (except those in the operating theatre) and all IV fluids prescribed during a 24-h period were analysed. Data collected included type, rate and volume administered. Each IV fluid was classified by indication (i.e., resuscitation/replacement, maintenance, catheter patency management, drug administration). Appropriateness was assessed using predefined criteria and validation by attending clinicians. IV fluids were administered to 60% (297) of patients, with a median of 3 [IQR 0.5-6] IV fluid bags per patient and a median daily volume of 1000 ml [IQR 100-1550]. Amongst the 1162 IV fluid prescribed bags, 61.2% (712) were for drug administration, 22.1% (257) for catheter patency, 9.7% (112) for maintenance and 7.1% (82) for replacement/resuscitation. Inappropriate use was found for 56.9% (169) of patients with an IV fluid, representing a median volume of 300 ml per patient [IQR 10-500], and median costs of 4.60 € per patient [IQR 0.4-6.7]. Inappropriate IV fluid use is frequent in hospitalised patients, and results in significant costs. Optimisation strategies are needed.

From Tissue to System: What Constitutes an Appropriate Response to Loading?

Optimal loading involves the prescription of an exercise stimulus that promotes positive tissue adaptation, restoring function in patients undergoing rehabilitation and improving performance in healthy athletes. Implicit in optimal loading is the need to monitor the response to load, but what constitutes a normal response to loading? And does it differ among tissues (e.g., muscle, tendon, bone, cartilage) and systems? In this paper, we discuss the "normal" tissue response to loading schema and demonstrate the complex interaction among training intensity, volume, and frequency, as well as the impact of these training variables on the recovery of specific tissues and systems. Although the response to training stress follows a predictable time course, the recovery of individual tissues to training load (defined herein as the readiness to receive a similar training stimulus without deleterious local and/or systemic effects) varies markedly, with as little as 30min (e.g., cartilage reformation after walking and running) or 72h or longer (e.g., eccentric exercise-induced muscle damage) required between loading sessions of similar magnitude. Hyperhydrated and reactive tendons that have undergone high stretch-shorten cycle activity benefit from a 48-h refractory period before receiving a similar training dose. In contrast, bone cells desensitize quickly to repetitive loading, with almost all mechanosensitivity lost after as few as 20 loading cycles. To optimize loading, an additional dose (≤ 60 loading cycles) of bone-centric exercise (e.g., plyometrics) can be performed following a 4-8h refractory period. Low-stress (i.e., predominantly aerobic) activity can be repeated following a short (≤ 24h) refractory period, while greater recovery is needed (≥ 72h) between repeated doses of high stress (i.e., predominantly anaerobic) activity. The response of specific tissues and systems to training load is complex; at any time, it is possible that practitioners may be optimally loading one tissue or system while suboptimally loading another. The consideration of recovery timeframes of different tissues and systems allows practitioners to determine the "normal" response to load. Importantly, we encourage practitioners to interpret training within an athlete monitoring framework that considers external and internal load, athlete-reported responses, and objective markers, to contextualize load-response data.

October 7th 2023 mass casualty incident in southern Israel: lessons for emergency preparedness and management.

Mass Casualty Incidents (MCIs) pose significant challenges for healthcare systems. While policies are typically crafted based on past experiences, the lessons learned from each incident play a crucial role in enhancing emergency preparedness. On October 7th, 2023, Israel came under the largest terror attack in its history. During an ongoing terror attack, more than 1300 Israelis were killed, and more than 200 were abducted to Gaza. During the first day of the attack, 1457 casualties were evacuated to a hospital, approximately half of them to Soroka University Medical Center (SUMC). This MCI surpassed conventional MCI challenges, necessitating a need to face the unexpected under fire. Through a description of this extreme MCI, we delve into the challenges faced, the strategic interventions deployed to address them, and the invaluable lessons learned. Injury characteristics, severity and outcomes of casualties are presented based on the medical records of all casualties arriving to SUMC between October 7th 6:30 a.m. andOctober 8th 7:00 a.m. Data regarding patient influx, capacity and hospital resource utilization, were collected from the Patient Registration System and other hospital information systems. During the incident, a total of 673 injured arrived at SUMC within a mere 24-h period, at a peak rate of 83 injured per hour. The mean casualty age was 29.6, with male predominance. Gunshot wounds and shrapnel injuries were the dominant types of injuries. Out of the casualties arrived, about half were hospitalized or transferred to receive definitive care at other hospitals after initial care at SUMC. Mortality rate was low, at 2.9% of those admitted alive. In this article, we describe the injury characteristics and outcomes of casualties seen at SUMC on October 7th 2023, during one of the largest MCIs in history. We present a detailed overview of the challenges encountered, strategies implemented to address them and lessons learned. These insights hold global relevance, offering actionable guidance for the refinement of future emergency protocols and policies on a global scale.

