Guidelines on artificial nutrition versus hydration in terminal cancer patients

Whether a terminally ill cancer patient should be actively fed or simply hydrated through subcutaneous or intravenous infusion of isotonic fluids is a matter of ongoing controversy among clinicians involved in the care of these patients. Under the auspices of the European Association for Palliative Care, a committee of experts developed guidelines to help clinicians make a reasonable decision on what type of nutritional support should be provided on a case-by-case basis. It was acknowledged that part of the controversy related to the definition of the terminal cancer patient, since this is a heterogeneous group of patients with different needs, expectations, and potential for a medical intervention. A major difficulty is the prediction of life expectancy and the patient's likely response to vigorous nutritional support. In an attempt to reach a decision on the type of treatment support (artificial nutrition vs. hydration) which would best meet the needs and expectations of the patient, we propose a three-step process: Step I: define the eight key elements necessary to reach a decision: Step II: make the decision; and Step III: reevaluate the patient and the proposed treatment at specified intervals. Step I involves assessing the patient concerning the following: 1) oncological/clinical condition; 2) symptoms; 3) expected length of survival; 4) hydration and nutritional status; 5) spontaneous or voluntary nutrient intake; 6) psychological profile; 7) gut function and potential route of administration; and 8) need for special services based on type of nutritional support prescribed. Step II involves the overall assessment of pros and cons, based on information determined in Step I, in order to reach an appropriate decision based on a well-defined end point (i.e. improvement of quality of life; maintaining patient survival; attaining rehydration). Step III involves the periodic reevaluation of the decision made in Step II based on the proposed goal and the attained result.

Characterisation of products of tricalcium silicate hydration in the presence of heavy metals

The hydration of tricalcium silicate (C(3)S) in the presence of heavy metal is very important to cement-based solidification/stabilisation (s/s) of waste. In this work, tricalcium silicate pastes and aqueous suspensions doped with nitrate salts of Zn(2+), Pb(2+), Cu(2+) and Cr(3+) were examined at different ages by X-ray powder diffraction (XRD), thermal analysis (DTA/TG) and (29)Si solid-state magic angle spinning/nuclear magnetic resonance (MAS/NMR). It was found that heavy metal doping accelerated C(3)S hydration, even though Zn(2+) doping exhibited a severe retardation effect at an early period of time of C(3)S hydration. Heavy metals retarded the precipitation of portlandite due to the reduction of pH resulted from the hydrolysis of heavy metal ions during C(3)S hydration. The contents of portlandite in the control, Cr(3+)-doped, Cu(2+)-doped, Pb(2+)-doped and Zn(2+)-doped C(3)S pastes aged 28 days were 16.7, 5.5, 5.5, 5.5, and <0.7%, respectively. Heavy metals co-precipitated with calcium as double hydroxides such as (Ca(2)Cr(OH)(7).3H(2)O, Ca(2)(OH)(4)4Cu(OH)(2).2H(2)O and CaZn(2)(OH)(6).2H(2)O). These compounds were identified as crystalline phases in heavy metal doping C(3)S suspensions and amorphous phases in heavy metal doping C(3)S pastes. (29)Si NMR data confirmed that heavy metals promoted the polymerisation of C-S-H gel in 1-year-old of C(3)S pastes. The average numbers of Si in C-S-H gel for the Zn(2+)-doped, Cu(2+)-doped, Cr(3+)-doped, control, and Pb(2+)-doped C(3)S pastes were 5.86, 5.11, 3.66, 3.62, and 3.52. And the corresponding Ca/Si ratios were 1.36, 1.41, 1.56, 1.57 and 1.56, respectively. This study also revealed that the presence of heavy metal facilitated the formation of calcium carbonate during C(3)S hydration process in the presence of carbon dioxide.

Selective hydration of dihydromyrcene in ionic liquids

Acid catalysed direct hydration of dihydromyrcene to dihydromyrcenol proceeds selectively in ionic liquid media. By making use of the tuneable physicochemical properties of ionic liquids, and depending upon the process requirement, either biphasic or triphasic systems can be developed. The selectivity to dihydromyrcenol remains extremely high over a wide range of reaction conditions.

