Hemodialysis catheter integrity during mechanical power injection of iodinated contrast medium for computed tomography angiography.

PURPOSE: CT angiography (CTA) requires vascular access with flow rates of 5-7 mL/s. Hemodialysis (HD) is performed at 6-10 mL/s. The purpose of our study is to evaluate the structural integrity of HD catheters in the administration of contrast media via a mechanical power injector under varying conditions. METHODS: Four HD catheters were evaluated in an in vitro study. Tested were contrast media type (iopamidol 300 and 370 mgI/mL), temperature (25 and 37 °C), catheter diameter (14 Fr to 16 Fr all with double-lumen capacity), catheter length (19-32 cm), and simultaneous double-lumen or single-lumen injection within each of the catheters. Peak plateau pressures (psi) were recorded with flow rates from 5 to 20 mL/s in 5 mL/s increments. In total, 864 unique injections were performed. RESULTS: No catheter failure (bulging/rupture) was observed in 864 injections. Maximum pressure for single-lumen injection was 51.7 psi (double-lumen: 26.3 psi). Peak pressures were significantly lower in simultaneous double-lumen vs. single-lumen injections (p < 0.001) and low vs. high viscosity contrast media (p < 0.001). Neither larger vs. smaller diameter lumens (p = 0.221) nor single-lumen injection in arterial vs. venous (p = 0.834) were significantly different. CONCLUSION: HD catheters can be used to safely administer iodinated contrast media via mechanical power injection in in vitro operating conditions. Maximum peak pressure is below the manufacturer's 30 psi limit at flow rates up to 20 mL/s in double-lumen injections and up to 10 mL/s in single-lumen injections, which is higher than the usual maximum of 8 mL/s for CT angiography in clinical settings.

Proton Pump Inhibitor Use Is Associated with an Increased Frequency of New or Worsening Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation.

PURPOSE: To determine whether proton pump inhibitor (PPI) use increases the rate of new or worsening hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS: In this retrospective study, 284 of 365 patients who underwent TIPS creation from January 1, 2005, to December 31, 2016, were analyzed (186 male, mean age 56 y, range 19-84 y). Dates of PPI use and dates of new or worsening HE, defined as hospitalization or escalation in outpatient medical management, were extracted from medical records. Mixed-effects negative binomial regression was used to test for an association between PPI usage and HE. RESULTS: After TIPS creation, among 168 patients on PPIs chronically, there were 235 episodes of new or worsening HE in 106,101 person-days (0.81/person-year). Among 55 patients never on PPIs, there were 37 episodes in 31,066 person-days (0.43/person-year). Among 61 patients intermittently taking PPIs, there were 78 episodes in 37,710 person-days while on PPIs (0.75/person-year) and 25 episodes in 35,678 person-days while off PPIs (0.26/person-year). In univariate regression, PPI usage was associated with a 3.34-fold increased rate of new or worsening HE (incidence rate ratio [IRR] 3.34; P < .001). In multivariate regression, older age (IRR 1.05; P < .001), male sex (IRR 1.58; P = .023), higher Model for End-Stage Liver Disease score (IRR 1.06; P = .015), previous HE or HE-preventive medication use (IRR 1.51; P = .029), and PPI use (IRR 3.19; P < .001) were significant risk factors. Higher PPI doses were associated with higher rates of HE (IRR 1.16 per 10 mg omeprazole equivalent; P = .046). CONCLUSIONS: PPI usage is associated with increased rates of new or worsening HE after TIPS creation.

Left renal vein compression as cause for varicocele: prevalence and associated findings on contrast-enhanced CT.