The effect of restricted and free-living conditions on light exposure and sleep in older adults

ABSTRACT During the COVID-19 pandemic, studies reported that restricted living conditions were associated with worse subjective sleep quality. This effect might have been caused by reduced light exposure during lockdowns. We investigated light exposure levels, subjective and objective sleep and physical activity levels in older adults during restricted and free-living conditions after the pandemic. Ninety-one participants (62.7 ± 8.4 years) recruited from the community using social media with 44 participants (63.4 ± 8.9 years) completed follow-up during free-living conditions. Participants wore an actigraphy device and completed sleep diaries for 7 days during each condition. Light values were extracted in hourly bins across the 24-h period and objective and subjective sleep were compared between the conditions. There was an increase in mean 24-h light exposure during restricted-living (1103.7 ± 1024.8 lux) compared to free-living (803.0 ± 803.6 lux; p < 0.001). This was partially related to participants spending 18 min more in bright light conditions (>1,000 lux) during wakefulness in restricted living (2.6 ± 1.9 h) compared to free-living (2.3 ± 2.0 h; p = 0.036). Despite differences in light exposure, there were no significant differences in objective and subjective sleep parameters between the two conditions. More research is required to better understand behaviours related to light exposure and how this may impact on sleep.

High dose of liraglutide impairs renal function in female hypertensive rats.

Glucagon-like peptide-1 (GLP-1) receptor agonists exhibit beneficial cardiovascular effects. However, the renal effects of different doses of liraglutide in an essential hypertension model have not yet been investigated. SHR female rats were treated for 30 days, twice a day, with saline (control) or liraglutide at low (0.06 mg/kg, LL) and high (0.6 mg/kg, LH) doses. Volume intake and excretion were monitored for a period of 24h. In renal tissue, nitrite-NO2-, nitrate-NO3-, advanced protein oxidation products-AOPP, collagen deposition, creatinine (Cr), urea (U), sodium, and potassium were analyzed. liraglutide reduced body weight gain in both groups. However, in the high dose, it increased urinary volume excretion and sodium/potassium ratio. Both doses reduced the urinary U/Cr ratio and LH increased the serum U/Cr ratio. AOPP was reduced only in LL. LH augmented collagen and early markers of kidney injury (blood urea nitrogen-BUN, BUN/Cr). LH increased NO3-, reduced NO2-, and caused an aberrant increase in GFR. Both doses' effects were independent of blood pressure and glycemic control. liraglutide appears to have distinct effects on the hypertensive female kidney depending on the dose, with higher doses impairing kidney function.

Serum concentration threshold and risk factors of tigecycline-induced hypofibrinogenaemia in critically ill patients.

Hypofibrinogenaemia is a serious adverse reaction associated with tigecycline (TGC) therapy and may lead to the discontinuation of the treatment. This study aimed to explore the relevant factors of TGC-induced hypofibrinogenaemia and determine the thresholds of serum concentration as a predictive indicator of TGC-induced hypofibrinogenaemia. A retrospective single-centre study was conducted on patients with severe infection who were treated with TGC. Clinical data and serum concentration parameters were extracted from the electronic medical records of these patients. Patients were divided into the hypofibrinogenaemia group (< 2.0 g/L) and the normal fibrinogen group (≥ 2.0 g/L) in order to evaluate risk factors associated with TGC-induced hypofibrinogenaemia. Logistic regression analysis and receiver operating characteristic curves were utilized to identify the risk factors associated with TGC-induced hypofibrinogenaemia and to establish plasma concentration thresholds as predictive indicators. A total of 114 patients were enrolled in this study, with 59.6% experiencing hypofibrinogenaemia. The multivariate regression analysis indicated that baseline fibrinogen level, trough concentration (Cmin), peak concentration (Cmax), the concentration at 6 h after the dosing (C6h) and the area under the concentration-time curve over a 24-h period (AUC0-24) were significantly associated with hypofibrinogenaemia (P < 0.05). Furthermore, it was found that AUC0-24 is the optimal predictor of TGC-induced hypofibrinogenaemia. The optimal cut-off for the AUC0-24 of TGC in ICU patients was determined to be 17.03 mg h/L. TGC exposure is highly predictive of TGC-induced hypofibrinogenaemia. We recommend closely monitoring plasma concentrations of TGC in patients to ensure patient efficacy and safety.

