Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia.

OBJECTIVE--To compare percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. DESIGN--Randomised 28 day study of inpatients requiring long term enteral nutrition. SETTING--Three Glasgow teaching hospitals. SUBJECTS--40 patients with dysphagia for at least four weeks secondary to neurological disorders: 20 patients (10 women) were randomised to nasogastric feeding and 20 (eight women) to endoscopic gastrostomy. MAIN OUTCOME MEASURES--Treatment failure (blocked or displaced tubes on three or more occasions or refusal to continue treatment); duration of feeding; intake of liquid diets; complications; nutritional status at end of trial. RESULTS--One patient in each group died before starting feeding. Treatment failure occurred in 18 of the 19 nasogastric patients and in none of the gastrostomy group. The mean (SE) duration of feeding for the nasogastric group was 5.2 (1.5) days. No complications occurred in the nasogastric group but three (16%) of the gastrostomy group developed minor problems (aspiration pneumonia (two patients) wound infection (one)). Gastrostomy patients received a significantly greater proportion of their prescribed feed (93% (2%)) compared with the nasogastric group, (55% (4%); p less than 0.001) and also gained significantly more weight after seven days of feeding (1.4 (0.5) kg v 0.6 (0.1) kg; p less than 0.05). Analyses at days 14, 21, and 28 were not possible due to the small numbers remaining in the nasogastric group. CONCLUSION--Percutaneous endoscopic gastrostomy tube feeding is a safe and effective method of providing long term enteral nutrition to patients with neurological dysphagia and offers important advantages over nasogastric tube feeding.     

Effects of 11-month interventions on oral cleanliness among the long-term hospitalised elderly

Objectives: This trial studied the effects of interventions on the oral cleanliness of the long‐term hospitalised elderly. Background: Oral cleanliness is mostly poor in long‐term facilities. While many agree on the importance of oral hygiene education for nursing personnel, little information and agreement exists on how to organise this education in geriatric institutions. Materials and methods: This is a longitudinal study with interventions. After a baseline clinical examination, the patient wards were divided into three groups (A, B and C) and the type of intervention was randomly assigned. In group A, dental hygienists provided oral hygiene measures for the subjects once every 3 weeks. In group B, the nursing staff first received hands‐on instructions after which they assumed responsibility for the subjects’ daily oral hygiene. Group C served as a control. Denture hygiene and dental hygiene were recorded at baseline and in the end of the 11‐month study period. In total, 130 subjects completed the interventions; their mean age was 82.9 years. Results: The best outcome in both denture and dental hygiene occurred when nursing staff at the wards took care of hygiene (group B). The increase in the proportion of those with good denture hygiene was the most prominent in group B (from 11% to 56%). The proportion of subjects with poor overall dental hygiene decreased from 61% at baseline to 57% in the end, for group B from 80% to 48%. Conclusions: Organised oral health education of the nursing staff should receive more attention.     

吸烟对老年克罗恩病的影响

目的探讨吸烟对老年人克罗恩病的影响。方法回顾性分析1995年1月～2011年8月在我院住院的老年克罗恩病患者87例的临床资料,分为吸烟组及无烟组,比较两组并发症（肠梗阻、肠穿孔）发生率、手术治疗率及复发率。结果吸烟组并发症的发生率、手术治疗率、复发率均明显高于无烟组。结论吸烟可增加老年克罗恩病患者并发症、手术治疗及复发的风险,建议老年克罗恩病患者戒烟是必要的。     

Tooth loss and associated factors in long-term institutionalised elderly patients

Objective: To compare partial and total tooth loss in dependent institutionalised elderly patients and identify any associated factors. Background: A poor oral health status, together with a reduction of autonomy can seriously affect the general health and increase the risk of death in elderly people. Those with total tooth loss and in need of assistance are the most at risk. Materials and methods: In 2004, a cross‐sectional study of 321 elderly patients was conducted in long‐term hospital services provided in Montpellier, France. Socio‐demographic, behavioural, medical and oral health information was recorded for each patient. Multivariate logistic regression models were performed to test the relationship between those covariates and partial or total tooth loss. Pearson chi‐squared tests were used for bivariate analyses. Results: The proportion of edentulousness was 26.9%; among these12.6% had no dentures. The factors significantly associated with edentulism were: an age ‘older than 87 years’ [odds ratio (OR) = 9.4], the presence of a nephropathy (OR = 6.8), and inadequate oral hygiene (OR = 0.1). The factors most significantly associated with partial tooth loss (at least 21 missing teeth) were ‘cancerous disease’ (OR = 9.9), the presence of a nephropathy (OR = 5.6) and the presence of a neurological disease (OR = 4.1). The factors significantly related to dentate status (20 or more natural teeth retained) were ‘hypertension treatment’ (OR = 2.4), and ‘cortisone treatment’ (OR = 0.2). Conclusion: General health problems as well as a poor oral condition were significant risk indicators for tooth loss among the long‐term institutionalised elderly. This suggests that the number of remaining teeth has a strong effect on oral health‐related quality of life.     

