Low Plasma Protein Levels Research Articles

131 Hedgehog Signaling Mediates Astrocytic Response and Blood-Brain Barrier Repair Following Traumatic Central Nervous System Injury

INTRODUCTION: Injury to the central nervous system (CNS) provokes a multicellular response to facilitate restoration of tissue homeostasis. Astrocytes consolidate at the lesion site to form a “glial scar” which restricts leukocyte infiltration and repairs the blood-brain barrier (BBB). However, this “scar” has been considered an impediment to regeneration and functional recovery. Therefore, uncovering molecular regulators that may be therapeutically targeted to promote pro-regenerative astrocyte phenotypes is of great interest. METHODS: Genetic reporter and conditional mutant mice were used to monitor, constitutively activate, or ablate Hh signaling following stereotactically-induced penetrating cortical or spinal cord injury. Outcomes including reactive astrocyte proliferation and polarization, leukocyte restriction, and blood-brain barrier repair were assessed via immunohistochemistry. RESULTS: Astrocytic expression of the Hh target gene Gli1 was downregulated acutely following injury but restored in the subacute phase. Constitutive activation of Hh signaling reduced astrocytic proliferation (%BrdU/EdU+ = 9.6% vs. 51.0%, p<0.01) and polarization (L/W Ratio = 2.8 vs. 1.5, p < 0.01). Additionally, in the spinal cord, constitutive activation impaired migration and integration of reactive astrocytes into the white matter lesion site. In animals with intact Hh signaling, the BBB recovered by 28 days after injury as evidenced by low levels of plasma protein and leukocyte infiltration. In contrast, conditional ablation of Hh signaling from 14-16 days after injury resulted in persistent BBB defects at 28 days. CONCLUSIONS: Our results suggest that acute downregulation of Hh signaling is required to specify reactive astrocyte properties including polarization and cell cycle re-entry. However, restoration of Hh signaling, which occurs subacutely from 10-28 days after injury and coincides with glial scar maturation, is required for leukocyte restriction and BBB repair. Understanding the temporospatial dynamics of postinjury Hh signaling is essential to modeling future therapeutic targets.

A CASE OF HEREDITARY ANGIOEDEMA SUBTYPE SWITCH

<h3>Introduction</h3> Hereditary angioedema (HAE) is a condition that is described by recurrent episodes of edema without pruritis that can involve multiple different organ systems including skin, gastroenterological tract, and upper respiratory tract. HAE arises from deficiency or abnormality of C1 inhibitor (C1-INH). HAE can be classified into two different classes. HAE-type I is a deficiency in C1-INH resulting in low plasma protein and abnormal functional C1 esterase level. HAE-type II is a dysfunctional C1-INH resulting in low plasma protein but normal functional C1 esterase. <h3>Case Description</h3> A 54-year-old man presents to his primary care doctor's office with a longstanding history of intermittent abdominal pain and and facial swelling lasting 12-24 hours. He has been evaluated by multiple other specialists including Gastroenterologists without an official diagnosis. He was seen by an Allergist and was diagnosed with HAE- type II after his functional C1 esterase inhibitor was normal, C3 complement was low range, and C4 complement was low. He was diagnosed with lymphoma around the same time of his HAE-type II. He was treated with Danazol and his symptoms resolved. Shortly after, the repeat functional C1 esterase was much lower, C3 and C4 complement was still low. It had appeared that he was now consistent with HAE-type I. <h3>Discussion</h3> This HAE subtype switch has not yet been described in the medical community. HAE is condition that is still misdiagnosed amongst medical specialities given the lack of understanding despite it being commonly reported condition as it may mimic other IgE mediated reactions.

Human plasma protein levels alter the in vitro antifungal activity of caspofungin: An explanation to the effect in critically ill?

