Optimal energy provision early in ICU stay for critically ill patients receiving parenteral nutrition.

BACKGROUND: Literature on optimal energy provision via parenteral nutrition (PN) is limited and the evidence quality is low. The purpose of this study is to determine if there is a difference in outcomes in adult critically ill patients when receiving lower vs higher calorie provision via PN early in intensive care unit (ICU) stay. METHODS: Adult patients initiated on PN within the first 10 days of ICU stay from May 2014 to June 2021 were included in this retrospective study. The primary outcome was to determine the impact of lower (<20 kcal/kg/day) vs higher (>25 kcal/kg/day) calorie provision on all-cause, in-hospital mortality. Secondary outcomes were to determine the impact of calorie provision on hospital or ICU length of stay and incidence of complications. RESULTS: This study included 133 patients: a lower calorie provision group (n = 77) and a higher calorie provision group (n = 56). There was a significant difference in all-cause, in-hospital mortality between the lower and the higher calorie provision groups (36.36% and 17.86%, respectively; P = 0.02). However, upon a multivariate analysis of death at discharge, the specific calorie provision group did not affect the probability of death at hospital discharge. The secondary outcomes were not significantly different between groups. CONCLUSION: When comparing lower calorie provision with higher calorie provision in adult critically ill patients receiving PN early within their ICU stay, there were no differences in outcomes after controlling for significant confounders. Future larger prospective studies should further evaluate optimal caloric provision via PN in this population.

Student Pharmacist-Led Basic Life Support Training for High School Students Improves Knowledge and Skill Achievement.

Introduction: The performance of bystander cardiopulmonary resuscitation (CPR) improves survival among cardiac arrest victims. Near-peer teaching of Basic Life Support (BLS) may be an effective way to deliver resuscitation education. This article aims to assess the effectiveness of a student pharmacist-led American Heart Association (AHA) BLS course on high school students' knowledge and skill achievement. Methods: Student pharmacists were trained as AHA instructors and delivered BLS certification courses to high school students. Participants completed pre- and post-assessments adapted from the course learning objectives. Skills performance was evaluated using the AHA's standardized forms. Participants completed questions regarding their perceptions of the pharmacist's role in BLS and confidence in pursuing a career in healthcare. Results: There were 321 participants with the majority in 11th or 12th grade (86.6%) and attending public school (99.1%). After completing the training, the mean percentage of correct assessment responses increased from 41.2% to 89% (p <0.0001). All participants correctly performed BLS skills. Most participants strongly agreed or agreed that the course changed their perspective of the pharmacist's role during BLS (74.8%) and increased their confidence in their decision to pursue future careers in healthcare (61.7%). Conclusion: Student pharmacist-led BLS training, using near-peer delivery, improves high school students' knowledge and skill achievement. This strategy promotes high school students' positive perceptions regarding pharmacists and their role in BLS, as well as their confidence in pursuing careers in healthcare.

Anti­inflammatory effects of Nypa fruticans Wurmb via NF­κB and MAPK signaling pathways in macrophages.

The inflammatory defense response of macrophages is a natural protective reaction in the immune system. Antioxidant and anti-inflammatory activities are closely related. In addition, the cell signaling pathway regulating inflammation is associated with MAPK and NF-κB signaling pathway phosphorylation. The present study aimed to evaluate whether the ethyl acetate fraction from N. fruticans (ENF) has a modulatory role in the MAPK signaling pathway and inhibition of the IκB/NF-κB signaling pathways, including translocation of NF-κB p65. Antioxidant and anti-inflammatory activities are closely related. In addition, the cell signaling pathway regulating inflammation is associated with MAPK and NF-κB signaling pathway phosphorylation. The results revealed that ENF exhibited antioxidant capacity, attenuated the cytokine levels and blocked nitric oxide production. ENF downregulated cyclooxygenase-2 and inducible nitric oxide synthase expression. We hypothesized that ENF treatment alleviated the various proinflammatory mediators via IκB phosphorylation and transcription of NF-κB compared with the untreated control. In conclusion, the present study demonstrated that the inhibitory effect of ENF treatment was attributed to the inhibition of MAPK and Akt/IκB/NF-κB signaling pathways.

