Association of Nutrition Status at Dialysis Start With Long-Term Survival: A 10-Year Retrospective Study.

OBJECTIVE: The objectives of the study are to explore the association between nutritional status at the initiation of dialysis and the improvement or worsening of nutrition status during first 3 months of dialysis and first 5 years of survival on dialysis. METHODS: Two hundred ninety-seven patients who started dialysis between March 2009 and March 2019 were enrolled in the study. The nutritional status of the patients at dialysis commencement was evaluated by the method of The Integrative Clinical Nutrition Dialysis Score (ICNDS). Improvement or worsening of nutrition status was monitored by calculating the ICNDS slope for each patient enrolled in the study from 3 ICNDS values from the first 3 months on dialysis. The baseline ICNDS and the slope of 3 subsequent monthly ICNDS values were tested for correlation with the odds of all-cause mortality for each of the first 5 years on dialysis. RESULTS: There was a significant difference between the survival odds of patients who started dialysis with an ICNDS at 75 and those who started dialysis with an ICNDS <75 (hazard ratio [HR] 2.505, confidence interval [Cl] 1.235-5.079, P = .011 after 1 year on dialysis;, HR 1.543, Cl 1.083-2.198, P = .016 after 5 years). Deterioration of nutritional status (a negative ICNDS slope) during the first 3 months of dialysis was associated with increased mortality during 1-3 years after dialysis start, compared to a positive ICNDS slope indicating a stable or improved nutritional status (HR 1.732, Cl 1.151-2.607, P = .008 after 3 years on dialysis). CONCLUSIONS: Nutritional status at initiation of dialysis is associated with long-term (5 years) survival. Deterioration of nutritional status during the first 3 months on dialysis significantly increases the risk of death during the first 3 years on dialysis.

Social spatial cognition.

Social spatial cognition refers to the interaction between self, place, and partners, with emphasis on the impact of the social environment on spatial behavior and on how individual spatial representations converge to form collective spatial behavior - i.e., common places and routes. Recent studies suggest that in addition to their mental representation (cognitive map) of the physical environment, humans and other animals also have a social cognitive map. We suggest that while social spatial cognition relies on knowledge of both the physical and the social environments, it is the latter hat predominates. This dominance is illustrated here in the modulation of spatial behavior according to dynamic social interactions, ranging from group formation to an attenuation of drug-induced stereotypy through the mere presence of a normal subject. Consequently we suggest that the numerous studies on the biobehavioral controlling mechanisms of spatial behavior (i.e. - the hippocampal formation, animal models for mental disorders) should also consider the social environment rather than solely focusing on the spatial behavior of lone animals.

Consumption of Nutrition Supplements Is Associated with Less Hypoglycemia during Admission-Results from the MENU Project.

AIM: We studied the effect of the addition of an oral nutrition supplement (ONS) on the rate of hypoglyemia among hospitalized type 2 diabetes mellitus (DM) patients. METHODS: In this retrospective analysis, all DM patients with hypoalbuminemia (albumin < 3.5 g/dL) admitted to internal medicine "E" at Wolfson Medical Center between 1 June 2016 and 30 April 2017 were included. One bottle of ONS (Glucerna, 330 KCAL, 28 g carbohydrates, 17 g protein, 17 g fat) was added to the morning meal. The consumption of the ONS was verified during the morning rounds. All glucose measurements were recorded automatically in the patients' electronic medical records. A logistic regression model was used to evaluate the effect of the nutrition support on the occurrence of hypoglycemia. RESULTS: 218 patients (mean age 77.4 ± 12.0 years, 63.3% female, mean albumin 3.13 ± 0.32 g/dL), of whom 27.9% had documented hypoglycemia during hospitalization were included. The patients consumed 69.5% ± 37.1 of the ONS provided, and ONS was started 4.3 ± 5.3 days from admission. A logistic regression model indicated that age (Odds ratio [OR] 1.048, 95% CI 1.014-1.083, p = 0.005), insulin treatment (OR 3.059, 95% CI 1.497-6.251, p = 0.002), and the day of ONS started from admission (OR 1.094, 95% CI 1.021-1.173, p = 0.011) were associated with an increased risk of hypoglycemia. Complete consumption of the ONS was associated with a reduced risk of hypoglycemia: OR 0.364, 95% CI 0.149-0.890, p = 0.027. Age, other DM medications and serum albumin did not affect the risk. CONCLUSION: The intake of a complete serving of ONS may be associated with a reduction of the risk of hypoglycemia among diabetes in-patients with hypoalbuminemia.

Spatio-temporal organization during group formation in rats.

