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Fulltext Mucopyocele in the oral region: an unusual case

Telang , Ajay, Lahari, T., Chacko , James P.

Archives of Orofacial Sciences, 2011;6(2):1-4.
MyJurnal

Mucopyoceles are rare lesions defined as infected mucoceles. They have been reported only in the paranasal sinuses and appendix. Our case is the first to be reported in the oral region. A 58- year-old male presented with complaint of a painless swelling of two years duration in the right buccal sulcus with associated pus discharge. Radiographic examination ruled out pulpal and periodontal foci of infection and histopathology confirmed an underlying mucopyocele in the right buccal mucosa.
Modified palatal flap--a simpler approach for removal of palatal tori

Chacko JP, Joseph C

J Oral Maxillofac Surg, 2010 Apr;68(4):943-4.
PMID: 20307780 DOI: 10.1016/j.joms.2009.04.009
Drug policies in Malaysia

James PF

Lancet, 1984 Feb 25;1(8374):453.
PMID: 6142178
Vulnerability of Vietnam to typhoons: A spatial assessment based on hazards, exposure and adaptive capacity

Nguyen KA, Liou YA, Terry JP

Sci Total Environ, 2019 Sep 10;682:31-46.
PMID: 31121354 DOI: 10.1016/j.scitotenv.2019.04.069

Typhoons have devastating impacts across many Asian countries. Vietnam is presently one of the most disaster-prone nations. Typhoons regularly disrupt human lives and livelihoods in various ways and cause significant damage. Making efficient policy decisions to minimize the vulnerability of affected communities is crucial. This requires a deep understanding of the factors that make a society vulnerable to extreme events and natural disasters. An appropriate approach is integrating the three dimensions of hazard, exposure and sensitivity, and community adaptive capacity. However, the vulnerability and adaptive capacity response to typhoons within Vietnam is poorly investigated. Here, we develop a conceptual framework that incorporates 21 indicators to identify vulnerability and adaptive capacity (VAC) using geospatial techniques at regional scales, applied over Vietnam. We find large spatial differences in VAC and are able to identify the top-priority regions that need to enhance their adaptation to typhoons. The Southern Coastal area, South East and Red River Delta demonstrate high and very high vulnerability because of their physical features and the intensity of typhoons that frequently cross these parts of Vietnam. The lower Mekong Delta and Northern Coastal areas are vulnerable to typhoon-driven flood threats, in particular where compounded by sea-level rise. Our framework successfully identified the spatial distribution and different levels of VAC within acceptable limits of uncertainty. It can therefore serve as a template to tackle national issues in disaster risk reduction in Vietnam and assist in the development of suitable mitigation strategies to achieve sustainable outcomes.
Fulltext Management of wooden foreign bodies in craniofacial region

Loganathan K, Chacko JP, Saravanan BS, Vaithilingam B

J Oral Biol Craniofac Res, 2012 Sep-Dec;2(3):210-2.
PMID: 25737868 DOI: 10.1016/j.jobcr.2012.10.011

Even though variety of foreign bodies has been reported in a various locations in the craniofacial region, wooden foreign bodies are uncommon. Appropriate management of wooden foreign bodies is considered essential because of their infectious complications and difficulty in radiographic localization. Even though literature is replete with articles on management of foreign bodies in the craniofacial region, specific management of wooden foreign bodies are rarely reported. The purpose of this article is to report two cases of deeply placed wooden foreign body and a protocol for managing them in the maxillofacial region.
Fulltext Chlamydia and Its Many Ways of Escaping the Host Immune System

