Correction of homeostasis indices in unformed small intestine fistulas

Problems of the correction of indices of protein and water-electrolyte metabolism in unformed fistulas of the small intestine were studied in 44 patients. The authors show that the use of the Alvesin "Novyi" amino acid mixture in parenteral feeding is more promising than the use of preparations of protein hydrolysates. For correction of water metabolism the authors give tea infusion per os.     

Use of protein C concentrate in critical conditions: clinical experience in pediatric patients with sepsis

The coagulation disturbance, typical of septic conditions, is associated to a reduction of clotting factors in plasma with an "acquired" deficiency (from consumption) of protein C. As observed with "purpura fulminans" in neonates affected by congenital protein C deficiency, administration of protein C concentrate has proved to reduce thrombotic manifestations and to improve morbidity and mortality of children with septic shock. The Protein C concentrate is presently utilized as a therapy for patients with a congenital deficiency of protein C and several papers in the literature support the efficacy of protein C concentrate in the treatment of children with meningococcus septicemia, with the aim of correcting the acquired protein C deficiency often seen in septic conditions and shown to be strongly correlated to a higher morbidity and mortality. Protein C, given as a plasma concentrate, can exert its therapeutic actions only after activation once in the blood stream: clinical trials with the use of protein C concentrate failed to show any increased risk of bleeding or related disorders. At our PICU 8 children, with sepsis, septic shock and purpura have been treated with protein C concentrate (Ceprotin); because the plasma protein C level was lower than the normal range (mean value 0.32 IU/ml, range 0.11-0.6 IU/ml). Six children have shown a rapid response to all therapeutic efforts and survived without sequelae and two are died. No adverse reaction was observed during and after Ceprotin administration to all patients.     

The role of keto acids in the supportive treatment of children with chronic renal failure

According to the hyperfiltration theory of renal diseases characterized by a decrease in the number of functional nephrons, increased arterial blood pressure, excessive protein intake in the diet, high levels of calcium (Ca) and phosphorus (P), secondary hyperparathyroidism, hypertriglyceridemia and/or hypercholesterolemia, proteinuria and metabolic acidosis are some factors that impair the prognosis of the disease. The amount of protein in the diet is the most important of these factors. A protein-restricted diet administered to patients with chronic renal failure results in the risk of inadequate amino acid intake. To overcome this problem, the use of dysaminated -keto analogues has been considered to reduce the risk of nitrogenemia resulting from the continuous intake of essential amino acids. Currently, the necessity of essential amino acids even in adult patients with chronic renal failure is controversial; besides, trials on the use of these amino acids in pediatric patients are scarce. The aim of this study is to investigate the efficacy and applicability of conservative therapy with a protein-restricted diet supplemented with keto acids in the management of chronic renal insufficiency or failure.     

A systematic review of comparative studies on bone graft alternatives for common spine fusion procedures

Background

The increased prevalence of spinal fusion surgery has created an industry focus on bone graft alternatives. While autologous bone graft remains the gold standard, the complications and morbidity from harvesting autologous bone drives the search for reliable and safe bone graft substitutes. With the recent information about the adverse events related to bone morhogenetic protein use, it is appropriate to review the literature about the numerous products that are not solely bone morphogenetic protein.

Purpose

The purpose of this literature review is to determine the recommendations for use of non-bone morphogenetic protein bone graft alternatives in the most common spine procedures based on a quantifiable grading system.

Study design

Systematic literature review.

Methods

A literature search of MEDLINE (1946–2012), CINAHL (1937–2012), and the Cochrane Central Register of Controlled Trials (1940–April 2012) was performed, and this was supplemented by a hand search. The studies were then evaluated based on the Guyatt criteria for quality of the research to determine the strength of the recommendation.

Results

In this review, more than one hundred various studies on the ability of bone graft substitutes to create solid fusions and good patient outcomes are detailed.

Conclusion

The recommendations for use of bone graft substitutes and bone graft extenders are based on the strength of the studies and given a grade.     

Notfalldiagnostik bei leichtem Sch?del-Hirn-Trauma

Context

For patients with minor head trauma there is the potential danger of intracranial hemorrhaging. However, current guidelines and recommendations incorporate various and divergent criteria for initial assessment and computed tomography.

Objective

The aim of this study was an assessment of neuroglial protein S100B as a screening test for minor head injuries.

Material and methods

A systematic search in Pubmed, MEDLINE and a manual search were carried out to review relevant articles published between January 1997 and August 2010. Keywords were ??head trauma??, ??head injury??, ??brain trauma?? or ??brain injury?? in combination with ??S100B?? or ??S-100B??.

