THE METABOLIC CONSEQUENCES OF HUMAN MILK AND FORMULA FEEDING IN PREMATURE INFANTS

Abstract. Schultz, K., Soltész, G. and Mestyán, J. (Department of Paediatrics, University Medical School, Pécs, Hungary). The metabolic consequences of human milk and formula feeding in premature infants. Acta Paediatr Scand, 69: 647, 1980.—Twenty premature low-birthweight infants were divided into two groups and assigned randomly to either a pooled human milk or to a cow's milk based infant formula feeding regimen. The protein intake was 2.0 g/kg/day in the human milk fed group and 4.4 g/kg/day in the formula fed group of infants. The concentrations of different metabolites were estimated at weekly intervals, and plasma amino acid analysis was performed biweekly on blood samples in the two groups of infants during the four-week study period. Formula milk fed infants had significantly lower fasting blood glucose levels and developed azotaemia, hyperaminoacidemia and metabolic acidosis in the early weeks of postnatal life. Blood lactate and plasma free fatty acid concentrations did not change significantly in the two groups during the study. No significant differences were found in the rate of weight gain between the two groups of infants, although formula fed infants regained their birthweight more slowly than human milk fed infants. High protein formula feeding causes potentially unfavorable metabolic and amino acid imbalances in preterm infants in the early postnatal life.     

肌松药物巴氯芬类似物的合成及其构效关系的研究

为研究解痉肌松药巴氯芬类似物的构效关系,合成了巴氯芬类似物15个,其中8个化合物是首次报道。采用小白鼠热板法及对抗吗啡竖尾反应实验评价目标化合物的镇痛和肌松作用。筛选结果表明:部分化合物有肌松和镇痛作用,其中Ⅰb,Ⅱb,Ⅲa和Ⅲc的镇痛作用较好,Ⅰd,Ⅱb,Ⅲa和Ⅲb的肌松作用较好,但均未超过巴氯芬。根据本研究及前人的研究结果,提出巴氯芬与GABA_B受体结合取决于巴氯芬分子中氨基、羧基和苯环三种基团。     

差示分光光度法测定牛黄类中成药中胆红素的含量

本文利用胆红素溶液在光照下易氧化变色及其吸收光谱发生显著变化的性质,在波长453 nm处,测其光照前后的吸收度差值(△A),△A与胆红素溶液浓度呈线性关系,对含牛黄的中成药(六应丸,六神丸和牛黄消炎丸)中胆红素进行了定量,并对其它组分进行了光照试验,排除了光照对其它组分的影响,从而确定了此法的可行性。     

脉冲电流对胰岛素经皮渗透的促进作用

实验结果表明,脉冲电流能有效地提高胰岛素的透皮扩散速率,并随着释放池中胰岛素浓度的递增,透皮扩散速率呈线性增加。同时,胰岛素在pH值偏离等电点的酸性溶液(pH3.6)中透皮速率最高,为324.2±33.4μU/(cm²·h),而在pH值高于等电点的溶液(pH7.4)中其透皮速率降至143.7±27.3μU/(cm²·h),在pH值接近等电点(pH5.3)时,胰岛素的透皮速率最低,为78.4±21.9μU/(cm²·h)。     

Acid-base Properties of Terbutaline in Terms of Protonation Macro- and Microconstants

The acid/base chemistry of terbutaline was characterized at the molecular level in terms of protonation macroconstants and microconstants. The macroconstants were measured by potentiometry and calculated by standard evaluation methods. The stepwise macroconstant values were log K₁ = 11·01, log K₂ = 9·89, and log K₃ = 8·57 at 250°C and 0·2 m ionic strength. The microconstants were deduced using the relationships between macro- and microconstants and an appropriate data set of model compounds (resorcinol and phenylephrine). The molecule of terbutaline contains three ionizable functional groups. In the unprotonated form of the molecule, the two identical phenolate groups are slightly more basic than the secondary amino group, whereas the amino basicity significantly exceeds that of the phenolate site, when the other phenol is protonated. This is due to the large phenolate-phenolate intramolecular interaction. The phenolate-phenolate and the phenolate-amino interactivity parameters were found to be ?1·21 and ?0·41 log E units, respectively.     