Wong WF, Chambers JP, Gupta R, Arulanandam BP

J Pathog, 2019;2019:8604958.
PMID: 31467721 DOI: 10.1155/2019/8604958

The increasing number of new cases of Chlamydia infection worldwide may be attributed to the pathogen's ability to evade various host immune responses. Summarized here are means of evasion utilized by Chlamydia enabling survival in a hostile host environment. The pathogen's persistence involves a myriad of molecular interactions manifested in a variety of ways, e.g., formation of membranous intracytoplasmic inclusions and cytokine-induced amino acid synthesis, paralysis of phagocytic neutrophils, evasion of phagocytosis, inhibition of host cell apoptosis, suppression of antigen presentation, and induced expression of a check point inhibitor of programmed host cell death. Future studies could focus on the targeting of these molecules associated with immune evasion, thus limiting the spread and tissue damage caused by this pathogen.
Biochemical events leading to the diversion of carbon into storage lipids in the oleaginous fungi Mucor circinelloides and Mortierella alpina

Wynn JP, Hamid AA, Li Y, Ratledge C

Microbiology (Reading), 2001 Oct;147(Pt 10):2857-2864.
PMID: 11577164 DOI: 10.1099/00221287-147-10-2857

The biochemical events associated with the onset of lipid accumulation in Mucor circinelloides and Mortierella alpina, under conditions of nitrogen-limited growth, have been elucidated; they differ in key aspects from those described in oleaginous yeasts. The NAD+:isocitrate dehydrogenases of Mc. circinelloides and Mort. alpina were not absolutely dependent on AMP for activity. Furthermore, changes in the cellular adenine nucleotide pools and energy charge were different from those reported for oleaginous yeasts. In Mc. circinelloides ATP, ADP and AMP concentrations all decreased by 50% after nitrogen limitation, leading to a constant energy charge at the expense of the size of the total adenylate pool. Pyruvate carboxylase in Mc. circinelloides was cytosolic, having implications for the organization of lipid synthesis in filamentous fungi. As a result of the data obtained, a revised and more concerted mechanism for the initiation of storage lipid accumulation is put forward for filamentous fungi.
Fulltext First record of Caligusdussumieri Rangnekar, 1957 (Copepoda, Siphonostomatoida, Caligidae) from Malaysia, with notes on caligids found from Malaysia and on host-specificity of caligids on lutjanid fishes

Ismail N, Nishida Y, Ohtsuka S, Boxshall G, Bernot JP

Biodivers Data J, 2024;12:e116598.
PMID: 38420188 DOI: 10.3897/BDJ.12.e116598

BACKGROUND: In total, 14 species of Caligus have been reported from Malaysia. Amongst them, four species are reported from lutjanid fishes.
NEW INFORMATION: Caligusdussumieri Rangnekar, 1957 is reported from Malabar snapper, Lutjanusmalabaricus, purchased from a local wet market in Terengganu, Peninsular Malaysia. This is the first record of this species in Malaysia and it is only the second species assigned to the bonito-group of the genus Caligus to be reported from Malaysia. A key to species of the bonito-group is presented herein. The list of caligids infecting lutjanid fishes and the geographical distributions plus the known hosts of members of the bonito-group of Caligus are discussed.
Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty

Kelly EG, Cashman JP, Imran FH, Conroy R, O'Byrne J

Surg Technol Int, 2014 Mar;24:295-301.
PMID: 24574017

The routine use of drains in surgery has been dogmatically instituted in some disciplines. Orthopaedic surgery is one such sub-speciality. The use of postoperative closed suction drainage in total hip arthroplasty (THA) has become increasingly controversial with multiple randomised control trials performed to assess the benefit to outcome in THA. The hypothesis of this systematic review is that closed suction drainage does not infer a benefit and increase transfusion requirements of primary total hip arthroplasty patients. A systematic review and meta-analysis was conducted adhering to the PRISMA guidelines. A search of the available literature was performed on PubMed, Cochrane Central Registry of Controlled Trials, MEDLINE (OVID) and EMBASE using a combination of MeSH terms and Boolean operators. All data analysis was performed using the Cochrane Collaboration's Review Manager 5.1. Sixteen studies (n=2705) were included in the analysis. Post-operative closed suction drainage was found to increase total blood loss and blood transfusion requirements (p<0.05). Surgical site infection demonstrated no significant difference between the two groups (p=0.82). No significant difference in haematoma formation between groups (p=0.19) was elicited. The routine use of closed suction drainage systems post primary hip arthroplasty is not supported by this meta-analysis. However, the heterogeneity between studies does limit the accuracy of the meta-analysis.
Fulltext Age- and Activity-Related Differences in the Abundance of Myosin Essential and Regulatory Light Chains in Human Muscle