Results

We identified 17 relevant articles of which 8 prospective studies with combined 2,082 patients analyzed the possible use of S100B as a screening test for minor head trauma. The interaction between the serum level of protein S100BB and sports activities was analyzed in 7 studies and 2 studies analyzed the prognostic value of S100B for survival in cardiac arrest patients. A cut-off level of 0.1???g/l S100B seemed to be safe enough to exclude a relevant intracranial injury resulting in a 30% reduction of cranial computed tomography (CCT) examinations.

Conclusion

For patients with minor head trauma protein S100B is suitable for routine use in emergency departments to rule out intracranial lesions and determine the need for CCT. An algorithm for the use of S100B in emergency departments is presented.     

Ketone bodies inhibit the viability of human neuroblastoma cells

Purpose

Recent studies have shown that brain tumor cells, unlike normal brain cells, are largely dependent upon glucose for energy and are not able to use ketone bodies as a primary energy source. These findings are thought to be because of decreased expression of succinyl-coenzyme A:3-oxoacid coenzyme A transferase (SCOT), a key enzyme involved in ketone body metabolism. Because of their neural crest origin, we hypothesized that neuroblastoma cells would also be unable to use ketone bodies as a primary energy source.

Methods

Human foreskin fibroblasts (control) and human neuroblastoma cells (SK-N-AS) were grown in standard media with glucose (glc+), standard media without glucose (glc−), glucose-free media with acetoacetate, or glucose-free media with β-hydroxybutyrate. Cell viability was determined with MTT [3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyltetrazolium bromide] assay and apoptosis with fluorescence-activated cell sorting analysis. Immunoblotting was performed to SCOT protein.

Results

Neuroblastoma cell viability was significantly decreased in the acetoacetate and hydroxybutyrate media by 52% and 61%, respectively, compared with control media. In addition, neuroblastoma cells showed significantly more apoptosis in the ketone media. Viability and apoptosis in the normal fibroblasts were not affected by the culture media. The expression of SCOT protein was significantly less in human neuroblastoma cells compared with the control fibroblasts.

Conclusions

Unlike human fibroblasts, neuroblastoma cells were unable to use ketone bodies as an energy source, likely because of their decreased expression of SCOT protein. Dietary manipulation using ketone bodies in accordance with SCOT expression may be a novel therapeutic strategy for neuroblastoma.     

Nutrition and muscle protein synthesis: a descriptive review

Background

Doctors of Chiropractic frequently give therapeutic exercise and nutritional advice to patients. Skeletal muscle’s role in health and disease is underappreciated. Creating synergy between protein consumption and exercise promotes protein synthesis and may impact patient outcomes.

Objective

To review the literature describing protein metabolism and exercise as it relates to the practice of chiropractic health care.

Method

The PubMed and Web of Science databases were searched using the key terms protein metabolism, protein synthesis, exercise, whey, soy, and resistance training in various combinations. Limits excluded the use of papers that were not based on human subjects, included infants or disease, or were published before 1988. Thirty papers were ultimately included for analysis.

Discussion

The amount, type and timing of protein consumption all play critical roles in promoting protein synthesis. The intracellular mechanism behind protein synthesis has many interrelated, interesting components.

Conclusion

An adaptation to exercise (protein synthesis) can be enhanced by controlling the type of protein, the amount of protein consumed and the timing of protein consumption. Doctors of Chiropractic may impact patient outcomes by using empirical evidence about protein consumption and exercise to maximize protein synthesis.     

Strategy of treatment of patients with acute purulent diseases of the lungs with bronchopleural fistulas, pyopneumothorax

The authors have made an analysis of their experiences with treatment of 222 patients with acute pyo-destructive diseases of the lungs, 82 of them had pleural complications and bronchopleural fistulas. A conclusion is made that it is expedient to use the method of searching occlusion for finding the fistula, the optimum terms of obturation in its treatment is determined. In the treatment of patients with acute pyo-destructive diseases of the lungs "the active conservative strategy" is recommended including active drainage of the destruction foci in the lungs and pleural cavity, hermetic sealing of the lung, together with detoxicating therapy, making up for protein and electrolyte losses with immunomodulation, sanitation of the bronchial tree.     