Assessing the effectiveness of bio-based oil in rejuvenating aged asphalt: a comprehensive physical, rheological, chemical, and mechanical examination

The utilization of reclaimed asphalt pavement (RAP) in flexible pavement construction and rehabilitation has gained significant traction, driven by the need to conserve limited natural resources. This study explores the effectiveness of bio-based oils derived from harvested crops as rejuvenators in asphalt mixtures containing 50% RAP. Comprehensive assessments were conducted, including penetration, softening point, viscosity and ductility tests, to determine the optimal rejuvenator dosage. Additionally, evaluations of rolling thin film oven (RTFO) aging, retained penetration and ductility, equivalent softening and breaking points, plasticity temperature range, stiffness modulus, complex modulus, and phase angle were performed. Fourier-transform infrared (FTIR) spectroscopy, Marshall immersion, and moisture susceptibility tests further validated the rejuvenator's efficacy in improving asphalt properties. The incorporation of 1.8% bio-oil significantly reduced the viscosity of the mixtures, enhancing workability. The rejuvenator effectively compensated for the loss of light components in aged binders, restoring the maximum and minimum temperature performance to levels comparable to virgin asphalt (VA). Mechanical testing revealed that bio-oil mitigated the aging effects of RAP asphalt, and the rejuvenated mixtures showed considerable improvements over both VA and non-rejuvenated RAP mixtures, where the rejuvenated specimens achieved 90.8 and 89.4% of retained strength index (RSI) values for 24- and 48-h immersion periods, respectively comparing with 88.9 and 86% post-immersion of VA for similar durations. These findings underscore the potential of bio-oil as a sustainable and eco-friendly solution for rejuvenating aged asphalts, paving the way for more sustainable asphalt production practices.

Machine learning for forecasting initial seizure onset in neonatal hypoxic-ischemic encephalopathy.

This study was undertaken to develop a machine learning (ML) model to forecast initial seizure onset in neonatal hypoxic-ischemic encephalopathy (HIE) utilizing clinical and quantitative electroencephalogram (QEEG) features. We developed a gradient boosting ML model (Neo-GB) that utilizes clinical features and QEEG to forecast time-dependent seizure risk. Clinical variables included cord blood gas values, Apgar scores, gestational age at birth, postmenstrual age (PMA), postnatal age, and birth weight. QEEG features included statistical moments, spectral power, and recurrence quantification analysis (RQA) features. We trained and evaluated Neo-GB on a University of California, San Francisco (UCSF) neonatal HIE dataset, augmenting training with publicly available neonatal electroencephalogram (EEG) datasets from Cork University and Helsinki University Hospitals. We assessed the performance of Neo-GB at providing dynamic and static forecasts with diagnostic performance metrics and incident/dynamic area under the receiver operating characteristic curve (iAUC) analyses. Model explanations were performed to assess contributions of QEEG features and channels to model predictions. The UCSF dataset included 60 neonates with HIE (30 with seizures). In subject-level static forecasting at 30 min after EEG initiation, baseline Neo-GB without time-dependent features had an area under the receiver operating characteristic curve (AUROC) of .76 and Neo-GB with time-dependent features had an AUROC of .89. In time-dependent evaluation of the initial seizure onset within a 24-h seizure occurrence period, dynamic forecast with Neo-GB demonstrated median iAUC = .79 (interquartile range [IQR] .75-.82) and concordance index (C-index) = .82, whereas baseline static forecast at 30 min demonstrated median iAUC = .75 (IQR .72-.76) and C-index = .69. Model explanation analysis revealed that spectral power, PMA, RQA, and cord blood gas values made the strongest contributions in driving Neo-GB predictions. Within the most influential EEG channels, as the preictal period advanced toward eventual seizure, there was an upward trend in broadband spectral power. This study demonstrates an ML model that combines QEEG with clinical features to forecast time-dependent risk of initial seizure onset in neonatal HIE. Spectral power evolution is an early EEG marker of seizure risk in neonatal HIE.