Cobley JN, Ab Malik Z, Morton JP, Close GL, Edwards BJ, Burniston JG

Proteomes, 2016 Apr 08;4(2).
PMID: 28248225 DOI: 10.3390/proteomes4020015

Traditional methods for phenotyping skeletal muscle (e.g., immunohistochemistry) are labor-intensive and ill-suited to multixplex analysis, i.e., assays must be performed in a series. Addressing these concerns represents a largely unmet research need but more comprehensive parallel analysis of myofibrillar proteins could advance knowledge regarding age- and activity-dependent changes in human muscle. We report a label-free, semi-automated and time efficient LC-MS proteomic workflow for phenotyping the myofibrillar proteome. Application of this workflow in old and young as well as trained and untrained human skeletal muscle yielded several novel observations that were subsequently verified by multiple reaction monitoring (MRM). We report novel data demonstrating that human ageing is associated with lesser myosin light chain 1 content and greater myosin light chain 3 content, consistent with an age-related reduction in type II muscle fibers. We also disambiguate conflicting data regarding myosin regulatory light chain, revealing that age-related changes in this protein more closely reflect physical activity status than ageing per se. This finding reinforces the need to control for physical activity levels when investigating the natural process of ageing. Taken together, our data confirm and extend knowledge regarding age- and activity-related phenotypes. In addition, the MRM transitions described here provide a methodological platform that can be fine-tuned to suite multiple research needs and thus advance myofibrillar phenotyping.
Two Groups of Phytoplasmas from Japan Distinguished on the Basis of Amplification and Restriction Analysis of 16S rDNA

Okuda S, Prince JP, Davis RE, Dally EL, Lee IM, Mogen B, et al.

Plant Dis, 1997 Mar;81(3):301-305.
PMID: 30861775 DOI: 10.1094/PDIS.1997.81.3.301

Phytoplasmas (mycoplasmalike organisms, MLOs) associated with mitsuba (Japanese hone-wort) witches'-broom (JHW), garland chrysanthemum witches'-broom (GCW), eggplant dwarf (ED), tomato yellows (TY), marguerite yellows (MY), gentian witches'-broom (GW), and tsu-wabuki witches'-broom (TW) in Japan were investigated by polymerase chain reaction (PCR) amplification of DNA and restriction enzyme analysis of PCR products. The phytoplasmas could be separated into two groups, one containing strains JHW, GCW, ED, TY, and MY, and the other containing strains GW and TW, corresponding to two groups previously recognized on the basis of transmission by Macrosteles striifrons and Scleroracus flavopictus, respectively. The strains transmitted by M. striifrons were classified in 16S rRNA gene group 16SrI, which contains aster yellows and related phytoplasma strains. Strains GW and TW were classified in group 16SrIII, which contains phytoplasmas associated with peach X-disease, clover yellow edge, and related phytoplasmas. Digestion of amplified 16S rDNA with HpaII indicated that strains GW and TW were affiliated with subgroup 16SrIII-B, which contains clover yellow edge phytoplasma. All seven strains were distinguished from other phytoplasmas, including those associated with clover proliferation, ash yellows, elm yellows, and beet leafhopper-transmitted virescence in North America, and Malaysian periwinkle yellows and sweet potato witches'-broom in Asia.
Guinea pig genital tract lipidome reveals in vivo and in vitro regulation of phosphatidylcholine 16:0/18:1 and contribution to Chlamydia trachomatis serovar D infectivity

Wali S, Gupta R, Yu JJ, Mfuh A, Gao X, Guentzel MN, et al.

