ABSTRACT
The Royal College of Psychiatrists recently published data showing an 84% increase in UK hospital admissions for eating disorders over the past 5 years, highlighting the importance of the college's new Medical Emergencies in Eating Disorders (MEED) guidance. This includes a 79% increase among adults, many of whom are admitted to general medical wards that do not have input from expert eating disorder services. Consequently, the multidisciplinary nutrition support team, nutrition specialist nurses and dietitians have a potentially vital role in implementing MEED to ensure that the appropriate nutritional, fluid and electrolyte management is in place for safe refeeding and avoidance of the potentially harmful underfeeding syndrome. Furthermore, the guidance includes special recommendations for the use of nasogastric feeding in eating disorder patients, which requires input from experts in this field, including specialist nurses and dietitians. This article focuses on the implementation of MEED on hospital wards that do not have input from specialist eating disorders services.
Subject(s)
Emergencies , Feeding and Eating Disorders , Humans , Adult , Feeding and Eating Disorders/therapy , Hospitalization , Nutritional Support , Intubation, GastrointestinalABSTRACT
Many patients in the intensive care unit are malnourished or unable to eat. Feeding them correctly has the potential to reduce morbidity and even mortality but is a very complex procedure. The inflammatory response induced by surgery, trauma or sepsis will alter metabolism, change the ability to utilise nutrients and can lead to rapid loss of lean mass. Both overfeeding and underfeeding macronutrients can be harmful but generally it would seem optimal to give less during metabolic stress and immobility and increase in recovery. Physical intolerance of feeding such as diarrhoea or delayed gastric emptying is common in the intensive care unit. Diarrhoea can be treated with fibre or peptide feeds and anti-diarrhoeal drugs; however, the use of probiotics is controversial. Gastric dysfunction problems can often be overcome with prokinetic drugs or small bowel feeding tubes. New feeds with nutrients such as n-3 fatty acids that have the potential to attenuate excessive inflammatory responses show great promise in favourably improving metabolism and substrate utilisation. The importance of changing nutrient provision according to metabolic and physical tolerance cannot be understated and although expert groups have produced many guidelines on nutritional support of the critically ill, correct interpretation and implementation can be difficult without a dedicated nutrition health care professional such as a dietitian or a multidisciplinary nutritional support team.
Subject(s)
Critical Care/methods , Critical Illness/therapy , Enteral Nutrition , Inflammation/therapy , Parenteral Nutrition , Enteral Nutrition/adverse effects , Fatty Acids, Omega-3/administration & dosage , Gastrointestinal Diseases/etiology , Humans , Parenteral Nutrition/adverse effects , Proteins/administration & dosageABSTRACT
BACKGROUND: The development of molecular probes capable of recognizing virus-infected cells is essential to meet the serious clinical, therapeutic, and national-security challenges confronting virology today. We report the development of DNA aptamers as probes for the selective targeting of virus-infected living cells. METHODS: To create aptamer probes capable of recognizing virus-infected cells, we used cell-SELEX (systematic evolution of ligands via exponential enrichment), which uses intact infected live cells as targets for aptamer selection. In this study, vaccinia virus-infected and -uninfected lung cancer A549 cells were chosen to develop our model probes. RESULTS: A panel of aptamers has been evolved by means of the infected cell-SELEX procedure. The results demonstrate that the aptamers bind selectively to vaccinia virus-infected A549 cells with apparent equilibrium dissociation constants in the nanomolar range. In addition, these aptamers can specifically recognize a variety of target infected cell lines. The aptamers' target is most likely a viral protein located on the cell surface. CONCLUSIONS: The success of developing a panel of DNA-aptamer probes capable of recognizing virus-infected cells via a whole living cell-SELEX selection strategy may increase our understanding of the molecular signatures of infected cells. Our findings suggest that aptamers can be developed as molecular probes for use as diagnostic and therapeutic reagents and for facilitating drug delivery against infected cells.
Subject(s)
Aptamers, Nucleotide/analysis , Aptamers, Nucleotide/chemistry , DNA, Viral/analysis , DNA, Viral/chemistry , SELEX Aptamer Technique/instrumentation , SELEX Aptamer Technique/methods , Aptamers, Nucleotide/genetics , Cell Line, Tumor , Cell Survival , DNA, Viral/genetics , Humans , Substrate SpecificityABSTRACT
The use of computer-based real-time visual displays is now well established in voice clinics. A number of situations exist, however, where a computer-based system is inconvenient and a battery-powered hand-held version would be preferred. This would, for example, enable voice monitoring to be carried out at any time and place, including during home visits. This paper describes a purpose-built device that provides real-time displays of fundamental frequency and larynx closed quotient (CQ) derived from the electrolaryngograph output. The fundamental frequency data can in addition, be acquired from a microphone. The system has been in use recently in a speech and language therapy clinic in Sheffield, UK and the advantages and disadvantages noted during that trial are discussed.