Higher Concentration of Dietary Selenium, Zinc, and Copper Complex Reduces Heat Stress-Associated Oxidative Stress and Metabolic Alteration in the Blood of Holstein and Jersey Steers.

This study investigated the influence of high concentrations of dietary minerals on reducing heat stress (HS)-associated oxidative stress and metabolic alterations in the blood of Holstein and Jersey steers. Holstein steers and Jersey steers were separately maintained under a 3 × 3 Latin square design during the summer conditions. For each trial, the treatments included Control (Con; fed basal TMR without additional mineral supplementation), NM (NRC recommended mineral supplementation group; [basal TMR + (Se 0.1 ppm + Zn 30 ppm + Cu 10 ppm) as DM basis]), and HM (higher than NRC recommended mineral supplementation group; [basal TMR + (Se 3.5 ppm + Zn 350 ppm + Cu 28 ppm) as DM basis]). Blood samples were collected at the end of each 20-day feeding trial. In both breeds, a higher superoxide dismutase concentration (U/mL) along with lower HSP27 (µg/L) and HSP70 (µg/L) concentrations were observed in both mineral-supplemented groups compared to the Con group (p < 0.05). The HM group had significantly higher lactic acid levels in Jersey steers (p < 0.05), and tended to have higher alanine levels in Holstein steers (p = 0.051). Based on star pattern recognition analysis, the levels of succinic acid, malic acid, γ-linolenic acid, 13-methyltetradecanoic acid, and tyrosine decreased, whereas palmitoleic acid increased with increasing mineral concentrations in both breeds. Different treatment groups of both breeds were separated according to the VIP scores of the top 15 metabolites through PLS−DA analysis; however, their metabolic trend was mostly associated with the glucose homeostasis. Overall, the results suggested that supplementation with a higher-than-recommended concentration of dietary minerals rich in organic Se, as was the case in the HM group, would help to prevent HS-associated oxidative stress and metabolic alterations in Holstein and Jersey steers.

Closing the Integration Gap: A Pilot for Incorporating Foundational Sciences, DEI-Decision Making, Empathy, and Communication for Congestive Heart Failure and Arrhythmia Management by Pharmacy Students.

Pharmacists must integrate foundational sciences with pharmacy practice for providing optimal patient care. Pharmacy students need to be trained to provide culturally competent, linguistically accessible, and empathetic care while integrating foundational science principles. However, such holistic integration is challenging to achieve and assess. To bridge this gap, we implemented and assessed an "integrated cardiovascular simulation" (ICS) module for P2 students, employing case-based and team-based learning. ICS focused on congestive heart failure with preexisting arrhythmia and incorporated patient counseling relating to diversity factors such as cultural competency, linguistic challenges, and the impact of population diversity on cardiac diseases. Students learned the SBAR communication technique (situation, background, assessment, and recommendation) and recommended therapy while elaborating on drug MOA and adverse effects. ICS was assessed through pre-and post-session quizzes and perception data immediately after the activity, and after two years, when students progressed to the cardiovascular APPE block. Student performance improved on a post-test (80.2%) compared to the pre-test (66.9%), p < 0.01 paired student t-test, with an increase in symptom and arrhythmia pattern recognition (41.2% and 36.7%, respectively). ICS was effective for teaching (1) arrhythmia pathophysiology (85%), (2) EKG interpretation (89%), (3) drug adverse effects (93%), (4) DEI-clinical decision making (92%), and (5) communication skills (85%).

Evaluation of dental caries detection with quantitative light-induced fluorescence in comparison to different field of view devices.

