Malnutrition and pressure ulcer risk in adults in Australian health care facilities

Aims To determine the effect of nutritional status on the presence and severity of pressure ulcers in statewide? public healthcare facilities, in Queensland, Australia. Research Methods A multicentre, cross sectional audit of nutritional status of a convenience sample of subjects was carried out as part of a large audit of pressure ulcers in a sample of state based public healthcare facilities in 2002 and 2003. Dietitians in 20 hospitals and six residential aged care facilities conducted single day nutritional status audits of 2208 acute and 839 aged care subjects using the Subjective Global Assessment. The effect of nutritional status on the presence, highest stage and number of pressure ulcers was determined by logistic regression in a model controlling for age, gender, medical specialty and facility location. The potential clustering effect of facility was accounted for in the model using an analysis of correlated data approach. Results Subjects with malnutrition had an adjusted odds risk of 2.6 (95% CI 1.8-3.5, p<0.001) of having a pressure ulcer in acute facilities and 2.0 (95% CI 1.5-2.7, p<0.001) for residential aged care facilities. There was also increased odds risk of having a pressure ulcer, having a higher stage pressure ulcer and a higher number of pressure ulcers with increased severity of malnutrition. Conclusion Malnutrition was associated with at least twice the odds risk of having a pressure ulcer of in public healthcare facilities in Queensland. Action must be taken to identify, prevent and treat malnutrition, especially in patients at risk of pressure ulcer.

Discovery and characterization of IGFBP-mediated endocytosis in the human retinal pigment epithelial cell line ARPE-19

Insulin-like growth factor binding proteins (IGFBPs) are prime regulators of IGF-action in numerous cell types including the retinal pigment epithelium (RPE). The RPE performs several functions essential for vision, including growth factor secretion and waste removal via a phagocytic process mediated in part by vitronectin (Vn). In the course of studying the effects of IGFBPs on IGF-mediated VEGF secretion and Vn-mediated phagocytosis in the RPE cell line ARPE-19, we have discovered that these cells avidly ingest synthetic microspheres (2.0 μm diameter) coated with IGFBPs. Given the novelty of this finding and the established role for endocytosis in mediating IGFBP actions in other cell types, we have explored the potential role of candidate cell surface receptors. Moreover, we have examined the role of key IGFBP structural motifs, by comparing responses to three members of the IGFBP family (IGFBP-3, IGFBP-4 and IGFBP-5) which display overlapping variations in primary structure and glycosylation status. Coating of microspheres (FluoSpheres®, sulfate modified polystyrene filled with a fluorophore) was conducted at 37 °C for 1 h using 20 μg/mL of test protein, followed by extensive washing. Binding of proteins was confirmed using a microBCA assay. The negative control consisted of microspheres treated with 0.1% bovine serum albumin (BSA), and all test samples were post-treated with BSA in an effort to coat any remaining free protein binding sites, which might otherwise encourage non-specific interactions with the cell surface. Serum-starved cultures of ARPE-19 cells were incubated with microspheres for 24 h, using a ratio of approximately 100 microspheres per cell. Uptake of microspheres was quantified using a fluorometer and was confirmed visually by confocal fluorescence microscopy. The ARPE-19 cells displayed little affinity for BSA-treated microspheres, but avidly ingested large quantities of those pre-treated with Vn (ANOVA; p < 0.001). Strong responses were also observed towards recombinant formulations of non-glycosylated IGFBP-3, glycosylated IGFBP-3 and glycosylated IGFBP-5 (all p < 0.001), while glycosylated IGFBP-4 induced a relatively minor response (p < 0.05). The response to IGFBP-3 was unaffected in the presence of excess soluble IGFBP-3, IGF-I or Vn. Likewise, soluble IGFBP-3 did not induce uptake of BSA-treated microspheres. Antibodies to either the transferrin receptor or type 1 IGF-receptor displayed slight inhibitory effects on responses to IGFBPs and Vn. Heparin abolished responses to Vn, IGFBP-5 and non-glycosylated IGFBP-3, but only partially inhibited the response to glycosylated IGFBP-3. Our results demonstrate for the first time IGFBP-mediated endocytosis in ARPE-19 cells and suggest roles for the IGFBP-heparin-binding domain and glycosylation status. These findings have important implications for understanding the mechanisms of IGFBP actions on the RPE, and in particular suggest a role for IGFBP-endocytosis.

