Effects of Individualised High Positive End-Expiratory Pressure and Crystalloid Administration on Postoperative Pulmonary Function in Patients Undergoing Robotic-Assisted Radical Prostatectomy: A Prospective Randomised Single-Blinded Pilot Study.

OBJECTIVES: Robotic-assisted laparoscopic prostatectomy (RALP) is typically conducted in steep Trendelenburg position (STP). The aim of the study was to evaluate whether crystalloid administration and individual management of positive end-expiratory pressure (PEEP) improve peri- and post-operative pulmonary function in patients undergoing RALP. DESIGN: Prospective randomised single-centre single-blinded explorative study. SETTING: Patients were either allocated to a standard PEEP (5 cmH2O) group or an individualised high PEEP group. Furthermore, each group was divided into a liberal and a restrictive crystalloid group (8 vs. 4 mL/kg/h predicted body weight). Individualised PEEP levels were determined by means of preoperative recruitment manoeuvre and PEEP titration in STP. PARTICIPANTS: Informed consent was obtained from 98 patients scheduled for elective RALP. INTERVENTIONS: The following intraoperative parameters were analysed in each of the four study groups: ventilation setting (peak inspiratory pressure [PIP], plateau pressure, driving pressure [Pdriv], lung compliance [LC] and mechanical power [MP]) and postoperative pulmonary function (bed-side spirometry). The spirometric parameters Tiffeneau index (FEV1/FVC ratio) and mean forced expiratory flow (FEF25-75) were measured pre- and post-operatively. Data are shown as mean ± standard deviation (SD), and groups were compared with ANOVA. A p-value of <0.05 was considered significant. RESULTS: The two individualised high PEEP groups (mean PEEP 15.5 [±1.71 cmH2O]) showed intraoperative significantly higher PIP, plateau pressure and MP levels but significantly decreased Pdriv and increased LC. On the first and second postoperative day, patients with individualised high PEEP levels had a significantly higher mean Tiffeneau index and FEF25-75. Perioperative oxygenation and ventilation and postoperative spirometric parameters were not influenced by restrictive or liberal crystalloid infusion in either of the two respective PEEP groups. CONCLUSIONS: Individualised high PEEP levels (≥14 cmH2O) during RALP improved intraoperative blood oxygenation and resulted in more lung-protective ventilation. Furthermore, postoperative pulmonary function was improved for up to 48 h after surgery in the sum of the two individualised high PEEP groups. Restrictive crystalloid infusion during RALP seemed to have no effect on peri- and post-operative oxygenation and pulmonary function.

Physical and molecular changes during the storage of gluten-free rice and oat bread.

Gluten-free bread crumb generally firms more rapidly than regular wheat bread crumb. We here combined differential scanning calorimetry (DSC), texture analysis, and time-domain proton nuclear magnetic resonance (TD (1)H NMR) to investigate the mechanisms underlying firming of gluten-free rice and oat bread. The molecular mobility of water and biopolymers in flour/water model systems and changes thereof after heating and subsequent cooling to room temperature were investigated as a basis for underpinning the interpretation of TD (1)H NMR profiles of fresh crumb. The proton distributions of wheat and rice flour/water model systems were comparable, while that of oat flour/water samples showed less resolved peaks and an additional population at higher T2 relaxation times representing lipid protons. No significant crumb moisture loss during storage was observed for the gluten-free bread loaves. Crumb firming was mainly caused by amylopectin retrogradation and water redistribution within bread crumb. DSC, texture, and TD (1)H NMR data correlated well and showed that starch retrogradation and crumb firming are much more pronounced in rice flour bread than in oat flour bread.

Influence of sourdough on in vitro starch digestibility and predicted glycemic indices of gluten-free breads.

