Depiction of pain in the self-drawings of children with sickle cell disease

In an attempt to explore the perception of pain in children, 30 children with sickle cell disease were asked to make two drawings; one of themselves and one of themselves in pain. It was hypothesized that the cognitive ability and the emotional state of the child would be affected by the pain experience. Children and their parents were interviewed on the incidence of pain and on the child's control over it. The cognitive ability of the child was related to the kind of control he/she exercised over the pain. An analysis of the drawings concerning their thematic representations, colour and size is also presented. The mental age of the child dropped in the drawing of pain as compared to the non-pain drawing but it was found to be irrelevant to the kind of control the child exercised on the pain.     

Isoflavonoid glucosides are deconjugated and absorbed in the small intestine of human subjects with ileostomies

BACKGROUND: Although soy isoflavonoids have a number of health-promoting benefits, information concerning the sites of their absorption and metabolism in humans remains limited. Isoflavonoid absorption from the gut requires deconjugation of glucosides to aglycones. OBJECTIVE: The objective was to investigate the role of the small intestine in isoflavonoid absorption and metabolism in humans. DESIGN: Human subjects with fully functional gastrointestinal tracts (n = 6) and ileostomy subjects (n = 6) were fed a single soy meal containing 64.8 mg isoflavonoid aglycone equivalents (95% as glucosides). Metabolism of isoflavonoids in the upper gastrointestinal tract was examined by analyzing ileal effluent from ileostomy subjects, and absorption was assessed indirectly by quantifying isoflavonoids and several metabolites in 24-h urine pools. RESULTS: Chyme contained 36.7% of ingested isoflavonoid aglycone equivalents, primarily (95.8%) as aglycones. Qualitative profiles (x +/- SEM) of isoflavonoid excretion in urine (daidzein > glycitein > genistein) and the quantity of isoflavonoid equivalents were not significantly different between the control (18.4 +/- 2.2 mg) and ileostomy (13.5 +/- 3.2 mg) subjects. Dihydrodaidzein was present in the urine of all subjects, although the amount excreted by ileostomy subjects was less than that excreted by the control subjects. The percentage of producers and mean quantities of dihydrogenistein, equol, and O-desmethylangolensin in the urine of ileostomy subjects also were lower than those of control subjects. CONCLUSIONS: Ileostomy subjects efficiently deglycosylate isoflavonoid glucosides in the small intestine and appear to absorb aglycones with an efficiency comparable with that of control subjects. However, the production of microbial metabolites of isoflavonoids is limited in ileostomy subjects.     

Beta-carotene micellarization during in vitro digestion and uptake by Caco-2 cells is directly proportional to beta-carotene content in different genotypes of cassava

Cassava, a staple food in sub-Saharan Africa, does not provide adequate amounts of pro-vitamin A (VA) carotenoids and has been targeted for biofortification (i.e. selectively breeding cultivars of increased nutrient density with agroeconomically acceptable characteristics). However, the accessibility of pro-VA carotenoids for absorption in different cultivars of cassava remains unknown. Here, we used the coupled in vitro digestion/Caco-2 cell uptake model to screen the relative accessibility of beta-carotene (betaC) in 10 cultivars of cassava with varying concentrations of betaC. After cooking (boiled for 30 min), the betaC concentration in tubers from different cultivars ranged from less than detectable to 6.9 microg betaC/g cassava. Samples were subjected to simulated oral, gastric, and small intestinal digestion to determine stability and micellarization of betaC. All-trans betaC, 9-cis betaC, and 13-cis betaC were the most abundant carotenoids in cooked cassava and recoveries after digestion exceeded 70%. Efficiency of micellarization of total betaC was 30 +/- 2% for various cultivars with no significant difference in isomers and linearly proportional to concentration in cooked cassava (r = 0.87; P < 0.001). Accumulation of all-trans betaC by Caco-2 cells incubated with the diluted micelle fraction for 4 h was proportional (R(2) = 0.99; P < 0.001) to the quantity present in micelles. These results suggest that all-trans betaC content appears to provide the key selection marker for breeding cassava to improve VA status and that the more complicated screening procedure using in vitro digestion coupled to cell uptake does not provide additional information on potential bioavailability.     

