The impact of multidisciplinary nutritional team involvement on nutritional care and outcomes in a medical intensive care unit.

The aim of this study was to evaluate nutritional care and outcomes in a medical intensive care unit (ICU) following multidisciplinary nutritional team (MNT) involvement. The authors retrospectively reviewed the data of all patients admitted to a medical ICU from April to October 2013 (pre-MNT period) and from April to October 2014 (post-MNT period). In total, 140 patients were included and allocated to the pre-MNT group (n=70) or the post-MNT group (n=70). The post-MNT group was more likely to use enteral nutrition (61.4 vs 37.1%, P=0.002). In terms of total calories and protein provided, the number of nutritional goal-achieved days during stays in ICU was significantly greater in the post-MNT group than in the pre-MNT group (63.7% vs 47.6%, P<0.05 and 44.3% vs 29.9%, respectively, P<0.05). The MNT activities resulted in significant improvements in terms of nutritional provision and adequacy in a medical ICU.

[Poly- ß -Hydroxybutyrate Accumulation by Rhodobacter sphaeroides Phase Variants].

The Rand M variants of a purple photosynthetic bacterium Rhodobacter sphaeroides 2R grown on a medium with acetate accumulate poly- ß-hydroxybutyrate (PHB). Accumulation of this polymer occurs in the cells grown either anaerobically on the light or aerobically in the dark. On the medium with C/N imbalance (C/N = 4), PHB content during the stationary growth phase under aerobic conditions in the dark was 40 and 70% of the dry biomass of the R and M variant, respectively. The Rba. sphaeroides M variant is therefore a promising culture for large-scale PHB production. Investigation of activity of the TCA cycle enzymes revealed that decreased activity of citrate synthase, the key enzyme for acetate involvement in the reactions of the tricarboxylic acids cycle, was primarily responsible for enhanced PHB synthesis by Rba. sphaeroides. Moreover, the Rba. sphaeroides M variant grown under aerobic conditions in the dark exhibited considerably lower activity of NADH oxidase, which participates in the oxidation of reduced NADH produced in the TCA cycle during acetate oxidation. The combination of these two factors increases the possibilities for acetate assimilation via an alternative mechanism of PHB synthesis.

[The process of bacterial population splitting into dissociants and long-term batch cultivation of bacteria].

The growth and composition of a population were studied during long-term (up to 50 days) batch cultivation of mono and mixed cultures of Pseudomonas aeruginosa S- and M-dissociants and Rhodobacter sphaeroides R- and M-dissociants without the addition of nutrients. During the cultivation of P. aeruginosa on a glucose-containing mineral medium, periodic lysis followed by polyculture growth resumption in the late stationary phase occurred on account of the M-dissociant: the change in its cell number corresponded to the change in the total cell number of the association. It was shown that the periodic occurrence of reducing sugars in the medium preceded the resumption ofpolyculture growth.

[metabolism of the phase variants of the phototrophic bacterium Rhodobacter sphaeroides].

Growth, bacteriochlorophyll a content, electron transport chain (ETC), and activities of the tricarboxylic acid (TCA) cycle enzymes were studied in R and M phase variants of Rhodobactersphaeroides cells grown anaerobically in the light and aerobically in the dark. Under all cultivation conditions tested, bacteriochlorophyll a content was 2-3 times lower in the cells of the M. variant compared to the R variant, which therefore was predominant in the cultures grown in the light. In both variants, activity of all TCA cycle enzymes was higher for the cells grown in the dark under aerobic conditions. When grown aerobically in the dark, the R variant, unlike the M variant, did not contain cytochrome aa3, acting as. cytochrome c oxidase, in its ETC. An additional point of coupling the electron transfer to the generation of the proton gradient al the cytochrome aa3 level provided for more efficient oxidation of organic substrates, resulting in predominance of the M variant in the cultures grown in the dark under aerobic conditions.

Ultrasonographic elastography of thyroid nodules: is adding strain ratio to colour mapping better?

