Whole body protein synthesis and energy expenditure in very low birth weight infants.

The aim of the present work was to study whole body protein synthesis and breakdown, as well as energy metabolism, in very low birth weight premature infants (less than 1500 g) during their rapid growth phase. Ten very low birth weight infants were studied during their first and second months of life. They received a mean energy intake of 114 kcal/kg X day and 3 g protein/kg X day as breast milk or milk formula. The average weight gain was 15 g/kg X day. The apparent energy digestibility was 88%, i.e. 99 kcal/kg X day. Their resting postprandial energy expenditure was 58 kcal/kg X day, indicating that 41 kcal/kg X day was retained. The apparent protein digestibility was 89%, i.e. 2.65 g/kg X day. Their rate of protein oxidation was 0.88 g/kg X day so that protein retention was 1.76 g/kg X day. There was a linear relationship between N retention and N intake (r = 0.78, p less than 0.001). The slope of the regression line indicates a net efficiency of N utilization of 67%. Estimates of body composition from the energy balance, coupled with N balance method, showed that 25% of the gain was fat and 75% was lean tissue. Whole body protein synthesis and breakdown were determined using repeated oral administration of 15N glycine for 60-72 h, and 15N enrichment in urinary urea was measured. Protein synthesis averaged 11.2 g/kg X day and protein breakdown 9.4 g/kg X day. Muscular protein breakdown, as estimated by 3-methylhistidine excretion, contributed to 12% of the total protein breakdown.(ABSTRACT TRUNCATED AT 250 WORDS)

Patient-ventilator asynchrony during noninvasive pressure support ventilation and neurally adjusted ventilatory assist in infants and children.

OBJECTIVES: To document the prevalence of asynchrony events during noninvasive ventilation in pressure support in infants and in children and to compare the results with neurally adjusted ventilatory assist. DESIGN: Prospective randomized cross-over study in children undergoing noninvasive ventilation. SETTING: The study was performed in a PICU. PATIENTS: From 4 weeks to 5 years. INTERVENTIONS: Two consecutive ventilation periods (pressure support and neurally adjusted ventilatory assist) were applied in random order. During pressure support (PS), three levels of expiratory trigger (ETS) setting were compared: initial ETS (PSinit), and ETS value decreased and increased by 15%. Of the three sessions, the period allowing for the lowest number of asynchrony events was defined as PSbest. Neurally adjusted ventilator assist level was adjusted to match the maximum airway pressure during PSinit. Positive end-expiratory pressure was the same during pressure support and neurally adjusted ventilator assist. Asynchrony events, trigger delay, and cycling-off delay were quantified for each period. RESULTS: Six infants and children were studied. Trigger delay was lower with neurally adjusted ventilator assist versus PSinit and PSbest (61 ms [56-79] vs 149 ms [134-180] and 146 ms [101-162]; p = 0.001 and 0.02, respectively). Inspiratory time in excess showed a trend to be shorter during pressure support versus neurally adjusted ventilator assist. Main asynchrony events during PSinit were autotriggering (4.8/min [1.7-12]), ineffective efforts (9.9/min [1.7-18]), and premature cycling (6.3/min [3.2-18.7]). Premature cycling (3.4/min [1.1-7.7]) was less frequent during PSbest versus PSinit (p = 0.059). The asynchrony index was significantly lower during PSbest versus PSinit (40% [28-65] vs 65.5% [42-76], p < 0.001). With neurally adjusted ventilator assist, all types of asynchronies except double triggering were reduced. The asynchrony index was lower with neurally adjusted ventilator assist (2.3% [0.7-5] vs PSinit and PSbest, p < 0.05 for both comparisons). CONCLUSION: Asynchrony events are frequent during noninvasive ventilation with pressure support in infants and in children despite adjusting the cycling-off criterion. Compared with pressure support, neurally adjusted ventilator assist allows improving patient-ventilator synchrony by reducing trigger delay and the number of asynchrony events. Further studies should determine the clinical impact of these findings.

Water, energy and early postnatal growth in preterm infants.

Non-invasive methods, including stable isotope techniques, indirect calorimetry, nutritional balance and skinfold thickness, have given a new insight into early postnatal growth in neonates. Neonates and premature infants in particular, create an unusual opportunity to study the fluid and metabolic adaptation to extrauterine life because their physical environment can be controlled, fluid and energy balance can be measured and the link between metabolism and the energetics of their postnatal growth can be assessed accurately. Thus the postnatal time course of total body water, heat production, energy cost of growth and composition of weight gain have been quantified in a series of "healthy" low-birth-weight premature infants. These results show that total body water is remarkably stable between postnatal days 3-21. Energy expenditure and heat production rates increase postnatally from mean values of 40 kcal/kg/day during the first week to 60 kcal/kg/day in the third week. An apparent energy balance deficit of 180 kcal/kg can be ascribed to premature delivery. The cost of protein metabolism is the highest energy demanding process related to growth. The fact that nitrogen balance becomes positive within 72 h after birth places the newborn in a transitional situation of dissociated balance between energy and protein metabolism during early postnatal growth: skinfold thickness, dry body mass and fat decrease, while there is a gain in protein and increase in supine length. This particular situation ends during the second postnatal week and soon thereafter the rate of weight gain matches statural growth. The goals of the following review are to summarize data on total body water and energy metabolism in premature infants and to discuss how they correlate with physiological aspects of early postnatal growth.

