610 Medizin, Gesundheit
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Institute
BACKGROUND:
Intraoperative electroencephalography (EEG) signatures related to the development of postoperative delirium (POD) in older patients are frequently studied. However, a broad analysis of the EEG dynamics including preoperative, postinduction, intraoperative and postoperative scenarios and its correlation to POD development is still lacking. We explored the relationship between perioperative EEG spectra-derived parameters and POD development, aiming to ascertain the diagnostic utility of these parameters to detect patients developing POD.
METHODS:
Patients aged ≥65 years undergoing elective surgeries that were expected to last more than 60 minutes were included in this prospective, observational single center study (Biomarker Development for Postoperative Cognitive Impairment [BioCog] study). Frontal EEGs were recorded, starting before induction of anesthesia and lasting until recovery of consciousness. EEG data were analyzed based on raw EEG files and downloaded excel data files. We performed multitaper spectral analyses of relevant EEG epochs and further used multitaper spectral estimate to calculate a corresponding spectral parameter. POD assessments were performed twice daily up to the seventh postoperative day. Our primary aim was to analyze the relation between the perioperative spectral edge frequency (SEF) and the development of POD.
RESULTS:
Of the 237 included patients, 41 (17%) patients developed POD. The preoperative EEG in POD patients was associated with lower values in both SEF (POD 13.1 ± 4.6 Hz versus no postoperative delirium [NoPOD] 17.4 ± 6.9 Hz; P = .002) and corresponding γ-band power (POD −24.33 ± 2.8 dB versus NoPOD −17.9 ± 4.81 dB), as well as reduced postinduction absolute α-band power (POD −7.37 ± 4.52 dB versus NoPOD −5 ± 5.03 dB). The ratio of SEF from the preoperative to postinduction state (SEF ratio) was ~1 in POD patients, whereas NoPOD patients showed a SEF ratio >1, thus indicating a slowing of EEG with loss of unconscious. Preoperative SEF, preoperative γ-band power, and SEF ratio were independently associated with POD (P = .025; odds ratio [OR] = 0.892, 95% confidence interval [CI], 0.808–0.986; P = .029; OR = 0.568, 95% CI, 0.342–0.944; and P = .009; OR = 0.108, 95% CI, 0.021–0.568, respectively).
CONCLUSIONS:
Lower preoperative SEF, absence of slowing in EEG while transitioning from preoperative state to unconscious state, and lower EEG power in relevant frequency bands in both these states are related to POD development. These findings may suggest an underlying pathophysiology and might be used as EEG-based marker for early identification of patients at risk to develop POD.
Background: New ischaemic brain lesions on magnetic resonance imaging (MRI) are reported in up to 86% of patients after transcatheter edge-to-edge repair of the mitral valve (TEER-MV). Knowledge of the exact procedural step(s) that carry the highest risk for cerebral embolisation may help to further improve the procedure.
Aims: The aim of this study was to identify the procedural step(s) that are associated with an increased risk of cerebral embolisation during TEER-MV with the MitraClip system. Furthermore, the risk of overt stroke and silent brain ischaemia after TEER-MV was assessed.
Methods: In this prospective, pre-specified observational study, all patients underwent continuous transcranial Doppler examination during TEER-MV to detect microembolic signals (MES). MES were assigned to specific procedural steps: (1) transseptal puncture and placement of the guide, (2) advancing and adjustment of the clip in the left atrium, (3) device interaction with the MV, and (4) removal of the clip delivery system and the guide. Neurological examination using the National Institutes of Health Stroke Scale (NIHSS) and cerebral MRI were performed before and after TEER-MV.
Results: Fifty-four patients were included. The number of MES differed significantly between the procedural steps with the highest numbers observed during device interaction with the MV. Mild neurological deterioration (NIHSS ≤3) occurred in 9/54 patients. New ischaemic lesions were detected in 21/24 patients who underwent MRI. Larger infarct volume was significantly associated with neurological deterioration.
Conclusions: Cerebral embolisation is immanent to TEER-MV and predominantly occurs during device interaction with the MV. Improvements to the procedure may focus on this procedural step.
BACKGROUND: Postoperative delirium (POD) is an acute and common complication after surgery that can increase morbidity and mortality. Few previous studies with inconsistent findings have examined the association of preoperative pain and POD. Our purpose is to investigate the association of preoperative chronic pain and POD.
METHODS: This prospective observational cohort study included 200 patients ≥ 18 years scheduled for elective surgery under general anaesthesia in a tertiary care hospital. POD was defined as meeting diagnostic criteria during the study visits (according to delirium screening tests and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), or by diagnosis of the responsible physicians. Chronic pain was defined as pain lasting six months or longer. Features of chronic pain were assessed with the German Pain Questionnaire, including the Depression Anxiety and Stress Scale-21 (DASS-21). Associations with POD were assessed using logistic regression analysis adjusting for confounding factors.
RESULTS: Thirty-nine (22%) out of 176 patients developed POD. Chronic pain was not associated with POD after adjustment for ASA physical status, duration of anesthesia and DASS-21 Anxiety score (Odds ratio [OR], 95%-Confidence Interval [CI], 2.216 [0.968;5.070], P=0.060). A subgroup analysis of chronic pain patients revealed that current pain intensity was higher in patients with POD.
CONCLUSIONS: Preoperative chronic pain was no independent predictor for POD. Current pain intensity was higher in chronic pain patients with POD. This indicates that certain features of pain might be influential. Further research is needed to examine different forms of preoperative pain and their possible influence on POD.
