Optimizing eating disorder treatment outcomes for individuals identified via screening: An idea worth researching

In recent years, online screens have been commonly used to identify individuals who may have eating disorders (EDs), many of whom may be interested in treatment. We describe a new empirical approach that takes advantage of current evidence on empirically supported, effective treatments, while at the same time, uses modern statistical frameworks and experimental designs, data-driven science, and user-centered design methods to study ways to expand the reach of programs, enhance our understanding of what works for whom, and improve outcomes, overall and in subpopulations. The research would focus on individuals with EDs identified through screening and would use continuously monitored data, and interactions of interventions/approaches to optimize reach, uptake, engagement, and outcome. Outcome would be assessed at the population, rather than individual level. The idea worth researching is to determine if an optimization outcome model produces significantly higher rates of clinical improvement at a population level than do current approaches, in which traditional interventions are only offered to the few people who are interested in and able to access them.     

脂质体介导核因子кB诱捕物寡聚脱氧核苷酸对重症急性胰腺炎大鼠肝炎症因子mRNA表达和肝损伤的影响

目的:研究表明,重症急性胰腺炎及其伴发的急性呼吸窘迫综合征、多器官功能障碍综合征与多种细胞因子的作用有关,然而促炎性细胞因子、趋化因子、黏附因子等基因的活化和表达均受到核因子κB调控。观察脂质体介导核因子κB诱捕物寡聚脱氧核苷酸对重症急性胰腺炎SD大鼠肝部核因子κB活性及受其调控炎症基因mRNA表达和肝损伤的影响。方法:实验于2004-12/2006-03在南方医科大学南方医院消化研究所实验室完成。①实验材料:清洁级雄性SD大鼠50只,3个半月龄,体质量300～400g。引物和寡聚脱氧核苷酸由上海生工生物工程有限公司合成和全硫代修饰。②实验分组及过程:实验分为5组,每组10只。假手术组:开腹翻动胰腺,未诱导重症急性胰腺炎。其余大鼠以牛磺胆酸钠诱导SD大鼠建立重症急性胰腺炎模型,各组分别于建模后1h静脉注射裸寡聚脱氧核苷酸、脂质体/诱捕物寡聚脱氧核苷酸复合物、脂质体/错配寡聚脱氧核苷酸复合物和生理盐水。③实验评估:注射4h后应用电泳迁移率变动分析核因子κB的活性;利用反转录-聚合酶链反应法检测肝组织细胞间黏附因子1、白细胞介素1α、白细胞介素2、肿瘤坏死因子α、血管细胞黏附分子1mRNA表达;检测血丙氨酸转氨酶和天门冬氨酸转氨酶水平。结果:①脂质体/诱捕物寡聚脱氧核苷酸复合物组血丙氨酸转氨酶、天门冬氨酸转氨酶低于生理盐水组、脂质体/错配寡聚脱氧核苷酸复合物组和裸寡聚脱氧核苷酸组(P<0.05);天门冬氨酸转氨酶高于假手术组。②电泳迁移率变动分析结果显示脂质体/诱捕物寡聚脱氧核苷酸复合物组核因子κB活性受到显著抑制,与假手术组比较活性依然较高(P<0.05)。③核因子κB特异性探针与核因子κB结合后,核因子κB与核蛋白DNA的结合活性显著被抑制,与非特异性SP1探针与核因子κB结合比较差异有显著性(P<0.05);诱捕物寡聚脱氧核苷酸与核因子κB结合后,核因子κB与核蛋白DNA的结合活性显著被抑制,与错配寡聚脱氧核苷酸与核因子κB结合比较差异有显著性(P<0.05)。④脂质体/诱捕物寡聚脱氧核苷酸复合物组肿瘤坏死因子α、细胞间黏附因子1、血管细胞黏附分子1、白细胞介素1α、白细胞介素2mRNA的表达均下降,与生理盐水组、脂质体/错配寡聚脱氧核苷酸复合物组和裸寡聚脱氧核苷酸组比较差异有显著性(P<0.05);肿瘤坏死因子α、细胞间黏附因子1mRNA、白细胞介素1α表达高于假手术组(P<0.05)。结论:肝组织核因子κB活化及其调控的炎症因子细胞间黏附因子1、肿瘤坏死因子α、血管细胞黏附分子1mRNA过度表达可能是重症急性胰腺炎肝损害发生的原因之一,核因子κB诱捕物寡聚脱氧核苷酸可特异性抑制肝核因子κB活性及其调控的炎症因子细胞间黏附因子1、肿瘤坏死因子α、血管细胞黏附分子1mRNA的表达,减轻肝损害。     

