Nutritional product use and practice in nursing and residential homes

AIM: To review the use of nutritional products in nursing and residential homes in the Northern Health and Social Services Board (NHSSB) area of Northern Ireland. METHOD: Two questionnaires on nutritional product use were sent to all (a total of 131) nursing and residential homes in the NHSSB area. RESULTS: A total of 122 nursing and residential homes completed and returned the questionnaires, giving a response rate of 93 per cent. Of these, 81 homes were administering nutritional products to some patients and residents. There were 3,208 residents in the homes that responded. Of these, 1,800 were residing in nursing homes and 1,390 in residential homes. Of the total of 3,190 people, 218 patients and 81 residents (299 in total) were receiving nutritional products. The findings suggest that oral supplements are the most commonly used means of nutritional support. There was a wide degree of variability between homes with regard to monitoring the use of nutritional products. In 39 per cent of cases (n = 118), the nutritional products was introduced into a person's diet because of frailty. Frailty was also mentioned in a further 15 per cent of cases (n = 45) as part of the reason for giving a nutritional product. CONCLUSION: The authors' findings suggest that guidelines should be developed to promote standardisation across nursing and residential care settings, where appropriate.     

Magnetic resonance imaging of coronary artery occlusions in the navigator technique

Non-invasive assessment of coronary arteries is possible with magnetic resonance imaging (MRI). Respiratory gated MR coronary angiography is a new imaging technique that permits reconstruction of the coronary arteries based on a three-dimensional (3D) data set obtained from the free-breathing patient. In this study, respiratory gated MR angiography (MRA) was performed to assess coronary artery occlusions. MRI was performed in 25 patients who had been referred for conventional coronary angiography because of suspected coronary artery disease. Coronary artery occlusion was evaluated in the proximal and middle vessel segments after multiplanar coronary reconstruction of the MR images. Five patients were excluded from the study; in the remaining 20 patients 120 coronary artery segments were analyzed. Good image quality could be obtained for 85% of the segments. Eighteen of the 24 occlusions were confirmed by MRI, the overall sensitivity was 75% and the specificity was 100%. The best results were found in the proximal left anterior descending (LAD) and descending parts of the right coronary artery (RCA), where all occlusions were confirmed. These results showed that coronary artery occlusions can be detected in the proximal and middle LAD and RCA using 3D respiratory gated MRA. Further technical improvements, especially in spatial resolution, are necessary before MRA can become a reliable diagnostic tool in the non-invasive evaluation of coronary arteries.     

Conversion of the failing ileoanal pouch to reservoir-ileostomy rather than to ileostomy alone

PURPOSE: We report the indications, technique, and results of conversion of the ileoanal pouch to the Kock's pouch in five patients. The indication was functional disturbance that could not be corrected by operation. Aim of the conversion operation was re-establishment of fecal control and complete preservation of existing ileal surface. METHODS: The ileal pouch was used again, and in one case an augmentation was made. The continence valve was made three times from the afferent loop and in two cases from a higher ileal segment. RESULTS: Following conversion, function was excellent in three patients with ulcerative colitis and in one patient with familial adenomatous polyposis. One woman who underwent proctocolectomy for slow-transit constipation needed a Brooke ileostomy for continuous abdominal distention pain. CONCLUSION: We conclude that conversion to a continent ileostomy is a rewarding method of safely eliminating dysfunction of the ileoanal pouch that cannot be corrected by operation. Presumption is, however, that the surgeon is familiar with both methods and that the primary disease is suitable for pouch surgery.     

Graft-versus-host disease after allogeneic hematopoietic stem cell transplantation induces a CD8+ T cell-mediated graft-versus-tumor effect that is independent of the recognition of alloantigenic tumor targets

Cure of hematologic malignancies after allogeneic hematopoietic stem cell transplantation is partially attributable to immunocellular antitumor reactions termed graft-versus-tumor (GvT) effect. GvT effects are heterogeneous with respect to effector cell populations, target antigens, and their interrelation with graft-versus-host disease (GvHD). In the present study, allogeneic parent-into-F1 murine transplantation models (BALB/c or C57BL/6 --> [C57BL/6 x BALB/c]F1) with different tumors derived from either parental strain were used to evaluate tumor-specific GvT effects. Compared with syngeneic F1-into-F1 controls, significant CD8+ T cell-mediated GvT effects occurred in both allogeneic transplantation models, even in the absence of histoincompatibilities between donor cells and host tumor. Identical genetic background of donor and tumor precluded allorecognition of tumor cells, indicating that tumor-associated antigens (TAAs) were targeted. With allowance made for selective major histocompatibility complex (MHC) disparities between donor cells and normal host tissue, GvHD was identified as a driving force for TAA-specific GvT effects. Adoptive transfer of the effector cells into secondary tumor-bearing recipients confirmed sustained antitumor activity and specificity of the T-cell response. The results provide experimental proof of a donor CD8+ T cell-mediated TAA-specific antitumor response in vivo that is driven by GvHD. It may represent one of the mechanisms contributing to GvT effects observed in allogeneic transplant recipients.     