Discussing religious and spiritual issues at the end of life: a practical guide for physicians

Bernard Lo, MD; Delaney Ruston, MD; Laura W. Kates; Robert M. Arnold, MD; Cynthia B. Cohen, PhD, JD; Kathy Faber-Langendoen, MD; Steven Z. Pantilat, MD; Christina M. Puchalski, MD; Timothy R. Quill, MD; Michael W. Rabow, MD; Simeon Schreiber; Daniel P. Sulmasy, OSM, MD, PhD; James A. Tulsky, MD; for the Working Group on Religious and Spiritual Issues at the End of Life

JAMA. 2002;287:749-754.

As patients near the end of life, their spiritual and religious concerns may be awakened or intensified. Many physicians, however, feel unskilled and uncomfortable discussing these concerns. This article suggests how physicians might respond when patients or families raise such concerns. First, some patients may explicitly base decisions about life-sustaining interventions on their spiritual or religious beliefs. Physicians need to explore those beliefs to help patients think through their preferences regarding specific interventions. Second, other patients may not bring up spiritual or religious concerns but are troubled by them. Physicians should identify such concerns and listen to them empathetically, without trying to alleviate the patient's spiritual suffering or offering premature reassurance. Third, some patients or families may have religious reasons for insisting on life-sustaining interventions that physicians advise against. The physician should listen and try to understand the patient's viewpoint. Listening respectfully does not require the physician to agree with the patient or misrepresent his or her own views. Patients and families who feel that the physician understands them and cares about them may be more willing to consider the physician's views on prognosis and treatment. By responding to patients' spiritual and religious concerns and needs, physicians may help them find comfort and closure near the end of life.

     

Primary care physician attitudes regarding communication with hospitalists

Hospitalist systems create discontinuity of care. Enhanced communication between the hospitalist and primary care physician (PCP) could mitigate the harms of discontinuity. We conducted a mailed survey of 4,155 physician members of the California Academy of Family Physicians to determine their preferences for and satisfaction with communication with hospitalists. We received 1,030 completed surveys (26%). PCPs overwhelmingly stated that they "very much prefer" to communicate with hospitalists by telephone (77%), at admission (73%), and discharge (78%). Only discharge medications (94%) and discharge diagnosis (90%) were deemed "very important" by >90% of PCPs. Of the 556 respondents (54%) who had ever used a hospitalist, 56% were very or somewhat satisfied with communication with hospitalists, and 68% agreed that hospitalists are a good idea. Regarding communication at discharge, only 33% of PCPs reported that discharge summaries always or usually arrive before the patient is seen for follow-up. Only 56% of PCPs in our survey were satisfied with communication with hospitalists. Hospitalists should communicate with PCPs in a timely manner by telephone, at least at admission and discharge, and provide the specific pieces of information deemed important by the vast majority of PCPs. Hospitalists should also ensure that discharge information arrives in time to assist the PCP in reassuming care of their patients. It may be possible to tailor communication to individual PCPs. Further research could assess the impact of such communication on patient satisfaction and outcomes.     

End-of-life care for the hospitalized patient

The majority of Americans die in hospitals where shortcomings in end-of-life care are endemic. Too often, patients die alone, in pain, their wishes unheeded by their physicians. Because hospitalists care for many of these dying patients, they can dramatically improve end-of-life care in hospitals. Hospitalists must first relieve distressing symptoms such as pain, dyspnea, nausea, vomiting, delirium, and depression. In addition, they should communicate clearly with patients and families, and provide them psychosocial support. Hospitalists can increase the number and the timeliness of hospice referrals, thereby allowing more patients to die at home. Finally, all physicians must attend to their own senses of grief and loss to avoid burnout and to continue to reap the rewards end-of-life care provides.     

Gastric trichobezoar: sonographic findings

Ultrasonographic diagnosis of trichobezoar may be relatively specific. A broad band of high-amplitude echoes can be seen superficially, with complete sonic shadowing behind. The authors describe a patient in whom the diagnosis was made prior to conventional barium studies and in whom the question of trichobezoar had not been raised clinically.