Novel Approach to Inpatient Glucometric Monitoring and Variability in a Community Hospital Setting

Background:

Hyperglycemia and glucose variability in the hospital environment are associated with higher rates of complications, longer lengths of stay, and mortality. Standardized metrics are needed to assess the efficacy and safety of glucose management interventions.

Methods:

Glucometric data were collected from 2024 inpatients in a San Diego hospital between 2009 and 2011. As a complementary measure of glucose control, individual patient excursion rates were calculated using counts of distinct excursions from normal to critical glucose ranges >180 or <70 mg/dL. Prediction models for excursion rates were devised, based on patient demographic and clinical characteristics.

Results:

Patients were predominantly male (51.2%), Caucasian (86.0%), and elderly (median age 72 years). Obesity was prevalent: 32% were overweight and 33% were obese. Median length of hospitalization was 5.0 days (range, 0.8-139.4 days). Unadjusted rate of excursions >180 mg/dL was 0.456 per 24 hours. The proportion of zero excursions decreased as severity of illness decreased, but was unrelated to age. Excursion rates were slightly smaller for major and extreme severity of illness compared to mild or moderate illness severity. Excursion rates did not vary in a monotone fashion with age, although the general pattern reflected a reduction in excursion rates from the first age quartile (19 to 59) through the last age quartile (83 to 100). Using the Akaike information criterion, zero-inflated negative binomial models were identified as appropriate for analyzing glucose excursion rates.

Conclusions:

Systematic approaches to glucose reporting and management in the hospital environment offer “windows of opportunity” to improve diabetes care.     

Interferon‐gamma inhibits healing post scald burn injury

Impaired healing after severe burns remains a reason for prolonged hospitalization, opportunistic infections, and debilitating scarring. Interferon‐gamma (IFN‐γ) is an important immune regulator that has been shown to inhibit collagen synthesis by fibroblasts, resulting in delayed healing in incision wounds. To determine whether IFN‐γ plays similar roles in the healing process after severe burn, we induced scald injury in mice deficient or sufficient in IFN‐γ and examined local responses. In the absence of IFN‐γ, scalded areas healed faster. This was associated with attenuated local inflammatory responses, enhanced reepithelialization, increased proliferation of keratinocytes in reepithelialized leading edges, and up‐regulation of growth factors in burned skin areas. Furthermore, angiogenesis and myofibroblast formation commenced and terminated earlier in IFN‐γ^–/– mice compared with wild type (WT) controls. Our observations demonstrate that inhibition of IFN‐γ results in accelerated healing after burn injury by dampening excessive inflammation and facilitating reepithelialization, collagen deposition, and wound contraction.     

Copper deficiency reversibly impairs DNA synthesis in activated T lymphocytes by limiting interleukin 2 activity.

The essentiality of adequate copper (Cu) nutriture for normal T-cell function in laboratory and domestic animals is well established. However, specific biochemical roles of Cu in the maturation and activation of T cells have not been defined. Previous work showed that when cultures of splenic mononuclear cells (MNCs) from Cu-deficient rats were exposed to T-cell mitogens, DNA synthesis was markedly reduced despite normal up-regulation of interleukin 2 (IL-2) receptors, transferrin receptors, and class II major histocompatibility complex molecules. In the present study, IL-2 activity in PHA-treated cultures of MNCs from Cu-deficient rats was 40-50% that of controls as determined by bioassay. Addition of rat IL-2 to phytohemagglutinin-treated cultures of MNCs from Cu-deficient rats increased blastogenic activity to control levels, demonstrating that Cu deficiency does not inhibit transition of quiescent cells to the competence phase of the activation process. Moreover, supplementation of MNC cultures from Cu-deficient rats with physiological levels of Cu enhanced IL-2 activity and DNA synthesis in response to phytohemagglutinin. These data indicate that IL-2 activity in cultures of activated splenic T lymphocytes from Cu-deficient rats is insufficient for optimal blastogenesis.     

Primary unilateral tuberculous inguinal lymphadenitis

We report the case of a young Greek woman who presented with erythema nodosum and isolated unilateral inguinal lymphadenopathy. Excision and biopsy of the lymph node showed infection due to M. tuberculosis. An extensive workup did not reveal any other foci of tuberculosis. Isolated tuberculous inguinal lymphadenitis is a rare entity in developed countries and is almost always bilateral. Our case is unique because the disease was unilateral and affected an otherwise healthy woman who had never traveled in endemic areas.