To clarify the relationship between malnutrition and dysphagia following stroke.
Systematic review.
All published trials that had examined both the swallowing ability and nutritional status of ...subjects following stroke were identified. Pooled analyses were performed to establish whether the odds of being malnourished were increased given the presence of dysphagia.
Eight studies were identified. The presence of malnutrition and dysphagia ranged from 8.2% to 49.0% and 24.3% to 52.6%, respectively. Five of the included trials were conducted within the first 7 days following stroke, while 3 were conducted during the rehabilitation phase. The overall odds of being malnourished were higher among subjects who were dysphagic compared with subjects with intact swallowing (odds ratio: 2.425; 95% confidence interval: 1.264-4.649, p < 0.008). In subgroup analysis, the odds of malnutrition were significantly increased during the rehabilitation stage (odds ratio: 2.445; 95% confidence interval: 1.009-5.925, p < 0.048), but not during the first 7 days of hospital admission (odds ratio: 2.401; 95% confidence interval: 0.918-6.277, p < 0.074).
In a systematic review including the results from 8 studies, the odds of being malnourished were increased given the presence of dysphagia following stroke.
Pathogen evolution and subsequent phenotypic heterogeneity during chronic infection are proposed to enhance Staphylococcus aureus survival during human infection. We tested this theory by genetically ...and phenotypically characterizing strains with mutations constructed in the mismatch repair (MMR) and oxidized guanine (GO) system, termed mutators, which exhibit increased spontaneous-mutation frequencies. Analysis of these mutators revealed not only strain-dependent increases in the spontaneous-mutation frequency but also shifts in mutational type and hot spots consistent with loss of GO or MMR functions. Although the GO and MMR systems are relied upon in some bacterial species to prevent reactive oxygen species-induced DNA damage, no deficit in hydrogen peroxide sensitivity was found when either of these DNA repair pathways was lost in S. aureus. To gain insight into the contribution of increased mutation supply to S. aureus pathoadaptation, we measured the rate of α-hemolysin and staphyloxanthin inactivation during serial passage. Detection of increased rates of α-hemolysin and staphyloxanthin inactivation in GO and MMR mutants suggests that these strains are capable of modifying virulence phenotypes implicated in mediating infection. Accelerated derivation of altered virulence phenotypes, combined with the absence of increased ROS sensitivity, highlights the potential of mutators to drive pathoadaptation in the host and serve as catalysts for persistent infections.
We report on observations of a gamma-ray burst (GRB 061126) with an extremely bright (R approximately 12 mag at peak) early-time optical afterglow. The optical afterglow is already fading as a power ...law 22 s after the trigger, with no detectable prompt contribution in our first exposure, which was coincident with a large prompt-emission gamma-ray pulse. The optical-infrared photometric SED is an excellent fit to a power law, but it exhibits a moderate red-to-blue evolution in the spectral index at about 500 s after the burst. This color change is contemporaneous with a switch from a relatively fast decay to slower decay. The rapidly decaying early afterglow is broadly consistent with synchrotron emission from a reverse shock, but a bright forward-shock component predicted by the intermediate- to late-time X-ray observations under the assumptions of standard afterglow models is not observed. Indeed, despite its remarkable early-time brightness, this burst would qualify as a dark burst at later times on the basis of its nearly flat optical-to-X-ray spectral index. Our photometric SED provides no evidence of host galaxy extinction, requiring either large quantities of gray dust in the host system (at redshift 1.1588 plus or minus 0.0006, based on our late-time Keck spectroscopy) or separate physical origins for the X-ray and optical afterglows.
