Constipation in specialized palliative care: factors related to constipation when applying different definitions.

CONTEXT: For patients in palliative care, constipation is primarily a result of opioid treatment. Impacts from other factors related to constipation in palliative care are rarely studied. OBJECTIVES: The aim was to identify factors related to constipation in patients in palliative care, and then to compare these factors between patients with different types of constipation and patients without constipation. METHODS: Cross-sectional data on constipation was collected with a 26-item questionnaire from 485 patients in 38 specialist palliative care units in Sweden. Three different constipation groups were used; MC ONLY, PC ONLY, and MC & PC. Logistic regression analyses were used to calculate odds ratios. RESULTS: Patients with <3 defecations/week, MC ONLY, (n = 36) had higher odds of being hospitalized, bed-restricted, in need of personal assistance for toilet visits, and of having a poor fluid intake. Patients with the perception of being constipated, PC ONLY, (n = 93) had higher odds of having poor appetite, hemorrhoids, hard stool, more opioid treatment, less laxative treatment and of being more dissatisfied with constipation information. Patients with both <3 defecations/week and a perception of being constipated, MC & PC, (n = 78) had higher odds of having cancer- disease. CONCLUSION: There were several significant factors related to constipation with higher odds than opioid- treatment, for patients in palliative care, such as; hard stool, cancer diagnosis, dissatisfaction with information, low fluid intake, hemorrhoids, bed restriction, hospitalization, and need of personal assistance for toilet visits.

Autophagosome-associated variant isoforms of cytosolic enzymes.

In a search for autophagosome-associated proteins, two-dimensional gel separations of proteins from purified autophagosomes, postnuclear supernatant, cytosol, lysosomes, mitochondria, endosomes and a cytomembrane fraction (mostly endoplasmic reticulum) were compared. Three proteins, with monomeric molecular masses of 43, 35 and 31 kDa, were enriched in total or sedimentable fractions of autophagosomes relative to the corresponding fractions of postnuclear supernatant, suggesting an association with the autophagosomal delimiting membrane. These proteins were also present on lysosomal membranes, but they were absent from mitochondria, and detected only in small amounts in the cytomembrane fraction and in endosomes, indicating that they were not associated with organelles sequestered by autophagy. However, all three proteins were present in the cytosol, suggesting that they were cytosolic proteins binding peripherally to the delimiting membrane of autophagosomes, probably to its innermost surface as indicated by their resistance to treatment of intact autophagosomes with proteinase or protein-stripping agents. Amino acid sequencing identified these proteins as an isoform of argininosuccinate synthase, an N-truncated variant of glyceraldehyde-3-phosphate dehydrogenase, and a sequence variant of short-chain 2-enoyl-CoA hydratase.

Ultrastructural characterization of the delimiting membranes of isolated autophagosomes and amphisomes by freeze-fracture electron microscopy.

The delimiting membranes of isolated autophagosomes from rat liver had extremely few transmembrane proteins, as indicated by the paucity of intramembrane particles in freeze-fracture images (about 20 particles/microm2, whereas isolated lysosomes had about 2000 particles/microm2). The autophagosomes also appeared to lack peripheral surface membrane proteins, since attempts to surface-biotinylate intact autophagosomes only yielded biotinylation of proteins from contaminating damaged mitochondria. All the membrane layers of multilamellar autophagosomes were equally particle-poor; the same was true of the autophagosome-forming, sequestering membrane complexes (phagophores). Isolated amphisomes (vacuoles formed by fusion between autophagosomes and endosomes) had more intramembrane particles than the autophagosomes (about 90 particles/microm2), and freeze-fracture images of these organelles frequently showed particle-rich endosomes fusing with particle-poor or particle-free autophagosomes. The appearence of multiple particle clusters suggested that a single autophagic vacuole could undergo multiple fusions with endosomes. Only the outermost membrane of bi- or multilamellar autophagic vacuoles appeared to engage in such fusions.

The role of nasal chemical senses in garter snake response to airborne odor cues from prey.

Garter snakes increase tongue-flick rates in the presence of airborne odorants (amyl acetate, limonene, earthworm wash vapor, fish water vapor, earthworms, goldfish) but not water vapor. Main olfactory (MO) nerve lesions result in loss of this tongue-flick rate elevation in the presence of airborne odorants. Vomeronasal (VN) nerve lesions result in a diminution of tongue-flick rate elevation. Garter snakes discriminate between the 2 arms of a maze containing airborne earthworm odor as compared with a blank control. Following MO nerve lesions, snakes fail to make this discrimination. Following VN nerve lesions or VN duct suture, snakes are initially able to make the discrimination but may eventually cease to prefer the prey-odor side of the maze and may stop eating prey rewards. These results support the idea that airborne odorants are detected by the main MO system and that such detection does not require a functional VN system.

Metal particles and tissue changes adjacent to miniplates. A retrieval study.