Vessana a Vessana. Reflexions sobre la pràctica dels establiments emfitèutics a la regió de Girona (segles XVIII-XIX)

Tenim documentats més de 30.000 contractes d'establiment emfitèutic (la majoria, amb caràcter de subestabliment) concedits a la regió de Girona (actuals comarques del Baix i de l'Alt Empordà, del Gironès i de La Selva) entre 1768 i 1862, anys en què van ser inscrits en els llibres del Registre d’hipoteques. Sabem que durant aquests mateixos anys se'n concediren molts més, ja que ens manca la informació relativa a l'ofici de Figueres entre 1774 i 1806 i la comarca de l’Alt Empordà va concentrar un 40% dels establiments concedits entre 1806 i 1862. És molt possible, doncs, que el nombre total s'apropés als 35.000. La xifra no és negligible; a mitjan segle XIX vivien a la regió unes cinquanta mil famílies. Es fa necessari, doncs, reflexionar sobre aquesta pràctica

Tractats, mètodes i influències externes de la restauració de pintures al segle XIX a Espanya. Un cas concret a la Barcelona de la segona meitat del segle XIX

Lligada a d’altres activitats, com la de l’artista pintor, la del fuster, l’artesà o l’arquitecte, larestauració no ha estat una disciplina ben delimitada que ens permeti seguir la seva progressióal llarg de la història. El posicionament de l’home davant del seu patrimoni cultural i artísticen cada moment històric, i el respecte per les mostres del passat, defi neix de quina formaes conservarà, o no, i també de quina forma s’hi intervindrà. Per fer un recorregut històriccal tenir en compte tots els aspectes que infl uencien en el fet de conservar i en la forma defer-ho: els gustos artístics del moment, l’evolució social i econòmica de la població i també lavessant funcional, ja sigui en el sentit estrictament pràctic on en el valor espiritual i religiós,que han tingut assignats molts objectes de patrimoni.

Tractats, mètodes i influències externes de la restauració de pintures al segle XIX a Espanya. Un cas concret a la Barcelona de la segona meitat del segle XIX

Lligada a d’altres activitats, com la de l’artista pintor, la del fuster, l’artesà o l’arquitecte, larestauració no ha estat una disciplina ben delimitada que ens permeti seguir la seva progressióal llarg de la història. El posicionament de l’home davant del seu patrimoni cultural i artísticen cada moment històric, i el respecte per les mostres del passat, defi neix de quina formaes conservarà, o no, i també de quina forma s’hi intervindrà. Per fer un recorregut històriccal tenir en compte tots els aspectes que infl uencien en el fet de conservar i en la forma defer-ho: els gustos artístics del moment, l’evolució social i econòmica de la població i també lavessant funcional, ja sigui en el sentit estrictament pràctic on en el valor espiritual i religiós,que han tingut assignats molts objectes de patrimoni.

Fertirrigação com diferentes doses de NPK e seus efeitos sobre a produção e qualidade de frutos de laranja (Citrus sinensis O.) 'Valência'

O experimento foi realizado na Fazenda Três Irmãos, no município de Pratânia, Estado de São Paulo, com o objetivo de estudar o efeito da fertirrigação com diferentes doses de NPK aplicadas por meio de um sistema de irrigação por microaspersão na cultura da laranja em comparação com a adubação convencional irrigada e não irrigada. A avaliação dos efeitos da irrigação e da fertirrigação na cultura foi feita com base na produção e qualidade dos frutos colhidos, na análise de solo da camada de 0-20 cm e na análise de folhas. Os tratamentos não influenciaram significativamente a produtividade de acordo com a análise estatística realizada, embora se tenha observado uma tendência de maior produtividade nos tratamentos de fertirrigação para uma mesma dose. A análise de qualidade dos frutos não mostrou diferenças significativas entre os tratamentos. Os teores de alguns dos elementos obtidos na análise de solo apresentaram diferenças significativas proporcionadas pela irrigação e/ou modo de aplicação dos fertilizantes à cultura. A análise de folhas diferiu quanto aos teores de Ca, Mg e K.