Antifungal peptide-loaded alginate microfiber wound dressing evaluated against Candida albicans in vitro and ex vivo

Invasive fungal infections have high mortality rates, and many current antimycotics are limited by host toxicity and drug resistance. Recent experiments in our laboratory have demonstrated the antifungal activity of dKn2-7, a synthetic peptide, against Candida albicans. The purpose of the current study was to develop a wound dressing capable of dKn2-7 release for extended periods to help combat fungal infection in wounds. dKn2-7 was incorporated into calcium alginate microfibers, an excipient with known wound healing and hemostatic properties. dKn2-7 release rates from the fibers were dependent on drug loading, but all formulations exhibited a burst release with 41–71 % of total release in the first 15 min and 84–96 % release by 24 h. Calcium release at 15 min was similar to that of a commercial hemostatic dressing, indicating dKn2-7 loading would not adversely affect the hemostatic capability of the alginate fibers. In vitro antifungal studies indicated a dose dependent effect with fibers loaded at ≥20 µg/mg causing significant planktonic killing and ≥30 µg/mg causing significant biofilm killing. Viable fungal counts in biofilms grown on ex vivo porcine skin declined by 99 % following 500 µg/mg fiber treatment. Skin histology indicated no significant differences in tissue damage between treatment groups and controls. Results confirm calcium alginate microfibers are capable of binding and subsequently releasing dKn2-7 over a 24-h period when rehydrated. Furthermore, dKn2-7 released from the fibers was able to significantly reduce biofilms in an ex vivo model with minimal toxicity, indicating these dKn2-7 loaded fiber dressings may be effective at controlling C. albicans biofilm infections in vivo.

Experimental assessment of using phase change materials in vapor compression refrigeration systems for condenser pre-cooling

The primary objective of this investigation is to empirically assess a new vapor compression cycle while employing phase change material (PCM) energy storage. During off-peak periods, the PCM undergoes charging, and during on-peak hours, it is discharged to cool the refrigerant entering the condenser, thereby enhancing the condenser's overall performance. In contrast to previous studies that exclusively examined the charging or discharging processes of air conditioning (AC) units, this research delves into the entire 24-h charge and discharge cycle. The proposed system is subjected to testing under identical conditions, both without PCM (conventional mode) and with a PCM storage tank, throughout a 24-h period. The PCM storage tank, which utilizes water as its phase change medium, possesses a volume of approximately 300 L and starts at an initial temperature of 25 °C. The outcomes of the study demonstrate notable improvements when incorporating the PCM storage tank. Specifically, the daily coefficient of performance (COP) increases by approximately 7 %, rising from 2.17 to 2.33. Additionally, it leads to a reduction in both the daily available cooling load and daily compressor energy consumption, with decreases of approximately 3.7 % (from 58.4 to 56.2 kWh) and 10.3 % (from 26.9 to 24.1 kWh), respectively.

Acute acetaminophen ingestion improves the recovery of neuromuscular fatigue following simulated soccer match-play

ObjectiveThis study aimed to investigate the impact of acute acetaminophen (ACT) ingestion on the responses of neuromuscular function, biomarkers of muscle damage, and physical performance during the 72-h recovery period following simulated soccer match-play. DesignThe study followed a crossover randomized, double-blind, placebo-controlled trial design. MethodsDuring the two experimental sessions, thirteen semi-professional male soccer players completed a 90-min simulated soccer match, 60 min after oral ingestion of 1 g ACT or placebo (PL). Maximal voluntary contraction (MVC) and twitch responses of the knee extensors muscles, elicited through electrical femoral nerve stimulation, were utilized to evaluate both peripheral fatigue (potentiated twitch force, Qtw,pot) and central fatigue (voluntary activation, VA). Performance was assessed through countermovement jump (CMJ) and 20 m sprint tests. Creatine kinase (CK) and lactate dehydrogenase (LDH) were also measured. ResultsSmaller reductions were observed in MVC (−13.3 ± 7.5 % vs. -24.7 ± 11.1 %) and VA (−3.8 ± 4.4 % vs. -12.9 ± 5.4 %) in the ACT compared to the PL condition immediately after simulated soccer match-play (p < 0.05). Afterwards, these parameters were recovered 24 h earlier in the ACT session compared to the PL session. Furthermore, the 20 m sprint performance was significantly better throughout the recovery period in the ACT session compared to the PL session. ConclusionThe findings of this study showed that acute ingestion of 1 g of ACT (1 h before exercise) attenuated the decrease in MVC and VA levels after exercise, as well as improved 20 m sprint performance.