White cell-associated procoagulant activity induced by ABO incompatibility

BACKGROUND: Disseminated intravascular coagulation is an established complication of acute hemolytic transfusion reactions, particularly those involving the ABO red cell (RBC) antigen system. In addition, peripheral blood white cells, particularly monocytes, have demonstrated expression of procoagulant activity (PCA) in response to inflammatory stimuli. To better define the activation of coagulation in immune hemolysis, in vitro experiments were conducted to investigate the expression of PCA by peripheral blood white cells in ABO RBC incompatibility. STUDY DESIGN AND METHODS: Fresh group O heparinized whole blood was incubated with washed, packed group A or O RBCs. White cells were separated, washed, and lysed before assay of PCA, which was measured by a one-stage recalcified clotting time assay. Units of activity were calculated on the basis of a rabbit brain thromboplastin standard curve. Mechanisms of coagulation activation were investigated by using specific coagulation factor-deficient plasmas, blocking antibodies to tissue factor, and anti-CD11b. RESULTS: Significant levels of white cell-associated PCA were found at 2 to 6 hours in response to incompatible (group A) RBCs, but not in response to compatible (group O) RBCs. PCA was not correlated with numbers of platelets in whole blood. Nonimmune lysis of compatible RBCs did not induce PCA. When whole blood reconstituted from washed cells and heat- inactivated plasma was incubated with incompatible RBCs, PCA and hemolysis were abrogated, which suggests that complement is a required intermediate. Protein synthesis inhibition by the addition of cycloheximide (5 mg/mL) to whole blood incubated with RBCs prevented the expression of PCA. Substitution of factor VIII-deficient plasma for normal plasma in the recalcified clotting time assay had no effect, whereas PCA was reduced by 68 percent with factor VII-deficient plasma and was unmeasurable with factor X-deficient plasma. PCA was restored by a 1-to-1 mix of normal and factor VII-deficient plasma. Incubation of samples in the PCA assay with tissue factor antibodies resulted in up to 86-percent inhibition of measured PCA. Titration of the response to the amount of tissue factor antibodies added demonstrated that maximal inhibition occurred with 0.45 mg per mL, above which no further inhibition took place. However, the addition of anti-CD11b (0.75 mg/mL) concomitantly with anti-tissue factor abolished measurable activity. This effect was independent of the amount of added protein, and anti- CD11b alone had no effect on measured activity. The addition to whole blood concomitantly with RBCs of polyclonal antibodies to tumor necrosis factor, sufficient to neutralize 2000 pg per mL, did not alter PCA expression. CONCLUSION: These results indicate that white cell- associated PCA is generated in whole blood in response to ABO RBC incompatibility and may contribute to disseminated intravascular coagulation in acute hemolytic transfusion reactions. Two possible cellular mechanisms are suggested, which involve tissue factor expression and the activation of factor × by a CD11b-dependent mechanism.     

Small bowel transplantation

Until very recently, outcomes from small bowel transplantation (SBTx) lagged behind those in liver, heart, and kidney transplantation because of the magnitude of the immunologic burden; the strong expression of histocompatibility antigens; and the contamination in grafts by bacterial organisms. With novel techniques of immune-induction therapies, such as recipient "preconditioning" with lymphocyte reduction, followed by the more subtle use of immunosuppression-based singleagent tacrolimus, graft and host 1-year survival is now over 90% in the most active US centers, a finding that parallels the outcomes in liver and kidney transplantation. In contrast to the alternative therapy for permanent intestinal failure, home total parenteral nutrition (TPN), SBTx improves quality of life and restores digestive and absorptive function, making patients nutritionally autonomous. With survival beyond 1 to 3 years, the procedure is cost-effective. Current results support expansion of the indications for SBTx from use as salvage therapy for patients with TPN failure to preemptive therapy for patients at risk of developing TPN failure.     

Association Between Vitamin B12 Levels and Mortality in Hospitalized Older Adults

OBJECTIVES: To investigate the effect of various medications on vitamin B12 status and the association between vitamin B12 levels and mortality. DESIGN: Retrospective cross‐sectional study. SETTING: Four internal medicine departments and the geriatrics department at Kaplan Medical Center (KMC), Rehovot and Harzfeld Geriatrics Hospital, Gedera, Israel. PARTICIPANTS: One thousand five hundred seventy patients aged 65 and older hospitalized at the KMC and Hartzfeld Hospital in 2007. MEASUREMENTS: Blood vitamin B12 levels and demographic, clinical, and laboratory data obtained from electronic medical records. RESULTS: Vitamin B12 deficiency (≤200 pmol/L) was found in 15% of older hospitalized patients. Fifty percent of the patients had high vitamin B12 levels (≥350 pmol/L), 68.2% of whom were aged 80 and older. Metformin use was clearly associated with lower vitamin B12 levels. In patients aged 65 and older, an inverse correlation was found between vitamin B12 levels and albumin, metformin, and angiotensin‐converting enzyme (ACE) inhibitor use. Age, number of medications, and mortality were linearly correlated with vitamin B12 levels. CONCLUSION: Higher vitamin B12 levels were associated with greater mortality, but it is unclear whether vitamin B12 is a marker or a surrogate marker or even a substance that directly causes death. Further investigation is needed to clarify.     

Nutritional considerations for the pureed diet texture in dysphagic elderly

In long-term care facilities little attention is given to the nutritional density, flavor, and presentation of the pureed diet texture. Use of the food processor to puree food offers opportunities for the development of pureed meals that are flavorful and appealing. This article presents guidelines that foodservice departments can use to transform their traditional pureed meals into “cuisine puree”.