Low DHA and plasmalogens associated with a precise PUFA-rich diet devoid of DHA

ObjectivesFatty acids, being multi-functional and partially diet-dependent, are crucial for health yet optimal dietary composition remains controversial. Previous work suggests that nutritionally-dependent populations live with significant fatty acid abnormalities despite abundant polyunsaturated fatty acid intake.Design and methodsAn analysis of fasting plasma phospholipids, including plasmalogens, and total fatty acids was conducted on twelve tube-fed people receiving a uniform diet which meets current polyunsaturated fatty acid intake recommendations, specifically, linoleic acid as 8.1% of energy and alpha-linolenic acid as 1.3% of energy for at least two years.ResultsEicosapentaenoic- and docosahexaenoic acid-related phospholipids were low. In addition, C16:0- and C18:0-related plasmalogens, components of phospholipids, were low. Essential fatty acid deficiency as classically defined was not present.ConclusionsBased upon extensive clinical investigations in neuro-typical people, abnormalities of these key cell-membrane components may have undesirable clinical consequences. In particular, docosahexaenoic acid sufficiency needs to be assured. Comprehensive re-evaluation of current recommendations may be necessary.     

The care of patients with dementia: a modern Jewish ethical perspective

Patients with dementia and their families can face many difficult and agonizing ethical dilemmas over the course of the illness. An awareness of the Jewish ethical response to some of these issues can help clinicians in treating patients of the Jewish faith and also serve as an example of how one ethical system addresses these questions. The Jewish response is grounded in a profound respect and value for human life in all its forms and man's responsibility to preserve it, but Judaism rejects unproven therapies and recognizes the limitations of modern medicine. Jewish law also codifies normative obligations that children have toward their elderly parents. With these principles in the forefront, this article analyzes a Jewish ethical response to various problems in the care of the demented patient such as truth telling, transfer to a nursing home, artificial nutrition, and end-of-life care, taking into account modern concepts of the doctor-patient relationship and ancient Jewish tradition.     

Lower Extremity Injury While Undergoing Urology Procedures in the Trendelenburg with Lithotomy Position: Three Case Reports

PurposeTo report and discuss the incidence of severe lower extremity injuries associated with robotic procedures in Trendelenburg with lithotomy position.Design and MethodsA case study method was used to describe three cases of patients who underwent robotically assisted urological procedures in Trendelenburg with lithotomy position and developed serious lower extremities injuries resulting in fasciotomies. Furthermore, a literature review was conducted to evaluate risk factors and possible interventions for the prevention of similar injuries.FindingsCase analysis revealed multifactorial causes, including patient comorbidities, long surgical procedures, and blood pressure decreases below the baseline for more than 30 minutes. The severity of lower extremity injury associated with lithotomy position may be underestimated. The etiology of peripheral nerve injury can be attributed to patient comorbidities, positioning, and surgical conditions. Injury prevention should include careful patient and procedural risk assessment, staff education, and communication strategies.ConclusionsExtreme Trendelenburg with lithotomy position for longer periods can lead to serious lower extremities injuries. Preanesthetic screening and multidisciplinary team discussions for additional precautions for high-risk patients are crucial interventions to decrease incidence and severity of lower extremities injuries.     

Endothelial lipase promotes the catabolism of ApoB-containing lipoproteins

Endothelial lipase (EL) has been found to be a key enzyme in high-density lipoprotein (HDL) metabolism in mice, leading to the concept that inhibition of EL could be a novel strategy for raising HDL cholesterol levels. However, mice are "HDL animals" and the effect of EL on atherogenic apoB-containing lipoproteins has not been elucidated. We previously found that EL is capable of hydrolyzing very low-density lipoprotein (VLDL) and LDL lipids ex vivo. To investigate the role of EL in the metabolism of apoB-containing lipoproteins in vivo, we expressed human EL in three mouse models of elevated apoB-containing lipoproteins: apoE-deficient, LDL receptor-deficient, and human apoB transgenic mice. Unexpectedly, hepatic expression of EL resulted in markedly decreased levels of VLDL/LDL cholesterol, phospholipid, and apoB accompanied by significantly increased LDL apolipoprotein and phospholipid catabolism. To determine whether lipolytic activity is required for this effect, we also expressed a catalytically inactive form of human EL (ELS149A); unexpectedly, expression of ELS149A did not lower and in fact increased plasma lipids. Coexpression and coimmunoprecipitation studies suggested that catalytically inactive ELS149A inhibits endogenous mouse EL, accounting for the increased lipid levels. We conclude that (1) in addition to its known effects on HDL metabolism, EL influences the metabolism of apoB-containing particles; (2) catalytic activity of EL is required for its effects on apoB-containing lipoproteins; and (3) overexpressed catalytically inactive EL inhibits endogenous mouse EL, resulting in increased levels of plasma lipids. In light of these results, inhibition of EL has the potential to raise levels of atherogenic lipoproteins in addition to HDL-C levels.     

Glycopeptides from Surface Membranes of Neuroblastoma Cells

Sequential removal of surface glycopeptides was achieved by subjection of mouse neuroblastoma cells to a two-step trypsin treatment under different conditions. The glycopetides released by each trypsinization step were digested by Pronase and examined on columns of Sephadex G-50. Different chromatographic patterns were found for the two digests. Thus, several groups of glycopeptides can be distinguished by the trypsinization procedure. One group is readily removed and appears to be at a more accessible location on the cell surface. Among the four neuroblastoma clones examined, the glycopeptide patterns from axon-forming cells differed from those of axon-minus cells.     

Patients' attitudes toward screening for medical conditions in a dental setting

Objectives: Previous studies demonstrated the efficacy of chairside medical screening by dentists to identify patients who are at increased risk for developing cardiovascular‐associated events and the favorable attitude of dentists toward chairside medical screening. This study assessed patient attitudes toward chairside medical screening in a dental setting. Methods: A self‐administered questionnaire of eight five‐point response scale questions was given to a convenience sample of adult patients attending an inner‐city dental school clinic and two private practice settings. Wilcoxon–Mann–Whitney tests and t‐tests were used to compare responses between study groups. Friedman nonparametric analysis of variance was used to compare response items within each question. Results: Regardless of setting, the majority of respondents was willing to have a dentist conduct screening for heart disease, high blood pressure, diabetes, human immunodeficiency virus infection, and hepatitis infection (55‐90 percent); discuss results immediately (79 percent and 89 percent); provide oral fluids, finger‐stick blood, blood pressure measurements, and height and weight (60‐94 percent); and pay up to $20 (50‐67 percent). Respondents reported that their opinion of the dentist would improve regarding the dentist's professionalism, knowledge, competence, and compassion (48‐77 percent). The fact that the test was not done by a physician was ranked as the least important potential barrier. While all respondents expressed a favorable attitude toward chairside screening, the mean score was significantly lower among clinic patients across most questions/items. The priority rankings within an item were similar for both groups. Conclusions: Acceptance by patients of chairside medical screening in a dental setting is a critical element for successful implementation of this strategy.