Growth hormone resistance and somatomedins in children with end-stage liver disease awaiting transplantation

Background: The success of orthotopic liver transplantation as treatment for end-stage liver disease has prompted investigation of strategies to maintain or improve nutrition and growth in children awaiting transplantation, because malnutrition is an adverse prognostic factor. The purpose of this study was to evaluate the effect of recombinant human growth hormone therapy on body composition and indices of liver function in patients awaiting transplant. Methods: The study was designed as a placebo- controlled, double-blind, crossover trial. Patients received 0.2 U/kg growth hormone, subcutaneously, or placebo daily for 28 days during two treatment periods, separated by a 2-week washout period. Ten patients (mean age, 3.06 ± 1.15 years; range, 0.51-11.65 years, five men), with extrahepatic biliary atresia (n = 8) or two with Alagille's syndrome (n = 2), with end-stage liver disease, completed the trial while awaiting orthotopic liver transplantation. Height, weight, total body potassium, total body fat, resting energy expenditure, respiratory quotient, hematologic and multiple biochemical profile, number of albumin infusions, insulin-like growth factor-1 and 1, growth hormone binding protein (GHBP), and insulin-like growth factor binding protein-1 (IGFBP-1) and insulin-like growth factor binding protein (IGFBP-3) were measured at the beginning and end of each treatment period. Results: Growth hormone treatment was associated with a significant decline in serum bilirubin (-34.6 ± 16.5 μmol/l vs. 18.2 ± 11.59 μmol/l; p < 0.02) but there was no significant effect on any anthropometric or body composition measurements, or on any biochemical or hematologic parameters. Conclusions: These children with end-stage liver disease displayed growth hormone resistance, particularly in relation to the somatomedin axis. Exogenous growth hormone administration may be of limited value in these patients

Nutritional impact of antipseudomonas intravenous antibiotic courses in cystic fibrosis

Editor,—In their study of cystic fibrosis patients who were nutritionally assessed at the start and end of a 14 day period of home intravenous antibiotic treatment for chest disease, Vicet al concluded that increased weight was a result of increased fat storage.1 While this may in part be true, their methodology dictates caution in drawing conclusions....

Architecture, the body and authority in performance

This is a theoretical investigation seeking to learn more about architecture by looking at architectural practice through another discipline. In this research architecture is investigated by examining its relationship with bodies through performance and theatre set design. This thesis aims to build on existing architectural theory, in which an absence of discourse on the body has been identified, by analysing representations of architecture and the body in performance. The research specifically examines the relationship between the body, architecture and authority in performance through the analysis of several performance works.

Unsteady free convection flow in the stagnation-point region of a three-dimensional body

The unsteady free convection flow in the stagnation-point region of a heated three-dimensional body placed in an ambient fluid is studied under boundary layer approximations. We have considered the case where there is an initial steady state that is perturbed by a step-change in the wall temperature. The non-linear coupled partial differential equations governing the free convection flow are solved numerically using a finite difference scheme. The presented results show the temporal development of the momentum and thermal boundary layer characteristics.

Concept of "Crossover Point" and its Application on Threshold Voltage Definition for Undoped-Body Transistors

As the conventional MOSFET's scaling is approaching the limit imposed by short channel effects, Double Gate (DG) MOS transistors are appearing as the most feasible candidate in terms of technology in sub-45nm technology nodes. As the short channel effect in DG transistor is controlled by the device geometry, undoped or lightly doped body is used to sustain the channel. There exits a disparity in threshold voltage calculation criteria of undoped-body symmetric double gate transistors which uses two definitions, one is potential based and the another is charge based definition. In this paper, a novel concept of "crossover point'' is introduced, which proves that the charge-based definition is more accurate than the potential based definition.The change in threshold voltage with body thickness variation for a fixed channel length is anomalous as predicted by potential based definition while it is monotonous for charge based definition.The threshold voltage is then extracted from drain currant versus gate voltage characteristics using linear extrapolation and "Third Derivative of Drain-Source Current'' method or simply "TD'' method. The trend of threshold voltage variation is found same in both the cases which support charge-based definition.

Concept of Crossover point and its application on Threshold Voltage definition for Undoped-Body Transistors

As the conventional MOSFETs scaling is approaching the limit imposed by short channel effects, Double Gate (DG) MOS transistors are appearing as the most feasible andidate in terms of technology in sub-45nm technology nodes. As the short channel effect in DG transistor is controlled by the device geometry, undoped or lightly doped body, is used to sustain the channel. There exits a disparity in threshold voltage calculation criteria of undoped-body symmetric double gate transistors which uses two definitions, one is potential based and the another is charge based definition. In this paper, a novel concept of "crossover point" is introduced, which proves that the charge-based definition is more accurate than the potential based definition. The change in threshold voltage with body thickness variation for a fixed channel length is anomalous as predicted by, potential based definition while it is monotonous for change based definition. The threshold voltage is then extracted from drain currant versus gate voltage characteristics using linear extrapolation and "Third Derivative of Drain-Source Current" method or simply "TD" method. The trend of threshold voltage variation is found some in both the cases which support charge-based definition.