Evaluating serotype-specific survival of Listeria monocytogenes and Listeria innocua on wax-coated Granny Smith apples during storage

Listeria monocytogenes serotypes 1/2a, 1/2b, and 4b are implicated in over 90 % of human listeriosis cases; however, information regarding the serotype-specific survival of L. monocytogenes on apples remains limited. This study evaluated the survival dynamics of these serotypes, using two sets of strains, on Granny Smith apples (GSA) and examined the impact of wax-coating on their survivability during storage. The fate of Listeria innocua on GSA during commercial refrigerated air (RA) storage was also investigated. Results revealed distinct behaviors among L. monocytogenes serotypes. The culturable count of the serotype 4b strain on apples decreased significantly (P < 0.05) by 1.36 log CFU/apple within the first 48 h post-inoculation at ambient temperature. In contrast, counts of serotypes 1/2a and 1/2b strains significantly increased (P < 0.05) by 0.44 and 0.50 log CFU/apple, respectively, during this 48-h attachment period. Over the subsequent 12 weeks of cold storage, serotypes 1/2a and 4b remained stable on GSA, while 1/2b decreased by 1.68 log CFU/apple. Wax coating had a minor impact on L. monocytogenes survival on GSA under both cold and ambient storage conditions, regardless of serotypes. During 18 weeks of commercial RA storage, L. innocua exhibited a gradual decrease of 1.76–1.96 log CFU/apple on wax-coated GSA. Yeasts and molds showed no significant changes in populations due to wax coating, maintaining counts between 5.5 and 5.7 log CFU/apple by the end of the 18-week storage. Additionally, wax coating enhanced quality attributes, significantly preventing (P < 0.05) firmness loss and internal browning compared to unwaxed apples at the conclusion of storage. This study highlights the serotype-specific survival traits of selected L. monocytogenes produce-outbreak isolates on apples, emphasizing the importance of understanding the distinct behaviors of different serotypes.

USO DA TERAPIA FOTODINÂMICA E DA CRIOTERAPIA NO CONTROLE DA DOR APÓS O TRATAMENTO ENDODÔNTICO: RELATO DE CASO CLÍNICO

Patients may undergo endodontic treatment for many reasons, including the presence of extensive decay that exposes pulp tissue and tooth fractures. The treatment, in turn, can generate, in some cases, the presence of painful symptoms, due to numerous reasons, such as incorrect removal of the smear layer and chemical injuries from the irrigating material. To reduce patient discomfort, alternative technical applications can be used to control post-operative pain, such as cryotherapy and laser therapy. The objective of this work, in the form of a case report, was to show the importance of controlling postoperative pain after endodontic treatment using laser therapy and cryotherapy techniques. Searches were carried out in electronic databases: Virtual Health Library (VHL), Scientifc Electronic Library Online (Scielo) and PubMed for the last 7 years (2017 to 2024), in addition to patient care where cryotherapy was used using serum physiological cold and laser therapy was performed. The results presented were satisfactory, as after 4 sessions, pain was assessed through telephone contact with the patient over periods of 24h, 72h and 7 days, where the patient’s pain-free response was verified and without need of analgesic use. The present study can conclude that performing cryotherapy concomitantly with the use of laser therapy presents a significant reduction in the postoperative pain response.

Analysis of the 24-h biting patterns and human exposures to malaria vectors in south-eastern Tanzania