PURPOSE: The purpose of this study is to determine the prevalence of left renal vein compression in patients with varicoceles. METHODS: Abdominal and pelvis contrast-enhanced CT images from 100 male patients with varicoceles (mean age 50.6 years) and 100 matched control patients (mean age 49.8 years) were retrospectively reviewed. The diameter of the left renal vein was measured as it crosses between the aorta and superior mesenteric artery and was classified as compressed if there was greater than 50% narrowing. The diameter of the left gonadal vein was measured at the origin. Comparison of the prevalence of left renal vein compression was made via a Chi-squared test and the gonadal vein diameter via a t test. RESULTS: The distribution of varicoceles was 68 on the left, 24 bilateral, and 8 on the right. Compression of the left renal vein was significantly more common in the left varicocele (78%, 53/68) than in the bilateral varicocele (42%, 10/24, p = 0.002), right varicocele (13%, 1/8, p < 0.001), or control group (10%, 10/100, p < 0.001). In the subgroup analysis, the gonadal vein diameter was significantly greater in the left varicocele (mean 5.6 mm) than in the bilateral varicocele (mean 4.6 mm, p = 0.018), right varicocele (mean 3.2 mm, p < 0.001), and control group (mean 3.1 mm, p < 0.001). CONCLUSION: Left renal vein compression by the superior mesenteric artery is a major contributor to left-sided varicoceles.

Effect of barley flour on the physical and sensory characteristics of chocolate chip cookies.

The present study explored the possibility of using barley flour as an ingredient to incorporate soluble fibre (ß-glucan) in chocolate-chip cookies. Some clinical studies have shown that ß-glucan might reduce the serum cholesterol levels. The objective of this study was to determine the physical and sensory characteristics of chocolate chip cookies partly substituted with barley flour at different levels. Physical characteristics (water activity and L*a*b* colour) and sensory characteristics (descriptive and consumer analysis) were evaluated on the experimental cookies substituted with 0, 30, 40, 50, 60 and 70% barley flour for all-purpose flour. There were increases in the baked-barley aroma and flavour, thickness, colour intensity, dryness and graininess with increasing barley flour content. Consumer data showed that cookies made with 30% (0.5 g ß-glucan/serving) and 50% (0.8 g ß-glucan/serving) barley flour substitution were comparable in liking to the control (0% substitution) cookie and a commercial cookie. The presence of ß-glucan in our chocolate-chip cookies might make them a healthier option for many consumers.

Disparities in access to fresh produce in low-income neighborhoods in Los Angeles.

BACKGROUND: Access to fresh produce and other healthy foods differs between poor ethnic and wealthier non-ethnic neighborhoods. Given the need to improve access, emergency food organizations, such as food pantries, can provide assistance. Food pantry clients, many living in poor ethnic neighborhoods, are at highest risk for inadequate intake of fruits and vegetables as emergency food assistance often does not include a supply of fresh produce. This study examines the extent to which food pantry clients live within reasonable walking distance of stores carrying fresh produce, and it proposes a strategy to increase accessibility of produce to those clients. METHODS: Addresses for 3,985 food pantry clients residing in Pomona, California, in 2003 and 84 food stores categorized as selling a "variety of produce" or "limited produce" were geocoded using geographic information systems technology in 2004. A 0.8-km network buffer was used to measure access to stores. Cluster areas with high densities of food pantry clients, or hot spots, were determined. RESULTS: Forty-one percent of Pomona food pantry clients were within walking distance of a store with fresh produce. Eighty-three percent were within walking distance of stores with limited produce, and 13% were not within walking distance of either store type. Seventeen cluster areas of food pantry clients accounted for 48% of clients with no access to a produce store. CONCLUSIONS: Using individual-level data allowed for the identification of significant numbers of food pantry clients with limited access to stores carrying a variety of fresh produce. Identification of the location of high concentrations of food pantry clients provides a potential solution to increase fresh fruit and vegetable access via mobile produce trucks.

Isoflavone-rich soy protein prevents loss of hip lean mass but does not prevent the shift in regional fat distribution in perimenopausal women.