This study evaluated dental caries detection ability between the Qraycam and Qraypen on the same dental caries lesions. A total of 178teeth from 61patients were imaged using Qraypen C®(QC) and Qraycam Pro®(QP) devices and evaluated using analysis software (QA2). Occlusal, secondary, and proximal dental caries were evaluated and scored according to International Caries Detection and Assessment System(ICDAS II) and X-ray criteria. Bland-Altman plots were used to compare quantitative light-induced fluorescence(QLF) parameters obtained from the different QLF devices. Sensitivity, specificity, and area under the receiver operating characteristic curve(AUROC) were calculated. The ΔFaver. of the QLF-parameters showed that the mean difference between the two different QLF devices was close to zero and that the ± 5 error value was included in the mean ± 1.96SD range for the detection of dental caries. The accuracies for diagnosing occlusal dental caries were 0.83-0.96 and 0.81-0.82 and the accuracies for diagnosing proximal dental caries were 0.52-0.62 and 0.52-0.71 for the QC and QP devices, respectively. In conclusion, the ΔFaver. obtained from the QP showed diagnostic value mainly for screening of demineralized teeth. For teeth selected through screening, the depth of the lesion must be precisely evaluated using additional QP and radiographic imaging.

Development of a maxillomandibular arch form based on the center of resistance of teeth using cone-beam computed tomography.

INTRODUCTION: Controlling transverse discrepancies is necessary to ensure stable and functional occlusion. Altered molar inclinations can camouflage the transverse relationship. The purpose of this research was to evaluate the maxillomandibular relationship of the center of resistance (CR) of the arch form created by the CR of teeth and compare these CR arch forms by their skeletal patterns. METHODS: Sixty patients with minor crowding and normal posterior overjet were divided into 3 groups according to ANB angle: skeletal Class I group had ANB angle between 0° and 4° (n = 20), skeletal Class II group had ANB angle >4° (n = 20), and skeletal Class III group had ANB angle <0° (n = 20). The 3-dimensional coordinates of the CR were estimated using cone-beam computed tomography images and projected on the CR occlusal plane to obtain the 2-dimensional coordinates. The CR arch forms were constructed and evaluated using Matlab (MathWorks, Natick, Mass). RESULTS: On comparing maxillomandibular CR arch form widths, the maxilla was significantly larger than the mandible of the canine and first premolar. The mandible was larger in the first molar of the skeletal Class III group. The maxillomandibular CR arch form width ratios were between 0.97 and 1.35. On comparing maxillomandibular CR arch form areas, the maxilla was significantly larger than the mandible in the anterior segment, and the mandible was larger in the posterior segment. The ratios were between 0.86 and 2.25. In between-group comparison, the skeletal Class III group showed significantly greater arch forms in the mandible. CONCLUSIONS: CR arch forms had significant maxillomandibular differences throughout the arch. The maxillomandibular ratios could be a reference for site-specific transverse discrepancy analysis.

Metabolomic analysis of amino acids and organic acids in aging mouse eyes using gas chromatography-tandem mass spectrometry.

This is a metabolomics study for monitoring altered amino acid (AA) and organic acid (OA) metabolism of in eyes from aging an mouse model at 8 and 18 weeks and 18 months. Simultaneous metabolic profiling analysis of OAs and AAs was performed as ethoxycarbonyl/methoxime/tert-butyldimethylsilyl derivatives by gas chromatography-tandem mass spectrometry. A total of 42 metabolites-24 AAs and 18 OAs-were determined and their composition values were normalized to the corresponding mean values of 8-week-old mice as the control group. Then their normalized values were plotted as star graphs, which were distorted and readily distinguishable for each age-related group. Among the 42 metabolites, 18 AAs and 11 OAs were age dependent and significantly different (p < 0.05). Principal component analysis and partial least squares discriminant analysis showed unclear separation between 8- and 18-week-old mice but clear separation between these and 18-month-old mice. In particular, the variable importance in projection scores of 4-hydroxyproline, cis-aconitic acid, glycine, isocitric acid, leucine, pipecolic acid and lysine from partial least-squares-discriminant analysis were higher than 1.3. A heatmap for the classification and visualization of 42 metabolites showed differences in metabolite changes with aging. Altered AA and OA profiles were monitored, which may explain the metabolic disturbance of AA and OA. These findings are related to mitochondrial dysfunctions related to energy metabolism and the impaired antioxidant system in the aging eye. Therefore, the present metabolomics results of the association between physiological states and altered metabolism of AA and OA will be useful for understanding the aging eye and related diseases.