BackgroundAfrotropical malaria vectors are generally believed to bite nocturnally, leading to the predominant use of insecticide-treated nets (ITNs), which target indoor, nighttime-biting mosquitoes. This focus is reinforced by biases in entomological surveys, which largely overlook daytime mosquito activity. However, recent evidence challenges this paradigm, showing that Anopheles biting can extend way into the daytime, coinciding with human activities at dawn, daytime and evenings, suggesting a broader risk spectrum and potential protection gaps. We have therefore investigated the diurnal and nocturnal biting patterns of the malaria vectors Anopheles arabiensis and Anopheles funestus in south-eastern Tanzania, to better understand the scope of residual transmission and inform strategies for improved control.MethodsHost-seeking mosquitoes were collected hourly using miniaturized double net traps, both indoors and outdoors over 24-h periods between June 2023 and February 2024. Concurrently, human activities indoors and outdoors were monitored half-hourly to correlate with mosquito collections. A structured questionnaire was used to assess household members’ knowledge, perceptions and experiences regarding exposure to mosquito bites during both nighttime and daytime.ResultsNocturnal biting by An. arabiensis peaked between 7 p.m. and 11 p.m. while that of An. funestus peaked later, between 1 a.m. and 3 a.m. Daytime biting accounted for 15.03% of An. arabiensis catches, with peaks around 7–11 a.m. and after 4 p.m., and for 14.15% of An. funestus catches, peaking around mid-mornings, from 10 a.m. to 12 p.m. Nighttime exposure to An. arabiensis was greater outdoors (54.5%), while daytime exposure was greater indoors (80.4%). For An. funestus, higher exposure was observed indoors, both at nighttime (57.1%) and daytime (69%). Plasmodium falciparum sporozoites were detected in both day-biting and night-biting An. arabiensis. Common daytime activities potentially exposing residents during peak biting hours included household chores, eating, sleeping (including due to sickness), resting in the shade or under verandas and playing (children). From evenings onwards, exposures coincided with resting, socializing before bedtime and playtime (children). Nearly all survey respondents (95.6%) reported experiencing daytime mosquito bites, but only 28% believed malaria was transmissible diurnally.ConclusionsThis study updates our understanding of malaria vector biting patterns in south-eastern Tanzania, revealing considerable additional risk in the mornings, daytime and evenings. Consequently, there may be more gaps in the protection provided by ITNs, which primarily target nocturnal mosquitoes, than previously thought. Complementary strategies are needed to holistically suppress vectors regardless of biting patterns (e.g. using larval source management) and to extend personal protection limits (e.g. using repellents). Additionally, community engagement and education on mosquito activity and protective measures could significantly reduce malaria transmission risk.Graphical

Nociception level index-directed superficial parasternal intercostal plane block vs erector spinae plane block in open-heart surgery: a propensity matched non-inferiority clinical trial.

This single-center study explored the efficacy of superficial parasternal intercostal plane block (SPIPB) versus erector spinae plane block (ESPB) in opioid-sparing within Nociception Level (NOL) index-directed anesthesia for elective open-heart surgery. After targeted propensity matching, 19 adult patients given general anesthesia with preincisional SPIPB were compared to 33 with preincisional ESPB. We hypothesized that SPIPB is non-inferior to ESPB in reducing total intraoperative fentanyl consumption, with a non-inferiority margin (δ) set at 0.1mg. Intraoperative fentanyl dosing targeted a NOL index ≤ 25. Postoperatively, paracetamol 1g 6-hourly and morphine for numeric rating scale (NRS) ≥ 4 were administered. This study could not demonstrate that SPIPB was inferior to ESPB for total intraoperative fentanyl consumption, as the confidence interval for the median difference of 0.1mg (95% CI 0.05-0.15) crossed the predefined δ, with the lower bound falling below and the upper bound exceeding δ, p = 0.558. SPIPB led to higher postoperative morphine use at 24 and 48h: 0 (0-40.6) vs. 59.5 (28.5-96.1) µg kg-1, p < 0.001 and 22.2 (0-42.6) vs. 63.5 (28.5-96.1) µg kg-1, p = 0.001. Four times fewer SPIPB patients remained morphine-free at 48h, p < 0.001, and their time to first morphine dose was three times shorter compared to ESPB patients, p = 0.001. SPIPB led to higher time-weighted average NRS scores at rest, 1 (0-1) vs. 1 (1-2), p = 0.004, and with movement, 2 (1-2) vs. 3 (2-3), p = 0.002, calculated over the 48-h period post-extubation. The SPIPB group had a significantly higher average NOL index, p = 0.003, and greater NOL index variability, p = 0.027. This study could not demonstrate that SPIPB was inferior to ESPB for intraoperative fentanyl consumption. Significant differences were observed in secondary outcomes, with SPIPB leading to higher postoperative morphine use, higher pain scores, and reduced nociception control.