Teores de nutrientes na folha, qualidade do suco e massa seca de raizes de laranja-"Valência" em função da irrigação e fertirrigação

O presente trabalho foi desenvolvido na Área Experimental de Irrigação da Faculdade de Ciências Agrárias e Veterinárias de Jaboticabal/Unesp, com o objetivo de avaliar o efeito da fertirrigação sobre o teor foliar de macro e de micronutrientes, a massa fresca de raízes e a qualidade do suco de frutos em um pomar de laranja-'Valência'. Os tratamentos utilizados foram: (SI) sem irrigação e adubação com fertilizante sólido parcelado em quatro vezes; (MI-100) fertirrigação por microaspersão com 100% da evapotranspiração; (MI-50) fertirrigação por microaspersão com 50% da evapotranspiração; (G-100) fertirrigação por gotejamento com 100% da evapotranspiração; e (G-50) fertirrigação por gotejamento com 50% da evapotranspiração. Os teores de macro e micronutrientes nas folhas não foram alterados pela irrigação, pelos sistemas de fertirrigação e pela lâmina de água aplicada. A acidez total titulável foi superior no tratamento sem irrigação, e a % de suco no fruto e "ratio" não foram afetadas pelos tratamentos com e sem irrigação. A massa fresca de raiz foi maior nos tratamentos irrigados, porém não foram constatadas para esse parâmetro diferenças entre os sistemas de gotejamento e microaspersão. A maior concentração de raízes ocorreu até 10 cm de profundidade e até 30 cm de distância do emissor.

Efeitos da adubação nitrogenada e potássica na produção e na qualidade de frutos de laranjeira-'Valência'

Os critérios para recomendação de adubação nitrogenada e potássica em pomares cítricos carecem de experimentação regional. O objetivo deste experimento foi avaliar os efeitos de doses combinadas de N e de K2O para a laranjeira-Valência cultivada em solo representativo do município de Adolfo, Norte do Estado de São Paulo, de citricultura desenvolvida. Em delineamento tipo fatorial 3 x 3, com 3 repetições, foram combinadas as doses de 94; 188 e 376 kg ha-1 de N, como nitrato de amônio e 38; 75 e 150 kg ha-1 de K2O, como cloreto de potássio, durante três safras (1997 a 1999). Anualmente, foram feitas avaliações de diagnose foliar para nitrogênio e potássio, de produção e de análise de suco para acidez titulável e teor total de sólidos solúveis. Os dados obtidos mostraram que os pomares mantiveram a produtividade com as doses mínimas de N e de K2O durante os três anos, não havendo resposta em produção às doses crescentes desses nutrientes. Os teores foliares de N e de K mantiveram-se dentro das faixas consideradas adequadas, nos tratamentos com doses mínimas de N e de K2O, nas três safras. Apenas no segundo ano, em que a produção foi diminuída por fatores climáticos, foram observados efeitos significativos de combinações de doses de N e de K2O sobre a acidez e o teor de sólidos solúveis do suco.

Recommendations for term and late preterm infants at risk for perinatal bacterial infection.

Since publication of the initial guidelines for the prevention of group B streptococcal disease in 1996, the incidence of perinatal infection has decreased significantly. Intrapartum antibiotic prophylaxis together with appropriate management of neonates at increased risk for early-onset sepsis not only reduces morbidity and mortality, but also decreases the burden of unnecessary or prolonged antibiotic therapy. This article provides healthcare workers in Switzerland with evidence-based and best-practice derived guidelines for the assessment and management of term and late preterm infants (>34 weeks) at increased risk for perinatal bacterial infection. Management of neonates at increased risk for early-onset sepsis depends on clinical presentation and risk factors. Asymptomatic infants with risk factors for early-onset sepsis should be observed closely in an inpatient setting for the first 48 hours of life. Symptomatic neonates must be treated promptly with intravenous antibiotics. As clinical and laboratory signs of neonatal infection are nonspecific, it is mandatory to reevaluate the need for continued antibiotic therapy after 48 hours.

La influencia de la Constitución Española de 1812 en el constitucionalismo chileno del s. XIX. Un análisis comparado

Aquest treball presenta un anàlisi comparat de la Constitució espanyola de 1812 i les diverses constitucions xilenes del segle XIX. L’objectiu és determinar la influència d’una constitució vigent en ambdós territoris al desenvolupament constitucionalisme xilè posterior. L’estudi es realitza des de tres perspectives: institucional, estructural i literal.

Body size and early growth in appropriate- and large-for-gestational-age infants.

AIMS: To study weight, length, body composition, sleeping energy expenditure (SEE), and respiratory quotient (RQ) at birth and at 5 mo of age in both adequate-for-gestational-age (AGA) and large-for-gestational-age (LGA) subjects; to compare the changes in body weight and body composition adjusting for gender, age, SEE, RQ and several maternal factors; to investigate the contribution of initial SEE and RQ to changes in body weight and body composition. METHODS: Sixty-nine neonates were recruited among term infants in the University Hospital of Verona, Italy. Forty-nine subjects participated until follow-up. At birth and follow-up, weight and length were measured and arm-fat area and arm-muscle area were calculated from triceps and subscapular skinfolds. SEE and RQ were measured by indirect calorimetry. RESULTS: At birth, weight, length, arm-muscle and arm-fat areas were significantly higher in LGA subjects than in AGA subjects. Weight status, SEE and RQ at birth did not explain the relative weight change after adjusting for gestational weight, placental weight, age at follow-up and gender. Arm-fat area and weight/length ratio at birth were negatively associated with relative changes in body weight after adjusting for the above variables (p < 0.05). CONCLUSION: Early growth from birth to 5 mo of life is significantly affected by body size and adiposity at birth. Fatter newborns had a slower growth rate than thinner newborns.