The costs arising from pressure ulcers attributable to malnutrition

Aim To estimate the economic consequences of pressure ulcers attributable to malnutrition. Method Statistical models were developed to predict the number of cases of pressure ulcer, associated bed days lost and the dollar value of these losses in public hospitals in 2002/2003 in Queensland, Australia. The following input parameters were specified and appropriate probability distributions fitted • Number of at risk discharges per annum • Incidence rate for pressure ulcer • Attributable fraction of malnutrition in the development of pressure ulcer • Independent effect of pressure ulcer on length of hospital stay • Opportunity cost of hospital bed day One thousand random re-samples were made and the results expressed as (output) probabilistic distributions. Results The model predicts a mean 16060 (SD 5 671) bed days lost and corresponding mean economic cost of AU$12 968 668 (SD AU$4 924 148) (EUROS 6 925 268 SD 2 629 495; US$ 7 288 391 SD 2 767 371) of pressure ulcer attributable to malnutrition in 2002/2003 in public hospitals in Queensland, Australia. Conclusion The cost of pressure ulcer attributable to malnutrition in bed days and dollar terms are substantial. The model only considers costs of increased length of stay associated with pressure ulcer and not other factors associated with care.

Intraocular pressure in keratoconus

Aims: To investigate IOP measurements with the dynamic contour tonometer (DCT) and non contact tonometer (NCT) in subjects with keratoconus. Methods: Twenty keratoconic subjects and 20 age-matched control subjects had IOP measurements taken using DCT and NCT instruments. Central and offcentre measures were taken with the DCT in order to highlight any systematic errors associated with corneal biomechanical factors. Measures of anterior and posterior corneal topography and thickness were also taken for each subject. Results: No significant difference was found between the central and off-centre DCT IOP readings for the keratoconics and age-matched controls (p>0.05). The average DCT IOP for the keratoconics was 14.2 ± 1.4 mmHg and for the agematched controls was 14.2 ± 1.6 mmHg. However, the average NCT readings differed significantly (p<0.001) between the keratoconics (9.2 ± 1.5 mmHg) and age-matched controls (12.9 ± 2.4 mmHg). DCT IOP showed no significant (p>0.05) correlation with the severity of keratoconus, as determined through measures of corneal topography and thickness. NCT IOP was correlated significantly with certain measures of corneal curvature and thickness in the keratoconic population. The difference between DCT and NCT IOP was strongly correlated with measures of corneal topography and thickness, with differences increasing for more advanced keratoconus. Conclusions: The measurements from the DCT do not appear to be dependent upon corneal factors, unlike the NCT. The presence or severity of keratoconus was not correlated with DCT IOP values.

Vitronectin modulates human mesenchymal stem cell response to insulin-like growth factor-I and transforming growth factor beta 1 in a serum-free environment

The use of animal sera for the culture of therapeutically important cells impedes the clinical use of the cells. We sought to characterize the functional response of human mesenchymal stem cells (hMSCs) to specific proteins known to exist in bone tissue with a view to eliminating the requirement of animal sera. Insulin-like growth factor-I (IGF-I), via IGF binding protein-3 or -5 (IGFBP-3 or -5) and transforming growth factor-beta 1 (TGF-beta(1)) are known to associate with the extracellular matrix (ECM) protein vitronectin (VN) and elicit functional responses in a range of cell types in vitro. We found that specific combinations of VN, IGFBP-3 or -5, and IGF-I or TGF-beta(1) could stimulate initial functional responses in hMSCs and that IGF-I or TGF-beta(1) induced hMSC aggregation, but VN concentration modulated this effect. We speculated that the aggregation effect may be due to endogenous protease activity, although we found that neither IGF-I nor TGF-beta(1) affected the functional expression of matrix metalloprotease-2 or -9, two common proteases expressed by hMSCs. In summary, combinations of the ECM and growth factors described herein may form the basis of defined cell culture media supplements, although the effect of endogenous protease expression on the function of such proteins requires investigation.

Microassembly fabrication of tissue engineering scaffolds with customized design

Browse > Journals> Automation Science and Enginee ...> Volume: 5 Issue: 3 Microassembly Fabrication of Tissue Engineering Scaffolds With Customized Design 4468741 abstract Han Zhang; Burdet, E.; Poo, A.N.; Hutmacher, D.W.; GE Global Res. Center Ltd., Shanghai This paper appears in: Automation Science and Engineering, IEEE Transactions on Issue Date: July 2008 Volume: 5 Issue:3 On page(s): 446 - 456 ISSN: 1545-5955 Digital Object Identifier: 10.1109/TASE.2008.917011 Date of Current Version: 02 July 2008 Sponsored by: IEEE Robotics and Automation Society Abstract This paper presents a novel technique to fabricate scaffold/cell constructs for tissue engineering by robotic assembly of microscopic building blocks (of volume 0.5$,times,$0.5$,times,$0.2 ${hbox{mm}}^{3}$ and 60 $mu {hbox{m}}$ thickness). In this way, it becomes possible to build scaffolds with freedom in the design of architecture, surface morphology, and chemistry. Biocompatible microparts with complex 3-D shapes were first designed and mass produced using MEMS techniques. Semi-automatic assembly was then realized using a robotic workstation with four degrees of freedom integrating a dedicated microgripper and two optical microscopes. Coarse movement of the gripper is determined by pattern matching in the microscopes images, while the operator controls fine positioning and accurate insertion of the microparts. Successful microassembly was demonstrated using SU-8 and acrylic resin microparts. Taking advantage of parts distortion and adhesion forces, which dominate at micro-level, the parts cleave together after assembly. In contrast to many current scaffold fabrication techniques, no heat, pressure, electrical effect, or toxic chemical reaction is involved, a critical condition for creating scaffolds with biological agents.

