ESPEN Guidelines on Parenteral Nutrition: intensive care.

Nutritional support in the intensive care setting represents a challenge but it is fortunate that its delivery and monitoring can be followed closely. Enteral feeding guidelines have shown the evidence in favor of early delivery and the efficacy of use of the gastrointestinal tract. Parenteral nutrition (PN) represents an alternative or additional approach when other routes are not succeeding (not necessarily having failed completely) or when it is not possible or would be unsafe to use other routes. The main goal of PN is to deliver a nutrient mixture closely related to requirements safely and to avoid complications. This nutritional approach has been a subject of debate over the past decades. PN carries the considerable risk of overfeeding which can be as deleterious as underfeeding. Therefore the authors will present not only the evidence available regarding the indications for PN, its implementation, the energy required, its possible complementary use with enteral nutrition, but also the relative importance of the macro- and micronutrients in the formula proposed for the critically ill patient. Data on long-term survival (expressed as 6 month survival) will also be considered a relevant outcome measure. Since there is a wide range of interpretations regarding the content of PN and great diversity in its practice, our guidance will necessarily reflect these different views. The papers available are very heterogeneous in quality and methodology (amount of calories, nutrients, proportion of nutrients, patients, etc.) and the different meta-analyses have not always taken this into account. Use of exclusive PN or complementary PN can lead to confusion, calorie targets are rarely achieved, and different nutrients continue to be used in different proportions. The present guidelines are the result of the analysis of the available literature, and acknowledging these limitations, our recommendations are intentionally largely expressed as expert opinions.

Kaikki Abbasta?

Luettua

Diving capacity and foraging behaviour of the water shrew (Neomys fodiens)

With regard to semi-aquatic mammals, Schröpfer & Stubbe (1992) distinguished three riparian guilds: the herbivores with the water vole and the beaver; the megacarnivores with the mink and the otter; and the macrocarnivores with water shrews and desmans. Among water shrews, the evolution of aquatic foraging behaviour occurred several times: Nectogale and Chimarrogale in Asia, several species of the genus Sorex in America, and Neomys in Eurasia (Churchfield, 1990). The fairly common European water shrew N. fodiens is the best known. However, the reports on the degree of adaptation to the water habitat are conflicting. Therefore some important findings from the literature are reviewed in this introduction, whereas new data are presented in the following sections. The swimming locomotion of water shrews was analysed by Ruthardt & Schröpfer (1985) and Köhler (1991), and the related morphological adaptation were reviewed by Hutterer (1985) and Churchfield (this volume pp. 49-51). They obviously present a compromise between the requirements for activity on land and in the water. Thermoregulation is a major problem for semi-aquatic mammals, because heat conductance in water is 25-fold greater than in air (Calder, 1969). According to this author, the body temperature of immersed American Sorex palustris dropped by a rate of 2.8 °C per min. However, this may be an experimental artefact, because Neomys fodiens can maintain its body temperature at 37 °C during an immersion of 6 min (Vogel, 1990).

Equip per a la recuperació de fluids d'un automòbil

El projecte defineix un equip per a l'extracció de fluids d'un vehicle fora d'ús. Aquest extreu per separat els combustibles, els olis, el líquid de frens i l'anticongelant. El sistema d'extracció es realitza per una bomba de buit, a partir del buit creat en un calderí hi entra el líquid corresponent per diferència de pressió i conduint els líquids als dipòsits d'emmagatzematge. L'equip consta d'un conjunt de conductes, vàlvules, filtres i sensors i també inclou un autòmat pel seu control automàtic.

Prediction of crude protein and classification of the growth stage of wheat plant samples from NIR spectra

Near-infrared spectroscopy (NIRS) was used to analyse the crude protein content of dried and milled samples of wheat and to discriminate samples according to their stage of growth. A calibration set of 72 samples from three growth stages of wheat (tillering, heading and harvest) and a validation set of 28 samples was collected for this purpose. Principal components analysis (PCA) of the calibration set discriminated groups of samples according to the growth stage of the wheat. Based on these differences, a classification procedure (SIMCA) showed a very accurate classification of the validation set samples : all of them were successfully classified in each group using this procedure when both the residual and the leverage were used in the classification criteria. Looking only at the residuals all the samples were also correctly classified except one of tillering stage that was assigned to both tillering and heading stages. Finally, the determination of the crude protein content of these samples was considered in two ways: building up a global model for all the growth stages, and building up local models for each stage, separately. The best prediction results for crude protein were obtained using a global model for samples in the two first growth stages (tillering and heading), and using a local model for the harvest stage samples.