Protein catabolism in advanced renal disease: role of cytokines

BACKGROUND: Protein energy wasting is a maladaptive metabolic state often associated with inflammation, which is common in patients with chronic kidney disease (CKD). METHODS: A literature search was performed using MEDLINE and the reference lists of relevant review articles. The following key words were used in the MEDLINE search: "cytokines", "inflammation", "protein metabolism", "acute-phase protein", "cachexia", "chronic kidney disease", "end-stage renal disease" and "hemodialysis". The search was limited to English-language articles. RESULTS: While experimental models have shown that uremic animals are more prone for proteolysis, the results from the human studies are controversial. Intradialytic loss of amino acids and activation of proinflammatory cytokines lead to protein catabolism during hemodialysis (HD). At the whole-body level, intradialytic parenteral nutrition (IDPN) increases protein synthesis and decreases proteolysis. Amino acid infusion during HD increases muscle protein synthesis, but does not decrease protein catabolism. Activation of interleukin-6 during HD induces protein catabolism, impairs amino acid utilization for protein synthesis and increases acute-phase protein synthesis. CONCLUSION: The changes in albumin, fibrinogen and muscle protein kinetics during HD could be due to competing and complementary effects of availability of amino acids and activation of proinflammatory cytokines.     

Self-Formation of Vascularized Hepatic Tissue From Human Adult Hepatocyte

Background

Recent study has demonstrated the important role of endothelial-mesenchymal interactions in 3-dimensional self-organization of immature progenitor populations with the use of mimicking of organogenesis. Here, we show that the same principle can be applicable to adult mature cells, ie, human adult hepatocytes (hAHs).

Methods

We cultivated hAHs with fluorescence-labeled human mesenchymal cells (hMSCs) and human umbilical vein endothelial cells (HUVECs) in micro-well culture plates and observed them for 9 days. Fluorescence microscopy imaging analyses were performed to evaluate the internal structures of generated 3-dimensional tissues. Maintenance of in vitro protein production capacity was examined with the use of enzyme-linked immunosorbent assay (ELISA).

Results

hAHs started to self-organize into 3-dimensional tissue with the use of coculturing with hMSCs and HUVECs. Live imaging analyses showed that endothelial cells started sprouting inside the generated tissues after 2 days of culture. ELISA showed that human albumin production capacity was improved with the use of coculture compared with hAHs-only culture after 9 days.

Conclusions

We demonstrated that 3-dimensional vascularized hepatic tissue could be generated from hAHs by reconstituting endothelial-mesenchymal interactions. Future studies are needed to evaluate the therapeutic potential of vascularized hepatic tissue transplantation, and this may pave a new way to establish a new transplantation modality as an alternative to hepatocyte transplantation.     

Serum cleaved tau protein and traumatic mild head injury: a preliminary study in the Thai population

Purpose

To determine the correlation between serum cleaved tau protein and traumatic mild head injury (MHI) (GCS 13–15).

Methods

A prospective observational study was conducted. Blood specimens from 12 healthy persons and 44 adult patients with traumatic MHI were collected in the emergency department to measure the cleaved tau protein level using a Human Tau phosphoSerine 396 ELISA kit. A brain computed tomography (CT) scan was done in all patients. The serum cleaved tau protein level was considered positive at a cut-off point of 0.1 pg/ml. An intracranial lesion was defined as any abnormality detected by brain CT scan.

Results

The mean age of the traumatic MHI patients was 34.9 ± 15.6 years (range 15–74). The median GCS was 15. The median time from injury to arrival at the emergency department was 30 min. There were 11 intracranial lesions detected by brain CT scan (25.0 %). Serum cleaved tau protein was not detected in either healthy or traumatic MHI patients.

Conclusion

As it was uncorrelated with traumatic MHI, serum cleaved tau protein proved to be an unreliable biomarker to use in the early detection of and decision-making for traumatic MHI patients at the emergency department.     

A systematic review of serologic tests in the diagnosis of necrotizing enterocolitis

Background

Although many serologic markers have been suggested for diagnosis of necrotizing enterocolitis, there is little consensus on which of these is potentially clinically useful. Our aims were (i) to systematically review circulating markers that are potentially useful in the diagnosis of NEC and (ii) to compare the relative performance of each serologic marker of NEC by pooling estimates of marker accuracies and presenting their combined diagnostic accuracies.

Methods

We undertook a systematic review of the literature to identify studies that reported serologic markers at the time of diagnosis of necrotizing enterocolitis. Where possible, we constructed 2-by-2 tables of diagnostic accuracy from each article, if 2 or more studies investigated the same test, their results were meta-analyzed by pooling estimates of sensitivity, specificity, likelihood ratio for positive index test (LR+), likelihood ratio for negative index test (LR−), diagnostic odds ratio, and their corresponding 95% confidence intervals.

Results

Twenty-five articles provided information on serology at the time of diagnosis of necrotizing enterocolitis. Of these, it was possible to construct diagnostic accuracy tables from 16 articles and to combine data from studies that used C-reactive protein, intestinal fatty acid binding protein, and platelet-activating factor. Of these C-reactive protein was a sensitive but nonspecific marker for necrotizing enterocolitis, whereas platelet-activating factor and intestinal fatty acid binding protein were both sensitive and specific.

