Factors associated with psychological distress, behavioral impact and health-related quality of life among patients with type 2 diabetes mellitus.

BACKGROUND: Data on psychological distress (DIS), behavioral impact (BI) and health-related quality of life (HRQoL) are important yet lacking among Asian patients with Type 2 diabetes mellitus (T2DM). We aim to identify factors associated with DIS, BI and HRQoL among T2DM to better understand patient needs. METHODS: DIS was measured with Diabetes Health Profile (DHP-18) Psychological Distress (DHP-PD) subscale, Problem Areas in Diabetes (PAID) and Kessler-10 (K10), BI with DHP-18 Barriers to Activity and Disinhibited Eating subscales and HRQoL with Audit of Diabetes-Dependent Quality of Life. Multiple linear regression analyses were performed to evaluate the associations between these outcomes and patient demographic, socioeconomic status, glycated hemoglobin (HbA1C) and comorbidities. RESULTS: 213 T2DM patients (mean (SD) age: 45.0 (12.1) years, mean (SD) HbA1C: 8.3% (1.9%) and 70.0% reported at least one comorbidity) were evaluated. Poorer glycemic control was significantly associated with higher DHP-PD, PAID and worse HRQoL. Taking oral hypoglycemic agents plus insulin was independently associated with Barrier to Activity and Disinhibited Eating. CONCLUSION: Poorer glycemic control was only associated with diabetes-related distress (measured by DHP-PD and PAID) but not major depressive disorder (measured by K10). It may be more appropriate to screen for diabetes-related distress rather than major depressive disorder for patients with T2DM.

Degradation effects in the extraction of antioxidants from birch bark using water at elevated temperature and pressure.

Experiments with birch bark samples have been carried to enable a distinction between extraction and degradation effects during pressurised hot water extraction. Two samples, E80 and E180, contained birch bark extracts obtained after extraction at 80 and 180°C for up to 45 min, respectively. Two other samples, P80 and P180, were only extracted for 5 min at the two temperatures and were thereafter filtered and hydrothermally treated at 80 and 180°C, respectively. During the latter treatment, samples were collected at different times to assess the stability of the extracted compounds. An offline DPPH (2,2-diphenyl-1-picrylhydrazyl) assay, as well as a high performance liquid chromatographic separation coupled to an electrochemical detector, were used to determine the antioxidant capacity of the processed samples. The results obtained with the different techniques were compared to assess the yield of the extraction and degradation processes. In addition, an online hyphenated system comprising high performance liquid chromatography coupled to diode-array; electrochemical; and tandem mass spectrometric detection (HPLC-DAD-ECD-MS/MS) was used to study the compositions of the extracts in more detail. The results for the samples processed at 80°C showed that the extraction reached a steady-state already after 5 min, and that the extracted compounds were stable throughout the entire extraction process. Processing at 180°C, on the other hand, gave rise to partly degraded extracts with a multitude of peaks in both the diode array and electrochemical detectors, and a higher antioxidant capacity compared to for the extracts obtained at 80°C. It is concluded that HPLC-DAD-ECD is a more appropriate technique for the determination of antioxidants than the DPPH assay. The mass spectrometric results indicate that one of the extracted antioxidants, catechin, was isomerised to its diastereoisomers; (+)-catechin, (-)-catechin, (+)-epicatechin, and (-)-epicatechin.

Dexmedetomidine as a procedural sedative for percutaneous tracheotomy: case report and systematic literature review.

Purpose. To describe the successful use of dexmedetomidine as the primary procedural sedative for a percutaneous tracheotomy procedure and to systematically present the supporting literature. Materials and Methods. A Case report of our experience and systematic literature search. PubMed, Embase, and Google Scholar were searched without restriction using the key words dexmedetomidine, percutaneous tracheotomy, and tracheotomy procedure. All relevant published references were retrieved irrespective of their methodological quality. Results. In total, only 3 relevant references were found. These include one small placebo controlled randomized trial and 2 case reports. The randomized, placebo controlled trial enrolled patients already sedated on midazolam and included 64 total patients. The 2 other case reports both described the use of dexmedetomidine as the primary procedural sedative. All of the cases reported the successful completion of the percutaneous tracheotomy without any major complication, but none reported the subjective patient experience. Conclusion. Based on the available published literature and our experience, we suggest that dexmedetomidine be considered for use as the primary procedural sedative for percutaneous tracheotomy procedure. Dexmedetomidine's ability to provide adequate sedation and amnesia, without blunting the respiratory drive and protective reflexes of the patient, may make it an optimal agent in specific cases.