Terutroban, A TP-receptor antagonist, reduces portal pressure in cirrhotic rats.

Increased production of vasoconstrictive prostanoids, such as thromboxane A2 (TXA2 ), contributes to endothelial dysfunction and increased hepatic vascular tone in cirrhosis. TXA2 induces vasoconstriction by way of activation of the thromboxane-A2 /prostaglandin-endoperoxide (TP) receptor. This study investigated whether terutroban, a specific TP receptor blocker, decreases hepatic vascular tone and portal pressure in rats with cirrhosis due to carbon tetrachloride (CCl4 ) or bile duct ligation (BDL). Hepatic and systemic hemodynamics, endothelial dysfunction, liver fibrosis, hepatic Rho-kinase activity (a marker of hepatic stellate cell contraction), and the endothelial nitric oxide synthase (eNOS) signaling pathway were measured in CCl4 and BDL cirrhotic rats treated with terutroban (30 mg/kg/day) or its vehicle for 2 weeks. Terutroban reduced portal pressure in both models without producing significant changes in portal blood flow, suggesting a reduction in hepatic vascular resistance. Terutroban did not significantly change arterial pressure in CCl4 -cirrhotic rats but decreased it significantly in BDL-cirrhotic rats. In livers from CCl4 and BDL-cirrhotic terutroban-treated rats, endothelial dysfunction was improved and Rho-kinase activity was significantly reduced. In CCl4 -cirrhotic rats, terutroban reduced liver fibrosis and decreased alpha smooth muscle actin (α-SMA), collagen-I, and transforming growth factor beta messenger RNA (mRNA) expression without significant changes in the eNOS pathway. In contrast, no change in liver fibrosis was observed in BDL-cirrhotic rats but an increase in the eNOS pathway. CONCLUSION: Our data indicate that TP-receptor blockade with terutroban decreases portal pressure in cirrhosis. This effect is due to decreased hepatic resistance, which in CCl4 -cirrhotic rats was linked to decreased hepatic fibrosis, but not in BDL rats, in which the main mediator appeared to be an enhanced eNOS-dependent vasodilatation, which was not liver-selective, as it was associated with decreased arterial pressure. The potential use of terutroban for portal hypertension requires further investigation.

Sinusoidal Endothelial Dysfunction Precedes Inflammation and Fibrosis in a Model of NAFLD

Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome. Most morbidity associated with the metabolic syndrome is related to vascular complications, in which endothelial dysfunction is a major pathogenic factor. However, whether NAFLD is associated with endothelial dysfunction within the hepatic vasculature is unknown. The aims of this study were to explore, in a model of diet-induced overweight that expresses most features of the metabolic syndrome, whether early NAFLD is associated with liver endothelial dysfunction. Wistar Kyoto rats were fed a cafeteria diet (CafD; 65% of fat, mostly saturated) or a control diet (CD) for 1 month. CafD rats developed features of the metabolic syndrome (overweight, arterial hypertension, hypertryglyceridemia, hyperglucemia and insulin resistance) and liver steatosis without inflammation or fibrosis. CafD rats had a significantly higher in vivo hepatic vascular resistance than CD. In liver perfusion livers from CafD rats had an increased portal perfusion pressure and decreased endothelium-dependent vasodilation. This was associated with a decreased Akt-dependent eNOS phosphorylation and NOS activity. In summary, we demonstrate in a rat model of the metabolic syndrome that shows features of NAFLD, that liver endothelial dysfunction occurs before the development of fibrosis or inflammation.