Effects of long-term feeding dairy cows on a diet supplemented with clinoptilolite on certain serum trace elements

The objective of the experiment was to investigate the effect of clinoptilolite (a natural zeolite) supplementation in the ration of dairy cows on serum copper (Cu), zinc (Zn), and iron (Fe) concentrations. Fifty-two clinically healthy Holstein cows were randomly assigned to one of three groups according to their age and parity. The first group (group A) comprised 17 cows fed a ration supplemented with 1.25% clinoptilolite, the second group (group B) comprised also 17 cows was given a ration with 2.5% clinoptilolite, and the third group (group C, the control), comprised 18 cows fed the basal ration that did not contain any clinoptilolite. The experiment started when the cows entered the fourth week before the expected parturition and lasted until the end of lactation. All cows were fed the above concentrates during the entire experimental period. Blood sample were collected from each animal at the starting day of the experiment, at the day of calving, and at monthly intervals thereafter. All samples were tested for serum Cu, Zn, and Fe concentrations. The results showed that the 1.25 and 2.5% supplementation of clinoptilolite did not have any adverse effects on serum concentrations of Cu, Zn, and Fe.     

长期住院老年患者感染的鲍曼不动杆菌耐药性分析

为了解复旦大学附属华东医院长期住院老年患者感染的鲍曼不动杆菌的耐药性特征,本研究收集了2011年9月~2012年8月临床分离自老年病区长期住院患者的52株鲍曼不动杆菌,分析菌株的耐药性、产酶类型、生物膜形成能力及耐药基因的携带情况。结果显示,菌株主要分布在呼吸重症监护室,分离的标本以痰标本为主,占86.54%。52株鲍曼不动杆菌中,多重耐药菌株最高,占76.92%。对头孢哌酮/舒巴坦耐药率最低,为30.77%,对其余抗菌药物耐药率均在50%以上。产酶阳性率为82.69%,其中产其他水解酶的菌株最多,占63.46%。生物膜形成的检出率为5.77%。6株广泛耐药菌株共检出9种耐药基因。结果提示,从老年病区长期住院患者分离的鲍曼不动杆菌耐药现状严重。因此,医院感染控制应以呼吸重症监护室为重点,同时加强对生物膜阳性菌株所分布病区的耐药性监测和消毒隔离,以预防和控制耐药菌的产生和传播。     

Effects of long-term feeding of high-protein or high-fat diets on the response to exercise in the rat

The aim of this work was to find by which mechanisms an increased availability of plasma free fatty acids (FFA) reduced carbohydrate utilization during exercise. Rats were fed high-protein medium-chain triglycerides (MCT), high-protein long-chain triglycerides (LCT), carbohydrate (CHO) or high-protein low-fat (HP) diets for 5 weeks, and liver and muscle glycogen, gluconeogenesis and FFA oxidation were studied in rested and trained runner rats. In the rested state the hepatic glycogen store was decreased by fat and protein feeding, whereas soleus muscle glycogen concentration was only affected by high-protein diets. The percentage decrease in liver and muscle glycogen stores, after running, was similar in fat-fed, high-protein and CHO-fed rats. The fact that plasma glucose did not drastically change during exercise could be explained by a stimulation of hepatic gluconeogenesis: the activity of phosphoenolpyruvate carboxykinase (PEPCK) and liver phosphoenolpyruvate (PEP) concentration increased as well as cyclic adenosine monophosphate (AMPc) while liver fructose 2,6-bisphosphate decreased and plasma FFA rose. In contrast, the stimulation of gluconeogenesis in rested HP-, MCT- and LCT-fed rats appears to be independent of cyclic AMP.     

Effects of systemic sitafloxacin on periodontal infection control in elderly patients

doi: 10.1111/j.1741‐2358.2011.00605.x
Effects of systemic sitafloxacin on periodontal infection control in elderly patients Objective: To evaluate the microbiological and clinical effects of the systemic administration of sitafloxacin (STFX) on periodontal pockets in elderly patients receiving supportive periodontal therapy (SPT). Background: Periodontitis is a risk factor for atherosclerosis. Better periodontal health contributes to reduce atherosclerosis‐related diseases in elderly population. Materials and methods: Forty‐four patients undergoing SPT were randomly assigned to two groups: a test group took 100 mg/day of STFX for five consecutive days, or a control group received scaling and root planing (SRP) under local anaesthesia. Microbiological and clinical parameters were examined at baseline and at 1 and 3 months after therapy. Results: The presence of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia was significantly reduced at 1 month after treatment in both groups. The median reductions of the bacteria between the baseline and 1 month were 3.08 and 2.54% in the STFX‐ and SRP‐treated groups, respectively. Both treatments significantly decreased the probing depth at 1 and 3 months compared to the baseline. Conclusion: The systemic administration of STFX is effective at improving periodontal health during SPT and could be an alternative to SRP for elderly patients who cannot undergo anaesthesia or are at risk of tissue injury.     