Geometry of anchoring miniscrew in the lateral palate that support a tissue bone borne maxillary expander affects neighboring root damage.

Anchoring miniscrews used for a tissue bone borne maxillary expander (C-expander) can fail if they contact tooth roots or perforate the maxillary sinus. Cone beam computed tomography images were reviewed retrospectively to evaluate the geometric factors of miniscrew placement in the palate that contribute to root proximity (RP) and sinus perforation (SP), and to investigate the differences of miniscrew placement depth (PD) and placement angle (PA) among the groups in each variable from 340 anchoring miniscrews on 70 patients whose C-expanders showed sufficient stability after palatal expansion for orthodontic treatment. Two types of miniscrews were used: a self-tapping miniscrew with 1.8 mm-in-diameter, and a self-drilling miniscrew with 1.6 mm-in-diameter. While the self-tapping larger diameter miniscrew influenced root proximity significantly, the screw location and PD affected the rate of sinus perforation. PA was significantly different between the right and left sides of the palate. The results of this study confirmed that root proximity and sinus perforation of anchoring miniscrews in a tissue bone borne palatal expander occurred due to certain risk factors, even when the palates were expanded successfully. Knowledge of these factors can help the clinician place miniscrews with less risk of root proximity or sinus perforation.

Evaluation of Periodontal Risk Factors with Quantitative Light-Induced Fluorescence Based Fluorescent Plaque Index, in Comparison to Radiographic and Oral Health Habit Scoring: A Retrospective Case Study.

The aim of this study was to evaluate periodontal risk factors with oral health habits and fluorescent plaque index (FPI) using quantitative light-induced fluorescence (QLF) images, and to evaluate their effect on the degree of radiographic bone loss (RBL). Selected were 276 patients over 19 years of age to complete the questionnaire for oral health habit and take QLF images, periapical and panoramic radiographs. Oral health habit score, age, and sex showed a statistically significant correlation with FPI. FPI showed a lower value as the oral health habit score increased and the age decreased. Moreover, females showed lower FPI values than did males. RBL showed a statistically significant positive correlation with age but did not show any correlation with oral health habit scores and sex. There was no correlation between FPI and RBL. The results of this study suggest that the clinical use of QLF allows plaque detection by non-invasive procedures and can aid in a more objective estimation for oral hygiene status.

Three-Dimensional Digital Superimposition of Orthodontic Bracket Position by Using a Computer-Aided Transfer Jig System: An Accuracy Analysis.

Accurate bracket placement is essential for successful orthodontic treatment. An indirect bracket bonding system (IDBS) has been developed to ensure proper bracket positioning with three-dimensional computer-aided transfer jigs. The purpose of this study was to investigate the accuracy of bracket positioning by a one-body transfer jig according to the tooth type and presence/absence of a resin base. In total, 506 teeth from 20 orthodontic patients were included in this study. After initial dental models were scanned, virtual setup and bracket positioning procedures were performed with 3D software. Transfer jigs and RP models were fabricated with a 3D printer, and brackets were bonded to the RP model with or without resin base fabrication. The best-fit method of 3D digital superimposition was used to evaluate the lineal and angular accuracy of the actual bracket position compared to a virtual bracket position. Although all the measurements showed significant differences in position, they were clinically acceptable. Regarding the tooth types, premolars and molars showed higher accuracy than anterior teeth. The presence or absence of a resin base did not consistently affect the accuracy. In conclusion, the proper application of IDBS should be performed considering the errors, and resin base fabrication might not be essential in ensuring high-accuracy IDBS.

