Impact of premorbid undernutrition on outcome in stroke patients

Background and Purpose - To assess the prevalence of premorbid undernutrition and its impact on outcomes 1 month after stroke. Methods - The study recruited from consecutive stroke admissions during a 10-month period. Premorbid nutritional status ( using the subjective global assessment [SGA]), premorbid functioning ( modified Rankin scale [MRS]), and stroke severity ( National Institutes of Health Stroke Scale [NIHSS] score) were assessed at admission. The associations between premorbid nutritional status, poor outcome ( defined as MRS greater than or equal to 3), and mortality were examined before and after adjustment for confounding variables, including age, gender, stroke risk factors, stroke severity, and admission serum albumin. Results - Thirty of 185 patients were assessed as having undernutrition at admission. Significant unadjusted associations were observed between undernutrition and poor outcome (odds ratio [OR], 3.4; 95% CI, 1.3 to 8.7; P = 0.01), and mortality (OR, 3.1, 95% CI, 1.3 to 7.7; P = 0.02) at 1 month. NIHSS, age, and premorbid MRS were also significantly associated with poor outcomes. After adjustment for these factors, the effect size of associations remained important but not significant ( poor outcome: OR, 2.4; 95% CI, 0.7 to 9.0, P = 0.18; mortality: OR, 3.2; 95% CI, 1.0 to 10.4, P = 0.05). Conclusions - Premorbid undernutrition, as assessed using the SGA, appears to be an independent predictor of poor stroke outcome. Stroke prevention strategies should target undernutrition in the population at risk for stroke to improve outcomes.

Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments

After initial infection, human cytomegalovirus remains in a persistent state with the host. Immunity against the virus controls replication, although intermitent viral shedding can still take place in the seropositive immunocompetent person. Replication of cytomegalovirus in the absence of an effective immune response is central to the pathogenesis of disease. Therefore, complications are primarily seen in individuals whose immune system is immature, or is suppressed by drug treatment or coinfection with other pathogens. Although our increasing knowledge of the host-virus relationship has lead to the development of new pharmacological strategies for cytomegalovirus-associated infections, these strategies all have limitations-eg, drug toxicities, development of resistance, poor oral bioavailability, and low potency. Immune-based therapies to complement pharmacological strategies for the successful treatment of virus-associated complications should be prospectively investigated.

Liver transplantation for HCV-associated liver cirrhosis: Predictors of outcomes in a population with significant genotype 3 and 4 distribution

End-stage liver disease associated with hepatitis C virus (HCV) infection is now the leading indication for liver transplantation in adults. However, reinfection of the graft is universal. We aimed to determine predictors of outcome of HCV-Iiver transplant recipients in the Australian and New Zealand communities. The following variables were analysed: demographic factors, coexistent pathology at the time of transplantation, HCV genotype, and donor age. Outcomes measures were: 1. mortality; 2. development of HCV-related complications, which were stage 3 or 4 fibrosis, or mortality from HCV-related graft failure, or both. Between January 1989 and December 30, 1999, 182 patients were transplanted for HCV-associated cirrhosis. The median follow-up period was 4 years (range, 0 to 13 years). Genotype data were available on 157 patients. The distribution of genotypes among the 157 patients was as follows: 36 (23%) genotype la, 30 (19%) genotype 1b, 4 (9%) genotype 1, 17 (11%) genotype 2, 41 (26%) genotype 3a, and 16 (10%) genotype 4. Eight (5%) patients were HCV-polymerase chain reaction (PCR)-negative (but HCV-antibody positive). Donor age and genotype 4 were associated with an increased risk of retransplantation or death (P < .001 and.05, respectively). Meanwhile, donor age, genotype 4, and pretransplant excess alcohol were risk factors for the development of HCV-related complications (P = .004, .008, and .02, respectively). In contrast, patients with genotype 3a were less likely to develop HCV-related complications (P = .05). In a population of HCV liver transplant recipients with a heterogeneous genotype distribution, donor age, and genotype 4, were predictors of a worse outcome, whereas genotype 3 was associated with a more favorable outcome.

Intravenous catheter-associated Staphylococcus aureus bacteraemia: a common problem that can be prevented [Editorial]

No Abstract

Boron nutrition and chilling tolerance of warm climate crop species

Background Field observations and glasshouse studies have suggested links between boron (B)-deficiency and leaf damage induced by low temperature in crop plants, but causal relationships between these two stresses at physiological, biochemical and molecular levels have yet to be explored. Limited evidence at the whole-plant level suggests that chilling temperature in the root zone restricts B uptake capacity and/or B distribution/utilization efficiency in the shoot, but the nature of this interaction depends on chilling tolerance of species concerned, the mode of low temperature treatment (abrupt versus gradual temperature decline) and growth conditions (e.g. photon flux density and relative humidity) that may exacerbate chilling stress. Scope This review explores roles of B nutrition in chilling tolerance of continual root or transient shoot chills in crop species adapted to warm season conditions. It reviews current research on combined effects of chilling temperature (ranging from > 0 to 20 degrees C) and B deficiency on growth and B nutrition responses in crop species differing in chilling tolerance. Conclusion For subtropical/tropical species (e.g. cucumber, cassava, sunflower), root chilling at 10-17 degrees C decreases B uptake efficiency and B utilization in the shoot and increases the shoot : root ratio, but chilling-tolerant temperate species (e.g. oilseed rape, wheat) require much lower root chill temperatures (2-5 degrees C) to achieve the same responses. Boron deficiency exacerbates chilling injuries in leaf tissues, particularly under high photon flux density. Suggested mechanisms for B x chilling interactions in plants are: (a) chilling-induced reduction in plasmalemma hydraulic conductivity, membrane fluidity, water channel activity and root pressure, which contribute to the decrease in root hydraulic conductance, water uptake and associated B uptake; (b) chilling-induced stomatal dysfunction affecting B transport from root to shoot and B partitioning in the shoot; and (c) B deficiency induced sensitivity to photo-oxidative damage in leaf cells. However, specific evidence for each of the mechanisms is still lacking. Impacts of B status on chilling tolerance in crop species have important implications for the management of B supply during sensitive stages of growth, such as early growth after planting and early reproductive development, both of which can coincide with the occurrence of chilling temperatures in the field.

