BACKGROUND: In critical care patients, reaching optimal β-lactam concentrations poses challenges, as infections are caused more often by microorganisms associated with higher MICs, and critically ill patients typically have an unpredictable pharmacokinetic/pharmacodynamic profile. Conventional intermittent dosing frequently yields inadequate drug concentrations, while continuous dosing might result in better target attainment. Few studies address cefotaxime concentrations in this population.OBJECTIVES: To assess total and unbound serum levels of cefotaxime and an active metabolite, desacetylcefotaxime, in critically ill patients treated with either continuously or intermittently dosed cefotaxime.METHODS: Adult critical care patients with indication for treatment with cefotaxime were randomized to treatment with either intermittent dosing (1 g every 6 h) or continuous dosing (4 g/24 h, after a loading dose of 1 g). We defined a preset target of reaching and maintaining a total cefotaxime concentration of 4 mg/L from 1 h after start of treatment. CCMO trial registration number NL50809.042.14, Clinicaltrials.gov NCT02560207.RESULTS: Twenty-nine and 30 patients, respectively, were included in the continuous dosing group and the intermittent dosing group. A total of 642 samples were available for analysis. In the continuous dosing arm, 89.3% met our preset target, compared with 50% in the intermittent dosing arm. Patients not reaching this target had a significantly higher creatinine clearance on the day of admission.CONCLUSIONS: These results support the application of a continuous dosing strategy of β-lactams in critical care patients and the practice of therapeutic drug monitoring in a subset of patients with higher renal clearance and need for prolonged treatment for further optimization, where using total cefotaxime concentrations should suffice.
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With a market demand for low cost, easy to produce, flexible and portable applications in healthcare, energy, biomedical or electronics markets, large research programs are initiated to develop new technologies to provide this demand with new innovative ideas. One of these fast developing technologies is organic printed electronics. As the term printed electronics implies, functional materials are printed via, e.g. inkjet, flexo or gravure printing techniques, on to a substrate material. Applications are, among others, organic light emitting diodes (OLED), sensors and Lab-on-a-chip devices. For all these applications, in some way, the interaction of fluids with the substrate is of great importance. The most used substrate materials for these low-cost devices are (coated) paper or plastic. Plastic substrates have a relatively low surface energy which frequently leads to poor wetting and/or poor adhesion of the fluids on the substrates during printing and/ or post-processing. Plasma technology has had a long history in treating materials in order to improve wetting or promote adhesion. The µPlasma patterning tool described in this thesis combines a digital inkjet printing platform with an atmospheric dielectric barrier discharge plasma tool. Thus enabling selective and local plasma treatment, at atmospheric pressure, of substrates without the use of any masking materials. In this thesis, we show that dependent on the gas composition the substrate surface can either be functionalized, thus increasing its surface energy, or material can be deposited on the surface, lowering its surface energy. Through XPS and ATR-FTIR analysis of the treated (polymer) substrate surfaces, chemical modification of the surface structure was confirmed. The chemical modification and wetting properties of the treated substrates remained present for at least one month after storage. Localized changes in wettability through µPlasma patterning were obtained with a resolution of 300µm. Next to the control of wettability of an ink on a substrate in printed electronics is the interaction of ink droplets with themselves of importance. In printing applications, coalescence of droplets is standard practice as consecutive droplets are printed onto, or close to each other. Understanding the behaviour of these droplets upon coalescence is therefore important, especially when the ink droplets are of different composition and/or volume. For droplets of equal volume, it was found that dye transport across the coalescence bridge could be fully described by diffusion only. This is as expected, as due to the droplet symmetry on either side of the bridge, the convective flows towards the bridge are of equal size but opposite in direction. For droplets of unequal volume, the symmetry across the bridge is no longer present. Experimental analysis of these merging droplets show that in the early stages of coalescence a convective flow from the small to large droplet is present. Also, a smaller convective flow of shorter duration from the large into the small droplet was identified. The origin of this flow might be due to the presence of vortices along the interface of the bridge, due to the strong transverse flow to open the bridge. To conclude, three potential applications were showcased. In the first application we used µPlasma patterning to create hydrophilic patterns on hydrophobic dodecyl-trichlorosilane (DTS) covered glass. Capillaries for a Lab-on-a-chip device were successfully created by placing two µPlasma patterned glass slides on top of each other separated by scotch tape. In the second application we showcased the production of a RFID tag via inkjet printing. Functional RFID-tags on paper were created via inkjet printing of silver nanoparticle ink connected to an integrated circuit. The optimal operating frequency of the produced tags is in the range of 860-865 MHz, making them usable for the European market, although the small working range of 1 m needs further improvement. Lastly, we showed the production of a chemresistor based gas sensor. In house synthesised polyemeraldine salt (PANi) was coated by hand on top of inkjet printed silver electrodes. The sensor proved to be equally sensitive to ethanol and water vapour, reducing its selectivity in detecting changes in gas composition.
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Exercise is one of the external factors associated with impairment of intestinal integrity, possibly leading to increased permeability and altered absorption. Here, we aimed to examine to what extent endurance exercise in the glycogen‐depleted state can affect intestinal permeability toward small molecules and protein‐derived peptides in relation to markers of intestinal function. Eleven well‐trained male volunteers (27 ± 4 years) ingested 40 g of casein protein and a lactulose/rhamnose (L/R) solution after an overnight fast in resting conditions (control) and after completing a dual – glycogen depletion and endurance – exercise protocol (first protocol execution). The entire procedure was repeated 1 week later (second protocol execution). Intestinal permeability was measured as L/R ratio in 5 h urine and 1 h plasma. Five‐hour urine excretion of betacasomorphin‐7 (BCM7), postprandial plasma amino acid levels, plasma fatty acid binding protein 2 (FABP‐2), serum pre‐haptoglobin 2 (preHP2), plasma glucagon‐like peptide 2 (GLP2), serum calprotectin, and dipeptidylpeptidase‐4 (DPP4) activity were studied as markers for excretion, intestinal functioning and recovery, inflammation, and BCM7 breakdown activity, respectively. BCM7 levels in urine were increased following the dual exercise protocol, in the first as well as the second protocol execution, whereas 1 h‐plasma L/R ratio was increased only following the first exercise protocol execution. FABP2, preHP2, and GLP2 were not changed after exercise, whereas calprotectin increased. Plasma citrulline levels following casein ingestion (iAUC) did not increase after exercise, as opposed to resting conditions. Endurance exercise in the glycogen depleted state resulted in a clear increase of BCM7 accumulation in urine, independent of DPP4 activity and intestinal permeability. Therefore, strenuous exercise could have an effect on the amount of food‐derived bioactive peptides crossing the epithelial barrier. The health consequence of increased passage needs more in depth studies.
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