Recent studies have shown low caspofungin concentrations in critically ill patients. In some patients, the therapeutic target, area under the total plasma concentration curve in relation to the minimal inhibition concentration (AUCtot /MIC), seems not to be achieved and therapeutic drug monitoring (TDM) has been proposed. Caspofungin is highly protein-bound and the effect of reduced plasma protein levels on pharmacodynamics has not been investigated. Fungal killing activity of caspofungin in vitro was investigated under varying levels of human plasma protein. Time-kill studies were performed with clinically relevant caspofungin concentrations of 1-9mg/L on four blood isolates of C.glabrata, three susceptible and one strain with reduced susceptibility, in human plasma and plasma diluted to 50% and 25% using Ringer's acetate. Enhanced fungal killing of the three susceptible strains was observed in plasma with lower protein content (p<.001). AUCtot /MIC required for a 1 log10 CFU/ml kill at 24h in 50% and 25% plasma was reduced with 36+12 and 80+9%, respectively. The maximum effect was seen at total caspofungin concentrations of 4-9×MIC. For the strain with reduced susceptibility, growth was significantly decreased at lower protein levels. Reduced human plasma protein levels increase the antifungal activity of caspofungin in vitro, most likely by increasing the free concentration. Low plasma protein levels in critically ill patients with candidemia might explain a better response to caspofungin than expected from generally accepted target attainment and should be taken into consideration when assessing TDM based on total plasma concentrations.

Echocardiographic changes in anorexia nervosa: a pathophysiological adaptation or a disease?

Anorexia Nervosa is one of the most common form of eating disorders. Cardiac involvement occurs in approximately 80% of patients. Few reports focused on the association between body weight fluctuations and echocardiographic abnormalities, considering linear measurements. We describe echocardiographic and clinical features among male and female patients with anorexia nervosa and the effect of weight gain on these parameters. We performed a single center, retrospective study of patients followed at a dedicated multidisciplinary Unit. The study population consisted of 81 patients, mean age 25 ± 11years, 94% female. Median body mass index was 14.4kg/m2 (25th-75th percentile 12.7-15.6kg/m2). Patients with body mass index below the median value had more often pericardial effusion, smaller left ventricular mass and left ventricular end-diastolic volume and thinner interventricular septum. However, when indexed to body surface area, left ventricular mass and volumes were within the normal range in 90% of population. Patients with pericardial effusion showed mitral valve abnormalities and lower values of white blood cells and platelets, although within normal limits. Presence of pericardial effusion was not related to inflammatory parameters or low plasma protein levels. In 39 patients who displayed weight gain during a median follow-up of 189days (25th-75th percentile 47-471), increased left ventricular mass, interventricular septum thickness, white blood cells and platelet count and decreased pericardial effusion were observed. Patients with anorexia nervosa have a specific echocardiographic pattern which seems to be proportional to the body size, suggesting a pathophysiological adaptation to the lack of substrates.

Low levels of plasma protein S as a risk factor for adverse pregnancy outcome

Endometriosis is a prevalent gynaecological disorder with a still unclear pathogenesis. So far inflammatory mechanisms are associated with disease progression and critical reviews have discussed the so-called ‘danger theory’ related to endometriosis. Hence, we performed immunoassays to evaluate whether local inflammation is linked to the severity of the disease. In addition, we investigated the role of recently described cytokines IL-33, IL-32α and the ‘alarmin’ high mobility group box 1 (HMGB1). We confirmed a dysfunctional immune response in the local environment of women suffering from endometriosis. However, we found no direct evidence for a significant up-regulation of danger signals in endometriosis, irrespective of the severity of the disease.

Confined placental mosaicism revisited: Impact on pregnancy characteristics and outcome.

ObjectivesWe wanted to re-evaluate the influence of confined placental mosaicism subtypes (type 2 and type 3) on pregnancy characteristics and outcome.Material and methodsFrom July 2009 to December 2015, 5512 chorionic villus samplings were performed in our Fetal Medicine Center. Conventional karyotyping was performed after long-term and short-term cultured villi to define type 2 or type 3 confined placental mosaicisms. Karyotype after amniocentesis was performed to exclude true fetal mosaicism, when appropriate. Pregnancy characteristics and outcomes were collected and compared to a control population.ResultsThirty-six (0.65%) confined placental mosaicisms were observed (13 type 2 and 23 type 3). Nuchal translucency was not increased for type 2 and type 3 confined placental mosaicisms. Pregnancy characteristics and outcomes were comparable between type 2 confined placental mosaicisms and the control population. In type 3 confined placental mosaicisms, median first trimester serum pregnancy-associated plasma protein A was lower than for the control population (p<0.001), preterm births were noticed in 56% (p<0.001), small for gestational age newborns in 74% (p<0.001), and adverse pregnancy outcome was reported in 35% (p<0.01).ConclusionAlthough type 2 confined placental mosaicisms appeared to have no influence on pregnancy characteristics and outcome, type 3 confined placental mosaicisms were associated with low levels of first trimester serum pregnancy-associated plasma protein A, preterm birth, small for gestational age newborns, and adverse pregnancy outcomes.