Shockwaves are mechanical pressure pulses generated in liquids and gases. Based on the principles of acoustics, shockwavescan propagate through fluids such as water. At interfaces of materials with different acoustic impedances, mechanical energy is dissipated, and disintegration of biological tissue can be achieved. Physical properties as well as technical requirements for shockwave generation by electrohydraulic, electromagnetic or piezoelectric energy conversion have been reported in the literature. The use of electrohydraulic shockwaves for food treatment is an emerging food processing technology, where a lack of scientific and technical knowledge has limited further advancements in process and equipment design. In scientific literature, single aspects required for process description are available, e.g., in metallurgy, mining, air purification or particle accelerators, but their combination toward a combined model is required to characterize underlying mechanisms of action. In food, most of the studies have focused on shockwave technology for treatment of meat cuts with the purpose of reducing aging time, softening of tissue and improving its tenderness. Other applications of the shockwave technology could expand to biological inactivation, targeted texture modifications and improving extractive and refining processes in agriculture industries. Total processing costs are estimated in a range of a few Euros per ton of product. Despite being a promising alternative to existing processes used for these purposes, the application of shockwave in the food industry is limited to date to research on pilot-scale prototypes.
This chapter presents the mechanism of the enhancement of freezing by means of ultrasound (US). It has been demonstrated that the effects of US are a rather complex issue. In theory, ultrasound creates cavitation bubbles throughout the volume of the product, which promotes nucleation of the ice and crushes the crystals already present in food. They can also enhance convective heat transfer to the cooling media, thereby accelerating freezing. Moreover, it has been shown that ultrasound reduces the degree of supercooling before nucleation in frozen food. Additionally, numerous experimental studies indicate that ultrasound assisted freezing is a good method to achieve homogenous crystallizations, reduce the deteriorating effect of freezing on food, and thus improve quality after thawing.
Among all nonthermal food processing technologies, high intensity pulsed electric fields (PEF) is one of the most appealing due to its short treatment times and reduced heating effects. Its capability to enhance extraction processes and to inactivate microorganisms at temperatures that do not cause any deleterious effect on flavor, color or nutrient value of foods opens interesting possibilities for the food processing industry.
This new and revised edition of Pulsed Electric Fields Technology for the Food Industry presents the information accumulated on PEF over the last decade by experienced microbiologists, biochemists, food technologists and electrical and food engineers. With insight into current applications of PEF across the food industry, this text offers a comprehensive and up to date resource on PEF application in the food industry from the scientific fundamentals to its use in various food types to environmental and regulatory aspects. For researchers and industry professionals seeking a single source containing all of the relevant and up to date information on PEF in foods, look no further than this essential text.
The influence of moderate electric fields (MEF) on thermally induced gelation and network structures of patatin enriched potato protein (PPI) was investigated. PPI solutions with 9 wt% protein (pH 7) and 25 mM NaCl were heated from 25 to 65 °C via OH (3–24 V/cm) or conventional heating (COV) at various come-up (240 s and 1200 s) and holding times (30 s and 600 s). Self-standing gels were produced but less proteins denatured when heated via OH. Further, SDS-PAGE and GPC measurements revealed more native patatin remaining after OH treatment. Scanning electron microscopy showed OH gels to have more gap-like structures and frayed areas than COV treated gels which resulted in lower water holding capacity. On molecular scale, less hydrophobic interactions were measured within the protein network and FTIR trials showed the MEF to affect beta-sheet structures. OH gels further showed lower rigidity and higher flexibility, thus, gelling functionality was affected via OH.
Novel foods by process are a special case in the catalogue of the ten novel food categories according to Article 3 (2) point (a) of the Novel Food Regulation (EU) 2015/2283, since the other nine categories derive their assessment as possible novel foods from their purely substantial properties. In the case of novel foods by process, the problem of dealing with the reference date of 15 May 1997, which is in the end a random reference date, is particularly significant. It would make more sense to have a dynamic reference date that ‘moves along the timeline’ or at least is reset from time to time and is more up-to-date. The characteristic that a process causes ‘significant changes in the composition or structure of the food, affecting its nutritional value, metabolism or level of undesirable substances’ must be understood in such a way that it is only a question of the generation of undesirable substances through the application of the process, but not their reduction, e.g. the reduction of undesirable microorganisms. Finally, the question also arises as to how the assessment of the process technology relates to the assessment of a food in the context of a novel food by composition category. This concerns the exemption for foods that have a history of use as safe foods, which, according to the view taken here, must also be interpreted into the category of novel foods by process.
Die vollständig überarbeitete Neuauflage des Lehrbuchklassikers jetzt ergänzt durch ein zusätzliches Kapitel und mit neuem Layout.
Dieses Standardwerk umfasst sämtliche Themengebiete der Lebensmittelphysik und behandelt u. a. die thermischen, rheologischen, akustischen und elektrischen Eigenschaften sowie die Dichte und Textur von Lebensmitteln. Zudem wird ausführlich auf die Funktion von online-Sensoren und deren Bedeutung für die Prozessautomatisierung in der Lebensmittelindustrie eingegangen.
Für Studierende der Lebensmittelwissenschaften und der Lebensmitteltechnologie ist dieses Lehrbuch mit vielen vorgerechneten Beispielen die Basis für ein grundlegendes Verständnis der Lebensmittelphysik. Ingenieure, Technologen und Techniker in der Lebensmittelproduktion können die aufgelisteten Anwendungsbeispiele am Ende jedes Kapitels nutzen, um ihre Kenntnisse für zukünftige physikalische Verfahren zu vertiefen.