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PubMedDate not supplied

Nutritional outcomes following pediatric intestinal transplantation.

BACKGROUND: This study sought to describe the long-term nutritional outcomes of children after intestinal transplant (SBT). METHODS: Between 1991 and March 2005, 30 children received 33 SBT at a single center. Eligibility criteria included patient and graft survival >6 months. Weight, height, albumin, prealbumin, zinc (Zn), and essential fatty acid (EFA) levels were reviewed retrospectively. RESULTS: The 19 patients who met inclusion criteria had a median age at SBT of 2.9 years. The majority of patients were male, Latino, transplanted for necrotizing enterocolitis and received combined liver-SBT. All patients were weaned off total parenteral nutrition to elemental formula at a mean of 39 days post-SBT. Seventeen of 19 patients were Zn deficient and four patients were EFA deficient post-SBT. CONCLUSIONS: Pre-SBT most subjects were significantly deficient in anthropometric and biochemical parameters. Post-SBT the mean Z score for weight and height improved significantly at year 1, then leveled off in year 2. Serum protein levels improved from pre-SBT, yet remained low-normal. Zn deficiency was seen frequently after SBT and is under investigation. Children who developed EFA deficiency were on the same formula, receiving inadequate EFA supplementation. Successful SBT was associated with growth and maintenance of serum nutritional parameters but not with significant catch-up growth.

Adolescent↗
PubMed1993

Prevention of graft-versus-host disease in rat small bowel transplantation by recipient pretreatment with UV-B-modulated bone marrow cells.

UV-B irradiation (700 J/m2) of bone marrow cells (BMC) before transplantation into lethally irradiated (1050R) allogeneic rats prevents graft-versus-host disease (GVHD) and results in stable chimerism. This study examined whether UV-B modulation of BMT is useful in the subsequent induction of tolerance to small bowel transplant (SBT) and avoids the danger of GVHD, which remains the major obstacle to successful SBT. Lethally irradiated Lewis recipients of UV-B irradiated (700 J/m2) BMT (10(8) BMC admixed with 5 x 10(6) splenic leukocytes) either from ACI or Wistar-Furth (WF) rats developed stable chimerism without any evidence of GVHD for > 360 days. Lewis recipients of UV-B ACI BMC expressed 95 +/- 6% ACI lymphoid cells at 50 and 150 days after BMT using complement-dependent cytotoxicity assay. Unmodified Lewis recipients of orthotopic ACI SBT rejected their grafts and died in 7-9 days, whereas Lewis chimeras accepted permanently (> 200 days) bone marrow donor (ACI) SBT without any evidence of GVHD when the SBT was performed at 60 or 150 days after BMT. In contrast, when SBT was performed, only 30 days after induction of chimerism with UV-B ACI BMT, the recipients developed severe GVHD and died between 17 and 21 days. The Lewis chimeras rejected third part (WF) SBT acutely and died in 7-9 days, thus demonstrating the specificity of the induction of tolerance in this model. That this immunologic unresponsiveness is not restricted by the recipient-donor rat strain combination was shown by the permanent acceptance of WF SBT without GVHD by Lewis/WF chimeric recipients. Furthermore, the Lewis chimeras that were made diabetic with STZ 28 days after BMT permanently accepted (> 300 days) BM donor-type (WF) and recipient-type (Lewis) islet cells and became normoglycemic, thus indicating tolerance to both donor and recipient Ags. The diabetic Lewis chimeras that became normoglycemic permanently accepted (> 200 days) WF SBT without any evidence of GVHD after donor-type SBT 110 days after WF islet transplantation. The apparent lack of organ-specific unresponsiveness in this model confirmed our previous observation with combined islet and heart transplants. In vitro MLR studies showed that the chimeric animals were specifically unreactive to donor- and recipient-type alloantigens. Our results demonstrate that UV-B irradiation of BMT is a promising approach to the induction of tolerance to SBT.

Animals↗
PubMed2006

Spontaneous breathing trial predicts successful extubation in infants and children.

OBJECTIVE: To assess the value of a spontaneous breathing trial (SBT) using a flow-inflating bag in predicting extubation success. Secondary goals were to evaluate the positive and negative predictive accuracy of a 15-min SBT. DESIGN: Prospective, blinded, clinical study. SETTING: Pediatric intensive care unit (ICU) of a university hospital PATIENTS: Infants and children intubated for >or=24 hrs. INTERVENTIONS: Patients who met defined criteria for extubation underwent a 15-min SBT connected to a flow-inflating bag set to provide 5 cm H2O continuous positive airway pressure. MEASUREMENTS AND MAIN RESULTS: Seventy patients underwent the SBT. Respiratory rate, heart rate, blood pressure, and pulse oxygen saturations were recorded at baseline and at 5 and 15 mins into the SBT. The ICU physicians were blinded to the results of the SBT, and all patients were extubated at the end of the trial. Patients were observed for the next 24 hrs, and the need for noninvasive ventilation or reintubation (i.e., extubation failure) was recorded.Sixty-four patients (91%) passed the SBT with a subsequent extubation failure rate of 7.8% (only 1.6% required reintubation). Six of the 70 (9%) patients enrolled failed the trial, but half were extubated successfully. Successful completion of the SBT has a 95% sensitivity for predicting successful extubation with a positive predictive value of 92% and an odds ratio of 12 (95% confidence interval, 1.3, 53.7). The specificity of the SBT was 37% with a negative predictive value of 50%. Logistic regression analysis revealed a significant association between passing the SBT and extubation success (p = .017). CONCLUSIONS: A 15-min flow-inflating bag SBT represents a practical, reliable bedside test that has 95% sensitivity for predicting extubation success in pediatric ICU patients. A trial failure is associated with but does not accurately predict extubation failure.