Effect of Endoplasmic Reticulum Stress on Trophoblast Cell Lineage Differentiation

Low maternal serum levels of pregnancy-associated plasma protein A (PAPP-A) measured in the first trimester and high levels of alpha fetoprotein (AFP) measured in the second trimester have been associated with adverse pregnancy outcomes reflective of placental insufficiency, and there is a synergistic relationship between the two. We investigated the utility as a screening test of a simple ratio of maternal serum AFP to PAPP-A (AFP:PAPP-A) measured in the first trimester.We studied 4057 nulliparous women with a singleton pregnancy from the Pregnancy Outcome Prediction (POP) study. We studied the predictive ability for adverse outcome of the AFP:PAPP-A ratio measured in the first trimester with and without correction for maternal weight and gestational age at measurement. We compared the AFP:PAPP-A ratio with corrected AFP and PAPP-A on their own and in combination.An AFP:PAPP-A ratio >10 was associated with placentally-related adverse outcomes, including fetal growth restriction (risk ratio (RR) 3.74, 95% confidence interval (CI) 2.30–6.09), severe preeclampsia (RR 2.12, 95% CI 1.39–3.25) and stillbirth (RR 5.05, 95% CI 1.48–17.18). The ratio performed favorably in predicting adverse pregnancy outcomes when compared with corrected measurements of either AFP or PAPP-A, and was equivalent to a model combining the two. Its predictive ability was not affected by correction for maternal weight or gestational age at measurement.An elevated maternal AFP:PAPP-A ratio in the first trimester is associated with placentally-related adverse outcomes in a cohort of unselected nulliparous women.

Hepatic lipidosis in transition buffaloes in relation to back fat thickness, hemato-biochemical and mineral profile

The study invoved 140 buffaloes, 125 (87.41%) with ultrasonography (USG) features of normal liver and 18 (12.58%) with features of hepatic lipidosis (HL). Among the later 7 had grade I, 6 grade II and 5 grade III USG features of HL. The grouping of animals according to transition stage and evaluation of body condition score (BCS) showed that buffaloes with moderate to severe HL lost BCS from Far off dry (FOD) to fresh stage by more than one (1.0) increment whereas, healthy buffaloes lost BCS from FOD to fresh stage by less than 0.5 increment. Significantly low levels of haemoglobin, packed cell volume and total erythrocyte count was observed in buffaloes with severe HL. Significantly low levels of total plasma protein, glucose, calcium, potassium, copper and zinc along with increased levels of plasma urea nitrogen, beta hydroxyl butyric acid, non esterified fatty acid, aspartate amino transferase, alanine amino transferase, gamma glutamyl transferase, lactate dehydrogenase and Glutamic dehydrogenase were observed in buffaloes with HL. A strong positive association exists between the severity of BCS and back fat thickness (BFT) reduction and occurrence of HL in transition buffaloes.

Low Plasma Protein Levels at Birth Are Associated with Poor Cardiovascular Adaptation and Serious Adverse Outcome in Infants with Gestational Age