AIM: To determine the diagnostic performance of colour mapping and strain ratio for characterizing malignant thyroid nodules on ultrasonographic (US) elastography. MATERIALS AND METHODS: The study was approved by the institutional review board and written informed consent was obtained. One hundred and thirty-one patients with 142 thyroid nodules >0.5 cm were prospectively enrolled between July 2010 and January 2011. Seven radiologists performed US elastography (iU22 Vision 2010; Philips, Seattle, WA, USA) using colour mapping and strain ratio for thyroid nodules blinded to the cytopathological results. Diagnostic performances of colour mapping alone, strain ratio alone, colour mapping and strain ratio, and colour mapping or strain ratio were compared using receiver operating characteristic (ROC) curve analysis. RESULTS: Of the 142 nodules, 69 (48.6%) were benign and 73 (51.4%) were malignant. Colour mapping of elastography showed a more frequent blue colour in malignant nodules than in benign nodules (65.8% versus 24.6%, p < 0.0001). A higher ratio than 1.21 as the best cut-off value was found in 65.8% of malignant nodules and 46.4% of benign nodules (p = 0.030). Area under the ROC curve (AUC) of colour mapping alone was significantly greater than that of colour mapping or strain ratio (AUC = 0.706 versus AUC = 0.63, p = 0.0195) and similar to that of colour mapping and strain ratio (AUC = 0.673, p = 0.1364). CONCLUSION: US elastography is helpful to predict malignant thyroid nodules. However, adding strain ratio to colour mapping does not improve performance compared to colour mapping alone.

Ultrasonography-guided core needle biopsy for the thyroid nodule: does the procedure hold any benefit for the diagnosis when fine-needle aspiration cytology analysis shows inconclusive results?

OBJECTIVE: We evaluated the diagnostic role of ultrasonography-guided core needle biopsy (CNB) according to ultrasonography features of thyroid nodules that had inconclusive ultrasonography-guided fine-needle aspiration (FNA) results. METHODS: A total of 88 thyroid nodules in 88 patients who underwent ultrasonography-guided CNB because of previous inconclusive FNA results were evaluated. The patients were classified into three groups based on ultrasonography findings: Group A, which was suspicious for papillary thyroid carcinoma (PTC); Group B, which was suspicious for follicular (Hurthle cell) neoplasm; and Group C, which was suspicious for lymphoma. The final diagnoses of the thyroid nodules were determined by surgical confirmation or follow-up after ultrasonography-guided CNB. RESULTS: Of the 88 nodules, the malignant rate was 49.1% in Group A, 12.0% in Group B and 90.0% in Group C. The rates of conclusive ultrasonography-guided CNB results after previous incomplete ultrasonography-guided FNA results were 96.2% in Group A, 64.0% in Group B and 90.0% in Group C (p=0.001). 12 cases with inconclusive ultrasonography-guided CNB results were finally diagnosed as 8 benign lesions, 3 PTCs and 1 lymphoma. The number of previous ultrasonography-guided FNA biopsies was not significantly different between the conclusive and the inconclusive result groups of ultrasonography-guided CNB (p=0.205). CONCLUSION: Ultrasonography-guided CNB has benefit for the diagnosis of thyroid nodules with inconclusive ultrasonography-guided FNA results. However, it is still not helpful for the differential diagnosis in 36% of nodules that are suspicious for follicular neoplasm seen on ultrasonography. ADVANCES IN KNOWLEDGE: This study shows the diagnostic contribution of ultrasonography-guided CNB as an alternative to repeat ultrasonography-guided FNA or surgery.

Automated volumetric breast density estimation: a comparison with visual assessment.

AIM: To compare automated volumetric breast density (VBD) measurement with visual assessment according to Breast Imaging Reporting and Data System (BI-RADS), and to determine the factors influencing the agreement between them. MATERIALS AND METHODS: One hundred and ninety-three consecutive screening mammograms reported as negative were included in the study. Three radiologists assigned qualitative BI-RADS density categories to the mammograms. An automated volumetric breast-density method was used to measure VBD (% breast density) and density grade (VDG). Each case was classified into an agreement or disagreement group according to the comparison between visual assessment and VDG. The correlation between visual assessment and VDG was obtained. Various physical factors were compared between the two groups. RESULTS: Agreement between visual assessment by the radiologists and VDG was good (ICC value = 0.757). VBD showed a highly significant positive correlation with visual assessment (Spearman's ρ = 0.754, p < 0.001). VBD and the x-ray tube target was significantly different between the agreement group and the disagreement groups (p = 0.02 and 0.04, respectively). CONCLUSION: Automated VBD is a reliable objective method to measure breast density. The agreement between VDG and visual assessment by radiologist might be influenced by physical factors.

Primary anaplastic lymphoma kinase-negative anaplastic large-cell lymphoma of the breast in a male patient.

Anaplastic large-cell lymphoma is an extremely rare lymphoma subtype. We describe the mammographic and ultrasonographic findings in a 51-year-old male patient who suffered from a palpable lump caused by this rare disease.

[Growth peculiarities of hydrocarbon-oxidizing rhodococcus and pseudomonads dissociates in mono- and mixed cultures].

