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Background: We investigated the accuracy of predicting preload responsiveness by means of a passive leg raising test (PLR) using the perfusion index (PI) in critically ill patients showing signs of hypoperfusion in a resource-limited setting. Methods: We carried out a prospective observational single center study in patients admitted for sepsis or severe malaria with signs of hypoperfusion in Chattogram, Bangladesh. A PLR was performed at baseline, and at 6, 24, 48, and 72 h. Preload responsiveness assessed through PI was compared to preload responsiveness assessed through cardiac index (CI change ≥5%), as reference test. The primary endpoint was the accuracy of preload responsiveness prediction of PLR using PI at baseline; secondary endpoints were the accuracies at 6, 24, 48, and 72 h. Receiver operating characteristic (ROC) curves were constructed. Results: The study included 34 patients admitted for sepsis with signs of hypoperfusion and 10 patients admitted for severe malaria. Of 168 PLR tests performed, 143 had reliable PI measurements (85%). The best identified PI change cutoff to discriminate responders from non-responders was 9.7%. The accuracy of PLR using PI in discriminating a preload responsive patient at baseline was good (area under the ROC 0.87 95% CI 0.75-0.99). The test showed high sensitivity and negative predictive value, with comparably lower specificity and positive predictive value. Compared to baseline, the AUROC of PLR using PI was lower at 6, 24, 48, and 72 h. Restricting the analysis to sepsis patients did not change the findings. Conclusions: In patients with sepsis or severe malaria and signs of hypoperfusion, changes in PI after a PLR test detected preload responsiveness. The diagnostic accuracy was better when PI changes were measured at baseline.

The food industry has to become more sustainable to face the challenge of food waste. The principles of circular economy are starting to be applied in real life and despite technological and regulatory challenges, some start-ups have started commercialising upcycled food products. Upcycled foods can be considered a new food category and to increase their potential it is essential to enhance their sensory quality and consumer appeal, while considering the regulatory framework that shapes their development. This review summarises the existing sensory studies on upcycled foods, highlighting gaps for future research. Moreover, it provides findings from a regulatory analysis of upcycled foods, highlighting the challenges and the opportunities to support upcycled food development. Since 2021, 34 studies have been published that include sensory evaluation of upcycled foods with at least 10% of upcycled ingredients. The incorporation of upcycled ingredients was reported to have considerable effects on the sensory characteristics of the final products. However, while undesirable alterations like dark hues and bitter tastes were reported, upcycled foods were often well-liked by consumers. The sensory evaluation approaches used in many studies were poor, using questionable techniques. Moreover, there was no in-depth work combining various ingredients and processing techniques and thus, upcycled ingredients and food matrices combinations should be more carefully designed and evaluated. A multidisciplinary approach and consumer involvement through co-creation are suggested for successful upcycled food product development. Further work is also required on how to enable upcycled foods using regulatory interventions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)