Background: Retrospective studies suggest that early hypoproteinemia has prognostic value for adverse outcome in preemies, but the underlying pathophysiology is unknown. We hypothesized that the prognostic relevance of hypoproteinemia could be related to its association with impaired cardiovascular function and organ perfusion during transition. Objectives: To describe the plasma protein status and the measures of cardiovascular function according to the outcome in infants <32 weeks' gestation. Methods: One hundred and twenty-eight infants were prospectively included from birth to discharge. During the first 24 h of life, we assessed the cardiovascular function and systemic and organ blood flow by Doppler ultrasound, and monitored cerebral and renal regional oxygen saturation (cRSO₂, rRSO₂) using near-infrared spectroscopy. These measures were analyzed in relationship to hypoproteinemia (total plasma protein level <40 g/L at 12 h of life) and severe adverse outcome (death or survival with severe neurological injury). Results: Hypoproteinemia was associated with a higher risk of a severe adverse outcome after adjustment of confounding variables (adjusted OR = 6.8; 95% CI 1.3-34). Compared to normoproteinemic infants and after adjustment for gestational age, hypoproteinemic ones had more significantly: hypotension (7 vs. 13%, p = 0.03), abnormal capillary refilling time (20 vs. 36%, p < 0.001), abnormal renal blood flow (resistive index 0.78 ± 0.11 vs. 0.85 ± 0.09, p = 0.04), lower rRSO₂ (82.9 ± 9.2 vs. 73.6 ± 10.5%, p = 0.04), and lower systemic vascular resistance (0.155 ± 0.058 vs. 0.108 ± 0.037 mm Hg/L/kg; p = 0.04). The cRSO₂ patterns were significantly decreased in infants with severe adverse outcome and independent from protein status. Conclusion: Hypoproteinemia is associated with impaired cardiovascular function. Further studies are required to elucidate the interplay between changes in protein levels, postnatal hemodynamics and clinical outcome.

Association between low levels of plasma protein S and recurrent pregnancy loss or perinatal complications

Association between low levels of plasma protein S and recurrent pregnancy loss or perinatal complications

Effects of bovine colostrum on performance, survival, and immunoglobulin status of suckling piglets during the first days of life

Supplementation of bovine colostrum (BC) has shown to improve growth performance, intestinal development, and immune response in early-weaned pigs. Little is known about whether BC may have similar effects in neonatal piglets. In the present study, the effect of BC supplementation on mortality, growth performance, and blood parameters (plasma proteins and white blood count) of suckling piglets in the first 10&amp;nbsp;days of life was investigated under practical conditions with special emphasis on low birth weight piglets. In total, 258 newborn piglets from 30 multiparous sows in a commercial breeding unit were randomly assigned to two different treatment groups. Piglets received either 1 ml of BC orally on days 1&amp;ndash;3 of life (group BC, n = 128) or 1 ml of saline (0.9%) (control (CON) group; n = 130). Body weight was measured on days 1, 4, and 10 of life. Blood was collected on days 1 and 4 from 60 piglets per group. No differences in mortality, body weight, and average daily weight gain were observed between treatment groups in days 1&amp;ndash;10. However, compared to CON, particularly in low birth weight piglets the administration of BC supported (P &amp;lt; 0.01) their survival. Group BC exhibited lower plasma total protein (P = 0.03) and beta-globulin (P = 0.02) concentrations compared to group CON. In conclusion, BC improved low and normal birth weight piglets&amp;rsquo; survival during their first 10 days of life. Further research is needed to clarify whether the survival rate is related to earlier gut closure indicated by lower plasma protein levels, which might be beneficial due to a lower uptake of potential antigenic substances.

O127. Low levels of plasma protein S, protein C and coagulation factor XII during early pregnancy and adverse pregnancy outcome