Growth of R-, S-, and M-dissociates of Rhodococcus rubropertinctus in mixed culture with R-, S-, and M-dissociates of Rhodococcus aeruginosa in comparison with rhodococcus monoculture cultivated on mineral nutrient medium with hexadecane has been studied. The amount of cells in the stationary growth phase has increased 10-15 times in comparison with the monoculture, and pseudomonads which dominated in population, in associations of M-dissociate of R. rubropertinctus with any dissociate of R. aeruginosa or two S-dissociates in the studied bacterial species. The emulsifying ability of the cells (maximal in R-dissociates), the synthesis of surface active compounds in pseudomonads, which is maximal in M-dissociate had the main influence on the growth of rhodococci on the nutrient medium with hydrocarbons.

[Development and population structure of mixed (S + M) Pseudomonas aeruginosa cultures in the late stationary growth phase].

Population growth, the ratio between dissociants, pH, and levels of reducing sugars in the medium were monitored during prolonged (375 h) batch cultivation of Pseudomonas aeruginosa S and M dissociants on mineral medium with glucose. During the stationary growth phase (100-375 h), two scenarios were possible. The first one included extensive cell autolysis coupled to alkalinization of the medium and an increased ratio of the M dissociant. In the second case, acidification of the medium was coupled to the oscillating secondary growth, mostly of the M dissociant; the dynamics of cell numbers of this dissociant correlated with the dynamics of the culture optical density. In this scenario, periodical appearance of reducing sugars in the medium was detected; it was in the opposite phase with the changes of the M dissociant cell numbers. The differences between scenarios of P. aeruginosa growth in the late stationary phase were probably due to the physiological and biochemical characteristics of the S and M dissociants, including different pathways of glucose utilization (respiration or fermentation), resistance to acidification, synthetic (proteolytic) activity, and productivity of autoinducers.

[Cultivation of Pseudomonas aeruginosa dissociants under specified limitation conditions].

The possibility of controlling the development of microbial communities was investigated on the basis of experimentally determined requirements for basic nutrients in R, S, and M dissociants of Pseudomonas aeruginosa. On media with the limitation conditions preset on the basis of the predictions of a mathematical model, exhaustion of glucose was experimentally confirmed for all monocultures and mixed cultures, as well as balanced consumption of glucose, nitrogen, and phosphorus by the R dissociant at the corresponding initial medium composition. The experimentally determined composition of mixed cultures was found to conform to the ones calculated using the mathematical model. The data obtained suggest the possibility of cyclic consumption of phosphorus by P. aeruginosa.

[Autoregulation of phenotypic dissiciation in Bacillus licheniformis].

Regulation of phenotypic variability of Bacillus licheniformis mediated by autoinducers of anabiosis, d1-factors was investigated. These factors are represented by alkylhydroxybenzenes. Colonial morphological variants of B. licheniformis were obtained and described (of R,S,M-types) in the first passage of both vegetative proliferative and resting cells. Resting cells were of different type, spores and cyst-like refractile cells induced by autoinducers of anabiosis. The possibility to manage the spectrum of dissociants by the mean of autoinducers of anabiosis was demonstrated.

[Dynamics of the growth and population composition of the mixed cultures of R, S, and M dissociants of Pseudomonas aeruginosa].

The population composition of polycultures of Pseudomonas aeruginosa dissociants (R + M and R + S + M) developing on media with various contents and ratios of nitrogen and phosphorus has been studied. Irrespective of its proportion (10 to 90%) in the inoculum, the R variant accounted for 65 to 84% of the whole population of linear-phase and stationary-phase binary cultures of R and M dissociants, which differ in terms of energy metabolism and nutritional requirements. After prolonged cultivation, the population in the binary culture contained only R cells (100%), which are characterized by minimum requirements with respect to the main biogenic elements. These data agree with the predictive data of model studies and can be attributed to regulation of the population composition of bacterial cultures by trophic factors. It was established that the proportion of M cells, which are distinguished by maximum nutrient requirements and enhanced stability, increased during two developmental stages of the Ps. aeruginosa polycultures (R + M and R + S + M): the lag phase and the decay stage. This result cannot be due to the influence of trophic factors and presumably results from changes in the levels of autoregulatory factors (anabiosis autoinducers) involved in stress resistance and plausibly in the adaptive interconversion of dissociants upon transfer to a new medium (during the lag phase) and under starvation conditions (at the onset of the decay phase).

[Effect of major nutrient elements on the growth and population homogeneity of the R, S and M dissociants of Pseudomonas aeruginosa and the glucose oxidation and fermentation pathways]. / Vliianie kontsentratsii osnovnykh biogennykh élementov na dinamiku rosta i sostav populiatsii R-, S- i M-dissotsiantov Pseudomonas aeruginosa i puti ispol'zovaniia imi gliukozy: okisleniie i brozhenie.