In the present study, the dynamic process of group formation in eight unfamiliar rats was followed in order to reveal how the group becomes oriented together in time and space, in light of the complexity that accompanies grouping. The focus was on who, where, and when joined together. We found that rats preferred to be in companionship over remaining alone, with all the rats gradually shifting to share the same location as a resting place. Group formation can be viewed as a tri-phasic process, with some rats gradually becoming more social than others, and thus playing a key role in group formation. Starting with seemingly independent traveling, the rats gradually converged to share the same location as a terminal (home base) for roundtrips in the arena. Because such a terminal is considered as the organizer of an individual's spatial behavior, the shared home-base location may be viewed as the organizer of spatial behavior of the entire group. Despite huddling together, the rats continued to travel alone or in duos throughout the 3 h of testing. We suggest that resting together and traveling alone or in duos enabled the maintenance of communal relationship while reducing the complexity involved in traveling in relatively large groups. Taken together, the present results demonstrate the dynamic process during which unfamiliar rats shift from independent to group spatial behavior.

Role reversal method for treatment of food refusal associated with infantile feeding disorders.

OBJECTIVES: Infantile feeding disorders (IFDs) are common causes of food refusal and failure to thrive, and are frequently encountered by primary care physicians and specialists. We have published the Wolfson criteria for IFD, which have eased the approach to the diagnosis of IFDs. Along with and complementary to the Wolfson criteria, we have also developed the role reversal treatment method for IFD, which has been briefly described earlier. The aim of this study was to validate the role reversal treatment method on a cohort of infants diagnosed as having IFD and to present a detailed description of this method for the first time. METHODS: Parents of infants and children diagnosed as having IFD were invited to participate in the study; they were handed over a questionnaire comprising 6 categories of questions related to patient and parents behaviors, attitudes, and perceptions, which was completed at initiation and at the end of treatment. Full response was defined as improved normative feeding, cessation of abnormal parental feeding, and improved or normal growth patterns. A partial response was defined as success with two-third categories. RESULTS: We enrolled 38 patients, and 32 patients completed the study. Improved feeding occurred in 78%, full recovery was documented in 53% of infants by 6 months, and partial response was observed in another 25%. All forms of pathological feeding improved significantly (mechanistic, nocturnal, persecutory, forced feeding, and distraction). CONCLUSIONS: The role reversal treatment method is a simple and effective approach to the treatment of food refusal associated with IFD.

Fat intolerance in developmentally impaired children with severe feeding intolerance.

Children with a variety of genetic, metabolic, and neurologic disorders can suffer from severe feeding intolerance that is unresponsive to medical, surgical, and nutritional therapy. Developmentally disabled tube-fed children with severe upper gastrointestinal symptoms that persisted after fundoplication who were unresponsive to all medical, surgical, and nutritional interventions underwent a thorough gastrointestinal evaluation, including gastroscopy, pH-metry, upper gastrointestinal barium series, and gastric emptying studies. They were placed on a low-fat diet, and the symptoms before and after the diet were compared. The patients were then rechallenged with incremental increases in fat until the symptoms recurred or the patients reached their former fat concentration. Six children meeting the study criteria were evaluated. Four of these patients had a significant improvement in symptoms, oral intake and feeding tolerance with a decrease in fat intake, and relapse of symptoms when fat calories were increased. Improvement occurred in children who had been intolerant to duodenal feeding. We were subsequently able to wean two children from tube feeding. Dietary fat can provoke upper gastrointestinal symptoms in children with gastric and intestinal dysmotility. Short-term manipulation of dietary fat intake can improve tolerance to feeding.

[Ketogenic diet as antiepileptic therapy: a description of the clinical experience and the multidisciplinary approach at the metabolic-neurogenetic clinic at the Wolfson Medical Center].

UNLABELLED: The ketogenic diet, built on a menu that includes a high fat content and low protein and carbohydrate percentages, constitutes an alternative therapy for children with refractory epilepsy. This study describes our clinical experience with the diet, its efficacy, and the adverse effects associated with this treatment modality, which is mainly indicated in patients who do not respond to conventional antiepileptic drugs (AEDs). We place particular emphasis on our multidisciplinary approach, which includes physicians, nurses, social workers, and dieticians. A chart review was performed on all pediatric patients who received the diet in our clinic between 1998 and 2003. We recorded the patients' demographic data, the age at epilepsy onset, the age of the patient at the time the diet was started, the characteristics of the epilepsy, the seizure frequency, the AEDs prior to and during the diet, the patient and family compliance, and the adverse effects. RESULTS: Ten patients were treated. The youngest patient was 8 months old and the oldest was 19 years old at the onset of the diet. Eight children suffered from a well-defined epileptic syndrome. All children had frequent seizures and received between 2 and 9 AEDs prior to the diet. The duration of the diet ranged between 6 weeks and two and a half years. Seven patients experienced over 50% seizure reduction while on the diet. However, total seizure control was not attained in any patient. Adverse effects were minimal. All the patients complied with this rigid diet in a good or excellent manner. Furthermore, we also observed an improvement in the degree of alertness, learning skills, and developmental milestones in most of the children. The diet failed to provide satisfactory seizure control or improvement in the well-being of 3 patients. In conclusion, the ketogenic diet is an effective therapeutic alternative for children with refractory epilepsy, irrespective of the patient's age, gender or disease duration. We attribute our therapeutic success with the diet to the multidisciplinary approach carried out in our clinic.