Metabolomics, 2016 Apr;12(4).
PMID: 27642272

INTRODUCTION: Chlamydia trachomatis (Ct), is the leading cause of sexually transmitted infections worldwide. Host transcriptomic- or proteomic profiling studies have identified key molecules involved in establishment of Ct infection or the generation of anti Ct-immunity. However, the contribution of the host metabolome is not known.
OBJECTIVES: The objective of this study was to determine the contribution of host metabolites in genital Ct infection.
METHODS: We used high-performance liquid chromatography-mass spectrometry, and mapped lipid profiles in genital swabs obtained from female guinea pigs at days 3, 9, 15, 30 and 65 post Ct serovar D intravaginal infection.
RESULTS: Across all time points assessed, 13 distinct lipid species including choline, ethanolamine and glycerol were detected. Amongst these metabolites, phosphatidylcholine (PC) was the predominant phospholipid detected from animals actively shedding bacteria i.e., at 3, 9, and 15 days post infection. However, at days 30 and 65 when the animals had cleared the infection, PC was observed to be decreased compared to previous time points. Mass spectrometry analyses of PC produced in guinea pigs (in vivo) and 104C1 guinea pig cell line (in vitro) revealed distinct PC species following Ct D infection. Amongst these, PC 16:0/18:1 was significantly upregulated following Ct D infection (p < 0.05, >twofold change) in vivo and in vitro infection models investigated in this report. Exogenous addition of PC 16:0/18:1 resulted in significant increase in Ct D in Hela 229 cells.
CONCLUSION: This study demonstrates a role for host metabolite, PC 16:0/18:1 in regulating genital Ct infection in vivo and in vitro.
Fulltext Managing fisheries for maximum nutrient yield

Robinson JPW, Nash KL, Blanchard JL, Jacobsen NS, Maire E, Graham NAJ, et al.

Fish Fish (Oxf), 2022 Jul;23(4):800-811.
PMID: 35912069 DOI: 10.1111/faf.12649

Wild-caught fish are a bioavailable source of nutritious food that, if managed strategically, could enhance diet quality for billions of people. However, optimising nutrient production from the sea has not been a priority, hindering development of nutrition-sensitive policies. With fisheries management increasingly effective at rebuilding stocks and regulating sustainable fishing, we can now begin to integrate nutritional outcomes within existing management frameworks. Here, we develop a conceptual foundation for managing fisheries for multispecies Maximum Nutrient Yield (mMNY). We empirically test our approach using size-based models of North Sea and Baltic Sea fisheries and show that mMNY is predicted by the relative contribution of nutritious species to total catch and their vulnerability to fishing, leading to trade-offs between catch and specific nutrients. Simulated nutrient yield curves suggest that vitamin D, which is deficient in Northern European diets, was underfished at fishing levels that returned maximum catch weights. Analysis of global catch data shows there is scope for nutrient yields from most of the world's marine fisheries to be enhanced through nutrient-sensitive fisheries management. With nutrient composition data now widely available, we expect our mMNY framework to motivate development of nutrient-based reference points in specific contexts, such as data-limited fisheries. Managing for mMNY alongside policies that promote access to fish could help close nutrient gaps for coastal populations, maximising the contribution of wild-caught fish to global food and nutrition security.
Fulltext Impaired coronary metabolic dilation in the metabolic syndrome is linked to mitochondrial dysfunction and mitochondrial DNA damage

Guarini G, Kiyooka T, Ohanyan V, Pung YF, Marzilli M, Chen YR, et al.

