Nutrition
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The p-aminobenzoic acid (PABA) test has been successfully used as an indicator of completeness of 24-h urine collection in field studies of the general population. Our study was designed to investigate its validity for elderly people. Urinary excretion of fractionated oral doses of PABA was measured in 21 young control subjects (19-39 yr old) and 356 elderly (60-89 yr old) men and women. ⋯ These subjects also had consistently lower creatinine output and urinary volume. The lower 24-h urinary PABA recovery over 70 yr of age is interpreted to reflect the delayed renal clearance of the marker substance and indicates that the PABA test is unsuitable for this age group. The low 48-h cumulative recoveries found in all age classes of the elderly are thought to be caused by small unreported losses, which are recurrent in free-living populations.
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Biography Historical Article Classical Article
Treatment of "pernicious anaemia of pregnancy" and "tropical anaemia" with special reference to yeast extract as a curative agent. 1931.
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Randomized Controlled Trial Clinical Trial
Improvement in immune function in ICU patients by enteral nutrition supplemented with arginine, RNA, and menhaden oil is independent of nitrogen balance.
Hypermetabolism and multiple organ failure syndrome (MOFS) after trauma, surgery, or sepsis is associated with accelerated catabolism, the rapid onset of malnutrition, and immune system failure. Current nutritional support, enteral or parenteral, can achieve an acceptable nutritional response but appears unable to improve immune function. Nutrients such as arginine, refined menhaden oil, and RNA have been found to have immune-stimulating properties. ⋯ However, the supplemented formula was associated with marked stimulation of in vitro lymphocyte proliferative responses and a significant reduction in 3-methylhistidine excretion. Six and 12-mo follow-up data demonstrated no long-term effects. Nutrients targeted to effect the disease-induced in vitro suppression of immune function in MOFS appear to achieve that end independent of the nutritional outcome of nitrogen balance and without adverse clinical outcome.
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Prompted by the continued frequency of mechanical complications associated with central venous catheter placement, a more effective and stable and safer catheter placement device has been proposed. Fifteen critically ill surgical patients who required central venous access for total parenteral nutrition (TPN) and fluid management had a central venous catheter placed using the new syringe technique. Despite an equipment-use learning curve, there was no equipment failure. ⋯ In one dehydrated patient, repeated attempts at percutaneous infraclavicular subclavian access were not successful, but internal jugular vein access was gained. There were no mechanical or infectious complications in the 15 patients. The new syringe provides a stable platform, reducing the fumbling usual when disconnecting the needle from the syringe and thereby avoiding the potential complications of dislodgment or hub contamination of the introducer needle and air embolism.
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The polyamines (PA) spermidine (SD) and spermine and their precursor putrescine (PU) play a leading role in the regulation of protein, RNA and DNA synthesis. We examined the role of PA along with other biomarkers of injury in eight victims of multiple trauma in the early post-traumatic period when they were hypermetabolic and highly catabolic. Intravenous nutritional therapy (TPN) was started 48 to 60h after trauma and continued for 6 days. ⋯ Injury stimulated ribonuclease and catecholamine levels were also enhanced by nutritional therapy, peaking on the first and fourth day of TPN, respectively. This study demonstrated for the first time elevated levels of PA in trauma patients that correlated well with the other known measures of protein metabolic response to injury and changes during nutritional therapy. Extracellular PA levels could be used as markers of both catabolic pathology in trauma and of its response to nutritional therapy.