Objectives A meta-analysis has revealed that women with pre-eclampsia/ eclampsia are more likely to have protein S (PS) deficiency and protein C (PC) deficiency, whereas another study has found no association between pre-eclampsia/ eclampsia and PS or PC deficiency. Coagulation factor XII (FXII) is involved in the initiation of the intrinsic coagulation pathway, fibrinolysis, bradykinin production, and the complement system. FXII deficiency causes a defect in fibrinolysis activation resulting in abnormal hemostasis. Many cases of VTE in FXII deficiency have been reported, but it remains unclear whether FXII deficiency is associated with an increased risk of thrombosis, and little is known about an association between FXII deficiency and adverse pregnancy outcomes. The aim of this cohort study was to evaluate whether low levels of plasma protein S (PS) activity, free PS, protein C (PC) activity and coagulation factor XII (FXII) during early pregnancy were related to adverse pregnancy outcomes. Methods The institutional ethics board approved this study. Peripheral blood samples were obtained at 8–14 gestational weeks (GW) from a consecutive series of 1,220 women with informed consent. The levels of plasma PS activity, free PS, PC activity, and FXII were measured. Cut-off values were defined as 1st, 5th, and 10th percentiles of values obtained from 933 women whose pregnancies ended in normal deliveries without complications . The low levels of plasma PS, free PS, PC and FXII during early pregnancy were evaluated for risks of adverse pregnancy outcomes occurring subsequently. Results PS activity of 10th percentile yielded risks of pregnancy-induced hypertension (PIH) and severe PIH, while free PS level of 5th percentile yielded a risk of pre-eclampsia. FXII level of 1st percentile yielded a risk of premature delivery (PD) at 34GW. None was associated with PD at 37GW, fetal growth restriction or fetal loss. A multivariate analysis demonstrated that PS activity of 10th percentile (odds ratio 5.9, 95% CI 1.7–18.1) and body mass index (BMI) ⩾ 25kg/m 2 (4.3, 1.1–13.3) were independent risk factors for severe PIH. Similarly, free PS level of 5th percentile (4.4, 1.0–14.3) and BMI ⩾ 25kg/m 2 (4.0, 1.3–10.9) were independent risk factors for pre-eclampsia. Conclusion Women with low levels of plasma PS activity and free PS during early pregnancy might have increased risks of PIH, severe PIH or pre-eclampsia. Women with low FXII level might have an increased risk of PD at 34GW.

Low levels of plasma protein S, protein C and coagulation factor XII during early pregnancy and adverse pregnancy outcome.

It was the study objective to evaluate whether low levels of plasma protein S (PS) activity, free PS, protein C (PC) activity and coagulation factor XII (FXII) during early pregnancy are related to adverse pregnancy outcomes. Peripheral blood samples were obtained at 8-14 gestational weeks (GW) from a consecutive series of 1,220 women. The levels of plasma PS activity, free PS, PC activity, and FXII were measured. Cut-off values were defined as < 1st, < 5th, and < 10th percentiles of values obtained from 933 women whose pregnancies ended in normal deliveries without complications. PS activity of < 10th percentile yielded risks of pregnancy-induced hypertension (PIH) and severe PIH, while free PS level of < 5th percentile yielded a risk of pre-eclampsia. FXII level of < 1st percentile yielded a risk of premature delivery (PD) at < 34 GW. None was associated with PD at < 37 GW, fetal growth restriction or fetal loss. A multivariate analysis demonstrated that PS activity of < 10th percentile (odds ratio 5.9, 95 % confidence interval 1.7-18.1) and body mass index (BMI) ≥ 25 kg/m² (4.3, 1.1-13.3) were independent risk factors for severe PIH. Similarly, free PS level of < 5th percentile (4.4, 1.0-14.3) and BMI ≥ 25 kg/m² (4.0, 1.3-10.9) were independent risk factors for pre-eclampsia. In conclusion, women with low levels of plasma PS activity and free PS during early pregnancy might have increased risks of PIH, severe PIH or pre-eclampsia. Women with low FXII level might have an increased risk of PD at < 34 GW.

First- and second-trimester tests to predict stillbirth in unselected pregnant women: a systematic review and meta-analysis.

Several biophysical and biochemical tests have been proposed to predict stillbirth but their predictive ability remains unclear. To assess the accuracy of tests performed during the first and/or second trimester of pregnancy to predict stillbirth in unselected women with singleton, structurally and chromosomally normal fetuses through use of formal methods for systematic reviews and meta-analytic techniques. Electronic databases, bibliographies and conference proceedings. Observational studies that evaluated the predictive accuracy for stillbirth of tests performed during the first two trimesters of pregnancy. Two reviewers selected studies, assessed risk of bias and extracted data. Summary receiver operating characteristic curves, pooled sensitivities, specificities and likelihood ratios (LRs) were generated. Data were synthesised separately for stillbirth as a sole category and for specific stillbirth categories. Seventy-one studies, evaluating 16 single and five combined tests, met the inclusion criteria. A uterine artery pulsatility index >90th centile during the second trimester and low levels of pregnancy-associated plasma protein A (PAPP-A) during the first trimester had a moderate to high predictive accuracy for stillbirth related to placental abruption, small-for-gestational-age or pre-eclampsia (positive and negative LRs from 6.3 to 14.1, and from 0.1 to 0.4, respectively). All biophysical and biochemical tests assessed had a low predictive accuracy for stillbirth as a sole category. Currently, there is no clinically useful first-trimester or second-trimester test to predict stillbirth as a sole category. Uterine artery pulsatility index and maternal serum PAPP-A levels appeared to be good predictors of stillbirth related to placental dysfunction disorders.