Doped poly(vinylidene fluoride) as solid polymer electrolyte in nanocrystalline dye-sensitized solar cell

A new solid composite polymer electrolyte was reported by incorporating Azino-bis-(3-ethyl benzo thiazoline-6-sulphonate) ion [ABTS] as dopant in poly(vinylidene flouride) along with redox couple (1-/13-). Under certain conditions, the electrolyte composition forms brush like nano-rods while it is doped with Azino-bis-(3-ethly) benzo thiazoline-6-sulphonate) ion [ABTS], a pi-electron donor. The polymer electrolyte forms nanoscale interpenetrating network with the crystalline order of the polymer electrolyte that seems to be a desirable architecture for the active layer of the photoelectrochemical cell. With this new polymer electrolyte, dye-sensitized solar cell was fabricated using N3 dye absorbed over Ti02- nonoparticles (photoanode) and conducting carbon cement coated on the conducting press (FTO, photocathode). This polymer composite has been successfully used as a promising candidate as solid polymer electrolyte in nanocrystalline dye-sensitized solar cell.

Solid-state nanocrystalline dye-sensitized solar cell using 2-mercapto benzimidazole doped poly(ethylene oxide) as a new polymer electrolyte

New composite doped poly (ethylene oxide) polymer electrolyte was developed using 2-mercapto benzimidazole as plasticizer and iodide/triiodide as redox couple. The fabrication of the cell involves Poly(ethylene oxide)/ 2-mercapto benzimidazole / iodide/triiodide as polymer electrolyte in dye-sensitized solar cell fabricated with N3 dye and TiO2 nanoparticles as the photoanode and Platinum coated FTO (fluorine doped SnO2) as counter electrode. The current-volatage characteristics under simulated sunlight AM1.5 shows a short circuit current Isc of 8.7mA and open circuit photovoltage 508 mV. The conductivity measurements for the new polymer electrolyte and the photoelectrochemical measurments were carried out systematically. In 2-mercapto benzimidazole the electron rich sulphur and nitrogen atoms, act as pi-electron donors that form good interaction with iodine which plays a vital role in the performance of the fabricated dye-sensitized solar cells. The resonance effect increases the stability of the cell to a considerable extent. These results suggest that the new composite polymer electrolyte performs as a promising new doped polymer-electrolyte.

On the affinity of Chuaria–Tawuia complex : a multidisciplinary study

In this study, biometric and structural engineering tool have been used to examine a possible relationship within Chuaria–Tawuia complex and micro-FTIR (Fourier Transform Infrared Spectroscopy) analyses to understand the biological affinity of Chuaria circularis Walcott, collected from the Mesoproterozoic Suket Shales of the Vindhyan Supergroup and the Neoproterozoic Halkal Shales of the Bhima Group of peninsular India. Biometric analyses of well preserved carbonized specimens show wide variation in morphology and uni-modal distribution. We believe and demonstrate to a reasonable extent that C. circularis most likely was a part of Tawuia-like cylindrical body of algal origin. Specimens with notch/cleft and overlapping preservation, mostly recorded in the size range of 3–5 mm, are of special interest. Five different models proposed earlier on the life cycle of C. circularis are discussed. A new model, termed as ‘Hybrid model’ based on present multidisciplinary study assessing cylindrical and spherical shapes suggesting variable cell wall strength and algal affinity is proposed. This model discusses and demonstrates varied geometrical morphologies assumed by Chuaria and Tawuia, and also shows the inter-relationship of Chuaria–Tawuia complex. Structural engineering tool (thin walled pressure vessel theory) was applied to investigate the implications of possible geometrical shapes (sphere and cylinder), membrane (cell wall) stresses and ambient pressure environment on morphologically similar C. circularis and Tawuia. The results suggest that membrane stresses developed on the structures similar to Chuaria–Tawuia complex were directly proportional to radius and inversely proportional to the thickness in both cases. In case of hollow cylindrical structure, the membrane stresses in circumferential direction (hoop stress) are twice of the longitudinal direction indicating that rupture or fragmentation in the body of Tawuia would have occurred due to hoop stress. It appears that notches and discontinuities seen in some of the specimens of Chuaria may be related to rupture suggesting their possible location in 3D Chuaria. The micro-FTIR spectra of C. circularis are characterized by both aliphatic and aromatic absorption bands. The aliphaticity is indicated by prominent alkyl group bands between 2800–3000 and 1300–1500 cm−1. The prominent absorption signals at 700–900 cm−1 (peaking at 875 and 860 cm−1) are due to aromatic CH out of plane deformation. A narrow, strong band is centred at 1540 cm−1 which could be COOH band. The presence of strong aliphatic bands in FTIR spectra suggests that the biogeopolymer of C. circularis is of aliphatic nature. The wall chemistry indicates the presence of ‘algaenan’—a biopolymer of algae.