Acremonamide, a Cyclic Pentadepsipeptide with Wound-Healing Properties Isolated from a Marine-Derived Fungus of the Genus Acremonium.

Acremonamide (1) was isolated from a marine-derived fungus belonging to the genus Acremonium. The chemical structure of 1 was established using MS, UV, and NMR spectroscopic data analyses. Acremonamide (1) was found to contain N-Me-Phe, N-Me-Ala, Val, Phe, and 2-hydroxyisovaleric acid. The absolute configurations of the four aforementioned amino acids were determined through acid hydrolysis followed by the advanced Marfey's method, whereas the absolute configuration of 2-hydroxyisovaleric acid was determined through GC-MS analysis after formation of the O-pentafluoropropionylated derivative of the (-)-menthyl ester of 2-hydroxyisovaleric acid. As an intrinsic biological activity, acremonamide (1) did not exert cytotoxicity to cancer and noncancer cells and increased the migration and invasion. Based on these activities, the wound healing properties of acremonamide (1) were confirmed in vitro and in vivo.

Root proximity of the anchoring miniscrews of orthodontic miniplates in the mandibular incisal area: Cone-beam computed tomographic analysis.

OBJECTIVE: This outcome analysis study evaluated the actual positions of the orthodontic miniplate and miniplate anchoring screws (MPASs) and the risk factors affecting adjacent anatomic structures after miniplate placement in the mandibular incisal area. METHODS: Cone-beam computed tomographic images of 97 orthodontic miniplates and their 194 MPASs (diameter, 1.5 mm; length, 4 mm) in patients whose miniplates provided sufficient clinical stability for orthodontic treatment were retrospectively reviewed. For evaluating the actual positions of the miniplates and analyzing the risk factors, including the effects on adjacent roots, MPAS placement height (PH), placement depth (PD), plate angle (PA), mental fossa angle (MA), and root proximity were assessed using the paired t-test, analysis of variance, and generalized linear model and regression analyses. RESULTS: The mean PDs of MPASs at positions 1 (P1) and 2 (P2) were 2.01 mm and 2.23 mm, respectively. PA was significantly higher in the Class III malocclusion group than in the other groups. PH was positively correlated with MA and PD at P1. Of the 97 MPASs at P1, 49 were in the no-root area and 48 in the dentulous area; moreover, 19 showed a degree of root contact (19.6%) without root perforation. All MPASs at P2 were in the no-root area. CONCLUSIONS: Positioning the miniplate head approximately 1 mm lower than the mucogingival junction is highly likely to provide sufficient PH for the P1- MPASs to be placed in the no-root area.

Quantitative cone-beam computed tomography evaluation of hard and soft tissue thicknesses in the midpalatal suture region to facilitate orthodontic mini-implant placement.

OBJECTIVE: To identify the most favorable sites that optimize the initial stability and survival rate of orthodontic mini-implants, this study measured hard and soft tissue thicknesses in the median and paramedian regions of the palate using cone-beam computed tomography (CBCT) and determined possible sexand age-related differences in these thicknesses. METHODS: The study sample comprised CBCT images of 189 healthy subjects. The sample was divided into four groups according to age. A grid area was set for the measurement of hard and soft tissue thicknesses in the palate. Vertical lines were marked at intervals of 0, 1.5, and 3.0 mm lateral to the midpalatal suture, while horizontal lines were marked at 2-mm intervals up to 24 mm from the posterior margin of the incisive foramen. Measurements were made at 65 points of intersection between the horizontal and vertical lines. RESULTS: The palatal hard tissue thickness decreased from the anterior to the posterior region, with a decrease in the medial-to-lateral direction in the middle and posterior regions. While the soft tissue was rather thick around the lateral aspects of the palatal arch, it formed a constant layer that was only 1-2-mm thick throughout the palate. Statistically significant differences were observed according to sex and age. CONCLUSIONS: The anterolateral palate as well as the midpalatal suture seem to be the most favorable sites for insertion of orthodontic mini-implants. The thickness of the palate differed by age and sex; these differences should be considered while planning the placement of orthodontic mini-implants.