Eficacia del tratamiento dietético en el síndrome nefrótico

We present the case of a male patient suffering from a primary amyloidosis and a nephrotic syndrome who came to dietotherapy clinic. In the first visit we made a nutritional record including an anthropometric evaluation, body composition, biochemistry, and food intake. The patient had an excess of body water, proteinuria, low plasma protein, albumin, prealbumin and HDL cholesterol levels, and high concentrations of total cholesterol, LDL and triglycerides. The consumption of protein and sodium was higher than the recommendation. An individualized diet was made. Six months later, his weight and the excess of body water decreased, but the fat free mass remained unchanged. The levels of albumin and prealbumin increased, the proteinuria decreased. Total cholesterol, LDL and triglycerides decreased until normal levels. Dietetary treatment in nephrotic syndrome is effective to decrease proteinuria, improve cholesterol and triglycerides levels, and to prevent malnutrition.

Inverse correlation between HPSE gene single nucleotide polymorphisms and heparanase expression: possibility of multiple levels of heparanase regulation

Heparanase is an endo-beta-glucuronidase that specifically cleaves the saccharide chains of heparan sulfate proteoglycans. Heparanase plays important roles in processes such as angiogenesis, tumor metastasis, tissue repair and remodeling, inflammation and autoimmunity. Genetic variations of the heparanase gene (HPSE) have been associated with heparanase transcription level. The present study was undertaken to identify haplotype or single nucleotide polymorphisms (SNPs) genotype combinations that correlate with heparanase expression both at the mRNA and protein levels. For this purpose, 11 HPSE gene SNPs were genotyped among 108 healthy individuals. Five out of the eleven polymorphisms revealed an association between the SNPs and heparanase expression. SNP rs4693608 exhibited a strong evidence of association. Analysis of haplotypes distribution revealed that the combination of two SNPs (rs4693608 and rs4364254) disclosed the most significant result. This approach allowed segregation of possible genotype combinations to three groups that correlate with low (LR: GG-CC, GG-CT, GG-TT, GA-CC), intermediate (MR: GA-CT, GA-TT) and high (HR: AA-TT, AA-CT) heparanase expression. Unexpectedly, LR genotype combinations were associated with low mRNA expressions level and high heparanase concentration in plasma, while HR genotype combinations were associated with high expression of mRNA and low plasma protein level. Because the main site of activity of secreted active heparanase is the extracellular matrix and cell surface, the origin and functional significance of plasma heparanase remain to be investigated. The current study indicates that rs4693608 and rs4364254 SNPs are involved in the regulation of heparanase expression and provides the basis for further studies on the association between HPSE gene SNPs and disease outcome.

Exogenous Testosterone Stimulates Gluconeogenesis In Hypoproteinemic Albino Rat

Changes in plasma glucose and protein concentrations in two experimental groups of albino rats, weghing 250 - 300g, were evaluated after 7 days of acclmatzaton to laboratory conditons and another 14 days o feeding the rats wth low protein diets. Frank hypoproeinmia was evident by the low plasma protein levels and some clear physical manifestations, such as hair loss, change in skin colour and edema. Edema was caused by lowered plasma protein concentrations. Daily intraperitoneal (i.p.) injections of 0.2 ml of testosterone for a period of 7 days produced a statistcally sgnificant increase in plasma glucose concentrations (P Keywords : Exogenous testosterone, Protein, Glucose, Gluconeogenesis, Hypoproteinemic rat Animal Research International Vol. 4 (1) 2007 pp. 597-600

Hospitalized mechanically ventilated patients are at higher risk of enteral underfeeding than non-ventilated patients

