Bacteria in the airways of patients with cystic fibrosis are genetically capable of producing VOCs in breath.

Breath contains hundreds of volatile organic compounds (VOCs), the composition of which is altered in a wide variety of diseases. Bacteria are implicated in the formation of VOCs, but the biochemical mechanisms that lead to the formation of breath VOCs remain largely hypothetical. We hypothesized that bacterial DNA fragments in sputum of CF patients could be sequenced to identify whether the bacteria present were capable of producing VOCs found in the breath of these patients.

A case of extreme hypokalaemia.

Hypokalaemia is a common clinical problem. It can lead to severe disturbances in cardiac, neurological and muscle function. We present the case of a 45-year-old woman who was transported to our hospital with cardiac arrest following ventricular fibrillation.

Increased incidence of co-infection in critically ill patients with influenza.

Background: Co-infection is frequently seen in critically ill patients with influenza, although the exact rate is unknown. We determined the rate of co-infection, the risk factors and the outcomes associated with co-infection in critically ill patients with influenza over a 7-year period in 148 Spanish intensive care units (ICUs).

Methods: This was a prospective, observational, multicentre study.

External validation of the APPS, a new and simple outcome prediction score in patients with the acute respiratory distress syndrome.

Background: A recently developed prediction score based on age, arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FiO2) and plateau pressure (abbreviated as 'APPS') was shown to accurately predict mortality in patients diagnosed with the acute respiratory distress syndrome (ARDS). After thorough temporal external validation of the APPS, we tested the spatial external validity in a cohort of ARDS patients recruited during 3 years in two hospitals in the Netherlands.

Methods: Consecutive patients with moderate or severe ARDS according to the Berlin definition were included in this observational multicenter cohort study from the mixed medical-surgical ICUs of two university hospitals.

Breathomics in the setting of asthma and chronic obstructive pulmonary disease.

Exhaled breath contains thousands of volatile organic compounds that reflect the metabolic process occurring in the host both locally in the airways and systemically. They also arise from the environment and airway microbiome. Comprehensive analysis of breath volatile organic compounds (breathomics) provides opportunities for noninvasive biomarker discovery and novel mechanistic insights.

Clinical practice of respiratory virus diagnostics in critically ill patients with a suspected pneumonia: A prospective observational study.

Background: Clinical guidelines suggest testing for respiratory viruses during the influenza season, but are unclear which categories of patients on the intensive care unit (ICU) should be tested.

Objective: We described the clinical practice of diagnostic testing for respiratory virus infections in patients presenting to ICU with suspected community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP).

Study Design: Prospective observational study in consecutive CAP and HAP patients with an ICU stay of more than 24h in two tertiary care hospitals in The Netherlands, from 2011 to December 2013.

Factors Influencing Continuous Breath Signal in Intubated and Mechanically-Ventilated Intensive Care Unit Patients Measured by an Electronic Nose.

Introduction: Continuous breath analysis by electronic nose (eNose) technology in the intensive care unit (ICU) may be useful in monitoring (patho) physiological changes. However, the application of breath monitoring in a non-controlled clinical setting introduces noise into the data. We hypothesized that the sensor signal is influenced by: (1) humidity in the side-stream; (2) patient-ventilator disconnections and the nebulization of medication; and (3) changes in ventilator settings and the amount of exhaled CO₂.

Point and trend accuracy of a continuous intravenous microdialysis-based glucose-monitoring device in critically ill patients: a prospective study.

Background: Microdialysis is a well-established technology that can be used for continuous blood glucose monitoring. We determined point and trend accuracy, and reliability of a microdialysis-based continuous blood glucose-monitoring device (EIRUS(®)) in critically ill patients.

Methods: Prospective study involving patients with an expected intensive care unit stay of ≥48 h.

Nation Binding: How Public Service Broadcasting Mitigates Political Selective Exposure.

Recent research suggests that more and more citizens select news and information that is congruent with their existing political preferences. This increase in political selective exposure (PSE) has allegedly led to an increase in polarization. The vast majority of studies stem from the US case with a particular media and political system.

Biomarker kinetics in the prediction of VAP diagnosis: results from the BioVAP study.

Background: Prediction of diagnosis of ventilator-associated pneumonia (VAP) remains difficult. Our aim was to assess the value of biomarker kinetics in VAP prediction.

Methods: We performed a prospective, multicenter, observational study to evaluate predictive accuracy of biomarker kinetics, namely C-reactive protein (CRP), procalcitonin (PCT), mid-region fragment of pro-adrenomedullin (MR-proADM), for VAP management in 211 patients receiving mechanical ventilation for >72 h.