Basic Res Cardiol, 2016 May;111(3):29.
PMID: 27040114 DOI: 10.1007/s00395-016-0547-4

Mitochondrial dysfunction in obesity and diabetes can be caused by excessive production of free radicals, which can damage mitochondrial DNA. Because mitochondrial DNA plays a key role in the production of ATP necessary for cardiac work, we hypothesized that mitochondrial dysfunction, induced by mitochondrial DNA damage, uncouples coronary blood flow from cardiac work. Myocardial blood flow (contrast echocardiography) was measured in Zucker lean (ZLN) and obese fatty (ZOF) rats during increased cardiac metabolism (product of heart rate and arterial pressure, i.v. norepinephrine). In ZLN increased metabolism augmented coronary blood flow, but in ZOF metabolic hyperemia was attenuated. Mitochondrial respiration was impaired and ROS production was greater in ZOF than ZLN. These were associated with mitochondrial DNA (mtDNA) damage in ZOF. To determine if coronary metabolic dilation, the hyperemic response induced by heightened cardiac metabolism, is linked to mitochondrial function we introduced recombinant proteins (intravenously or intraperitoneally) in ZLN and ZOF to fragment or repair mtDNA, respectively. Repair of mtDNA damage restored mitochondrial function and metabolic dilation, and reduced ROS production in ZOF; whereas induction of mtDNA damage in ZLN reduced mitochondrial function, increased ROS production, and attenuated metabolic dilation. Adequate metabolic dilation was also associated with the extracellular release of ADP, ATP, and H2O2 by cardiac myocytes; whereas myocytes from rats with impaired dilation released only H2O2. In conclusion, our results suggest that mitochondrial function plays a seminal role in connecting myocardial blood flow to metabolism, and integrity of mtDNA is central to this process.
Fulltext Mitochondrial DNA integrity and function are critical for endothelium-dependent vasodilation in rats with metabolic syndrome

Kiyooka T, Ohanyan V, Yin L, Pung YF, Chen YR, Chen CL, et al.

Basic Res Cardiol, 2022 Jan 17;117(1):3.
PMID: 35039940 DOI: 10.1007/s00395-021-00908-1

Endothelial dysfunction in diabetes is generally attributed to oxidative stress, but this view is challenged by observations showing antioxidants do not eliminate diabetic vasculopathy. As an alternative to oxidative stress-induced dysfunction, we interrogated if impaired mitochondrial function in endothelial cells is central to endothelial dysfunction in the metabolic syndrome. We observed reduced coronary arteriolar vasodilation to the endothelium-dependent dilator, acetylcholine (Ach), in Zucker Obese Fatty rats (ZOF, 34 ± 15% [mean ± standard deviation] 10-3 M) compared to Zucker Lean rats (ZLN, 98 ± 11%). This reduction in dilation occurred concomitantly with mitochondrial DNA (mtDNA) strand lesions and reduced mitochondrial complex activities in the endothelium of ZOF versus ZLN. To demonstrate endothelial dysfunction is linked to impaired mitochondrial function, administration of a cell-permeable, mitochondria-directed endonuclease (mt-tat-EndoIII), to repair oxidatively modified DNA in ZOF, restored mitochondrial function and vasodilation to Ach (94 ± 13%). Conversely, administration of a cell-permeable, mitochondria-directed exonuclease (mt-tat-ExoIII) produced mtDNA strand breaks in ZLN, reduced mitochondrial complex activities and vasodilation to Ach in ZLN (42 ± 16%). To demonstrate that mitochondrial function is central to endothelium-dependent vasodilation, we introduced (via electroporation) liver mitochondria (from ZLN) into the endothelium of a mesenteric vessel from ZOF and restored endothelium-dependent dilation to vasoactive intestinal peptide (VIP at 10-5 M, 4 ± 3% vasodilation before mitochondrial transfer and 48 ± 36% after transfer). Finally, to demonstrate mitochondrial function is key to endothelium-dependent dilation, we administered oligomycin (mitochondrial ATP synthase inhibitor) and observed a reduction in endothelium-dependent dilation. We conclude that mitochondrial function is critical for endothelium-dependent vasodilation.
Small pelagic fish supply abundant and affordable micronutrients to low- and middle-income countries

Robinson JPW, Mills DJ, Asiedu GA, Byrd K, Mancha Cisneros MDM, Cohen PJ, et al.