This study was conducted to investigate the effect of dextrose, starch, NDF, and a carbohydrate (CHO) mix on utilization of ruminal ammonia in dairy cows. Four ruminally and duodenally cannulated ...Holstein cows (BW = 788 ± 31 kg; 217 ± 35 d in milk) were allocated to four treatments in a 4 x 4 Latin square design trial. Cows were fed an all alfalfa diet at 12-h intervals (DMI = 22.2 ± 0.25 kg/d). Treatments were control, white oat fiber (NDF); corn dextrose (GLU); cornstarch (STA); and a CHO mix (25% of each): apple pectin, GLU, STA, and NDF (MIX). Carbohydrates were introduced intraruminally during feeding at 20% of dietary DMI. Ruminal ammonia was labeled with ¹⁵N. Ruminal pH was the highest for NDF followed by STA and MIX and GLU (P < 0.001). Ruminal ammonia concentration and pool size were decreased by GLU and STA compared with NDF (P < 0.001 and P = 0.03, respectively). Acetate, isobutyrate, isovalerate, and total VFA concentration in the rumen were decreased (P = 0.009 to 0.001), and butyrate was increased (P < 0.001) by GLU compared with the other CHO. Microbial N flow to the duodenum was decreased (P < 0.05) by NDF compared with the other CHO, and the flow of microbial N formed from ammonia was greater for STA compared with GLU and NDF (P = 0.04 and 0.03, respectively). Urinary N loss was decreased (P = 0.05) by GLU and STA, but overall (feces plus urine) N losses were not affected (P = 0.73) by treatment. Milk urea concentration was lowered by GLU and STA compared with NDF and MIX (P = 0.002). The proportion of bacterial N synthesized from ammonia in the rumen was greater with STA than with NDF and MIX and was least for GLU (P = 0.02). Irreversible ammonia loss and flux were lower (P = 0.09 and 0.02, respectively) for GLU than for STA and NDF. As a percentage of the dose given, cumulative secretion of ¹⁵N ammonia in milk protein was greater for STA than for GLU or NDF (P = 0.01 and 0.001, respectively). This experiment demonstrated that provision of readily fermentable energy can decrease ammonia concentrations in the rumen through decreased ammonia production (GLU), or through enhanced uptake of ammonia for microbial protein synthesis (STA). Rapidly fermentable energy in the rumen decreased ammonia production and flux, but the overall efficiency of ammonia utilization for milk protein synthesis was only increased by enhancing ruminal microbial ammonia uptake.
Summary
Background
Inhalational antigen tolerance typically protects against the development of allergic airway disease but may be overcome to induce allergic sensitization preceding the development ...of asthma.
Objectives
We examined in vivo whether pre‐existing inhalational antigen tolerance could be overcome by activation of the transcription factor NF‐κB in conducting airway epithelial cells, and used a combination of in vivo and in vitro approaches to examine the mechanisms involved.
Methods
Wild‐type and transgenic mice capable of expressing constitutively active IκB kinase β (CAIKKβ) in airway epithelium were tolerized to inhaled ovalbumin. Twenty‐eight days later, the transgene was transiently expressed and mice were exposed to inhaled OVA on Day 30 in an attempt to overcome inhalational tolerance.
Results
Following ovalbumin challenge on days 40–42, CAIKKβ mice in which the transgene had been activated exhibited characteristic features of allergic airway disease, including airway eosinophilia and methacholine hyper‐responsiveness. Increases in the CD103+ and CD11bHI lung dendritic cell populations were present in CAIKKβ mice on Day 31. Bronchoalveolar lavage from mice expressing CAIKKβ mice induced CD4+ T cells to secrete TH2 and TH17 cytokines, an effect that required IL‐4 and IL‐1 signalling, respectively. CAIKKβ mice on Dox demonstrated increased numbers of innate lymphoid type 2 cells (ILC2) in the lung, which also exhibited elevated mRNA expression of the TH2‐polarizing cytokine IL‐4. Finally, airway epithelial NF‐kB activation induced allergic sensitization in CAIKKβ mice on Dox that required IL‐4 and IL‐1 signalling in vivo.
Conclusions
Our studies demonstrate that soluble mediators generated in response to airway epithelial NF‐κB activation orchestrate the breaking of inhalational tolerance and allergic antigen sensitization through the effects of soluble mediators, including IL‐1 and IL‐4, on pulmonary dendritic cells as well as innate lymphoid and CD4+ T cells.
To examine the relationship between substance use, other health risk behaviors, and sexual victimization among adolescent females.
A cross-sectional telephone survey of 16–20-year-olds, including 647 ...female “ever drinkers” (1999) and 1236 female “never drinkers” and “ever drinkers” (2000) from 17 states, was conducted as part of the National Evaluation of the Enforcing Underage Drinking Laws Program. The survey assessed underage alcohol use, sexual victimization, and other risky behaviors. Logistic regression modeling was used to measure the association among sexual victimization, substance use, and other risk behaviors.
In 1999, 8.2% and in 2000, 7.1% of the participants reported having experienced actual or attempted sex against their will. Logistic regression analyses revealed that binge drinking in the past 2 weeks (1999), age at first drink (2000), sex without birth control (1999 and 2000), marijuana use in the past 30 days (1999 and 2000), and ever having been in a fight (2000) were associated with sexual victimization.
Indicators of substance abuse and other health risk behaviors were strongly associated with sexual victimization among adolescent females. Implications for the direction of causal relationships are discussed.