Smelling the Diagnosis: The Electronic Nose as Diagnostic Tool in Inflammatory Arthritis. A Case-Reference Study.

Objective: To investigate whether exhaled breath analysis using an electronic nose can identify differences between inflammatory joint diseases and healthy controls.

Methods: In a cross-sectional study, the exhaled breath of 21 rheumatoid arthritis (RA) and 18 psoriatic arthritis (PsA) patients with active disease was compared to 21 healthy controls using an electronic nose (Cyranose 320; Smiths Detection, Pasadena, CA, USA). Breathprints were analyzed with principal component analysis, discriminant analysis, and area under curve (AUC) of receiver operating characteristics (ROC) curves.

Modeled Analysis of Entrance of Colloid Suspensions into the Middle Ear Cavity.

Otic suspensions have a positive effect on the duration of otorrhea in children with a tympanostomy tube. It is still questionable how eardrops reach the middle ear. We hypothesized that otic suspensions do not pass the tympanostomy tube if the middle ear is dry but pass by diffusion when wet.

Training Inference Making Skills Using a Situation Model Approach Improves Reading Comprehension.

This study aimed to enhance third and fourth graders' text comprehension at the situation model level. Therefore, we tested a reading strategy training developed to target inference making skills, which are widely considered to be pivotal to situation model construction. The training was grounded in contemporary literature on situation model-based inference making and addressed the source (text-based versus knowledge-based), type (necessary versus unnecessary for (re-)establishing coherence), and depth of an inference (making single lexical inferences versus combining multiple lexical inferences), as well as the type of searching strategy (forward versus backward).

Attitudes of Psychiatric Nurses about the Request for Euthanasia on the Basis of Unbearable Mental Suffering(UMS).

Introduction: When psychiatric patients express a wish for euthanasia, this should first and foremost be interpreted as a cry for help. Due to their close day-to-day relationship, psychiatric nurses may play an important and central role in responding to such requests. However, little is known about nurses' attitudes towards euthanasia motivated by unbearable mental suffering.

Comparison of classification methods in breath analysis by electronic nose.

Currently, many different methods are being used for pre-processing, statistical analysis and validation of data obtained by electronic nose technology from exhaled air. These various methods, however, have never been thoroughly compared. We aimed to empirically evaluate and compare the influence of different dimension reduction, classification and validation methods found in published studies on the diagnostic performance in several datasets.

Associations between bolus infusion of hydrocortisone, glycemic variability and insulin infusion rate variability in critically Ill patients under moderate glycemic control.

Background: We retrospectively studied associations between bolus infusion of hydrocortisone and variability of the blood glucose level and changes in insulin rates in intensive care unit (ICU) patients.

Methods: 'Glycemic variability' and 'insulin infusion rate variability' were calculated from and expressed as the standard deviation (SD) of all blood glucose levels and insulin infusion rates during stay in the ICU, respectively. Glycemic and insulin infusion rate variability in patients who received bolus infusion of hydrocortisone were compared to those in patients who never received bolus infusion of hydrocortisone.

Role of Vascular Disease in the Evolution of Heart Transplant Patients.

Background: The clinical profile of heart transplantation (HT) recipients has changed in recent years. Nowadays, we have to deal with a higher number of co-morbidities, including peripheral vascular disease (PVD). Previous studies suggest an increase in post-HT morbidity and mortality associated with PVD, especially when it is symptomatic.

Exhaled Molecular Fingerprinting in Diagnosis and Monitoring: Validating Volatile Promises.

Medical diagnosis and phenotyping increasingly incorporate information from complex biological samples. This has promoted the development and clinical application of non-invasive metabolomics in exhaled air (breathomics). In respiratory medicine, expired volatile organic compounds (VOCs) are associated with inflammatory, oxidative, microbial, and neoplastic processes.

Tumor necrosis factor receptor 1 (TNFRI) for ventilator-associated pneumonia diagnosis by cytokine multiplex analysis.

Background: The diagnosis of ventilator-associated pneumonia (VAP) is challenging. An important aspect to improve outcome is early recognition of VAP and the initiation of the appropriate empirical treatment. We hypothesized that biological markers in plasma can rule out VAP at the moment of clinical suspicion and could rule in VAP before the diagnosis can be made clinically.

Levels of cytokines in broncho-alveolar lavage fluid, but not in plasma, are associated with levels of markers of lipid peroxidation in breath of ventilated ICU patients.

Alkanes and alkenes in the breath are produced through fatty acid peroxidation, which is initialized by reactive oxygen species. Inflammation is an important cause and effect of reactive oxygen species. We aimed to evaluate the association between fatty acid peroxidation products and inflammation of the alveolar and systemic compartment in ventilated intensive care unit (ICU) patients.