Quality Evaluation of Shiitake Blanched and Centrifuged Broths as Functional Instant Drinks.

In the process of making mushrooms into vacuum-fried crisps, the resulting blanched broth (BB) and centrifuged broth (CB) are often discarded, thereby increasing the amount of wastewater and treatment costs. This study measured the proximate compositions, bioactive components, taste components, and minerals of freeze-dried BB and CB and then used functional indigestible dextrin (Fibersol-2) as a carrier to make these two broths into instant drinks. The solids of the BB and CB contained protein (16.88-19.21%), fat (0.01-0.23%), ash (12.89-13.50%), carbohydrate (67.28-70.00%), sugars and polyols (40.55-45.68%), free amino acids (6.58-6.69%), 5'-nucleotides (0.98-1.47%), and bioactive components, especially polysaccharides (4.53-7.45%), ergothioneine (both 0.19%), and total phenols (0.15-0.36%). The equivalent umami concentration of BB was 2.77-fold higher than that of the CB. Both BB and CB showed compositions and essential minerals that are rich in taste. Using a nine-point hedonic test, it was found that the solid contents of BB and CB in the instant drink affected the consumer's preference. The flavor and overall preference of instant drinks with 2.5% BB or CB were the best amongst consumers. Overall, the BB and CB were rich in nutrients and bioactive and taste components and could be developed as a functional food in the form of a drink.

Bubbles in the Box: Recurrent Pneumothorax From Bronchopleural Fistula in Rheumatoid Arthritis.

When considering rheumatoid arthritis (RA)-associated pulmonary diseases, interstitial lung disease and pleural disease are the most common RA-associated pulmonary manifestations while spontaneous pneumothorax and bronchopleural fistula (BPF) are among the extremely rare ones. To the best of our knowledge, all the previous reports of RA-associated BPFs were attributed to peripherally located pulmonary nodules that necrotized, burst into the pleural cavity, and eventually lead to the fistula formation. However, we hereby present the first case of BPF in an RA patient that formed in the absence of any underlying rheumatic pulmonary nodules. Additionally, our patient was on chronic methotrexate therapy, and there are no data in the literature that suggest methotrexate-induced parenchymal lung disease can predispose to BPF formation. Our report is the first to introduce a probe to further investigate this association.

Making of a Successful Early Mobilization Program for a Medical Intensive Care Unit.

OBJECTIVES: To provide a guideline for intensive care unit (ICU) early mobilization program development and implementation and to describe the patient characteristics and endpoints for those who participated in our hospital's early mobilization program. METHODS: An ICU early mobilization program was developed with five guiding principles: analgesia/sedation optimization, sedation minimization, protocol of progressive mobility, physical therapy and occupational therapy recruitment, and nursing education. This program began in April 2014, and the initial 32 patients who ambulated while receiving mechanical ventilation were retrospectively assessed and their characteristics described. RESULTS: After program implementation, more than 50 mechanically ventilated patients ambulated in the first year following early mobilization initiation. Patients with an FiO2 as high as 1.0 and on nonconventional modes of mechanical ventilation successfully ambulated without adverse events. The mean ambulation distance was 102 ± 152 f. and usually required three ICU staff members with 5 to 10 minutes of preparation before ambulation. After implementation, a retrospective analysis revealed a decrease in the average length of ICU stay, from 4.8 to 4.1 days. CONCLUSIONS: Addressing analgesia and sedation practices, along with instituting a progressive mobility protocol and recruiting physical and occupational therapy, may serve as a guide to the creation of a successful early mobilization program. This study provides additional supportive evidence that early mobilization in the ICU is safe and effective.

Utility of the shock index in patients with sepsis.

The shock index (SI) equals the heart rate/systolic blood pressure and has been used to predict clinical outcomes, especially in trauma and surgery patients. The authors reviewed the literature to determine its utility in the management of patients with sepsis and in the prediction of adverse outcomes in these patients. The medical literature was searched using PubMed, Scopus, Web of Science and Google Scholar databases to identify articles in English on the SI in humans. These studies demonstrated that the SI could help evaluate the adequacy of fluid resuscitation and the potential response to additional fluid. It can predict the presence of lactic acidosis. The SI also helps predict the development of organ failure and mortality. Consequently, this easily available bedside measurement has utility in the identification, management and prediction of prognosis in patients with sepsis.