Conclusions

Most serologic markers of necrotizing enterocolitis have been used in too few studies to evaluate their use. Of those tests that have been tested repeatedly, platelet-activating factor and intestinal fatty acid binding protein are potentially useful, although their use must be further tested in larger prospective studies.     

Proteomics-based identification of spontaneous regression-associated proteins in neuroblastoma

Background

Spontaneous regression is usually found in stage 4s neuroblastoma, whereas the elucidation of the underlying molecular mechanism(s) is still limited.

Purpose

Our study aims to investigate the pathogenesis of spontaneous regression at the protein level.

Methods and materials

Differential expression of proteins in stage 4s neuroblastoma tissue, in stage 4 neuroblastoma tissue, and in normal adrenal tissue was investigated by use of 2-dimensional difference gel electrophoresis (2D-DIGE).

Results

Twenty-four protein spots were found to have significant changes among the different tissues, in which 16 proteins were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). Among these proteins, 7 proteins (RhoGDP-dissociation inhibitor 1, phosphatidylethanolamine-binding protein, prohibitin, etc) were up-regulated and 2 proteins (F-actin capping protein 1 subunit and aldose reductase) were down-regulated in stage 4s neuroblastoma compared with stage 4 neuroblastoma. The differential expression of selected candidate protein (RhoGDP-dissociation inhibitor 1 and CAPZA1) was further validated by western blotting.

Conclusion

Some proteins are differentially expressed between stage 4s and stage 4 neuroblastoma tissue, including those associated with differentiation and proliferation as well as apoptosis. RhoGDP-dissociation inhibitor 1 is highly expressed in stage 4s neuroblastoma tissue, whereas CAPZA1 is down-regulated.     

A unique approach to peritoneal dialysis in infants

Little recorded experience exists concerning the use of chronic peritoneal dialysis in the infant. We herein report the results of a multidisciplinary approach to two infants who were treated with a unique modification of "short-dwell" peritoneal dialysis. A single-bag technique was devised in the hopes of reducing glucose absorption and protein losses while concomitantly permitting a simplified manual method of cycling peritoneal dialysis. The desired nutritional needs of the infants consisted of a caloric intake of 140 calories/kg/d and a protein intake of 3.0 to 4.0 g/kg/d, a goal that often required administration through a nasogastric tube. The timely initiation of peritoneal dialysis and the strict adherence to the prescribed dietary regimen was associated with continued growth in both patients. Repeated developmental assessments of each child were conducted and revealed normal development in one patient and mild delay, but gradual improvement, in the other.     

Two different therapeutic regimes in patients with sequelae of hemolytic-uremic syndrome

Renal disease is the most important long-term complication of hemolytic-uremic syndrome (HUS). A comparative study of renal function was carried out in two groups of patients. Group 1 included 19 children followed for a median of 11 years, 1960–1980, with a low-sodium diet, antihypertensive drugs, and a restricted protein intake in the end stage of renal disease. Group 2 included 26 children treated for a median of 9 years, 1988–2002, on a low-sodium diet, early restriction of protein intake according to recommendations, and angiotensin converting enzyme inhibitors (ACEi). Long-term renal function was assessed by the inverse of the plasma creatinine concentration (1/[Cr]) over time. Linear regression lines were fitted to individual values of 1/[Cr] for each child. Regression coefficients of children in group 1 were all negative, ranging from –0.031 to –0.00043; 7 were significantly different from zero, indicating a linear fall in renal function over time. In contrast, children from group 2 had 11 negative slopes (only 1 significant) and 15 positive slopes, ranging from 0.17893 to –0.3899. Fishers exact test showed that group 1 had significantly more children with negative slopes than group 2. This comparatively better long-term outcome of renal function in children under contemporary treatment was probably associated with early restriction of protein and use of ACEi.     

