The forearm ischemic exercise test (FIET) is a very important clinical tool for evaluation of patients suspected to have a metabolic disorder of muscle function. Failure to elevate lactate in blood washed out from ischemically exercised muscles confirms an abnormality of glycolytic metabolism. A normal increase of lactate on FIET is assumed to rule out a disorder of glycolytic metabolism. Two patients with low levels of muscle phosphorylase are presented who produced a normal elevation of lactate on FIET. This suggests that, although the FIET is capable of identifying patients with absence of myophosphorylase, the test cannot identify patients with a partial expression of that disorder. Evaluation of the blood samples for ammonia in addition to lactate can be a significant help in confirming that the exercise performed by the patient was an adequate challenge for the glycolytic pathway. In addition, failure to elevate ammonia on ischemic exercise can identify a relatively new disorder of muscle metabolism.

Adult↗

PubMedDate not supplied

Towards understanding the process of intestinal adaptation.

When bowel is lost due to disease or surgery, the residual bowel increases its functional capacity in order to compensate for the loss of absorptive capacity. The success and extent of this adaptive process is critical to recovery. This article reviews the current understanding of the intestinal adaptation. Adaptation is a complex process which as yet is poorly understood and thus it is difficult to develop strategies to enhance the out-come of the adaptation phase. Extensive loss of bowel brings about functional as well as morphologic changes in the remaining intestine. The exact relationship between histologic changes and function is still unknown and some studies show that histologic changes may precede functional changes. Both nonnutritive and nutritive factors have been identified as major stimuli to the adaptive process. The importance of oral intake as a positive stimulus has been demonstrated and the role of diet composition rather than diet complexity being recognized. Recent studies attempt to understand the molecular basis of intestinal adaptation by seeking to characterize the nature of humoral factors involved and to establish alterations in the patterns of gene expression. These new approaches may facilitate the identification of both nutritional and pharmacological methods to manipulate the intestinal adaptation process.

Adaptation, Physiological↗

PubMedDate not supplied

Application of a computer-based zero-one methodology to the assignment of nurses to a clinical rotation schedule.

This article discusses the application of a zero-one approach to the development of a total program schedule that assigns students to all required clinical courses in an academic nursing program. The approach is based on an operations research technique, zero-one programming. Unlike zero-one programming, the objective function in this formulation is arbitrary; any solution that meets the constraints of the system is acceptable. Also described in this article are the constraints that limit flexibility of student assignments (i.e., available clinical sites and units, instructors, day or evening, maximum class sizes, order of courses), a solution to the scheduling problem at Saint Joseph's (which involves 1,067 equations), and suggestions for the general utility of a zero-one approach for similar administrative problems.

Computers↗