Extraction of antioxidants from spruce (Picea abies) bark using eco-friendly solvents.

INTRODUCTION: Antioxidants are known to avert oxidation processes and they are found in trees and other plant materials. Tree bark is a major waste product from paper pulp industries; hence it is worthwhile to develop an extraction technique to extract the antioxidants. OBJECTIVE: To develop a fast and environmentally sustainable extraction technique for the extraction of antioxidants from bark of spruce (Picea abies) and also to identify the extracted antioxidants that are abundant in spruce bark. METHODOLOGY: A screening experiment that involved three different techniques was conducted to determine the best technique to extract antioxidants. The antioxidant capacity of the extracts was determined with DPPH (2,2-diphenyl-1-picrylhydrazyl) assay. Pressurised fluid extraction (PFE) turned out to be the best technique and a response surface design was therefore utilised to optimise PFE. Furthermore, NMR and HPLC-DAD-MS/MS were applied to identify the extracted antioxidants. RESULTS: PFE using water and ethanol as solvent at 160 and 180°C, respectively, gave extracts of the highest antioxidant capacity. Stilbene glucosides such as isorhapontin, piceid and astringin were identified in the extracts. CONCLUSION: The study has shown that PFE is a fast and environmentally sustainable technique, using water and ethanol as solvent for the extraction of antioxidants from spruce bark.

Identification and characterization of polyphenolic antioxidants using on-line liquid chromatography, electrochemistry, and electrospray ionization tandem mass spectrometry.

It is demonstrated that electrochemistry (EC) coupled to liquid chromatography (LC) and electrospray ionization tandem mass spectrometry (LC/EC/ESI-MS/MS) can be used to rapidly obtain information about the antioxidant activity (i.e., oxidation potential) and capacity (i.e., amount) of polyphenolic compounds, including catechin, kaempferol, resveratrol, quercetin, and quercetin glucosides. The described on-line LC/EC/ESI-MS/MS method facilitates the detection and characterization of individual antioxidants based on a combination of the obtained m/z values for the antioxidants and their oxidation products, the potential dependences for the ion intensities, and correlations between the retention times in the LC, EC, and MS chromatograms. As these results provide patterns that can be used in rapid screening for antioxidants in complex samples, the method should be a valuable complement to chemical assays commonly used to determine the total antioxidant capacity of samples. It is shown that the antioxidant capacity for a mixture of polyphenolic compounds depends on the redox potential employed in the evaluation, and this should consequently be taken into account when comparing results from different total antioxidant capacity assays. It is also demonstrated that the inherent antioxidant capacities of phenolic compounds increase with an increasing number of hydroxyl groups and that the potential needed to oxidize the remaining hydroxyl groups increases successively upon oxidation of the compound. Unlike chemical assays, which generally do not provide any information about the identities of the compounds on the molecular level, the present screening method can be used to identify individual antioxidants, rank compounds with respect to their ease of oxidation, and to study the antioxidant capacity at any redox potential of interest.

Ultrasensitive magnetic particle-based immunosupported liquid membrane assay.

A magnetic particle-based immuno-supported liquid membrane assay (m-ISLMA) based on chemiluminescence detection of a horseradish peroxidase-labeled hapten tracer that allows sample cleanup, analyte enrichment, and detection in a single analysis unit has been developed. Antibodies were immobilized on magnetic beads, and their position in the acceptor was controlled by two alternating opposing electromagnetic fields generated by a voltage applied to either of two electromagnets placed below and above the acceptor channel of the supported liquid membrane unit. The influence of antibody bead dilution in the acceptor was investigated and found to follow the ISLM theory, that is improved enrichment and sensitivity with increasing antibody concentration. Two different extraction procedures were investigated: procedure 1 (m-ISLMA-P1), which keeps the antibody beads trapped at the bottom of the acceptor during the entire analysis process; and procedure 2 (m-ISLMA-P2), which keeps the antibody beads dispersed and in motion in the acceptor phase during the extraction process. m-ISLMA-P2 resulted in 2000 times improved enrichment of simazine and a more than 3 orders of magnitude better limit of detection (LOD(10%)) (1.29 x 10(-5) microg L(-1)) than for m-ISLMA-P1 (2.00 x 10(-2) microg L(-1)) and corresponding microtiter plate magnetic particle-based ELISA (m-ELISA, LOD(10%) 1.30 x 10(-1) microg L(-1)). m-ISLMA-P2 and m-ELISA were further applied for the extraction and analysis of simazine-spiked surface water and fruit juice, finding no evidence for matrix influence for the former method; however, indications that trace amounts (nanograms per liter) of simazine or specific cross-reactants were present in both samples.