Nutritional screening and dietitian consultation rates in a geriatric evaluation and management unit

Aim

Nutritional screening may not always lead to intervention. The present study aimed to determine: (i) the rate of nutritional screening in hospitalised older adults; (ii) whether nutritional screening led to dietitian consultation and (iii) factors associated with malnutrition.

Methods

In this prospective study of patients aged ≥70 years admitted to a Geriatric Evaluation and Management Unit (GEMU), malnutrition was screened for using the Mini Nutritional Assessment Short Form (MNA‐SF) and identified using the Mini Nutritional Assessment (MNA).

Results

Of the 172 patients participating in the study, 53 (30.8%) patients were malnourished, and 84 (48.8%) were at risk of malnutrition. Mean (SD) age was 85.2 (6.4 years), with 131 patients (76.2%) female. Nutritional screening was performed for all patients; however, it was incomplete in 59 (34.3%) because of omission of the anthropometric measurement. Overall, 62 (36.0%) of the total number of patients were seen by the dietitian, which included 26 (49%) of malnourished patients, 27 (32%) of at‐risk patients and 9 (26%) of the well‐nourished patients. No patients lost >1% of body weight during GEMU stay. Malnourished patients were more likely to be frail, have poor appetite, depression, and have lower levels of: albumin, cognition, physical function, grip strength and quality of life.

Conclusions

The full benefits of nutritional screening by MNA‐SF may not be realised if it does not result in malnourished patients receiving a dietitian consultation. However, it is possible that enrichment of the foodservice with high protein/high‐energy options minimised patient weight loss in the GEMU.     

Effect of a fluoridated etching gel on enamel morphology and shear bond strength of orthodontic brackets

The purpose of this study was to compare the enamel morphology and shear bond strengths of orthodontic brackets bonded to enamel etched with a fluoridated or a nonfluoridated phosphoric acid gel. Ten extracted third molars were used for the enamel morphology evaluation. The buccal surfaces were divided in two sections separated by an occlusogingival groove. One side was etched for 60 seconds with a 38% phosphoric acid gel, and the other side was etched with a 60% phosphoric acid gel containing 0.5% sodium fluoride. The specimens were then examined with a scanning electron microscope. For the shear bond strength tests, 30 extracted third molars were used. The buccal enamel surfaces of the mesial cusp were used, and the teeth were randomly divided into two groups of 15 teeth each--group 1, 38% phosphoric acid gel for 60 seconds; group 2, 60% phosphoric acid gel with 0.5% sodium fluoride for 60 seconds. Orthodontic lingual buttons were bonded to the etched surfaces with a composite resin. The results showed that the overall morphologic etching effect was similar in both groups. The mean shear bond strength for group 1 was 11.8 MPa +/- 4.2, and for group 2 it was 16.5 MPa +/- 5.1. This difference was statistically significant (p less than 0.01).     

Aggregation-prone c9FTD/ALS poly(GA) RAN-translated proteins cause neurotoxicity by inducing ER stress

The occurrence of repeat-associated non-ATG (RAN) translation, an atypical form of translation of expanded repeats that results in the synthesis of homopolymeric expansion proteins, is becoming more widely appreciated among microsatellite expansion disorders. Such disorders include amyotrophic lateral sclerosis and frontotemporal dementia caused by a hexanucleotide repeat expansion in the C9ORF72 gene (c9FTD/ALS). We and others have recently shown that this bidirectionally transcribed repeat is RAN translated, and the “c9RAN proteins” thusly produced form neuronal inclusions throughout the central nervous system of c9FTD/ALS patients. Nonetheless, the potential contribution of c9RAN proteins to disease pathogenesis remains poorly understood. In the present study, we demonstrate that poly(GA) c9RAN proteins are neurotoxic and may be implicated in the neurodegenerative processes of c9FTD/ALS. Specifically, we show that expression of poly(GA) proteins in cultured cells and primary neurons leads to the formation of soluble and insoluble high molecular weight species, as well as inclusions composed of filaments similar to those observed in c9FTD/ALS brain tissues. The expression of poly(GA) proteins is accompanied by caspase-3 activation, impaired neurite outgrowth, inhibition of proteasome activity, and evidence of endoplasmic reticulum (ER) stress. Of importance, ER stress inhibitors, salubrinal and TUDCA, provide protection against poly(GA)-induced toxicity. Taken together, our data provide compelling evidence towards establishing RAN translation as a pathogenic mechanism of c9FTD/ALS, and suggest that targeting the ER using small molecules may be a promising therapeutic approach for these devastating diseases.     

The proportion of Model for End-stage Liver Disease Sodium score attributable to creatinine independently predicts post-transplant survival and renal complications

The post-transplant outcomes of patients with Model for End-stage Liver Disease (MELD) score primarily driven by renal dysfunction are poorly understood. This was a retrospective cohort study of liver transplant (LT) alone recipients between 2005 and 2017 using the United Network for Organ Sharing (UNOS) database. The proportion of MELD Sodium score attributable to creatinine (“KidneyMELD”) was calculated: (9.57 × ln (creatinine) × 100)/(MELD-Na − 6.43). The association of KidneyMELD with (a) all-cause mortality and (b) estimated glomerular filtration rate ≤30 mL/min/1.73² at 1-year post-LT were evaluated. Recipients with KidneyMELD ≥50% had a 52% higher risk of post-LT mortality (adjusted hazard ratio 1.52 vs KidneyMELD 0%, 95% CI: 1.36-1.69; P < .001). This risk was significantly greater for older patients, particularly when >50 years at LT (interaction P < .001). KidneyMELD ≥50% was also associated with an 11-fold increase in the odds of advanced renal dysfunction at 1-year post-LT (adjusted odds ratio 11.53 vs KidneyMELD 0%; 95% CI 8.9-14.93; P < .001). Recipients prioritized for LT primarily on the basis of renal dysfunction have marked post-LT mortality and morbidity independent of MELD Sodium score. The implications of these results in the context of the new UNOS “safety net” kidney transplant policy require further study.     

A multi-group model of Schistosoma japonicum transmission dynamics and control: model calibration and control prediction

Previously we formulated a quantitative model to characterize site-specific schistosomiasis transmission. In this paper, we present a procedure to calibrate the model to data collected in endemic villages of south-western Sichuan, China, with the objective of reducing parametric uncertainty to allow the model to describe local transmission with relative confidence. A Bayesian approach using local epidemiological data and expert opinion is employed to calibrate the model. Results indicate that, after calibration, the output uncertainty is reduced substantially. The calibrated model is then used for prediction of the effects of different intervention options. Simulations reflect a bimodal transmission in both human (early summer and early fall) and snail (late summer and late fall) infections in this area, for which there is some field evidence. Also shown in the simulations are relatively high reinfection rates following chemotherapy in these endemic villages. These results suggest that a sustainable control strategy is essential in reducing transmission, and that transmission can be reduced by chemotherapy, focal snail (e.g. snail clusters) control, and egg control. Our work demonstrates the feasibility of characterizing site-specific schistosomiasis transmission using a mathematical model and a calibration approach that integrates diverse field data, and the use of the calibrated model to design control strategies.     

Arteriovenous malformations of the spinal cord.

Spinal AVM's are not rare, and are diagnosed today with increasing frequency by utilization of moedern neuroradiological techniques. Their relationship to the spinal medulla is related to vascular embryological anatomy, and the only effective treatment is directed at obliteration of the fistula. Males are affected more frequently in the middle years of life. Symptoms may mimic spinal cord tumors and demyelinating disorders. The pathogenesis of symptoms, classification, and methods of diagnosis are reviewed, and the various methods of treatment discussed.