Losing the Battle but Winning the War: Can Defeated Antibacterials Form Alliances to Combat Drug-Resistant Pathogens?

Despite the recent development of antibacterials that are active against multidrug-resistant pathogens, drug combinations are often necessary to optimize the killing of difficult-to-treat organisms. Antimicrobial combinations typically are composed of multiple agents that are active against the target organism; however, many studies have investigated the potential utility of combinations that consist of one or more antibacterials that individually are incapable of killing the relevant pathogen. The current review summarizes in vitro, in vivo, and clinical studies that evaluate combinations that include at least one drug that is not active individually against Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, or Staphylococcus aureus. Polymyxins were often included in combinations against all three of the Gram-negative pathogens, and carbapenems were commonly incorporated into combinations against K. pneumoniae and A. baumannii. Minocycline, sulbactam, and rifampin were also frequently investigated in combinations against A. baumannii, whereas the addition of ceftaroline or another ß-lactam to vancomycin or daptomycin showed promise against S. aureus with reduced susceptibility to vancomycin or daptomycin. Although additional clinical studies are needed to define the optimal combination against specific drug-resistant pathogens, the large amount of in vitro and in vivo studies available in the literature may provide some guidance on the rational design of antibacterial combinations.

Detection of Dental Caries and Cracks with Quantitative Light-Induced Fluorescence in Comparison to Radiographic and Visual Examination: A Retrospective Case Study.

The aim of this study was to present an optimal diagnostic protocol by comparing and analyzing a conventional examination and the quantitative light-induced fluorescence (QLF) technique. Selected were 297 teeth of 153 patients to take QLF images and bitewing radiographs. Occlusal dental caries, proximal dental caries and cracks were evaluated and scored using QLF, X-ray and/or visual criteria. The sensitivity, specificity, and area under the curve (AUC) of a receiver operating characteristic analysis were calculated. Two fluorescence parameters (|ΔFmax| and ΔRmax) were utilized to evaluate the fluorescence pattern according to the severity of lesions based on QLF or X-ray criteria. QLF showed higher scores for detecting occlusal dental caries and cracks than the conventional method. ΔRmax increased more clearly than ΔFmax did with occlusal dental caries. The |ΔFmax| values of occlusal dental caries, proximal dental caries and cracks showed good AUC levels (0.84, 0.81 and 0.83, respectively). The ΔRmax of occlusal dental caries showed the highest AUC (0.91) and the ΔRmax of proximal dental caries showed a fail level (0.59) compared to bitewing radiographs. The QLF image could visualize and estimate the degree of occlusal dental caries or cracks. Consequently, the QLF technique may be an adjunct tool to conventional methods for the detection of occlusal caries and peripheral cracks.

Effect of Different Surface Designs on the Rotational Resistance and Stability of Orthodontic Miniscrews: A Three-Dimensional Finite Element Study.

High orthodontic forces and various directions of applied forces can be associated with loosening of the screw anchorage in the bone. Screw designs have been modified to increase the stability of the miniscrews. This research evaluates the influence of three-designs on the stability of orthodontic miniscrews. A conventionally cylinder-type miniscrew design (Bio-Action screw, Jin-Biomed co., Bucheon, Korea) was set as a control, and three conditions were studied based on modifications of this control design. Condition-1 has narrowed threads in the upper part of the screw; Condition-2 has a notch at the middle part; and Condition-3 has the combination of Condition-1 and Condition-2. The moment required to unwind the miniscrew to five degrees is tested, and the moment generated at the cortical bone and the trabecular bone were calculated with finite element analysis. Compared to the control, all three conditions showed a higher moment required to unwind the miniscrew and a higher moment generated at the cortical bone. At the trabecular bone, condition-2 and -3 showed higher moment than the control, and condition-1 showed similar moment to the control. Condition-3 required a higher overall moment to unwind the miniscrew. These findings validate the design modifications used to increase the rotational resistance.