Nat Food, 2022 Dec;3(12):1075-1084.
PMID: 37118295 DOI: 10.1038/s43016-022-00643-3

Wild-caught fish provide an irreplaceable source of essential nutrients in food-insecure places. Fishers catch thousands of species, yet the diversity of aquatic foods is often categorized homogeneously as 'fish', obscuring an understanding of which species supply affordable, nutritious and abundant food. Here, we use catch, economic and nutrient data on 2,348 species to identify the most affordable and nutritious fish in 39 low- and middle-income countries. We find that a 100 g portion of fish cost between 10 and 30% of the cheapest daily diet, with small pelagic fish (herring, sardine, anchovy) being the cheapest nutritious fish in 72% of countries. In sub-Saharan Africa, where nutrient deficiencies are rising, <20% of small pelagic catch would meet recommended dietary fish intakes for all children (6 months to 4 years old) living near to water bodies. Nutrition-sensitive policies that ensure local supplies and promote consumption of wild-caught fish could help address nutrient deficiencies in vulnerable populations.
UEFA expert group statement on nutrition in elite football. Current evidence to inform practical recommendations and guide future research

Collins J, Maughan RJ, Gleeson M, Bilsborough J, Jeukendrup A, Morton JP, et al.

Br J Sports Med, 2021 Apr;55(8):416.
PMID: 33097528 DOI: 10.1136/bjsports-2019-101961

Football is a global game which is constantly evolving, showing substantial increases in physical and technical demands. Nutrition plays a valuable integrated role in optimising performance of elite players during training and match-play, and maintaining their overall health throughout the season. An evidence-based approach to nutrition emphasising, a 'food first' philosophy (ie, food over supplements), is fundamental to ensure effective player support. This requires relevant scientific evidence to be applied according to the constraints of what is practical and feasible in the football setting. The science underpinning sports nutrition is evolving fast, and practitioners must be alert to new developments. In response to these developments, the Union of European Football Associations (UEFA) has gathered experts in applied sports nutrition research as well as practitioners working with elite football clubs and national associations/federations to issue an expert statement on a range of topics relevant to elite football nutrition: (1) match day nutrition, (2) training day nutrition, (3) body composition, (4) stressful environments and travel, (5) cultural diversity and dietary considerations, (6) dietary supplements, (7) rehabilitation, (8) referees and (9) junior high-level players. The expert group provide a narrative synthesis of the scientific background relating to these topics based on their knowledge and experience of the scientific research literature, as well as practical experience of applying knowledge within an elite sports setting. Our intention is to provide readers with content to help drive their own practical recommendations. In addition, to provide guidance to applied researchers where to focus future efforts.
Fulltext Illuminating the multidimensional contributions of small-scale fisheries

Basurto X, Gutierrez NL, Franz N, Mancha-Cisneros MDM, Gorelli G, Aguión A, et al.

Nature, 2025 Jan;637(8047):875-884.
PMID: 39814892 DOI: 10.1038/s41586-024-08448-z

Sustainable development aspires to "leave no one behind"1. Even so, limited attention has been paid to small-scale fisheries (SSF) and their importance in eradicating poverty, hunger and malnutrition. Through a collaborative and multidimensional data-driven approach, we have estimated that SSF provide at least 40% (37.3 million tonnes) of global fisheries catches and 2.3 billion people with, on average, 20% of their dietary intake across six key micronutrients essential for human health. Globally, the livelihood of 1 in every 12 people, nearly half of them women, depends at least partly on small-scale fishing, in total generating 44% (US$77.2 billion) of the economic value of all fisheries landed. Regionally, Asian SSF provide fish, support livelihoods and supply nutrition to the largest number of people. Relative to the total capture of the fisheries sector (comprising large-scale and small-scale fisheries), across all regions, African SSF supply the most catch and nutrition, and SSF in Oceania improve the most livelihoods. Maintaining and increasing these multidimensional SSF contributions to sustainable development requires targeted and effective actions, especially increasing the engagement of fisherfolk in shared management and governance. Without management and governance focused on the multidimensional contributions of SSF, the marginalization of millions of fishers and fishworkers will worsen.
Fulltext Four ways blue foods can help achieve food system ambitions across nations

Crona BI, Wassénius E, Jonell M, Koehn JZ, Short R, Tigchelaar M, et al.