OBJECTIVE: Menopause-induced estrogen deficiency increases the risk of cardiovascular disease, which is related to a shift in regional fat distribution. We tested the hypothesis that estrogen-like isoflavones in soy protein isolate (SPI+) would lessen both regional fat gain and lean loss compared with isoflavone-poor soy (SPI-). DESIGN: Perimenopausal participants (N = 69) were randomly assigned (double-blind) to 24 weeks of treatment (40 g soy or whey protein per day): SPI+ (n = 24), SPI- (n = 24), or whey control (n = 21); each participant had blood drawn in the fasted (12 hours) state, had physical activity assessed, and kept a 5-day food diary. Dual-energy x-ray absorptiometry was used to examine the effects of SPI+ on regional fat and lean tissue distribution changes in the waist, hip, and thigh regions. RESULTS: Mean body mass increased (P < 0.01) in each group, but treatment had no effect on gain in overall body mass, fat mass, or lean mass using analysis of variance. In all treatment groups combined, lean mass increased in each region; fat mass increased only in the waist region. Treatment had an effect (P = 0.039) on hip lean mass and a marginal effect (P = 0.077) on thigh fat. Regression analyses revealed that SPI+ diminished the increase in thigh fat (P = 0.018) and heightened the increase in hip lean (P = 0.035) mass. Carbohydrate intake (P = 0.006) and cohort (reflective of season; P = 0.011) contributed to the gain in thigh fat. Total protein intake (P = 0.0012), plasma insulin (P = 0.0034), and physical activity (P = 0.047) contributed to the gain in hip lean mass. CONCLUSIONS: Gain in hip lean mass was greater (P = 0.014) in SPI+ than other groups, but SPI+ did not reduce the disease-promoting menopausal shift in regional fat mass.

A single daily dose of soybean phytosterols in ground beef decreases serum total cholesterol and LDL cholesterol in young, mildly hypercholesterolemic men.

BACKGROUND: Consumption of phytosterol-supplemented margarine lowers total plasma cholesterol (TC) and LDL-cholesterol concentrations in older middle-aged hypercholesterolemic individuals. The effects of incorporating phytosterols into lower-fat foods on the plasma lipids of young men at increased risk of developing cardiovascular disease have not been studied. OBJECTIVE: We tested the hypothesis that a single daily dose of soybean phytosterols added to ground beef will lower plasma TC and LDL-cholesterol concentrations in mildly hypercholesterolemic young men. DESIGN: In a triple-blind, 4-wk study, 34 male college students with elevated plasma TC (5.85 +/- 0.70 mmol/L), LDL cholesterol (4.02 +/- 0.60 mmol/L), and TC:HDL cholesterol (5.5 +/- 1.2) were randomly assigned to the control (ground beef alone) or treatment (ground beef with 2.7 g of phytosterols) group. The phytosterol mixture was two-thirds esterified and one-third nonesterified and consisted of beta-sitosterol (48%), campesterol (27%), and stigmasterol (21%). RESULTS: Consumption of phytosterol-supplemented ground beef lowered plasma TC and LDL-cholesterol concentrations and TC:HDL cholesterol from baseline by 9.3%, 14.6%, and 9.1%, respectively (P < 0.001). The LDL particle size did not change, suggesting that the decrease was primarily of particle number. The decreases were similar in subjects with (n = 8) and without (n = 9) a family history of premature cardiovascular disease. No significant changes were found in the control group. CONCLUSION: Phytosterol-supplemented ground beef effectively lowers plasma TC and LDL cholesterol and has the potential to become a functional food to help reduce the risk of cardiovascular disease.

Body composition in baboons: Evaluating a morphometric method.

The objective of this study was to determine whether noninvasive morphometric measurements of olive baboons (Papio cynocephalus anubis) can reliably predict lean body mass and fat mass in this species. Crown-rump length, triceps circumference, and skinfold measures at the neck, subscapular, suprailiac, and triceps sites were obtained prior to necropsy from 21 clinically normal infant baboons at 18 weeks of age and from 22 clinically normal adolescent baboons at 5 years of age. At necropsy, the lean body mass and body fat mass were measured using gravimetric methods. Pearson's correlations and regression analysis were used to test the relationship between direct measures of lean and fat mass obtained at necropsy with calculated estimates based on morphometric measures obtained prior to death. Our null hypothesis was that the morphometric measures (individually or in combination) were not related to direct measures of fat mass or lean mass. Non-linear and multiple regression estimators, by age and gender, were derived and provided increased predictability. Our results indicate that (1) morphometric measures can accurately predict lean body mass in male and female baboons; (2) morphometric measures used to predict lean body mass change with age; (3) morphometric measures are strongly associated with body fat mass at 18 weeks of age but are not as strongly associated with body fat mass in 5-year-old baboons; (4) triceps circumference provides the best single indicator of lean body mass for both genders and age periods; (5) baboons are like humans in that adolescent females tend to accumulate body fat while males of the same age tend to develop lean mass; and (6) combinations of these morphometric measurements explain between 70% and 100% of the variability and can be used to estimate lean and fat mass in baboons.