The nature of malnutrition in children with end-stage liver disease awaiting orthotopic liver transplantation

To evaluate malnutrition in chronic liver disease, and its relationship to nutrient deficiencies and hepatic dysfunction. 27 children with end-stage liver disease were studied. Mean protein-energy intakes were 70% of recommended daily intakes. The patients were underweight and stunted with reduced mean triceps and subscapular skinfold thicknesses and midupper arm circumference. Mean total body potassium was only 63 ± 18% of that expected for age and sex. Deficiency of essential fatty acids (32%), and low concentrations of fat-soluble vitamins (A, 92%; E, 32%), iron (32%), zinc (42%), and selenium (13%) were common. Serum ammonia concentrations were raised in all patients, and increased methionine, tyrosine, and glutamic acid, and reduced glutamine concentrations were noted. There was no correlation between the degree of malnutrition and the degree of liver synthetic function, the degree of cholestasis, or the degree of liver injury. We suggest that potentially correctable factors in addition to liver failure (eg, inadequate absorbed intake) were important determinants of malnutrition in these patients.

Malnutrition in children with chronic liver disease accepted for liver transplantation : clinical profile and effect on outcome

The nutritional profiles of 37 children (aged 0.5-14.0 years) with chronic liver disease at the time of acceptance for orthotopic liver transplantation (OLTP) have been evaluated using clinical, biochemical and body composition methods. Nutritional progress while waiting for a donor has been related to outcome, whether transplanted or not. At the time of acceptance, most children were underweight (mean standard deviation (s.d.) weight = -1.4 ± 0.2) and stunted (mean s.d. height = - 2.2 ± 0.4), had low serum albumin (27/35) and had reduced body fat and depleted body cell mass (measured by total body potassium - mean % expected for age = 58 ± 5%, n = 15). Mean ad libitum nutrient intake was 63 ± 5% of recommended daily intake (RDI). Those who died while waiting (n = 8) had significantly lower mean initial s.d. weight compared with those transplanted. The overall actuarial 1 year survival of those who were transplanted (mean waiting time = 75 days) was 81% but those who were initially well nourished (s.d. weight >-1.0) had an actuarial 1 year survival of 100%. There were no significant differences in actuarial survival in relationship to age, type of transplant (whole liver or segmental), liver biochemistry or the presence or absence of ascites. Of the total group accepted for OLTP, whether transplanted or not, the overall 1 year survival for those who were relatively well nourished was 88% and for those undernourished (initial s.d. weight <-1.0) was 38% (P<0.003). Declining nutritional status during the waiting period also adversely affected outcome. We conclude that malnutrition and/or declining nutritional status is a major factor adversely affecting survival in children awaiting OLTP. In transplant units where waiting time is greater than 40 days, earlier referral, prioritization of cases and the use of adult donor livers may reduce this risk and efforts to maintain or improve nutritional status deserve further study.

Body composition studies in cystic fibrosis and myelomeningocele

One of the major considerations of improving the management of many chronic diseases has been the realisation of the importance of nutrition, and, in children, the maintenance of normal growth. Cystic Fibrosis (CF) and Myelomeningocele (MMC) are two such disease states in which nutritional status has a significant effect on morbidity.

Justifying threshold voltage definition for undoped body transistors through ``crossover point'' concept

Two different definitions, one is potential based and the other is charge based, are used in the literatures to define the threshold voltage of undoped body symmetric double gate transistors. This paper, by introducing a novel concept of crossover point, proves that the charge based definition is more accurate than the potential based definition. It is shown that for a given channel length the potential based definition predicts anomalous change in threshold voltage with body thickness variation while the charge based definition results in monotonous change. The threshold voltage is then extracted from drain current versus gate voltage characteristics using linear extrapolation, transconductance and match-point methods. In all the three cases it is found that trend of threshold voltage variation support the charge based definition.

Total body potassium in cystic fibrosis

To further evaluate the nature of malnutrition, define at-risk groups, and confirm the efficacy of nutritional supplementation on body composition in cystic fibrosis (CF), we have conducted longitudinal and cross-sectional studies of total body potassium (TBK) in 161 unselected CF subjects aged 1 month to 17 years. TBK was determined by measurement of40K in a whole body counter, reflecting body cell mass (BCM), the vital work-performing and growing cellular component of the body. Compared with normal TBK data for age and sex from pooled measurements of 1,629 healthy children aged 1 week to 17 years, CF infants (n = 12) diagnosed by newborn screening were depleted in TBK at diagnosis and showed catch-up with therapy by 1 year; CF children aged 2-17 years (n = 140) showed a tendency for inadequate accretion of TBK (and thus BCM) with increasing age, although the normal correlation between TBK and weight and height was maintained in the majority suggesting a pattern of nutritional stunting of growth; and malnourished CF children (n = 9) showed significant catchup in TBK with long-term nutritional rehabilitation (85-98% of TBK predicted for weight and height). These studies suggest that potentially serious, but possibly correctable deficits, in the growth of the body cell mass as measured by TBK occur commonly in CF. These deficits may be established very early in life and if not corrected lead to progressive nutritional growth retardation with increasing age. © 1989 Raven Press, Ltd., New York.

