High lipid parenteral nutrition improves portasystemic encephalopathy

We have conducted a randomized double crossover study over 4 days in six parenterally fed patients with portasystemic encephalopathy (PSE) in which the nonprotein energy source of otherwise identical feeds was alternately all glucose or predominantly fat. Concentrations of plasma branched chain amino acids (BCAA), plasma insulin, and blood glucose were measured after an initial fast and subsequently after each of the four 24-hr periods of isonitrogenous feeding. The grade of PSE was assessed clinically and by the number connection test, BCAA concentrations were significantly lower during the glucose infusion than during fasting or the lipid infusion. PSE was significantly less with the lipid than with the glucose infusion. Trials testing the effect of infused BCAA must take account of the opposing effect on BCAA concentrations of simultaneous glucose infusion. A high lipid feed may have advantages in the short-term treatment of PSE.     

The information needs of women newly diagnosed with breast cancer

Nurses can play a key role in patient education, including providing patients with useful and approrate information Rather than focusing on the process of education or information giving by nurses, this study places emphasis on the content of that information by taking the patients'perspective and asking the patients themselves what particular types of information are perceived as important at a specific point in time The aim of the study was to explore what particular types of information were important to women newly diagnosed with breast cancer, to enable nurses and other health care professionals to utilize their time as effectively as possible and provide a high-quality service to individuals in their care Women with breast cancer (a mean of 2 5 weeks from diagnosis) were interviewed and asked to compare items of information The items of information were presented m pairs and the women stated a preference for one item in that pan- Thirty-six pairs were presented in total The analysis involved the use of a Thurstone scaling model, which allowed rank ordermgs, or profiles of information needs, to be developed, reflecting the perceived importance of each item Information about the likelihood of cure, the spread of the disease and treatment options were perceived as the most important items of information at the tune of diagnosis Other information needs, in order of descending priority, included information about the risk to family, side-effects     

Competitive dissociation of encephalitogenic complexes between antigen presenting cells and myelin basic protein

Splenic T cells from myelin basic protein (MBP)-immunised Lewis rats were activated to transfer experimental autoimmune encephalomyelitis (EAE) by co-culture with MBP-pulsed lymphoid dendritic cells (DC). MBP-pulsed DC could be kept for at least 24 h at 37 degrees C in antigen-free medium without affecting their ability subsequently to activate encephalitogenic T cells. However, MBP-pulsed DC were rendered much less stimulatory after a 6 h, but not 2 h, secondary incubation with ovalbumin. Thus, although encephalitogenic complexes between MBP and DC appear very stable in the absence of competing antigens, in their presence, antigen exchange can take place over a period of a few hours; this has positive implications for therapy of EAE by antigen competition.     

Hip fractures: failure of fixation and outcome of salvage arthroplasty

Between 1999 and 2005, we treated 41 patients with a total hip arthroplasty for failed fixation of a hip fracture. This study had three purposes: (1) to determine the reason/s for fixation failure (2) to record difficulties/complications encountered in converting to a salvage arthroplasty and (3) to compare the outcome of these patients (Group 1) with a matched group of patients who underwent a primary hip arthroplasty (Group 2). Failure to achieve a good reduction and optimal screw placement was evident in 80% of cases of failed fixation. A high incidence of complications was recorded in the perioperative period during conversion to a salvage arthroplasty. Functional outcome was statistically inferior in Group1; this group also had a higher incidence of complications. Radiographs at 2 years postoperatively showed evidence of femoral stem loosening in 16% of the salvage group compared with 3% in the primary hip arthroplasty group.     

The quitting experience for smokers in sixth through twelfth grades

The present study examined the withdrawal process for adolescents who had attempted to quit smoking. A sample of 622 6th through 12th graders were interviewed. Smoking status was reported prior to attempting to quit and its relationship with the withdrawal experience was evaluated. Although over half of those who smoked regularly reported trying to quit, 78% of the "quitters" were smoking six months after their quit attempt. Experiencing adverse withdrawal symptoms was related to smoking at daily levels before quitting; delaying trying to quit was associated with initiation of smoking at an early age; and quitting success was predicted by early quitting age, lower pre-quitting smoking levels, a lack of a prior quitting failure, and peer smoking. The results suggest that smoking intervention programs for adolescents should include components facilitating the quitting process that take into consideration youngsters' smoking and quitting histories.     

A cross-reaction between Str. pyogenes and human fibroblasts, endothelial cells and astrocytes

Antisera were raised in rabbits to whole streptococci of group A grown in a semi-synthetic medium, containing tryptic digest of casein. Twelve of these sera were tested for their ability to react with a variety of human tissues by the immunofluorescence technique. One serum, raised against a type 6 glossy strain, contained no detectable antibodies to the sarcolemmal/subsarcolemmal region of the myocardium, but gave strong staining of fibroblasts, endothelial cells, smooth muscle and the pia-arachnoid. In addition there was staining of astrocytes, best demonstrated in sections of an astrocytoma, and of the stratum granulosum of the skin. This reaction was prevented by absorption with the homologous organism but not with Staph. aureus. In addition the titre of the serum against fibroblasts was not affected by the presence of 10 mg/ml tryptic digest of casein in the diluent. Antisera to two other strains of streptococci (type 6 matt and type 24) gave this staining reaction in addition to the sarcolemmal/subsarcolemmal staining reaction.