An ovine septic shock model of live bacterial infusion

BackgroundEscherichia coli is the most common cause of human bloodstream infections and bacterial sepsis/septic shock. However, translation of preclinical septic shock resuscitative therapies remains limited mainly due to low-fidelity of available models in mimicking clinical illness. To overcome the translational barrier, we sought to replicate sepsis complexity by creating an acutely critically-ill preclinical bacterial septic shock model undergoing active 48-h intensive care management.AimTo develop a clinically relevant large-animal (ovine) live-bacterial infusion model for septic shock.MethodsSeptic shock was induced by intravenous infusion of the live antibiotic resistant extra-intestinal pathogenic E. coli sequence type 131 strain EC958 in eight anesthetised and mechanically ventilated sheep. A bacterial dose range of 2 × 105–2 × 109 cfu/mL was used for the dose optimisation phase (n = 4) and upon dose confirmation the model was developed (n = 5). Post-shock the animals underwent an early-vasopressor and volume-restriction resuscitation strategy with active haemodynamic management and monitoring over 48 h. Serial blood samples were collected for testing of pro-inflammatory (IL-6, IL-8, VEGFA) and anti-inflammatory (IL-10) cytokines and hyaluronan assay to assess endothelial integrity. Tissue samples were collected for histopathology and transmission electron microscopy.ResultsThe 2 × 107 cfu/mL bacterial dose led to a reproducible distributive shock within a pre-determined 12-h period. Five sheep were used to demonstrate consistency of the model. Bacterial infusion led to development of septic shock in all animals. The baseline mean arterial blood pressure reduced from a median of 91 mmHg (71, 102) to 50 mmHg (48, 57) (p = 0.004) and lactate levels increased from a median of 0.5 mM (0.3, 0.8) to 2.1 mM (2.0, 2.3) (p = 0.02) post-shock. The baseline median hyaluronan levels increased significantly from 25 ng/mL (18, 86) to 168 ng/mL (86, 569), p = 0.05 but not the median vasopressor dependency index which increased within 1 h of resuscitation from zero to 0.39 mmHg−1 (0.06, 5.13), p = 0.065, and. Over the 48 h, there was a significant decrease in the systemic vascular resistance index (F = 7.46, p = 0.01) and increase in the pro-inflammatory cytokines [IL-6 (F = 8.90, p = 0.02), IL-8 (F = 5.28, p = 0.03), and VEGFA (F = 6.47, p = 0.02)].ConclusionsThis critically ill large-animal model was consistent in reproducing septic shock and will be applied in investigating advanced resuscitation and therapeutic interventions.

Evaluation of WRF model performance with different microphysics schemes for extreme rainfall prediction in Lagos, Nigeria: Implications for urban flood risk management

In Nigeria, particularly in urban areas like Lagos, flooding is a frequent natural hazard. In 2011, Lagos experienced one of its worst floods resulting in significant economic losses and displacement of people. In recent years, Lagos has continued to grapple with flooding challenges, with an equally significant flood episode occurring in 2021. This study focuses on predicting floods and forecasting extremely heavy rainfall in West Africa's equatorial zone using the Weather Research and Forecasting (WRF) model, particularly in humid tropical environments like Lagos. The study discusses the need to review existing flood models and adopt alternative flood models to address the limitations of flood prediction. As potential causes of these rainfall episodes, the interconnections between synoptic systems such as tropical easterly waves, southwesterly winds related to the West African Monsoon, and local topography and oceanic conditions are investigated. Three key metrics: root mean square error (RMSE), mean bias (MB), and mean absolute error (MAE) are used to assess the effectiveness of the computational model. Results indicate that the WRF model, specifically when using the Thompson parameterisation, can estimate the amount of rainfall accumulated over a 24-h period. This suggests that the model can predict the size of daily precipitation during intense rain events. The Thompson scheme shows better performance compared to the WSM6 scheme while evaluating the stations and episodes. During the rainfall episode on July 10, 2011, Thompson's spatial rainfall predictions were better than WSM6, resulting in a decrease in root mean square error (RMSE) of 15–31% depending on the area. Simulations of the July 2021 episode also show better performance, with a decrease in RMSE of 11–25% when comparing Thompson to WSM6 scheme. The Thompson scheme’s improved ability is directly linked to a more accurate depiction of the microphysical mechanisms that control the rainfall formation. By explicitly simulating the dynamics of ice crystals and graupel, it is possible to accurately replicate the processes of orographic lifting and moist convection that are responsible for driving intense monsoon precipitation. In addition, Thompson scheme shows a reduced degree of systemic bias in comparison to WSM6, with a 75% reduction in the average bias in rainfall accumulation over the research area. The combination of the advanced Thompson microphysics method and WRF's atmospheric dynamics shows a high level of accuracy in predicting intense rainfall and the risk of floods in this area with diverse tropical topography.

The relation between dietary polysaccharide intake and urinary excretion of tetraglucoside.

