Postprandial cholecystokinin secretion in elderly with protein-energy undernutrition.

OBJECTIVE: Malnutrition is currently observed in aged people, and cholecystokinin is an important peripheral satiety signal. The aim of this study was to examine the effect of aging and protein-energy malnutrition on postprandial cholecystokinin (CCK) release. DESIGN: Non-randomized, cross-sectional comparison by age group. SETTING: Gastroenterology section of a teaching hospital. PARTICIPANTS: Twenty-one human volunteers divided into three groups: young healthy subjects (Group 1: mean 29 years, n = 7), aged healthy subjects (Group 2, mean 80 years, n = 7), and aged subjects with an important degree of malnutrition (Group 3, mean 84.6 years, n = 7). INTERVENTION: Each subject ingested a standardized liquid meal after an overnight fast. MAIN OUTCOME MEASURES: Plasma cholecystokinin was measured using a sensitive bioassay before and after the ingestion of the liquid meal. RESULTS: Basal cholecystokinin levels were similar (0.9 to 1 pM equivalent CCK-8) in the three groups. Postprandial levels were significantly increased over basal (P less than 0.05). The maximal cholecystokinin value was lower in Group 1 (3.5 +/- 0.8 pM equivalent CCK-8) and Group 2 (3.3 +/- 0.77 pM equivalent CCK-8) than in Group 3 (8.3 +/- 2 pM equivalent CCK-8) (P less than 0.05). Integrated plasma cholecystokinin was also similar in Group 1 (171 +/- 38 pM.60 min), (P less than 0.05). CONCLUSION: The increase of postprandial maximal levels of cholecystokinin is more related to malnutrition than to aging.     

Variability of medial and posterior offset in patients with fourth-generation stemmed shoulder arthroplasty

Purpose  

Most anthropometric data on the proximal humerus has been obtained from deceased healthy individuals with no deformities. Endoprostheses are implanted for primary and secondary osteoarthritis, rheumatoid arthritis, humeral-head necrosis, fracture sequelae and other humeral-head deformities. This indicates that pathologicoanatomical variability may be greater than previously assumed. We therefore investigated a group of patients with typical shoulder replacement diagnoses, including posttraumatic and rheumatic deformities.     

Comparative evaluation of the new ARCHITECT EBV assays considering different testing algorithms

In the current evaluation, Epstein-Barr virus (EBV) serology was performed on 1113 routine serum samples. Although the initial request for all samples from the general practitioner was EBV IgM testing, 80.9% were classified as past infections. The ARCHITECT^® viral capsid antigen (VCA) IgM, VCA IgG, and EBV nuclear antigen (EBNA) 1 IgG assays showed good results for sensitivity and specificity, being 100.0%, 98.3%, and 100.0% and 99.9%, 95.4%, and 99.6%, respectively. Using an algorithm based on initial EBNA-1 IgG testing, followed by VCA IgG and IgM for samples that were not EBNA-1 IgG reactive, the number of tests per sample could be reduced to nearly 50% compared to parallel testing. The high sensitivity and specificity of the ARCHITECT^® EBNA-1 IgG assay in combination with a low number of grayzone results are a precondition for the chosen test algorithm. Thus, the newly developed ARCHITECT^® EBV panel is suitable for accurate and cost-efficient EBV serology in a routine clinical laboratory.     

Psychosocial work environment,hearing impairment and health

This article summarizes results from a study of hearingimpaired men and women in the labour force in Sweden. A questionnaire about psychosocial work environment (in accordance with the Demand-Control Model), health and wellbeing was sent out and answered by 445 hearingimpaired people, 20-64 years of age. A large reference group had previously answered the same questionnaire. The results indicate that imbalances between demand and control (i.e. high demand and low control, so-called high stress work type) is more common among hearingimpaired people than in the reference group. The outcome of the combination high demand and low control among hearing-impaired people is (much) worse than among hearing-impaired people with other work types ( passive, active, low stress). Hearing-impaired people with the high-stress work type more frequently report bad physical health status and psychological wellbeing regarding a number of indicators. There is, moreover, a tendency for women to be worse off than men. Our data suggest that those involved in audiological rehabilitation should pay great attention to hearing-impaired people with jobs that can be characterized as high stress.     

Demonstration of digital radiographs by means of ink jet-printed paper copies: Pilot study

Different digital medical images have been printed on paper with a continuous ink jet printer, and the quality has been evaluated. The emphasis has been on digital chest radiographs from a computed radiography system. The ink jet printing technique is described as well as the handling of the image data from image source to printer. Different versions of paper prints and viewing conditions were compared to find the optimum alternative. The evaluation has been performed to maximize the quality of the paper images to make them conform with the corresponding film prints and monitor images as much as possible. The continuous ink jet technique offers high-quality prints on paper at a considerably lower cost per copy compared with the cost of a film print. With a future switch-over from diagnosing of digital images on film to diagnosing them on monitors, hard copies for demonstration purposes will occasionally be needed. This need can be filled by ink jet-printed paper copies.     

Diet and alcohol in liver cirrhosis: a case-control study

A retrospective case-control study on alcohol and dietary habits was conducted over 3 years in a Gastroenterology Department on 152 male patients with liver cirrhosis. The study also included 304 hospital controls, selected within the same age range (32-83 years). Alcohol consumption and dietary habits were assessed from a standardized questionnaire by a highly trained dietician. The variations of the relative risk (RR) of liver cirrhosis as a function of the estimated mean daily intakes of alcohol, fats, carbohydrates and proteins were studied using stratified conditional logistic regression models. Obviously the relative risk of liver cirrhosis was found to be strongly and positively correlated with alcohol consumption but, in addition, this study has been able to show a significant and positive association with the mean daily fat intake and negative associations with the mean daily carbohydrate and protein intakes. Whereas in the control group, the calorie percentage from fats was 33.8 (87.11 g/d), it was 39.6 in the cirrhotic group (102.1 g/d). These findings indicate that in addition to alcohol consumption, dietary habits and in particular, high mean daily fat intake, should be considered.     

Radiovitamin B12 as a dilution indicator in gastrointestinal research

Summary The possibility of using radiovitamin B₁₂ as a gastrointestinal dilution indicator has been investigated. It was mixed with polyethylene glycol (PEG) and infused at the level of the papilla of Vater in five secretin tests. The recovered duodenal and gastric juices were analyzed for radio-vitamin B₁₂ and PEG. A very good correlation between the concentrations of the two substances was found, but about 4.5% more radiovitamin B₁₂ than PEG was recovered in the duodenum.     

Strength and voluntary activation of quadriceps femoris muscle in total knee arthroplasty with midvastus and subvastus approaches

To determine and compare the influence of 2 different approaches on quadriceps femoris muscle function in total knee arthroplasty (TKA), 20 patients (14 women, 6 men) with bilateral knee osteoarthritis underwent a 1-stage bilateral TKA. Surgical approaches (subvastus, midvastus) were performed by a random selection. Measurements of quadriceps voluntary activation and maximal voluntary contraction were estimated by a twitch interpolation technique before, 3 and 6 months after TKA. Knee pain was quantified by the Lewis Score. There was no difference between the 2 approaches at 3 and 6 months after TKA with regard to maximal voluntary contraction (P = 0.84, F = 0.041) and voluntary activation (P = .863, F = 0.031). In the subvastus group was a significantly higher knee pain until 6 months after surgery (P = .02). The subvastus approach for TKA does not provide any advantages compared with the midvastus approach with respect to the quadriceps femoris muscle strength in the early postoperative period. Furthermore, the subvastus approach caused significantly more pain postoperatively.