Influence of Different European Cements (CEM) on the Hydration of Cover-Zone Concrete during the Curing and Post Curing Periods

The durability of reinforced concrete structures depends, in the main, on the performance of the cover-zone concrete as it is this which protects the steel from the external environment. This paper focusses on the use of discretised electrical property measurements to study depth-related features during both the curing and post-curing period thereby allowing an integrated assessment of the protective properties of the cover region. In the current work, use is made of a small, multi-electrode array embedded within the surface 75mm of concrete specimens. Concretes were manufactured with different European cements (CEM) and water/binder ratios representing mixes which satisfied the minimum requirements for a range of environmental exposure classes including exposure to chlorides. Electrical resistance measurements were taken over a period in excess of 300 days which showed on-going hydration, pozzolanic reaction and pore-structure refinement; in addition, in the post-curing period, when exposed to a cyclic chloride ponding regime, measurements could be used to study the convective zone and ionic enrichment of the surface layer.

Hydration and properties of sodium sulfate activated slag

Interest in alkali-activated slag as a construction material is increasing, primarily due to its environmentally friendly nature. Although strong alkaline activators, such as sodium hydroxide and sodium silicate solution, are preferred for high strength, none of them exists naturally and their manufacturing process is quite energy intensive. Whilst sodium sulfate (NaSO ) can be obtained from natural resources, the early strength of NaSO activated slag is usually low. In this paper, the effects of slag fineness and NaSO dosage on strength, pH, hydration and microstructure were investigated and compared with those of a pure Portland cement (PC). Test results indicated that increasing the slag fineness is a more effective approach than increasing NaSO dosage for increasing both the early and long-term strength of NaSO activated slags. In addition, increasing the slag fineness can also increase the strength without increasing the pH of the hardened matrix, which is beneficial for immobilizing certain types of nuclear waste containing reactive metals and resins.© 2012 Elsevier Ltd. All rights reserved.

Characterization of physio-chemical processes and hydration kinetics in concretes containing supplementary cementitious materials using electrical property measurements

The current study monitors both the short- and long-term hydration characteristics of concrete using discretized conductivity measurements from initial gauging, through setting and hardening, the latter comprising both the curing and post-curing periods. In particular, attention is directed to the near-surface concrete as it is this zone which protects the steel from the external environment and has a major influence on durability, performance and service-life. A wide range of concrete mixes is studied comprising both plain Portland cement concretes and concretes containing fly-ash and ground granulated blast furnace slag. The parameter normalised conductivity was used to identify four distinct stages in the hydration process and highlight the influence of supplementary cementitious materials (SCM) on hydration and hydration kinetics. A relationship has been presented to account for the temporal decrease in conductivity, post 10-days hydration. The testing procedure and methodology presented lend itself to in-situ monitoring of reinforced concrete structures. (c) 2013 Elsevier Ltd. All rights reserved.

Mechanochemical interconversion between discrete complexes and coordination networks - formal hydration/dehydration by LAG

Using a small planetary ball mill, liquid-assisted grinding (LAG) of metal salts or oxides (ZnO, CdO, CdCO3, Cu(OAc)(2)center dot H2O, Co(OAc)(2)center dot 4H(2)O, Mn(OAc)(2)center dot 4H(2)O, Ni(OAc)(2)center dot 4H(2)O, FeSO4 center dot 7H(2)O) with two equivalents of isonicotinic acid (HINA) and small amounts of water ( up to 5.6 molar equivalents) gave discrete aquo complexes trans-[M(INA)(2)(OH2)(4)] (M = Zn, Cd, Cu, Fe, Co, Ni, Mn) efficiently within 30 min. For M = Zn, Cd and Cu these complexes readily undergo reversible formal dehydration to the extended network structures [M(INA)(2)] (M = Zn, Cu) or [Cd(INA)(2)(OH2)]center dot DMF by further LAG with non-aqueous liquids such as methanol or DMF. Overall, the mechanochemical dehydrations are more effective than heating or immersion in bulk solvents. The work demonstrates a two-step mechanochemical synthesis of coordination networks via discrete aquo complexes which may be preferable to single step reactions or grinding-annealing procedures in some cases. For example, the two step method was the only way to prepare [Cd(INA)(2)(OH2)]center dot DMF mechanochemically and the porous network Cu(INA)(2) could not be obtained from the aquo complex by heating.

Stability and hydration studies of Y-Doped Ba(Ce,Zr)O3

BaC_e1-xYxO_3-δ (BCY) and BaCe_0.8-yZr_yY_0.2O_3-δ (BCZY) compounds were synthesised via an aqueous sol-gel method and two different calcination processes were tested for BCZY synthesis. The highest hydration capacity was recorded for the compound that contained the highest Y-doping level (x=0.2). Further substitution of Ce⁴⁺ by Zr⁴⁺ enhanced the chemical stability especially for y≥0.2, although decreased proton conductivity. However, BaCe_0.6-0.2Zr_0.2Y_0.2O_2.9 (BCZ20Y20) which presented adequate water uptake and high chemical stability in presence of CO₂, was found to be the best candidate compound to be used in applications such as electrocatalytic CO₂ hydrogenation.