Iron (Fe) bioavailability and the distribution of anti-Fe nutrition biochemicals in the unpolished, and bran fraction of five rice gei polished grain riotypes

Iron (Fe) bioavailability in unpolished, polished grain and bran fraction of five rice genotypes with a range of Fe contents was measured by in vitro digestion and cultured Caco-2 cells of cooked grain. There was a significant difference in Fe bioavailability among the five rice genotypes tested, in both the unpolished and polished grain. The range of Fe bioavailability variation in polished rice was much wider than that of unpolished, suggesting the importance of using Fe levels and bioavailability in polished rice grain as the basis for selecting high-Fe rice cultivars for both agronomic and breeding purposes. Milling and polishing the grain to produce polished (or white) rice increased Fe bioavailability in all genotypes. Iron bioavailability in polished rice was high in the UBON2 and Nishiki, intermediate in both IR68144 and KDML105, and low in CMU122. All genotypes had low bioavailability of Fe in bran fraction compared to unpolished and polished grain, except in CMU122. CMU122 contained the lowest level of bioavailable Fe in unpolished and polished grain and bran, because of the dark purple pericarp colored grain and associated tannin content. The level of bioavailable Fe was not significantly correlated with grain Fe concentration or grain phytate levels among these five genotypes tested. The negative relationship between Fe bioavailability and the levels of total extractable phenol was only observed in unpolished (r = -0.83**) and bran fraction (r = -0.50*). The present results suggested that total extractable phenol and tannin contents could also contribute to lowering bioavailability of Fe in rice grain, in addition to phytate. (c) 2006 Society of Chemical Industry

Phosphorus nutrition of Caustis blakei grown with two phosphorus sources of different solubility in two soils of differing phosphorus adsorption capacity

A barrier to the domestication of the phosphorus (P) sensitive Australian species Caustis blakei (Cyperaceae) is the standard production systems used commercially which invariably result in problems associated either with P deficiency or P toxicity. This paper reports on the growth responses of Caustis blakei cv. M63 to applications of fertiliser P as either monocalcium phosphate (MCP) or granulated Guano Gold (R) rock phosphate (RP) in two soils with different capacities to adsorb P. The Caustis M63 plants grown in the two soils did not show P toxicity symptoms when fertilised with RP, but shoot dry weight was 30-60% lower than the control in both soils at the highest rate of MCP-P application (156 kg ha(-1), 184 g m(-3)) and this was associated with visible symptoms of drying of the tips of the ultimate branchlets, in the Mt Cotton soil only. The greatest shoot and root dry weights were achieved by plants grown in the higher P adsorbing Palmwoods soil fertilised with RP at P rates of 30-184 g m(-3). Caustis plants grown in the Palmwoods soil had 2.3 times greater root dry weights than plants grown in the Mt Cotton soil irrespective of the P fertiliser type used. Caustis plants growing in Mt Cotton soil which did not receive P showed significantly lower shoot and root dry weight when compared to plants in the Palmwoods soil, probably due to the low initial bicarbonate-extractable P and the high buffering capacity of the Mt Cotton soil. The P concentration in shoots of Caustis fertilised with MCP at 184 g m(-3) was higher when grown in Mt Cotton soil (0.22%) than in the Palmwoods soil (0.15%). The P concentration was lower in the terminal ultimate branchlets (TUB); 0.15% for the Mt Cotton soil and 0.10% for the Palmwoods soil, suggesting that shoots would provide a more useful indicator of P toxicity than the TUB. It is interesting to speculate as to why plants in the Palmwoods soil showed greater root growth and fewer symptoms of P toxicity. This could be because the Palmwoods soil had the greater P adsorption capacity. These results indicate in ground production of Caustis cut foliage will require careful management of P nutrition and understanding of the complex soil/plant interactions associated with the acquisition of P. (c) 2006 Elsevier B.V. All rights reserved.

Relative validity of food intake estimates using a food frequency questionnaire is associated with sex, age, and other personal characteristics

We invostigated the validity of food intake estimates obtained by a self-administered FFQ relative to weighed food records (WFR) and the extent to which demographic, anthropometric, and social characteristics explain differences between these methods. A community-based sample of 96 Australian adults completed a FFQ and 12 d of WFR over 12 mo. The FFQ was adapted to the Australian setting from the questionnaire used in the US Nurses' Health Study. Spearman rank correlation coefficients ranged from 0.08 for other vegetables to 0.88 for tea. Exact agreement by quartiles of intake ranged from 27% (eggs) to 63% (tea). Differences between FFQ and WFR regressed on personal characteristics were significantly associated with at least 1 characteristic for 20 of the 37 foods. Sex was significantly associated with differences for 17 food groups, including 5 specific vegetable groups and 2 total fruit and vegetable groups. Use of dietary supplements and the presence of a medical condition were associated with differences for 5 foods; age, school leaving age, and occupation were associated with differences for 1-3 foods. BMI was rot associated with differences for any foods. Regression models explained from 3% (wholemeal bread) to 37% (for all cereals and products) of variation in differences between methods. We conclude that the relative validity of intake estimates obtained by FFQ is different for men and women for a large number of foods. These results highlight the need for appropriate adjustment of diet-disease relations for factors affecting the validity of food intake estimates.