Effects of food texture change on metabolic parameters: short- and long-term feeding patterns and body weight

A complete diet was prepared with cooked pieces of meat, beans, cream starch, and water and presented to the rats in two different textures: a blended purée and a rough mixture that required a lot of chewing. We hypothesized that this texture modification might change both anticipatory reflexes and feeding behavior. Feeding rate, meal size, intermeal intervals, and their correlation were monitored in response to each texture. The long-term (6 wk) effect on body weight was assessed. Periprandial plasma glucose, insulin, glucagon, and lipid concentrations were assayed. Whole and background metabolism, respiratory quotient, and locomotion were measured using a computerized calorimeter of original design. In the short term, rats preferred the mixture. However, after 3 wk, they ingested more purée than mixture and gained more body weight per gram of food ingested as purée. Insulin response declined earlier with the mixture. During meals, glycerol and free fatty acid increased earlier with purée, whereas in the postprandial period, glycerol increased earlier with mixture. The metabolic rate, however, was not significantly affected. We concluded that texture, an everyday manipulation performed on food for human consumption, affects not only palatability of ingestants but also their metabolic management in the short and long term.     

Importance of feeding strategies on the long-term success of fish invasions

This study assessed the feeding strategies of nine fish species in their native (Cuiabá River) and in an invaded basin (upper Paraná River) to identify trophic variables that may explain the success of these species in the new basin, over 30 years. The following predictions were analyzed: (i) species that display omnivorous or piscivorous diets in the native basin are favored in the invasion process over the long term, and (ii) specialist feeders are favored in the invasion process provided that their food items are highly available in the invaded area. These predictions were supported by the data; the species that were successful invaders had high trophic plasticity (omnivores), consumed a wide variety of food items from specific trophic guilds (piscivores), or if a species had a specialized diet, the resources demanded are abundant (detritivores). Thus, in a long-term perspective, the food resources used by these species are rarely limiting in aquatic ecosystems, and these feeding characteristics should be one of the key factors determining the colonization success of fishes. Understanding the factors that determine the success of invasive species in new areas is critical for developing management policies aimed at minimizing the impacts of biological invasions.     

Effects of functional training of dysphagia to prevent pneumonia for patients on tube feeding

Objective: The purpose of this study was to evaluate the effects of functional training on outbreak frequency of pneumonia for the elderly dysphagia patients who were being tube fed. Methods: Subjects were divided into two groups; one group (n = 10) received oral care (i.e. non‐training group) and the other group (n = 11) received functional training of dysphagia in addition to oral care (i.e. training group). The dental health team treated subjects once a week for 3 years (1999–2001). The frequency of pneumonia outbreaks and changes in activities of daily living scale (ADL) were evaluated for each year. Result: It was recognised that the frequency of pneumonia in the training group decreased year by year (p < 0.05). Cognitive items in ADL improved in two subjects of the training group. No statistical differences were recognised in the non‐training group. Conclusion: It was suggested that once‐a‐week functional training of dysphagia with professional oral care might be effective in preventing pneumonia for elderly people who were being tube fed.     

Effects of feeding on medicinal leech swimming performance

The locomotor system of sanguivorous leeches is presented with a unique challenge: how to maintain mobility while coping with a >500% increase in body mass during feeding. A meal of this size is likely to disrupt the function of the muscular hydrostat during swimming, reducing speed and increasing predation risks. We quantified the effects of feeding to satiety on swimming kinematics, and the time course of recovery of swimming performance post-feeding in the medicinal leech Hirudo verbana . There was a 5.07 ± 0.04-fold increase in mass during feeding (mean ± sem , n =7). Despite this, leeches were able to swim immediately after feeding, reaching 27% of their pre-feeding speed. Reduced speed was a consequence of a reduction in both swimming cycle frequency and stride length to 69 and 42% of the pre-feeding values, respectively. Recovery of swimming ability was rapid, despite a prolonged increase in body mass. Fifty per cent restoration of swimming speed was achieved in c . 1 h while body mass was still 4.2-fold greater than before feeding. Rapid mass and volume reduction immediately post-feeding, and the properties of the obliquely striated swimming muscles appear to aid recovery of swimming performance. Such features that aid post-feeding recovery of mobility may have been important in the evolution of leech sanguivory.     