Nature, 2023 Apr;616(7955):104-112.
PMID: 36813964 DOI: 10.1038/s41586-023-05737-x

Blue foods, sourced in aquatic environments, are important for the economies, livelihoods, nutritional security and cultures of people in many nations. They are often nutrient rich1, generate lower emissions and impacts on land and water than many terrestrial meats2, and contribute to the health3, wellbeing and livelihoods of many rural communities4. The Blue Food Assessment recently evaluated nutritional, environmental, economic and justice dimensions of blue foods globally. Here we integrate these findings and translate them into four policy objectives to help realize the contributions that blue foods can make to national food systems around the world: ensuring supplies of critical nutrients, providing healthy alternatives to terrestrial meat, reducing dietary environmental footprints and safeguarding blue food contributions to nutrition, just economies and livelihoods under a changing climate. To account for how context-specific environmental, socio-economic and cultural aspects affect this contribution, we assess the relevance of each policy objective for individual countries, and examine associated co-benefits and trade-offs at national and international scales. We find that in many African and South American nations, facilitating consumption of culturally relevant blue food, especially among nutritionally vulnerable population segments, could address vitamin B12 and omega-3 deficiencies. Meanwhile, in many global North nations, cardiovascular disease rates and large greenhouse gas footprints from ruminant meat intake could be lowered through moderate consumption of seafood with low environmental impact. The analytical framework we provide also identifies countries with high future risk, for whom climate adaptation of blue food systems will be particularly important. Overall the framework helps decision makers to assess the blue food policy objectives most relevant to their geographies, and to compare and contrast the benefits and trade-offs associated with pursuing these objectives.
Fulltext Mean arterial pressure targets in intensive care unit patients receiving noradrenaline: An international survey

Young PJ, Bellomo R, Al-Fares A, Antognini DG, Arabi YM, Ashraf MS, et al.

Crit Care Resusc, 2025 Mar;27(1):100095.
PMID: 40109286 DOI: 10.1016/j.ccrj.2024.12.001

OBJECTIVE: This study aimed to evaluate intensive care doctors' views about a large-scale pragmatic minimum mean arterial pressure (MAP) targets trial and their attitudes and beliefs about minimum MAP targets in different clinical scenarios.
DESIGN: An online survey was conducted.
SETTING AND PARTICIPANTS: An online survey was distributed to intensive care doctors in sites participating in a large-scale international randomised clinical trial evaluating oxygen therapy targets in 15 countries and to additional intensive care clinicians from Canada.
MAIN OUTCOME MEASURES: Outcomes included the expressed level of support for a large pragmatic trial to evaluate minimum MAP targets in critically ill adults and stated current practice and acceptability of minimum MAP for specific scenarios.
RESULTS: The response rate to our survey for respondents who work in sites participating in the mega randomised registry trial research program was 265 out of 701 (37.8%), with an additional 56 out of 256 (21.8%) responses obtained from a direct email containing a link to the survey sent to intensive care clinicians in Canada. A total of 309 of 321 respondents (96.3%) were supportive, in principle, of conducting a very large pragmatic trial to evaluate MAP targets in intensive care unit patients receiving noradrenaline. The commonest response in all scenarios was to agree that the optimal minimum MAP target was uncertain. In all scenarios, except for active bleeding, the most common reported minimum MAP target was 65 mmHg; for patients who were actively bleeding, the most common reported target was 60 mmHg.
CONCLUSIONS: Our data suggest that intensive care clinicians are broadly supportive of a large-scale pragmatic minimum MAP targets in intensive care unit patients receiving noradrenaline.

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