Intake, growth and carcass characteristics of lambs consuming low digestible hay and cereal grain

The influence of barley and oat grain supplements on hay dry matter intake (DMI), carcass components gain and meat quality in lambs fed a low quality basal diet was examined. Thirty five crossbred wether lambs (9 months of age) were divided into four groups. After adaptation to a basal diet of 85% oat hay and 15% lucerne hay for one week, an initial group of 11 was slaughtered. The weights of carcass components and digesta-free empty body weight (EBW) of this group was used to estimate the weight of carcass components of the other three experimental groups at the start of the experiment. The remaining three groups were randomly assigned to pens and fed ad libitum the basal diet alone (basal), basal with 300 g air dry barley grain (barley), basal with 300 g air dry oat grain (oat). Supplements were fed twice weekly (i.e., 900 g on Tuesday and 1200 g on Friday). After 13 weeks of feeding, animals were slaughtered and, at 24 h post-mortem meat quality and subcutaneous fat colour were measured. Samples of longissimus muscle were collected for determination of sarcomere length and meat tenderness. Hay DMI was reduced (P<0.01) by both barley and oat supplements. Lambs fed barley or oat had a higher and moderate digestibility of DM, and a higher intake of CP (P<0.05) and ME (P<0.01) than basal lambs. Final live weight of barley and oat lambs was higher (P<0.05) than basal, but this was not reflected in EBW or hot carcass weight. Lambs fed barley or oat had increases in protein (P<0.01) and water (P<0.001) in the carcass, but fat gain was not changed (P>0.05). There were no differences in eye muscle area or fat depth (total muscle and adipose tissue depth at 12th rib, 110 mm from midline; GR) among groups. The increased levels of protein and water components in the carcass of barley and oat fed lambs, associated with improved muscle production, were small and did not alter (P>0.05) any of the carcass/meat quality attributes compared to lambs fed a low quality forage diet. Feeding barley or oat grain at 0.9–1% of live weight daily to lambs consuming poor quality hay may not substantially improve carcass quality, but may be useful in maintaining body condition of lambs through the dry season for slaughter out of season

Luce Irigaray's Philosophy of Feminine Being : Body, Desire and Wisdom

Luce Irigaray is a Belgian-born philosopher, psychoanalyst and linguist. Irigaray s concept of woman is crucial for understanding her own work but also for examining and developing the theoretical and methodological basis of feminist theory. This thesis argues that, ultimately, Irigaray s exploration of woman s being challenges our traditional notion of philosophy as a neutral discourse and the traditional notion of ourselves as philosophizing persons or human beings. However, despite its crucial role, Irigaray s idea of woman still lacks a comprehensive explication. This is because the discourse of sexual difference is blurred by the ideas of essentialism and biologism. --- Irigaray s concept of woman has been interpreted and criticized from the perspectives of metaphysical essentialism, strategic essentialism, realist essentialism and deconstructionism. This thesis argues that a reinterpretation is necessary to account for Irigaray s claims about the the traditional woman , mimesis, the specificity of the feminine body, feminine expression and sexual difference. Moreover, any reading should account for the differences between women and avoid giving a prescriptive function to the essence of woman. --- My thesis develops a new interpretation of Irigaray s concept of woman on the basis of the phenomenology of the body. It argues that Irigaray s discourse on woman can and must be understood by an idea of existential style. Existential style is embodied, affective and spiritual and it is constituted in relation to oneself, to others and to the world. It is temporal, it evolves and changes but preserves its open unity in its transformations. Stylistic unities, such as femininity or philosophy, are constituted in and by the singulars. -- This study discusses and analyses feminine existential style as a central theme and topic of Irigaray s works and shows how her work operates as a primary and paradigmatic example of the feminine style. These tasks are performed by studying the mimetic positions available for women and by explicating the phenomenological background of Irigaray s conceptions of the philosophical method, and the lived, expressive and affective body. The critical occupation and transformation of these mimetic positions, the inquiry into the first-person pre-discursive experience, and the cultivation of feminine expressivity open up the possibility of becoming a woman writer, a woman lover and a woman philosopher. The appearance of these new feminine figures is a precondition for the realization of sexual difference. So Irigaray opens up the possibility of sexual difference by instituting and constituting a feminine subject of love and wisdom, and by problematizing the idea of a neutral and absolute subject.

Many-body effects in electrochemisorption : Part III. Beyond mean field and hartree-fock

Several channels provided by many-body couplings — both fermion-fermion and fermion-boson — for the evolution of the chemisorption system are discussed. This provides an opportunity of a systematic study of the effects of correlations reflected through the intricate pole structure of the absorbate Green functions. The results of Newns, Anda and others in the context of chemisorption are generalized.