The population homogeneity of the stationary-phase monocultures of Pseudomonas aeruginosa dissociants was studied as a function of the initial content of major nutrient elements (C, N, and P) in the cultivation medium. The monocultures of the dissociants remained homogeneous during cultivation if the initial concentrations of the major nutrient elements were either sufficiently high or, conversely, very low, but became heterogeneous during cultivation in unbalanced (with respect to the major nutrient elements) media. At the initial concentration of nitrate in the medium equal to 0.07% or phosphate equal to 0.004-0.014%, the initially homogeneous population of R dissociant cultivated to the stationary growth phase turned out to contain 30-40% of S-type cells, whereas the initially homogeneous population of S dissociant was found to contain 50-80% of M-type cells. The population of M dissociant remained homogeneous throughout the cultivation period. R dissociant grew better at sufficiently high concentrations of glucose, nitrate, and phosphate in the medium, whereas M dissociant grew better when the initial concentrations of these nutrients were low. During the cultivation of R dissociant, the pH of the medium changed insignificantly, and the C/P ratio (the ratio of the carbon and phosphorus consumed during growth) was minimal (among the three dissociants), indicating that the R dissociant accomplishes the oxidative pathway of glucose metabolism. During the cultivation of the M dissociant, the pH of the medium dropped to 3.4-3.9, and the C/P ratio was maximal, indicating that this dissociant accomplishes the fermentative pathway of glucose metabolism. During the cultivation of the S dissociant, the pH of the medium and the C/P ratio exhibited variations, indicating that this dissociant triggers its pathways of glucose metabolism.

[The requirements of Pseudomonas aeruginosa dissociants for carbon, nitrogen, and phosphorus]. / Opredelenie potrebnosti dissotsiantov Pseudomonas aeruginosa v uglerode, azote i fosfore.

Quantitative data on the nutritional requirements of microorganisms are necessary to predict the behavior of bacterial populations and to control their cultivation. The requirements of the R, S, and M dissociants of Pseudomonas aeruginosa for carbon, nitrogen, and phosphorus were derived from the results of 88 cultivation experiments. For each of the dissociants, we derived a coefficient that relates the optical density and the number of cells in the dissociant culture, determined the time when the cultures entered the stationary growth phase, studied cultural changes induced by transfer to the stationary phase, and determined what nutrients limit the growth of particular dissociants. The nutritional requirements of the dissociants are discussed in relation to our earlier data.

[Requirements of Pseudomonas aeruginosa dissociants in glucose, nitrate, and phosphate. Limiting concentrations of the nutrients during batch cultivation]. / Potrebnosti dissotsiantov Pseudomonas aeruginosa v gliukoze, nitratakh i fosfatakh. Limitiruiushchie rost kontsentratsii veshchestv pri kul'tivirovanii bez popolneniia zapasa resursov.

Requirements of R-, S-, and M-dissociants of Pseudomonas aeruginosa K-2 strain in glucose, nitrate, and phosphate, as well as the error of determination, have been calculated from the data of 250 experiments on their batch cultivation on the media with the various initial content of these resources. The resource requirements of R- and S-dissociants appear indistinguishable within the error limits. The requirements of M-dissociant significantly differ from those of R- and S-forms; however, due to specific growth of the M-form, the confidence intervals of the measured values can overlap with those of R-space and S-forms. The obtained requirement values allow an evaluation of the studied resources concentration limiting the culture growth.

[Effect of reduced concentrations of carbon, nitrogen, and phosphorus in a medium on growth of three dissociants of Pseudomonas aeruginosa]. / Vliianie ponizhennykh kontsentratsii ugleroda, azota i fosfora v srede na dinamiku rosta trekh dissotsiantov Pseudomonas aeruginosa.

The effect of lowered concentrations of carbon, nitrogen, and phosphorus sources in the medium on the specific growth rate mu of the R, S, and M dissociants of the hydrocarbon-oxidizing strain Pseudomonas aeruginosa K-2, culture pH, and the population composition was studied. Within the first 16 hours of cultivation in all of the four media tested, the R, S, and M dissociants had virtually identical mu. The maximal values of mu were reached by the 20th h of growth in the basal medium (R and S dissociants) and in the carbon-deficient medium containing 0.4% glucose (M dissociant). The R and M dissociants showed the most rapid decrease in mu in the nitrogen-deficient medium containing 0.55% NaNO3. By the end of cultivation in the basal medium, the pH of the R, S, and M cultures decreased to 6.3, 5.3, and 3.3, respectively. In the case of the carbon-deficient medium, the drop in the culture pH was lower. After a 2.5-day incubation of the S dissociant in the phosphorus-deficient medium containing 0.028% NaH2PO4.2H2O and of the M dissociant in the basal medium supplemented with chalk powder, these dissociants were completely displaced from the media.