The effect of glutamine-enriched enteral nutrition on intestinal permeability in very-low-birth-weight infants: a randomized controlled trial

BACKGROUND: Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion. Glutamine depletion has negative effects on intestinal integrity. The lower infection rate in VLBW infants receiving glutamine-enriched enteral nutrition may originate from improved intestinal integrity, as reflected by decreased intestinal permeability. The aim of our study was to investigate whether glutamine-enriched enteral nutrition in VLBW infants enhances the normal decrease in intestinal permeability, as measured by the sugar absorption test (SAT). METHODS: In a double-blind, randomized, placebo-controlled trial, VLBW infants (gestational age <32 weeks or birth weight <1,500 g) received enteral glutamine supplementation (0.3 g/kg/d) or an isonitrogenous placebo supplementation (alanine) between days 3 and 30 of life. Intestinal permeability, determined from the urinary lactulose/mannitol (L/M) ratio after an oral dose of lactulose and mannitol, was assessed at 4 time points: before the start of the study, and at days 7, 14, and 30 of life. RESULTS: At least 2 SATs were performed in 45/52 (86%) and 45/50 (90%) infants in the glutamine-supplemented and control groups, respectively. Baseline patient and nutrition characteristics were not different between the groups. There was no effect of glutamine-enriched enteral nutrition on the decrease of the L/M ratio between the start and end of the study (p = .78). In both treatment groups, median urinary lactulose concentrations decreased (p < .001), whereas median urinary mannitol concentrations increased (p = .003). CONCLUSIONS: Glutamine-enriched enteral nutrition does not enhance the postnatal decrease in intestinal permeability in VLBW infants. Any beneficial effect of glutamine may involve other aspects of intestinal integrity; for example, modulation of the intestinal inflammatory response.     

Dyspnoea: a study of measurement instruments for the assessment of dyspnoea and their application for patients with advanced cancer

Dyspnoea or breathlessness is a problem commonly encountered in the palliative care of many patients with advanced cancer, although its impact on the patient is frequently under-estimated In advanced cancer, the aim of effective management is to minimize the patient's perception of breathlessness which, in turn, depends on reliable assessment Most of the knowledge and experience of dyspnoea has been acquired through working with patients with chronic pulmonary disease and there is a dearth of literature relating specifically to the assessment of dyspnoea in advanced cancer A critical analysis of available literature was undertaken and measurement instruments available for assessing breathlessness and their application to dyspnoeic patients with advanced cancer were reviewed Dyspnoea is a complex, multidimensional sensation and its subjectivity makes it difficult to quantify For patients with advanced cancer, dyspnoea may be one of many symptoms and measurement instruments need to take this into account No single measurement instrument takes into account the different components of dyspnoea and as the final choice will depend on the purpose of assessment, it is likely that more than one instrument will be required     

Burns to the perineum and genitals — management,results and function of the thermally injured perineum in a 5-year-review

From 1987 until 1991, 68 patients were treated for partial or full thickness burns of the perineum and genitals. Thirty-seven percent died as an early result of their extended burns. The remainder were analysed with respect to demographics, management, urinary and faecal deviation, operations, infections, anal and urogenital function, and sexual function. This was accompolished by chart study, questionnaires, and physical examination. The results are compared to thos published previsouly. Burns of the perineum and genitals, as such, are not associated with an additional risk for survival. Most of them can be managed conservatively. No dysfunction was seen in the long-term follow-up. However, the quality of life may be affected after a burn trauma.     

Event-related brain potential and heart rate manifestations of visual selective attention

Twenty-eight volunteers were instructed to attend stimuli presented at one side of the computer screen and to ignore stimuli presented at the other side. Both attended and unattended stimulus series consisted of targets (25%) and nontargets (75%) defined on the basis of stimulus shape. Attended targets required a binary choice based on stimulus color. Selective attention led to the expected increase in both midlatency (N2b) and late (P3) brain potential components. Furthermore, selective attention led to increased anticipatory cardiac slowing preceding the target stimulus and to increased primary bradycardia. Correlational analyses revealed a positive relation between the effects of selective attention on N2b amplitude and primary bradycardia suggestive of cortical involvement in the chronotropic control of heart rate.     

