Ca2+ signaling forms part of a possible mechanotransduction pathway by which chondrocytes may alter their metabolism in response to mechanical loading. In this study, a well-characterized model system utilizing bovine articular chondrocytes embedded in 4% agarose constructs was used to investigate the effect of physiological mechanical compressive strain applied after 1 and 3 days in culture. The intracellular Ca2+ concentration was measured by use of the ratiometric Ca2+ indicator indo 1-AM and confocal microscopy. A positive Ca2+ response was defined as a percent increase in Ca2+ ratio above a preset threshold. A significantly greater percentage of cells exhibited a positive Ca2+ response in strained constructs compared with unstrained controls at both time points. In strained constructs, treatment with either Ga3+ or EGTA significantly reduced the number of positive Ca2+ responders compared with untreated controls. These results represent an important step in understanding the physiological role of intracellular Ca2+ in chondrocytes under mechanical compression.

No adverse events occurred with the implementation of bedside feeding tube placement using an ETPD. In addition, SBFT placement with an ETPD by designated ICU RD/RN teams resulted in lower x-ray costs and more timely initiation of enteral feedings compared with blind placement.

Isolated chondrocytes stained with fluo 4-AM and visualized using standard confocal microscopy techniques exhibited Ca2+ transients and oscillations. Decreasing the power of the laser light decreased the percentage of cells exhibiting these Ca2+ signals. Treatment with the antioxidant ascorbate reduced the Ca2+ response, suggesting that it was mediated by light-induced release of reactive oxygen species (ROS). Cell viability 24 h after the 1-h confocal imaging period was ∼90% for cells that were neither fluorescently stained nor subjected to laser excitation. By contrast, fluorescently stained cells imaged for 1 h exhibited greatly reduced viability. Treatment with ascorbate reduced the level of cell death, suggesting that the effect was mediated by release of exogenous ROS associated with the interaction of light and the fluorochrome. Ca2+oscillations were not always associated with cell death, suggesting that separate light-sensitive pathways mediate the two processes. Light-activated Ca2+ signaling may trigger alterations in numerous cell processes and thereby represent an important and hitherto overlooked artifact in fluorescent microscopy of viable cells.

Enteral feedings are an integral part of care for many hospitalized patients. Accessing the gastrointestinal (GI) tract safely and in a timely manner can be challenging. Various techniques and devices to enhance the safety of bedside feeding tube placement are available for clinicians. Three specific devices are highlighted, including the colorimetric CO(2) detector (CCD), a magnetically guided feeding tube (MGFT), and the electromagnetic tube placement device (ETPD). The CO(2) detector is applied to detect the presence or absence of CO(2), thus assisting in correct placement of the feeding tube tip into the GI tract vs the lung. The MGFT uses a magnetic device to manipulate the feeding tube through the GI tract into the small intestine. The ETPD provides real-time visualization of the feeding tube as it progresses into the small intestine. Training and repetition are essential for safe and successful feeding tube placement, and the highlighted devices can contribute to both of these goals.

change in alcohol use over time lead to underestimation of an elevated relative risk. 4 However, we found a clear association between level of alcohol use at conscription and risk of subsequent hospitalisation or death with a diagnosis of alcoholism, alcohol psychosis, or alcohol intoxication, with a significant relative risk of 5.71 for consumers of >15 g ethanol/day, indicating a stability over time. The results also indicate a cardioprotective effect of alcohol use in relatively young men, in whom myocardial infarction is rare. Possible biological mechanisms include an increase in high density lipoprotein cholesterol, a decrease in platelet coagulability, and a decrease in plasma fibrinogen associated with alcohol intake. 1Calculation of the attributable proportions clearly indicated that alcohol consumption had a negative net effect on the subjects' health up to the age of 45. The results support a restrictive alcohol policy and recommendations for little or no alcohol consumption by young men.

No abstract

Summary:Autologous HCT patients often have poor oral intake for 2-4 weeks post transplant. To compare outcomes between patients provided prophylactic total parenteral nutrition (TPN) or an oral diet (OD), 55 well nourished breast cancer/ hematopoietic cell transplantation (HCT) patients were randomized to TPN (n ¼ 27), beginning day À1, or OD (n ¼ 28). Parameters studied include length of stay (LOS), engraftment, infections, survival, weight, anthropometrics, handgrip strength, and quality of life (QOL) In all, 50% of OD patients were given TPN due to poor oral intake for 10 consecutive days. No significant differences were found between the groups for any of the above parameters except weight and anthropometrics, which were better maintained in the TPN group than the OD group. Trends were seen for increased infections, more stable handgrip strength, and improved QOL in the TPN group vs the OD group. Prophylactic TPN did result in a more intact nutritional status and preservation of lean body mass post transplant but did not impact LOS or survival when compared to OD. For this reason, TPN should be reserved for autologous HCT patients with pretransplant nutritional depletion, complications post transplant, or prolonged poor oral intake. These results should not be extrapolated to allogeneic HCT patients but are likely applicable to other well nourished autologous HCT patients. The nutrition problems associated with high-dose chemotherapy and hematopoietic cell transplantation (HCT) are well known. 1-3 Most patients' oral intake is minimal for at least 2-3 weeks post transplant (posttx) and use of total parenteral nutrition (TPN) during this period is common. The preparative regimens utilized at our center typically result in significant pancytopenia and gastrointestinal (GI) toxicities, including mucositis, leading to the intuitive conclusion that TPN is necessary. Weisdorf et al 4 showed that provision of prophylactic TPN was beneficial to marrow transplant recipients. At the time our study was initiated, TPN was a standard of care posttx at our center. However, since HCT for breast cancer (CA) is relatively new, no breast CA patients were included in the aforementioned trial. Also, several advances have been made since that trial was conducted (cytokine growth factors and peripheral blood stem cell transplants), which have shortened the neutropenic period in this patient population, which, in turn, may lead to more rapid return to normal GI function. While currently the use of autologous HCT in breast CA is controversial and not currently carried out at our center, interest in HCT for breast CA still exists. [5][6][7][8] This study was carried out to compare clinical, and nutritional outcomes, as well as sense of well-being and survival, in breast CA patients undergoing HCT randomized to an oral diet vs prophylactic TPN. Patients and methodsA total of 55 females with stage II-IV breast CA undergoing high-dose chemotherapy and HCT were prospectively randomized to an oral diet (OD) (n ¼ 28) or TPN (n ¼ 27). Inst...

Graft-vs-host disease (GVHD) is a major complication after allogeneic hematopoietic stem cell transplantation. Both acute and chronic forms of GVHD are challenging to manage medically and nutritionally. Patients with advanced GVHD commonly become depleted nutritionally, with loss of lean body mass (LBM) and functional status. We present 2 case reports of patients who developed GVHD and subsequent nutrition decline. Although both patients were candidates for specialized nutrition support (SNS), only 1 was able to receive enteral and parenteral nutrition due to GVHD complications preventing access for provision of SNS. Fortunately, the patients have remained in remission from their hematologic malignancy, but they continue to cope with chronic GVHD and its consequences. These cases exhibit the complexity of managing a patient with extensive GVHD and nutrition interventions for clinicians to consider to optimize outcomes.