Downregulation of islet hormone-sensitive lipase during long-term high-fat feeding

Lipid accumulation in pancreatic beta-cells during high-fat (HF) feeding may be involved in inducing a defective insulin secretion due to lipotoxicity. Hormone-sensitive lipase (HSL) is expressed and active in beta-cells, but its importance for islet dysfunction during the development of type 2 diabetes is not known. In this study, prolonged HF feeding of C57BL/6J mice, resulted in decreased HSL expression in islets, representing only 25+/-4% of the levels observed in controls. This was paralleled by triglyceride accumulation and blunted insulin secretion both in vivo and in vitro. After switching the HF diet to a LF diet, HSL expression increased 10-fold compared to the HF fed mice. This was accompanied by reduced triglyceride levels and a restored insulin secretion. These results support the notion that HSL plays a critical role in the regulation of intracellular triglyceride levels in beta-cells, and that downregulation of the enzyme may serve to protect against fatty acid-induced islet dysfunction.     

Effects of ethanol feeding on hepatic lipid synthesis

Rats were fed a high-fat, liquid diet containing either 36% of total calories as ethanol or an isocaloric amount of sucrose, for a period up to 35 days. At different time intervals we measured the effects of ethanol administration on the activities of a number of key enzymes involved in hepatic lipid synthesis. At the start of the experimental period the activities of acetyl-CoA carboxylase and fatty acid synthase, measured in liver homogenates, increased in the control as well as in the ethanol-fed group. After 35 days these enzyme activities were still elevated but there were no significant differences between the two groups. In hepatocytes isolated from controls as well as from ethanol-fed rats, short-term incubations with ethanol induced an increase in the rate of fatty acid synthesis and in the activities of acetyl-CoA carboxylase and fatty acid synthase. However, no alterations in the regulation of these enzymes by short-term modulators of lipogenesis were apparent in hepatocytes isolated from alcohol-treated animals. The results do not indicate a major role for the enzymes of de novo fatty acid synthesis in the development of the alcoholic fatty liver. The amount of liver triacylglycerols increased in ethanol-fed rats during the entire treatment period, whereas the hepatic levels of phosphatidylcholine and phosphatidylethanolamine were not affected by ethanol ingestion. Ethanol administration for less than 2 weeks increased the activities of phosphatidate phosphohydrolase, diacylglycerol acyltransferase, and microsomal phosphocholine cytidylyltransferase, whereas the cytosolic activity of phosphocholine cytidylyltransferase was slightly decreased. Upon prolonged ethanol administration the activities of these enzymes were slowly restored to control values after 35 days, suggesting development of some kind of adaptation. It is interesting that, although the activities of phosphatidate phosphohydrolase and diacylglycerol acyltransferase were restored to the levels found in the control rats, this effect was not accompanied by a stabilization or decrease of the concentration of hepatic triacylglycerols.     

Effects of feeding on aminophylline induced supra-maximal thermogenesis

Single injection of aminophylline (a phosphodiesterase inhibitor which prolongs cyclic AMP actions) elicited “supra-maximal thermogenesis” in cold exposed rats. The increases were 19.4, 16 and 15%, respectively, above their saline-injected self-control maxima in the overnight fasted, rationed, and ad libitum fed states. However, in the fasted state the increased thermogenesis could not be sustained. Feeding of a 5 ml substrate mixture containing carbohydrate, protein and fat (12.56 kJ/ml) prior to aminophylline injection elicited increases of 29.6, 16 and 13.7%, respectively, for the three feeding regimens and a sustained “supra-maximal thermogenesis” in the fasted state. Since substrate feeding modulated aminophylline stimulated thermogenesis only in the fasted state when endogenous substrate reserves are diminished, it is indicative that both the magnitude and duration of aminophylline induced thermogenesis are substrate dependent.     

Effects of substituted phenylethylamines on blowfly feeding behavior

The pharmacology of adult Phormia regina (Meigen) feeding behavior was explored by injecting candidate drugs into starved blowflies and then determining their responsiveness to aqueous sucrose, via the proboscis extension reflex. d-Amphetamine caused responsiveness to fall dramatically, while related drugs and biogenic amines had varying effects. When d-amphetamine-treated flies were fed 1 M sucrose, they consumed significantly more than control flies. Electrophysiological studies demonstrated that the responses of tarsal sugar receptor neurons to aqueous sucrose were not significantly altered by d-amphetamine. These observations are compatible with our hypothesis that octopamine positively modulates blowfly feeding behavior and suggest that other aromatic biogenic amines affect feeding behavior in this insect.