State of malnutrition in Cuban hospitals

OBJECTIVE: We assessed the current state of undernutrition as observed in 1905 patients hospitalized in 12 Cuban health care institutions, as part of a Latin American, multinational survey similar in design and goals. METHODS: We surveyed 1905 randomly selected patients from 12 Cuban hospitals in a two-phase study. Patients' clinical charts were audited in phase 1, the Subjective Global Assessment was used to assess patients' nutritional status in phase 2. The study was locally conducted by a properly trained team. RESULTS: The frequency of undernutrition in Cuban hospitals was 41.2% (95% confidence interval = 38.9 to 43.4), and 11.1% of patients were considered severely undernourished. Statistically significant (P < 0.05) univariate relations were identified between undernutrition and patient's age and sex. Nutritional status was a dependent of the patient's instruction level (P < 0.05). Patients' nutritional status was statistically associated with the presence of cancer and infection. Undernutrition was highly prevalent among cancer patients, no matter the stage of medical or surgical treatment. Undernutrition became extremely frequent after surgical treatment in non-cancer patients. High nutritional risks hospital services/specialties were identified: geriatrics (56.3%), critical care (54.8%), nephrology (54.3%), internal medicine (48.6%), gastroenterology (46.5%), and cardiovascular surgery (44.8%). Malnutrition rates increased progressively with prolonged length of stay. CONCLUSION: A high malnutrition rate was observed among participating hospitals. The design and inception of policies that foster intervention programs focusing on early identification of hospital malnutrition and its timely management is suggested to decrease its deleterious effects on outcomes of health care in the participating hospitals.     

Progressive Hemodialysis: Is It The Future?

Progressive hemodialysis is based on the simple idea of adjusting its dose according to residual renal function (RRF). The progressive, infrequent paradigm is slowly gaining a foothold among nephrologists, despite a lot of skepticism in the scientific world. Given the importance of RRF preservation in conservative therapy, it seems a contradiction to ignore the contribution of RRF when patients initiate hemodialysis (HD), especially when it is routinely considered with peritoneal dialysis. While a three‐times‐weekly HD regimen is broadly considered the standard starting regimen for new patients, twice‐weekly HD has been used in selected patients and is currently a common practice in South‐East Asia. Small studies indicate that a once‐weekly HD regimen may be a viable starting option as well. Progressive hemodialysis still requires validation, yet it is promising. We share the belief that a randomized clinical trial to investigate progressive hemodialysis is much needed, but we also strongly recommend including a once‐weekly HD starting dose as part of any such investigation.     

A pilot investigation of accelerated deep transcranial magnetic stimulation protocols in treatment-resistant depression

European Archives of Psychiatry and Clinical Neuroscience - Accelerated repetitive transcranial magnetic stimulation (rTMS) protocols are being increasingly studied because of their potential to...     

Morphological alterations of T24 cells on flat and nanotubular TiO2 surfaces

Aim

To investigate morphological alterations of malignant cancer cells (T24) of urothelial origin seeded on flat titanium (Ti) and nanotubular titanium dioxide (TiO₂) nanostructures.

Methods

Using anodization method, TiO₂ surfaces composed of vertically aligned nanotubes of 50-100 nm diameters were produced. The flat Ti surface was used as a reference. The alteration in the morphology of cancer cells was evaluated using scanning electron microscopy (SEM). A computational model, based on the theory of membrane elasticity, was constructed to shed light on the biophysical mechanisms responsible for the observed changes in the contact area of adhesion.

Results

Large diameter TiO₂ nanotubes exhibited a significantly smaller contact area of adhesion (P < 0.0001) and had more membrane protrusions (eg, microvilli and intercellular membrane nanotubes) than on flat Ti surface. Numerical membrane dynamics simulations revealed that the low adhesion energy per unit area would hinder the cell spreading on the large diameter TiO₂ nanotubular surface, thus explaining the small contact area.

Conclusion

The reduction in the cell contact area in the case of large diameter TiO₂ nanotube surface, which does not enable formation of the large enough number of the focal adhesion points, prevents spreading of urothelial cells.The material and topographical characteristics of the contact surface affect the functional activity of cells (1-7). Titanium is the most widely used material in numerous medical applications, because it is non-toxic. The titanium surface has recently been modified by a self-assembled layer of vertically oriented titanium oxide (TiO₂) nanotubes with diameters between 15 nm and 100 nm (8-10). It was revealed that cell adhesion, spreading, growth, and differentiation was maximally induced on 15 nm nanotubes, but hindered on 100 nm nanotubes, which facilitated cell death (8,9). These results suggest that magnitude of TiO₂ nanotube diameter has an important role in cell adhesion and cell growth, and that the mechanics of the formation of focal adhesions is similar between different types of cells. The aim of the present study is to analyze effects of flat titanium and nanotubular TiO₂ surfaces on the morphology of malignant cancer cells (T24) of urothelial origin.Using anodization method, vertically aligned TiO₂ nanotubular surfaces were produced (Figure 1). The produced nanotubes had a large diameter (50-100 nm). The T24 cells grown on the nanotubular surface had a smaller top view diameter and more membrane protrusions than the counterpart on the flat titanium surface. A computational model was constructed to shed light on the biophysical mechanism underlying the observed morphologic changes. The underlying hypothesis is that the low density of TiO₂ nanotube edges could not facilitate the cell adhesion, ie, the formation of large enough number of focal adhesion points. Mathematically, the density of negative charges is predicted to be greatest at sharp edges (7), which would then facilitate the mediated electrostatic interactions between the TiO₂ nanotube surface and membrane proteins at the focal contact. Using numerical simulations of membrane dynamics, it is revealed that low adhesion of the membrane to the large diameter nanotubular surface is not sufficient to counterbalance the loss of entropic energy during the clustering of proteins at a focal contact, and consequently, the increased membrane bending energy does not favor intensive spread of cancer cells on the large diameter TiO₂ nanotube surface underneath.Open in a separate windowFigure 1Scanning electron microscopy images of surface layers of self-assembled vertically aligned TiO₂ nanotubes synthesized by anodization method. Ethylene glycol solution with 0.3 wt % NH₄F and 1% volume water was used in preparation. High-resolution scanning electron microscopy FEG-SEM 7600F from JEOL was used. Images were taken at 100000× magnitude using low accelerating voltage of 2kV. The internal TiO₂ tube diameter was around 50-60 nm (A-D) and 100 nm (E-F) while the length could be up to 10 micrometers (B).