High Protein Intake Associates with Cardiovascular Events but not with Loss of Renal Function

The long-term effects of higher dietary protein intake on cardiovascular and renal outcomes in the general population are not clear. We analyzed data from 8461 individuals who did not have renal disease and participated in two or three subsequent screenings (6.4-yr follow-up) in a prospective, community-based cohort study (Prevention of Renal and Vascular ENd-stage Disease [PREVEND]). We calculated daily protein intake from 24-h urinary urea excretion (Maroni formula) and used Cox proportional hazard models to analyze the associations between protein intake, cardiovascular events, and mortality. We used mixed-effects models to investigate the association between protein intake and change in renal function over time. The mean ± SD daily protein intake was 1.20 ± 0.27 g/kg. Protein intake was significantly associated with cardiovascular events during follow-up. The associations seemed U-shaped; compared with intermediate protein intake, individuals with either higher or lower protein intake had higher event rates. All-cause mortality and noncardiovascular mortality also were significantly associated with protein intake; individuals with low protein intake had the highest event rates. We found no association between baseline protein intake and rate of renal function decline during follow-up. In summary, in the general population, high protein intake does not promote accelerated decline of renal function but does associate with an increased risk for cardiovascular events.Protein restriction is often prescribed to slow the progression of renal failure in patients with chronic kidney disease (CKD). The Modification of Diet in Renal Disease (MDRD) study, designed to clarify the role of protein restriction in CKD, supports the role of dietary protein restriction but provides no conclusive evidence for renoprotection.^1,2 Meta-analyses on this topic also do not provide convincing results. Uncertainty about the optimal level and duration of dietary protein restriction, together with the possibility of publication bias, which has been suggested by the authors of two meta-analyses,^3,4 make it questionable whether low-protein diets should be applied to patients with CKD. In the Nurses'' Health Study, the influence of daily protein intake (assessed with a food frequency questionnaire) on the long-term course of renal function was investigated in individuals with normal renal function and in individuals with mild renal insufficiency. In this study, high protein intake was associated with accelerated renal function decline in individuals with a baseline renal function <80 ml/min per 1.73 m² but not in women with normal renal function.⁵A few studies have been published on the effects of protein intake on all-cause mortality, in particular on cardiovascular morbidity and mortality. Interest in these effects was based on the fact that in Western populations, dietary pattern changes toward diets with high protein intake. Indeed, low-carbohydrate diets, which frequently contain a high amount of protein, have become very popular to prevent obesity.^6–10 In one of these studies, carried out in a cohort of Swedish women, high protein intake in middle-aged women was associated with a higher cardiovascular mortality.¹¹ These findings, however, were not in line with the results of the Nurses'' Health Study, which showed a decreased risk for coronary heart disease in individuals with high protein intake.^12,13 The effect of high protein intake on both renal function and cardiovascular mortality and morbidity in the general population is thus not well known; therefore, the aim of our study was to investigate the associations between protein intake and cardiovascular and renal outcomes in a cohort derived from the general population.     

Distinguishing cerebrospinal fluid from saline used to identify the extradural space

Because of the potential seriousness of unrecognized dural puncture during the performance of extradural analgesia and the widespread use of normal saline for the "loss of resistance" technique, it is important to differentiate between cerebrospinal fluid (CSF) and saline dripping from the extradural needle. During insertion of lumbar drains in 10 neurosurgical patients, we first identified the extradural space using saline for loss of resistance. Temperature (using the back of the gloved hand), pH, glucose and protein (using urine testing sticks) were tested by a blinded observer for ability to distinguish saline aspirated from the extradural space from CSF aspirated on establishing the dural puncture. Temperature, glucose and protein were independently 100% accurate in distinguishing saline from CSF. One saline sample had a pH value greater than 7 compared with nine CSF samples. We conclude that simple bedside testing for temperature, glucose, protein and pH accurately distinguished between CSF and saline used to identify the extradural space.      

Lipopolysaccharide-binding protein: A valuable biomarker in the differentiation between periprosthetic joint infection and aseptic loosening?

Purpose

The pre-operative differentiation between periprosthetic joint infection (PJI) and aseptic loosening after total hip (THA) or knee (TKA) arthroplasty is essential for successful therapy and relies in part on the use of molecular markers. The objective of this study was to assess serum levels of lipopolysaccharide-binding protein (LBP) as a diagnostic tool for PJI and to compare its accuracy with standard tests.

Methods

One hundred and twenty patients presenting with a painful TKA or TKA with indication for surgical revision were included in this prospective, controlled, clinical trial at a single centre. Pre-operative blood and serum samples were collected and analysed for white blood cell (WBC) count, C-reactive protein (CRP) and LBP. The definite diagnosis of periprosthetic joint infection was determined on the basis of clinical, microbiological and histopathological examination.

Results

LBP showed significantly higher values in PJI compared with aseptic loosening (p?p?7 ng/ml. In combination with CRP, the positive predictive value for PJI was at 0.67; negative predictive value with both negative was at 0.77.

Discussion

Patients with PJI have elevated serum levels of LBP when compared with patients with aseptic loosening. The use of LBP in serum appears not to be a more accurate marker than CRP level in serum for detecting PJI. On the basis of these results, we cannot recommend the sole use of LBP for differentiating PJI and aseptic loosening following THA and TKA.