Immunoregulatory and anti-inflammatory effects of n-3 polyunsaturated fatty acids

1. Fish oils are rich in the long-chain n-3 polyunsaturated fatty acids (PUFAs), eicosapentaenoic (20:5n-3) and docosahexaenoic (22:6n-3) acids. Linseed oil and green plant tissues are rich in the precursor fatty acid, a-linolenic acid (18:3n-3). Most vegetable oils are rich in the n-6 PUFA linoleic acid (18:2n-6), the precursor of arachidonic acid (20:4n-6). 2. Arachidonic acid-derived eicosanoids such as prostaglandin E2 are pro-inflammatory and regulate the functions of cells of the immune system. Consumption of fish oils leads to replacement of arachidonic acid in cell membranes by eicosapentaenoic acid. This changes the amount and alters the balance of eicosanoids produced. 3. Consumption of fish oils diminishes lymphocyte proliferation, T-cell-mediated cytotoxicity, natural killer cell activity, macrophage-mediated cytotoxicity, monocyte and neutrophil chemotaxis, major histocompatibility class II expression and antigen presentation, production of pro-inflammatory cytokines (interleukins 1 and 6, tumour necrosis factor) and adhesion molecule expression. 4. Feeding laboratory animals fish oil reduces acute and chronic inflammatory responses, improves survival to endotoxin and in models of autoimmunity and prolongs the survival of grafted organs. 5. Feeding fish oil reduces cell-mediated immune responses. 6. Fish oil supplementation may be clinically useful in acute and chronic inflammatory conditions and following transplantation. 7. n-3 PUFAs may exert their effects by modulating signal transduction and/or gene expression within inflammatory and immune cells.

Long-chain n-3 fatty acids and inflammation: potential application in surgical and trauma patients

Lipids used in nutritional support of surgical or critically ill patients have been based on soybean oil, which is rich in the n-6 fatty acid linoleic acid (18:2n-6). Linoleic acid is the precursor of arachidonic acid (20:4n-6). In turn, arachidonic acid in cell membrane phospholipids is the substrate for the synthesis of a range of biologically active compounds (eicosanoids) including prostaglandins, thromboxanes, and leukotrienes. These compounds can act as mediators in their own right and can also act as regulators of other processes, such as platelet aggregation, blood clotting, smooth muscle contraction, leukocyte chemotaxis, inflammatory cytokine production, and immune function. There is a view that an excess of n-6 fatty acids should be avoided since this could contribute to a state where physiological processes become dysregulated. One alternative is the use of fish oil. The rationale of this latter approach is that fish oil contains long chain n-3 fatty acids, such as eicosapentaenoic acid. When fish oil is provided, eicosapentaenoic acid is incorporated into cell membrane phospholipids, partly at the expense of arachidonic acid. Thus, there is less arachidonic acid available for eicosanoid synthesis. Hence, fish oil decreases production of prostaglandins like PGE2 and of leukotrienes like LTB4. Thus, n-3 fatty acids can potentially reduce platelet aggregation, blood clotting, smooth muscle contraction, and leukocyte chemotaxis, and can modulate inflammatory cytokine production and immune function. These effects have been demonstrated in cell culture, animal feeding and healthy volunteer studies. Fish oil decreases the host metabolic response and improves survival to endotoxin in laboratory animals. Recently clinical studies performed in various patient groups have indicated benefit from this approach.

Brock vs Concordia

Marty Calder of Brock wrestles Anthony Merlo of Concordia. This photograph has been translated into a painting which can now be seen just outside the Ian D. Beddis Gymnasium.

Training distribution and the acquisition of maximal isometric elbow flexion strength

Twenty-six sedentary, college-aged females were matched and randomly assigned to one of two groups. The massed group (n=13) completed 15 maximal isometric elbow flexion strength trials in one session, while the distributed group (n=13) performed five such contractions on three successive days. After a two-week and three month rest interval, both groups returned to perfonn another five maximal isometric elbow flexion strength trials to assess retention of any potential strength gains. Elbow flexion torque and surface electromyography (SEMG) of the biceps and triceps were monitored concurrently. There was a significant (P < 0.05) increase in strength in both groups from block one (first five contractions) to block four (first retest) and from block one to block five (second retest). Both groups exhibited a similar linear increasing (P < 0.05) trend in biceps root-mean-square (RMS) SEMG amplitude. A significant (P < 0.05) decrease in triceps RMS SEMG amplitude was found between block one and block four for the distributed group. However, a significant (P < 0.05) increase was then found between block one and five for the massed group, and between blocks four and five for distributed group. These results suggest that there is flexibility in resistive exercise schedules. An increase in neural drive to the agonist muscle continued throughout testing. This was accompanied by a reduction in antagonist co activation that was a short-tenn (two weeks) training effect, dissipated over the longer rest interval (three months).