Gluten-free flours (buckwheat, quinoa, sorghum and teff) were fermented using obligate heterofermentative strain Weissella cibaria MG1 (Wc) and facultative heterofermentative Lactobacillus plantarum FST1.7 (Lp). Starch hydrolysis of breads with and without sourdough (controls) was analyzed in vitro using enzymatic digestion followed by dialysis (10-11 kDa). Hydrolysis indices as well as predicted glycemic indices (pGI) were calculated from reducing sugars released into the dialysate. Amounts of resistant starch (RS; % of total starch) were determined by enzymatic digestion. Upon sourdough addition, RS significantly decreased in buckwheat (Wc 1.28%, Lp 1.44%) and teff sourdough breads (Wc 0.87%, Lp 0.98%) in comparison to their controls (2.01% and 1.92%, respectively). However, no correlation was found with starch hydrolysis. Predicted GIs were reduced upon sourdough addition in wheat (ctrl 100; Wc 85; Lp 76) in comparison to control breads. This was not the case in most gluten-free breads with the exception of sorghum (ctrl 72; Lp 69) and teff sourdough breads (ctrl 74; Lp 68). In contrast, increased pGIs were found in quinoa (ctrl 95; Wc 106; Lp 103) and buckwheat sourdough breads (ctrl 80; Wc 89; Lp 86).

Influence of dextran-producing Weissella cibaria on baking properties and sensory profile of gluten-free and wheat breads.

Breads based on gluten-free buckwheat, quinoa, sorghum and teff flours were produced with addition of 20% sourdough fermented with exopolysaccharide (EPS) producing Weissella cibaria MG1. Wheat bread was baked as a reference. Dough rheology, bread quality parameters and sensory properties of the sourdough-containing breads were compared to sourdough non-containing control breads of the respective flour. The specific volume remained unaffected by sourdough application. In buckwheat, sorghum, teff and wheat sourdough breads acidification increased crumb porosity compared to control breads. Crumb hardness was significantly reduced in buckwheat (-122%), teff (-29%), quinoa (-21%) and wheat sourdough breads (-122%). The staling rate was significantly reduced in buckwheat, teff and wheat sourdough breads. Water activity of the sourdough containing bread crumb was not influenced by the presence of EPS. Due to the presence of exopolysaccharides (EPS) and influence of acidification, the dough strength, AF, as measured by oscillation tests decreased significantly in sourdough-containing buckwheat, sorghum and wheat dough, but increased in sourdough-containing quinoa and teff dough. Microbial shelf-life was significantly prolonged neither for gluten-free sourdough nor for wheat sourdough breads. Scanning electron microscopy of control and sourdough bread crumbs did not show differences concerning structural starch features. In addition, the aroma of most bread was not improved by sourdough addition.

Influence of gallic acid and tannic acid on the mechanical and barrier properties of wheat gluten films.

Vital wheat gluten, a byproduct of wheat starch production, is a highly functional ingredient having a unique viscoelasticity that makes it ideal for the production of edible biodegradable films. However, its functional properties must be modified to ensure sufficient strength and elasticity, in addition to water vapor barrier properties. In this study, vital gluten was modified using tannic and gallic acid. It was found that the addition of tannic acid resulted in stiffer, more resistant, and less resilient and flexible films, having as well decreased water vapor permeability. Tannic acid containing films became reddish brown, whereas gallic acid addition did not have an influence on the film appearance. Films containing gallic acid became more elastic. Gallic acid was found to potentially act like a plasticizer. Scanning electron microscopy was used to investigate the ultrastructure of the produced films.

Survey of ixodid ticks and two tick-borne pathogens in African buffaloes, Syncerus caffer, from the Caprivi Strip, Namibia.

A capture operation to ascertain health status in free-ranging buffaloes from six different areas in the Caprivi Strip in the northeast corner of Namibia was conducted in October 2009. Basic information on the ticks and tick-borne pathogens normally found in wildlife from this area are scarce. The objective of this study was to assess the host status of African buffaloes, Syncerus caffer, for ixodid ticks and two selected tick-borne pathogens in the Caprivi Strip, a key area bordering Angola, Zambia, Botswana, and Zimbabwe. Four different tick species have been identified among the 233 collected specimens, and, of 95 tested buffaloes, 54 (57%) were positive for Theileria parva, whereas only 3 (3%) showed evidence of being infected with Ehrlichia ruminantium.

African horse sickness: a description of outbreaks in Namibia.

African horse sickness is a vector-transmitted viral disease that affects equidae. The authors report cases of disease that occurred in Namibia between 2006 and 2008. These were recorded by staff of the Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise 'G. Caporale' and the Central Veterinary Laboratory in Windhoek. All cases described were confirmed by laboratory testing. This study received the support of Namibian state and private veterinarians and horse breeders.