Discrepancies between metabolic activity and DNA content as tool to assess cell proliferation in cancer research

Cell proliferation is a critical and frequently studied feature of molecular biology in cancer research. Therefore, various assays are available using different strategies to measure cell proliferation. Metabolic assays such as AlamarBlue, WST-1, and MTT, which were originally developed to determine cell toxicity, are being used to assess cell numbers. Additionally, proliferative activity can be determined by quantification of DNA content using fluorophores, such as CyQuant and PicoGreen. Referring to data published in high ranking cancer journals, 945 publications applied these assays over the past 14 years to examine the proliferative behaviour of diverse cell types. Within this study, mainly metabolic assays were used to quantify changes in cell growth yet these assays may not accurately reflect cellular proliferation rates due to a miscorrelation of metabolic activity and cell number. Testing this hypothesis, we compared metabolic activity of different cell types, human cancer cells and primary cells, over a time period of 4 days using AlamarBlue and fluorometric assays CyQuant and PicoGreen to determine their DNA content. Our results show certain discrepancies in terms of over-estimation of cell proliferation with respect to the metabolic assay in comparison to DNA binding fluorophores.

Changes in intraocular pressure and ocular pulse amplitude with accommodation

Aims: To investigate the change that occurs in intraocular pressure (IOP) and ocular pulse amplitude (OPA) with accommodation in young adult myopes and emmetropes. Methods: Fifteen progressing myopic and 17 emmetropic young adult subjects had their IOP and OPA measured using the Pascal dynamic contour tonometer. Measurements were taken initially with accommodation relaxed, and then following 2 min of near fixation (accommodative demand 3 D). Baseline measurements of axial length and corneal thickness were also collected prior to the IOP measures. Results: IOP significantly decreased with accommodation in both the myopic and emmetropic subjects (mean change 1.861.1 mm Hg, p<0.0001). There was no significant difference (p>0.05) between myopes and emmetropes in terms of baseline IOP or the magnitude of change in IOP with accommodation. OPA also decreased significantly with accommodation (mean change for all subjects 0.560.5, p<0.0001). The myopic subjects (baseline OPA 2.060.7 mm Hg) exhibited a significantly lower baseline OPA (p¼0.004) than the emmetropes (baseline OPA 3.261.3 mm Hg),and a significantly lower magnitude of change in OPA with accommodation. Conclusion: IOP decreases significantly with accommodation, and changes similarly in progressing myopic and emmetropic subjects. However, differences found between progressing myopes and emmetropes in the mean OPA levels and the decrease in OPA associated with accommodation suggested some changes in IOP dynamics associated with myopia.

Development of a method to measure upper eyelid pressure on the cornea

Purpose: The cornea is known to be susceptible to forces exerted by eyelids. There have been previous attempts to quantify eyelid pressure but the reliability of the results is unclear. The purpose of this study was to develop a technique using piezoresistive pressure sensors to measure upper eyelid pressure on the cornea. Methods: The technique was based on the use of thin (0.18 mm) tactile piezoresistive pressure sensors, which generate a signal related to the applied pressure. A range of factors that influence the response of this pressure sensor were investigated along with the optimal method of placing the sensor in the eye. Results: Curvature of the pressure sensor was found to impart force, so the sensor needed to remain flat during measurements. A large rigid contact lens was designed to have a flat region to which the sensor was attached. To stabilise the contact lens during measurement, an apparatus was designed to hold and position the sensor and contact lens combination on the eye. A calibration system was designed to apply even pressure to the sensor when attached to the contact lens, so the raw digital output could be converted to actual pressure units. Conclusions: Several novel procedures were developed to use tactile sensors to measure eyelid pressure. The quantification of eyelid pressure has a number of applications including eyelid reconstructive surgery and the design of soft and rigid contact lenses.