The urinary metabolite tetraglucoside (Glc4) is a potential biomarker for hepatic glycogen storage diseases (GSDs). Glc4 is believed to reflect body glycogen content and/or turnover. However, dietary polysaccharide intake may influence Glc4 excretion, potentially limiting the utility of Glc4 as a monitoring biomarker in hepatic GSDs. We aimed to investigate the association of dietary polysaccharide intake with Glc4 excretion. Urinary Glc4 excretion (mmol/mmol creatinine and mmol/24 h) was analyzed using a validated LC-MS/MS method. Data was analyzed from 65 kidney transplant recipients and 58 healthy kidney donors in the TransplantLines cohort study. Spearman's correlation and multivariable linear regression analyses were performed. In the multivariable analysis, dry lean body mass (DLBM), dietary polysaccharide intake, transplantation status, age, sex, and glycated hemoglobin (HbA1c) served as independent variables. Daily variation was examined in 21 healthy individuals of urinary Glc4 excretion in 2-h collections over a 24-h period. Mixed generalized additive models were built to study the association of prior polysaccharide intake with Glc4 excretion. No (univariate) associations were found between polysaccharide intake and Glc4 excretion. However, a significant interaction between DLBM and polysaccharide on 24 h Glc4 excretion was observed in the multivariate analysis. Glc4 excretion throughout the day exhibited no relationship to prior polysaccharide intake. Our findings suggest an indirect effect of polysaccharide intake on Glc4 excretion, potentially due to changes in muscle glycogen content and/or turnover. We have found no evidence that dietary polysaccharides under normal intakes increase urinary Glc4 directly.

Unveiling the Spectrum of Glucose Variability: A Novel Perspective on FreeStyle Libre Monitoring Data.

Since the introduction of insulin therapy, it has become apparent that type 1 diabetes (T1D) is accompanied by long-term microvascular and macrovascular complications. In the context of the many benefits of continuous glucose monitoring (CGM), there remain opportunities to study the large amount of data now available in order to maximise its potential in the endeavour to reduce the occurrence of diabetes tissue complications in the longer term. Continuous glucose monitoring values were downloaded for 89 type 1 diabetes mellitus (T1D) individuals for up to 18 months from 2021 to 2023. Data for patient demographics was also taken from the patient record which included Sex, Date of Birth, and Date of Diagnosis. The recorded laboratory glycated haemoglobin (HbA1c) test results were also recorded. The glucose management index (GMI) was calculated from average glucose readings for 18 months using the formula GMI (%) = (0.82-(Average glucose/100)). This was then adjusted to give GMI (mmol/mol) = 10.929 * (GMI (%) - 2.15). Average Glucose Fluctuation (AGF) was calculated by adding up the total absolute change value between all recorded results over 18 months and dividing by the number of results minus one. The % Above Critical Threshold (ACT) was calculated by summing the total number of occurrences for each result value. A cumulative 95% limit was then applied to identify the glucose value that only 5% of results exceeded in the overall population. Using this value, we estimated the percentage of total tests that were above the Critical Threshold (ACT). The mean age of the participants was 42.6years, and the mean duration of T1D was 18.4years. A total of 3.22 million readings were analysed, yielding an average blood glucose level of 10.3mmol/l and a GMI of 57.2mmol/mol. There was a strong correlation between GMI and measured HbA1c (r2 = 0.82). However, there were patients who had an above-critical threshold (ACT) of 4-10% at a GMI of 60mmol/mol or less. The percentage average value at the time of day (%AVTD) was applied to all blood glucose readings at each 15-min interval throughout the day, averaged over 18months. The %AVTD of GMI (overall average 57.2mmol/mol) increased after midday, dipped at 18:00, and peaked at 22:00. The %AVTD of AGF (overall average 0.60mmol/l) showed higher change rates after 09:00 declining at the end of the day. The %AVTD of ACT peaked at 22:00, with those having the highest %ACT showing an additional peak at 15:00. We have shown here that the percentage glucose results above 18mmol/l (top 5% of distribution) increased exponentially above 54mmol/mol HbA1c. The %AVTD is introduced as a useful measure. Our data indicate that over the 24-h period, improvement in metabolic control could be focussed on the afternoon and evening, when there are higher-than-average levels of GMI, a higher-than-average degree of glucose change, and higher-than-average risks of being above the critical threshold. In conclusion, a measure of glycaemic variation based on the amplitude of glucose change to a population mean could be used to provide valuable clinical insights into glucose change over a 24-h period.