Comparative analyses of bone marrow micrometastases in breast and gastric cancer

This study is a comparative analysis of the prevalence, absolute number and aggregation status of bone marrow micrometastases (BMM) between breast (n = 234) and gastric (n = 102) cancer patients based on a standardized number of 1 × 10⁶ bone marrow-derived cells per patient. Additionally, expression of the epithelial cell adhesion molecule E-cadherin was analyzed on disseminated tumor cells. A positive BMM status was demonstrated in 88/234 breast and 45/102 gastric cancer patients. The presence of CK18⁺ cells positively correlated with parameters of advanced tumor progression in breast, but not in gastric cancer. Interestingly, 25.2% of the node-negative patients already had micrometastatic cells in the bone marrow at diagnosis. Regarding the absolute number of CK18⁺ cells and the frequency of CK18⁺ cell clusters, no significant difference was found between the 2 tumor types. However, clusters consisting of more than 10 CK18⁺ cells (type II clusters) were present exclusively in breast cancer patients. Additionally, co-expression of CK18 and E-cadherin was detectable in 15/21 micrometastases-positive breast but in only 1/9 gastric cancer patients. While prevalence of micrometastatic cells in bone marrow is discussed as an early indicator for systemic disease, aggregation status and a certain antigen profile might be indicative for site-specific differences in the manifestation pattern of solid metastases. © 1996 Wiley-Liss, Inc.     

Protection of mice from H5N1 influenza challenge by prophylactic DNA vaccination using particle mediated epidermal delivery

Mice were vaccinated with a DNA plasmid encoding the haemagglutinin (HA) antigen of H5N1 influenza A/Vietnam/1194/2004 by particle mediated epidermal delivery (PMED). Vaccination led to potent anti-HA serological responses that were significantly enhanced by the inclusion of a plasmid expressing the A and B subunits of Escherichia coli heat labile enterotoxin (designated DEI-LT). Mice were vaccinated with H5 or H5/DEI-LT and challenged with 100LD50 H5N1 A/Vietnam/1194/2004 virus. Vaccination provided considerable protection, and mice that received two doses (prime-boost) of H5/DEI-LT showed no symptoms of disease post vaccination, did not shed detectable virus and did not show any rise in anti-H5N1 HI titre post challenge, indicating that they were fully protected. These results demonstrate that the PMED technology may hold promise for the prophylaxis of pandemic influenza.     

Intralipid minimizes hepatocytes injury after anoxia-reoxygenation in an ex vivo rat liver model

OBJECTIVE: Ischemia-reperfusion injury is a determinant in liver injury occurring during surgical procedures, ischemic states, and multiple organ failure. The pre-existing nutritional status of the liver, i.e., fasting, might contribute to the extent of tissue injury. This study investigated whether Intralipid, a solution containing soybean oil, egg phospholipids, and glycerol, could protect ex vivo perfused livers of fasting rats from anoxia-reoxygenation injury. METHODS: The portal vein was cannulated, and the liver was removed and perfused in a closed ex vivo system. Isolated livers were perfused with glucose 5.5 and 15 mM, and two different concentrations of Intralipid, i.e., 0.5:100 and 1:100 (v/v) Intralipid 10%:medium (n = 5 in each group). The experiment consisted of perfusion for 15 min, warm anoxia for 60 min, and reoxygenation during 60 min. Hepatic enzymes, potassium, glucose, lactate, bilirubin, dienes, trienes, and cytochrome-c were analyzed in perfusate samples. The proportion of glycogen in hepatocytes was determined in biopsies. RESULTS: Intralipid attenuated transaminases, lactate dehydrogenase, potassium, diene, and triene release in the perfusate (dose-dependant) during the reoxygenation phase when compared with glucose-treated groups. The concentration of cytochrome-c in the medium was the highest in the 5.5-mM glucose group. The glycogen content was low in all livers at the start of the experiment. CONCLUSION: Intralipid presents, under the present experimental conditions, a better protective effect than glucose in anoxia-reoxygenation injury of the rat liver.     

Comparison of microencapsulation techniques for the water-soluble drugs nitenpyram and clomipramine HCl.

In this investigation, the water-soluble drugs nitenpyram and clomipramine HCl were encapsulated using coacervation, solvent evaporation and film-coating. The effect of different process factors on the encapsulation efficiency and the release profile of the microparticles was evaluated. For coacervation it was shown that the core to wall ratio was the most important factor. For solvent evaporation using an w/o emulsion the type and concentration of the surfactant were the most important parameters for a successful encapsulation. Additionally the coated material was tested for its stability under different conditions as a powder or compressed into tablets. It could clearly be demonstrated that the coated drug substance exhibited a better stability then the uncoated material. The particles prepared by film-coating showed the best stability.     

Treatment of Visual Disorders in Parkinson Disease

Purpose of review

This article discusses visual disorders in both Parkinson disease (PD) and other Parkinsonian disorders. It is organized largely by the anatomical site of pathology and emphasizes practical treatments. Targeted treatment options include medications, surgery, occupational, and physical therapies as well as optical aids.

Recent findings

The causes of visual complaints in Parkinson disease and other similar disorders are being more clearly identified. A new medication approved specifically to treat hallucinations in PD now is available. There is increased understanding of the important role that an ophthalmologist can play in the care of these patients. Finally, research and therapeutic development are unmet needs in accessing and treating visual complaints in PD and Parkinsonian disorders.

Summary

A better understanding of Parkinson-related visual complaints and of available treatment options is important to optimize patient safety and quality of life. Vision impairment leads to difficulties in many common activities including reading, ambulating, and driving. Falls and injuries, made more likely because of impaired vision, result in an early loss of independence. Awareness of the problem, patient education, ophthalmologic care, selected therapeutics, physical therapy, and occupational therapy are crucial to maximizing quality of life in these patients.