Solid-state NMR and powder XRD studies of the structure of SAPO-40 upon hydration-dehydration cycles

It is well known that after the removal of the template many porous aluminophosphates and related materials are very sensitive to water.' Depending on the type of structure, reversible or irreversible phase transitions, loss of crystallinity and changes in the coordination of some framework A1 upon rehydration are observed. For example, solid-state NMR shows that the rehydration of SAPO-5 leads to the formation of octahedral Al. Subsequent dehydration restores the initial tetrahedral coordination of Al. Template-free SAPO-37 becomes totally amorphous to X-rays after exposure to water and stays so after subsequent thermal treatment^.,,^ In contrast, Barthomeuf and co-workers have shown recently, that, on hydration, template-free SAPO-34, an analogue of chabasite, shows the opening of some Si-0-A1 bonds, the effect being reversible upon dehydrati~n.T~h e hydrated distorted structure was found to be stable for months with no further modifications and the ordered material could be regenerated by removal of water. Here we wish to report that the structure of template-free SAPO-40 undergoes a similar reversible modification.

A randomized trial to assess the potential of different beverages to affect hydration status: development of a beverage hydration index

Background: The identification of beverages that promote longer- term fluid retention and maintenance of fluid balance is of real clinical and practical benefit in situations in which free access to fluids is limited or when frequent breaks for urination are not desirable. The postingestion diuretic response is likely to be influenced by several beverage characteristics, including the volume ingested, energy den- sity, electrolyte content, and the presence of diuretic agents. Objective: This study investigated the effects of 13 different com- monly consumed drinks on urine output and fluid balance when ingested in a euhydrated state, with a view to establishing a beverage hydration index (BHI), i.e., the volume of urine produced after drinking expressed relative to a standard treatment (still water) for each beverage. Design: Each subject (n = 72, euhydrated and fasted male subjects) ingested 1 L still water or 1 of 3 other commercially available beverages over a period of 30 min. Urine output was then collected for the subsequent 4 h. The BHI was corrected for the water content of drinks and was calculated as the amount of water retained at 2 h after ingestion relative to that observed after the ingestion of still water. Results: Total urine masses (mean 6 SD) over 4 h were smaller than the still-water control (1337 6 330 g) after an oral rehydration solution (ORS) (1038 6 333 g, P , 0.001), full-fat milk (1052 6 267 g, P , 0.001), and skimmed milk (1049 6 334 g, P , 0.001). Cumulative urine output at 4 h after ingestion of cola, diet cola, hot tea, iced tea, coffee, lager, orange juice, sparkling water, and a sports drink were not different from the response to water ingestion. The mean BHI at 2 h was 1.54 6 0.74 for the ORS, 1.50 6 0.58 for full- fat milk, and 1.58 6 0.60 for skimmed milk. Conclusions: BHI may be a useful measure to identify the short- term hydration potential of different beverages when ingested in a euhydrated state.

Hydration, conformational states and kinetics of yeast hexokinase PII /

The kinetic study of the coupled enzymatic reaction involving monomeric yeast hexokinase PII (HK) and yeast glucose-6-phosphate dehydrogenase (G-6-PDH) yields a Michaelis constant of 0.15 ± 0.01 mM for D-glucose. At pH 8.7 HK is present in monomeric form. The addition of polyethylene glycol (PEG), to the reaction mixture increased the affinity of HK for glucose, independent ofMW of the PEG from 2000 to 10000. The osmotic stress exerted by PEG can be used to measure the change in number of water molecules that accompany enzyme conformational changes (Rand, et al., 1993). Results indicate that the G-6-PDH is not osmotically sensitive and thus, the change in the number of PEG-inaccessible water molecules (ANw) measured in the coupled reaction is only the difference between the glucose-bound and glucosefree conformations of HK. ANw ~ 450 with PEGs of MW > 2000 under conditions for both binding (Reid and Rand, 1997) and kinetic assays. The contribution water may play in the binding of ATP (Km = 0.24 + 0.02 mM) has also been examined. It was found that in this case ANw = (for osmotic pressures < 2.8x10* dynes/cm^), suggesting no additional numbers of waters are displaced when ATP binds to HK. Osmotic pressure experiments were also performed with dimeric HK. It was determined that both the monomeric and dimeric forms of HK give the same ANw under low pressures. If this large ANw is due to conformational flexibility, it would appear that the flexibility is not reduced upon dimerization ofthe enzyme.