Comparison of pregnancy outcomes in Dutch kidney recipients with and without calcineurin inhibitor exposure: a retrospective study

Within pregnancies occurring between 1986 and 2017 in Dutch kidney transplant recipients (KTR), we retrospectively compared short-term maternal and foetal outcomes between patients on calcineurin inhibitor (CNI) based (CNI+) and CNI-free immunosuppression (CNI−). We identified 129 CNI+ and 125 CNI− pregnancies in 177 KTR. Demographics differed with CNI+ having higher body mass index (P = 0.045), shorter transplant-pregnancy interval (P < 0.01), later year of transplantation and -pregnancy (P < 0.01). Serum creatinine levels were numerically higher in CNI+ in all study phases, but only reached statistical significance in third trimester (127 vs. 105 µm ; P < 0.01), where the percentual changes from preconceptional level also differed (+3.1% vs. −2.2% in CNI−; P = 0.05). Postpartum both groups showed 11–12% serum creatinine rise from preconceptional level. Incidence of low birth weight (LBW) tended to be higher in CNI+ (52% vs. 46%; P = 0.07). Both groups showed equal high rates of preterm delivery. Using CNIs during pregnancy lead to a rise in creatinine in the third trimester but does not negatively influence the course of graft function in the first year postpartum or direct foetal outcomes. High rates of preterm delivery and LBW in KTR, irrespective of CNI use, classify all pregnancies as high risk.     

Response Initiation, Not Completion, Seems to Alter Cardiac Cycle Length

The effects on cardiac interbeat interval (IBI) length of the initiation and completion of speeded motor reactions were examined at different points in the cardiac cycle (different times after the Rwave of the electrocardiogram). Stimuli were presented either at the R-wave or 350 ms afterward. Responses were paced by instructions to release a start key prior to three different target times (150, 275, or 500 ms). Initiation time was defined as the interval between stimulus onset and the release of the start key; completion time was defined as the interval between the onset of the stimulus and the depression of one of two response keys. The shift from anticipatory deceleration to acceleration varied systematically as a function of time of response relative to the R-wave. Responses that occurred early in the cardiac cycle were associated with a shift from deceleration to acceleration in the same IBI; for late occurring responses the shift occurred in the subsequent IBI. Most importantly, when response initiation occurred early in the cycle (<300 ms) and response completion occurred late, deceleration was terminated during the same IBI. Initiation rather than completion seems to control the inhibitory vagal input to the heart that is responsible for anticipatory deceleration.     

Characterization of a nuclear receptor for testosterone in seminiferous tubules of mature rat testes.

A specific androgen receptor could be demonstrated in the nuclear and cytoplasmic fractions of testicular tissue of mature hypophysectomized rats, either in vivo after injection of testosterone or in vitro after incubation of testis tissue with testosterone. Using agar-gel electrophoresis this receptor could be distinguished from the testicular transport-like protein for androgens (androgen binding protein = ABP). After in vivo administration of testosterone the steroid bound to the receptor in mature rat testis was mainly unmetabolized testosterone. After dissection of testis tissue the larger part of the receptor was shown to be present in the seminiferous tubules. The amount of exogenous testosterone that could be bound per mg of protein in the nuclear extract increased gradually during 20 days after hypophysectomy. Some characteristics of the receptor in the nuclear extract and of ABP were compared : the receptor was more sensitive to temperature increases than ABP; the steroid dissociated more slowly from the receptor than from ABP; cyproterone acetate showed almost no effect on the binding of dihydrotestosterone to ABP, but did compete for the receptor binding sites in the nuclear extract.