Summary Background Inhalational antigen tolerance typically protects against the development of allergic airway disease but may be overcome to induce allergic sensitization preceding the development ...of asthma. Objectives We examined in vivo whether pre-existing inhalational antigen tolerance could be overcome by activation of the transcription factor NF-kappaB in conducting airway epithelial cells, and used a combination of in vivo and in vitro approaches to examine the mechanisms involved. Methods Wild-type and transgenic mice capable of expressing constitutively active IkappaB kinase beta (CAIKKbeta) in airway epithelium were tolerized to inhaled ovalbumin. Twenty-eight days later, the transgene was transiently expressed and mice were exposed to inhaled OVA on Day 30 in an attempt to overcome inhalational tolerance. Results Following ovalbumin challenge on days 40-42, CAIKKbeta mice in which the transgene had been activated exhibited characteristic features of allergic airway disease, including airway eosinophilia and methacholine hyper-responsiveness. Increases in the CD103+ and CD11bHI lung dendritic cell populations were present in CAIKKbeta mice on Day 31. Bronchoalveolar lavage from mice expressing CAIKKbeta mice induced CD4+ T cells to secrete TH2 and TH17 cytokines, an effect that required IL-4 and IL-1 signalling, respectively. CAIKKbeta mice on Dox demonstrated increased numbers of innate lymphoid type 2 cells (ILC2) in the lung, which also exhibited elevated mRNA expression of the TH2-polarizing cytokine IL-4. Finally, airway epithelial NF-kB activation induced allergic sensitization in CAIKKbeta mice on Dox that required IL-4 and IL-1 signalling in vivo. Conclusions Our studies demonstrate that soluble mediators generated in response to airway epithelial NF-kappaB activation orchestrate the breaking of inhalational tolerance and allergic antigen sensitization through the effects of soluble mediators, including IL-1 and IL-4, on pulmonary dendritic cells as well as innate lymphoid and CD4+ T cells.
Notoedric mange, caused by obligately parasitic sarcoptiform Notoedres mites, is associated with potentially fatal dermatitis with secondary systemic disease in small mammals, felids and procyonids ...among others, as well as an occasional zoonosis. We describe clinical spectra in non-chiropteran hosts, review risk factors and summarize ecological and epidemiological studies. The genus is disproportionately represented on rodents. Disease in felids and procyonids ranges from very mild to death. Knowledge of the geographical distribution of the mites is highly inadequate, with focal hot spots known for Notoedres cati in domestic cats and bobcats. Predisposing genetic and immunological factors are not known, except that co-infection with other parasites and anticoagulant rodenticide toxicoses may contribute to severe disease. Treatment of individual animals is typically successful with macrocytic lactones such as selamectin, but herd or wildlife population treatment has not been undertaken. Transmission requires close contact and typically is within a host species. Notoedric mange can kill half all individuals in a population and regulate host population below non-diseased density for decades, consistent with frequency-dependent transmission or spillover from other hosts. Epidemics are increasingly identified in various hosts, suggesting global change in suitable environmental conditions or increased reporting bias.
Carbon monoxide (CO) poisoning may result in white matter hyperintensities (WMH) and neurocognitive impairments.
To assess in a prospective study WMH in CO-poisoned patients and their relationship to ...cognitive functioning.
Seventy-three consecutive CO-poisoned patients were studied. MR scans and neurocognitive tests were administered on day 1 (within 36 hours after CO poisoning), 2 weeks, and 6 months. Age- and sex-matched control subjects for white matter analyses only were obtained from the authors' normative imaging database. MR scans were rated for WMH in the periventricular and centrum semiovale regions, using a 4-point rating scale. Two independent raters rated the scans, and a consensus was reached.
Thirty percent of CO-poisoned patients had cognitive sequelae. Twelve percent of the CO-poisoned patients had WMH, with significantly more periventricular, but not centrum semiovale, WMH than control subjects. The WMH in CO-poisoned patients did not change from day 1 to 6 months. Centrum semiovale hyperintensities were related to worse cognitive performance. Duration of loss of consciousness correlated with cognitive impairment at all three times. Initial carboxyhemoglobin levels correlated with loss of consciousness but not with WMH or cognitive sequelae.
CO poisoning can result in brain injury manifested by WMH and cognitive sequelae. The WMH were not related to CO poisoning severity. The WMH occurred in both the periventricular and the centrum semiovale regions; however, only those in the centrum semiovale were significantly associated with cognitive impairments.
The sensation of pressure allows us to feel sustained compression and body strain. While our understanding of cutaneous touch has grown significantly in recent years, how deep tissue sensations are ...detected remains less clear. Here, we use quantitative sensory evaluations of patients with rare sensory disorders, as well as nerve blocks in typical individuals, to probe the neural and genetic mechanisms for detecting non-painful pressure. We show that the ability to perceive innocuous pressures is lost when myelinated fiber function is experimentally blocked in healthy volunteers and that two patients lacking Aβ fibers are strikingly unable to feel innocuous pressures at all. We find that seven individuals with inherited mutations in the mechanoreceptor PIEZO2 gene, who have major deficits in touch and proprioception, are nearly as good at sensing pressure as healthy control subjects. Together, these data support a role for Aβ afferents in pressure sensation and suggest the existence of an unknown molecular pathway for its detection.
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