Enteral nutrition (EN) is the preferred method of nutrition support in hospitalized patients but only 50-90% of the required calories are actually delivered. In order to identify where our nutrition support team (NST) should focus its activity, we prospectively evaluated the level of coverage of energy and protein needs during the first 5 days of EN in intensive care unit (ICU) and non-ICU patients and the relationship of energy and protein coverage with serum albumin, transthryretin, insulin-like growth factor-1 (IGF-1) and C-reactive protein (CRP). Subjects (n=183) who required nutrition support and received EN were prospectively recruited. Calorie prescription was 20 and 25, 25 and 30 kcal/kg BW for women and men 60 years and <60 years, respectively. Protein needs were estimated as 1.2g protein/kg BW. Logistic regression analysis was used to estimate odds ratios (OR) for energy and protein delivery 66.6% and <66.6% and albumin, transthryretin, IGF-1 (low vs. normal) and CRP (high vs. normal) in ventilated vs. non-ventilated patients. Significantly more mechanically ventilated than non-ventilated patients received <66.6% of energy (71% vs. 48%) and protein (96% vs. 65%). The ventilated patients were more likely to be energy (OR 2.1, CI 1.1-4.0) and protein (OR 15.7, CI 4.9-50.8) underfed than non-ventilated patients. There was a significant association on day 5 between low protein delivery and low albumin (OR 2.9, CI 1.3-6.5), low transthyretin (OR 3.0, CI 1.4-6.5), low IGF-1 (OR 2.8, CI 1.2-6.7) and high CRP (OR 3.5, CI 1.6-7.8). The energy and protein needs of hospitalized patients are not met during the first 5 days of EN. Ventilated patients are more likely to be energy and protein underfed than non-ventilated patients and to have low plasma protein level. These findings support our decision to intensify EN monitoring by our NST in ventilated patients to optimize their nutritional coverage.

Enteraler Eiweißverlust: Pathophysiologie, Ursachen, Diagnostik und Therapie mit Fallbeispielen

The protein-loosing enteropathy (PLE) may result from a broad variety of underlying diseases. These conditions are of systemic nature or locally affecting the gastrointestinal tract. Major symptoms are oedema due to low plasma protein levels. Gastrointestinal symptoms are not necessarily present. The diagnosis is confirmed by the finding of increased faecal concentrations of Alpha-1-Antitrypsin (> 320 mg/L). In the majority of cases, in which underlying diseases are present, the etiology is obvious. In unclear cases the differentiation into inflammatory or circulatory disturbances or alterations of the architecture of the basal membrane is helpful. An economic, staged approach is presented. To localize the site of protein loss imaging is required (abdominal ultrasound, CT-scan, endoscopy and Technetium-Scan). If a circumscribed intestinal source of protein loss is suspected which may be amenable to surgery, intraoperative enteroscopy should be considered. If causal treatment is impossible; intravenous replacement of albumin and immunoglobulines in intervals from 1 to 4 weeks will be necessary. The prognosis in patients with isolated PLE is good. Otherwise it depends on the underlying disease.

Blood profile of pigeons ( Columba livia) during growth and breeding

Changes in the blood profile of domestic pigeons ( Columba livia) were studied during growth and breeding cycle. Counts of erythrocytes and leucocytes, and values of mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), blood volume, plasma volume (BV), width of erythrocytes, and length, width and volume of erythrocyte nuclei of squabs almost reached adult values by the 4th week of age. During courtship and mating, while the level of plasma glucose increased, those of albumin, potassium, cholesterol, calcium and uric acid decreased. At nest-building, plasma albumin and plasma calcium increased significantly. The initial phase of incubation showed an elevation in plasma calcium and a decline in cholesterol and sodium, whereas mid-phase of incubation indicated a marked rise in cholesterol and uric acid. Terminal phase of incubation had significantly low plasma protein level. During feeding and brooding period, a significant rise in sodium, protein and glucose levels and a fall in calcium were observed. Following egg-laying, there was a significant rise in calcium and a drop in protein, haemoglobin, cholesterol, sodium and MCH values. Concomitant with the phenomenal rate of growth of squabs, their haematological indices neared adult values by the 4th week of age and during breeding activity significant changes in blood values occurred.