Battlefield House flyer, n.d.

Battlefield House was originally the home of Mary Gage, a widow who arrived in Canada with 2 children after her husband was killed in action in the American Revolution in 1777. The original house was a log cabin which was replaced by a storey and a half frame house. Col. Nelson was the next owner of the house, and in the middle of the 19th century he raised the roof to make it a 2 storey house and added a large west wing. Successive owners: the Glover, Williams and Fisher families made a few changes to the house. The last owner was D.A. Fletcher who tore down the newer, western half of the building in 1895. In 1899, Mrs. John Calder, a granddaughter of James Gage formed the Women’s Wentworth Historical Society and raised enough money to buy the Gage Farmhouse and the land around it on which the Battle of Stoney Creek was fought. In 1910 this group purchased another 13 acres of the original Crown Grant and made 17 ½ acres of parkland open to the public. The women of the Society renovated and furnished the house. They maintained the building for 63 years. It was due to them that a monument was erected above the house by the Dominion Government. The monument was unveiled on the 100th anniversary of the Battle, June 6, 1913. The house was turned over by the Historical Society to The Niagara Parks Commission on January 19th, 1962. Source: Battlefield House Flyer, information provided by Mrs. E.B. Thompson, past president of the Women’s Wentworth Historical Society.

The Constitutional basis of aboriginal rights

Aboriginal rights are rights held by aboriginal peoples, not by virtue of Crown grant, legislation or treaty, but “by reason of the fact that aboriginal peoples were once independent, self-governing entities in possession of most of the lands now making up Canada.” It is, of course, the presence of aboriginal peoples in North America before the arrival of the Europeans that distinguishes them from other minority groups in Canada, and explains why their rights have special legal status. However, the extent to which those rights had survived European settlement was in considerable doubt until as late as 1973, which was when the Supreme Court of Canada decided the Calder case.2 In that case, six of the seven judges held that the Nishga people of British Columbia possessed aboriginal rights to their lands that had survived European settlement. The actual outcome of the case was inconclusive, because the six judges split evenly on the question whether the rights had been validly extinguished or not. However, the recognition of the rights was significant, and caught the attention of the Government of Canada, which began to negotiate treaties (now called land claims agreements) with First Nations in those parts of the country that were without treaties. That resumed a policy that had been abandoned in the 1920s, when the last numbered treaty was entered into.

L’influence du vieillissement normal et pathologique sur le traitement des expressions faciales et du jugement de confiance

Déterminer si quelqu’un est digne de confiance constitue, tout au long de notre vie, une décision à la base de nos interactions sociales quotidiennes. Des études récentes chez les jeunes adultes ont proposé que le jugement de confiance basé sur un visage constituerait une extension des processus de reconnaissance des expressions faciales, particulièrement de la colère et de la joie (Todorov, 2008). Bien que le jugement de confiance soit d’une grande importance tout au long de notre vie, à notre connaissance, aucune étude n’a tenté d’explorer l’évolution de ce processus au cours du vieillissement. Pourtant, sachant que les personnes âgées saines sont moins efficaces que les jeunes adultes pour reconnaître les expressions faciales émotionnelles (Ruffman et al., 2008; Calder et al., 2003), des différences pourraient exister dans les capacités de ces deux groupes d’âge à poser un jugement de confiance. Le présent travail a permis d’explorer, pour une première fois, les processus perceptifs sous-jacents au jugement de confiance chez une population âgée saine ainsi que chez une population présentant une démence fronto-temporale. Les résultats démontrent que les représentations de colère, de joie et de confiance sont similaires chez les jeunes et les âgés sains et suggèrent qu’il existe bel et bien un lien entre le jugement de confiance et les jugements de joie et de colère. De plus, ils révèlent que ce lien persiste au cours vieillissement, mais que les adultes âgés sains se fient davantage à leur représentation de la colère que les jeunes adultes pour déterminer si un visage est digne de confiance ou non. Enfin, les patients présentant une démence fronto-temporale possèdent des représentations différentes des âgés sains en ce qui concerne la colère, la joie et la confiance, et ils semblent se fier davantage à leur représentation de la joie que les âgés sains pour déterminer le niveau de confiance d’un visage.