Peri-implant soft tissue and bone from 12 patients undergoing removal of stainless steel miniplates and screws after healing of jaw fractures were studied with regard to histomorphology and metal content. Three patients with titanium plates were also included. Light microscopy and scanning electron microscopy with energy-dispersive X-ray microanalysis were used. Non-osseous tissue adjacent to devices of both materials showed fibrosis, including areas of mild chronic inflammation. The cellular picture was dominated by fibroblasts with small aggregates of lymphocytes and scattered macrophages. A connective tissue collar was found between the bone tissue and the screws of both stainless steel and titanium. Bone formation was also evident adjacent to screws of both materials. Stainless steel or titanium particles 5-50 microns in diameter were found in both soft tissue and bone next to implants of their corresponding bulk material. The amount of metal impregnation varied between individual sections, and fewer particles were found in the bone specimens than in soft tissue. The mild inflammatory changes were not restricted to areas of metal impregnation.

Nickel and iron in saliva of patients with fixed orthodontic appliances.

Saliva was obtained from patients receiving treatment with fixed orthodontic appliances. One saliva sample was taken without appliances, and another at least 3 weeks after placement. In some patients samples were also taken immediately after insertion of the appliance. Nickel and iron were quantified by electrothermal atomic absorption spectroscopy. There was a large scatter in the results. No statistically significant differences were found either in the concentrations or in absolute masses of nickel or iron in samples taken without appliances and in those obtained when the appliances had been in the mouth for at least 3 weeks. For samples taken immediately after placement of the appliance, there was a significant increase in both concentrations and masses of nickel and iron. It thus seems that there is a high initial release of metals, and the effect diminishes with time.

Porosity of rat femora following intramedullary reaming and nailing.

The present study evaluated cortical porosity and thickness of intact rat femora 12 weeks after intramedullary reaming and nailing. The right femora were reamed and received either flexible polyacetal nails or rigid stainless steel nails. A third group was reamed but not nailed. The left femora were used as controls. The anterior cortical wall was analyzed at the mid-diaphyseal level. Neither reaming nor reaming combined with nailing influenced porosities with a diameter less than 10 microns. For larger pores, polyacetal nailing doubled the porosity, whereas steel nails increased porosity by a factor of 4.5. A slightly increased porosity was observed for the reamed group. Reduced cortical thickness was found in both nailed groups, whereas cortical thickness was increased in the reamed group compared with the control side. Implantation of rigid and flexible intramedullary nails in rat femora increased porosity along the anterior cortical wall.

The effect of abrasion on corrosion of dental Co-Cr alloys. An in vitro study.

The effect of abrasion on corrosion of two dental Co-Cr alloys was investigated in vitro. The metals were abraded with a toothbrush and with a piece of tooth enamel. Changes in corrosion potentials and metal release due to the abrasion were measured. Abrasion by tooth enamel caused a persistent drop in corrosion potentials. The release of both chromium and, in particular, cobalt was higher than during brushing. The two alloys tested did not significantly differ with regard to mode and rate of corrosion. It was demonstrated that the corrosion behavior of electrochemically passive dental alloys was affected by abrasion of a magnitude normally encountered during clinical service.

Metal release from cobalt-chromium partial dentures in the mouth.

The amounts of cobalt and chromium released to the saliva in individuals wearing cobalt-chromium partial dentures have been measured. Saliva was collected during a 5-min period, both with and without dentures in the mouth, and the two samples compared. More than 80% of the 30 cases showed increased amounts of metals with the denture in the mouth. Newer and larger dentures liberated more than did older and smaller ones. The median increase in chromium was approximately twice that of cobalt.

Corrosion of silver soldered orthodontic wires.

The amounts of metals liberated from silver soldered stainless steel and cobalt-chromium orthodontic wires were measured. Measurements were taken after 3 days and 24 days immersion in 0.9% sodium chloride solution. High amounts of copper and zinc and some cadmium from the silver solder were found. The silver soldered stainless steel wire corroded more than the cobalt-chromium type, and liberated more nickel and chromium than did the cobalt-chromium wires.

Fast neutron and x-ray induced single strand DNA breaks in cultured mammalian cells.

The relative biologic effectiveness (RBE) of fast neutrons in the production of single strand DNA breaks is 1.6 as compared to that of 250 kVp x rays. Monolayers of L-929 cells were treated with dinitrophenol during irradiation to prevent the DNA strands from rejoining; the extent of DNA damage was measured by the alkaline sucrose sedimentation method. The RBE for DNA damage is essentially the same as the RBE measured by cell survival methods.

A fast neutron source for cultured cell irradiation.

Because of recent interest in the use of neutrons for radiotherapy, there has been an increased interest in the radiology of neutrons. In this irradiated cell study, a 1.3 MeV accelerator produced beam currents over 100 muA on the water-cooled 3-mm thick beryllium disk target. The monolayer of irradiated cells was neutron-shielded by about 700 kg of paraffin. The neutron energy spectrum for the 9Be(d,n)10B reaction was obtained, with an average neutron energy calculated to be between 3.3 and 3.5 MeV, and an average linear energy transfer calculated at more than 30 keV/micron.

Survival of mouse L-929 cells following neutron irradiation.

Mouse L-929 cells were exposed in a monolayer to x rays and to a 3.5 MeV neutron beam for comparison of damage effects. Single dose experiments showed a radiobiological effectiveness of 1.5 for neutrons when compared to x rays. Both single and paired dose experiments indicated that the cells were unable to repair neutron-induced damage. Dinitrophenol was found to increase the survival of those cells irradiated with neutrons.