Adolescent↗
PubMed1989

[Pharmacokinetic, bacteriological and clinical studies of sulbactam/ampicillin in pediatric patients].

Plasma and urine concentrations of sulbactam (SBT) and ampicillin (ABPC) were determined following bolus administration of injectable SBT/ABPC combined in a fixed ratio of 1:2 to 6 pediatric patients, 3 at a dose of 30 mg/kg and the other 3 at 60 mg/kg. Clinical and bacteriological efficacies of SBT/ABPC were evaluated in a total of 65 patients composed of 45 cases with pneumonia, 3 cases each with bronchitis, urinary tract infections, staphylococcal scalded skin syndrome, purulent lymphadenitis, 2 cases each with tonsillitis, pleuropneumonia, phlegmon and 1 case each with pyothorax, submaxillitis. The dosage used was 101.2 mg/kg daily given in 3 or 4 divided doses (t.i.d. in 24 patients and q.i.d. in 41 patients) by bolus intravenous injection for 7 days on an average. Side effects and effects on clinical laboratory parameters were monitored in the 65 patients. The results of these evaluations are summarized as follows. 1. Mean serum concentrations of SBT and ABPC in 3 children each given an intravenous bolus injection of 30 mg/kg and other 3 each given 60 mg/kg reached peak levels at 5 minutes after administration with values of 49.8 and 90.3 micrograms/ml, respectively, for SBT and 99.8 and 189.7 micrograms/ml, respectively, for ABPC. The latter values were about twice as high as SBT, and both were dose-related. Mean half-lives were 0.889 hour for SBT and 0.857 hour for ABPC in the 30 mg/kg group and 0.882 hour for SBT and 0.834 hour of ABPC in the 60 mg/kg group, showing similarities between the 2 dosage groups as well as between SBT and ABPC. 2. Mean urine concentrations in the 2 groups mentioned above were the highest for both SBT and ABPC during the first 2 hours after administration, with values of 1,677 micrograms/ml for SBT and 2,730 micrograms/ml for ABPC in the 30 mg/kg group and 2,693 micrograms/ml and 3,623 micrograms/ml, respectively, in the 60 mg/kg group. Mean recovery rates in urine in the first 6 hours were 72.4% for SBT and 56.8% for ABPC in the low dosage group and 72.7% and 52.0%, respectively, in the high dosage group. In the 2 groups, the amounts of ABPC recovered were less than those of SBT. 3. Clinical efficacies of SBT/ABPC in 65 patients with various bacterial infections were excellent or good in 62 (95.4%) patients. 4. The bacteriological efficacy was evaluable with 10 patients. The pathogenic bacteria were eradicated in 9 patients and the efficacy rate was 90%.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗
PubMed1984

[Bacteriological, pharmacokinetic and clinical studies on sulbactam/cefoperazone in the pediatric field].

Bacteriological and clinical effect of a newly developed SBT/CPZ in the treatment for pediatric patients was assessed by a study group consisting of 15 institutions. The results were as follows. Antibacterial effect Susceptibility studies were performed with 93 clinical isolates. The MIC of SBT/CPZ was one-tube inferior or almost similar to that of CPZ in susceptible organisms. In CPZ-resistant organisms at the inoculum of 10(8) cells/ml, however, SBT/CPZ was much superior to CPZ on the basis of the MIC. When the MIC of SBT/CPZ was compared to that of CPZ in 27 strains which have high beta-lactamase-producing activity, it was found that many of CPZ-resistant organisms were susceptible to SBT/CPZ. Serum concentration and urinary excretion The serum concentrations of SBT and CPZ were 33.2 micrograms/ml, respectively at 15 minutes after 20 mg/kg SBT/CPZ was administered by intravenous bolus injection, and those of SBT and CPZ, 51.0 micrograms/ml and 108.3 micrograms/ml, respectively following 40 mg/kg SBT/CPZ therapy. The serum concentrations of CPZ were 2.1-2.4 times as high as those of SBT. The concentrations were dose-related. The half-lives of SBT and CPZ following 20 mg/kg SBT/CPZ administration were 0.94 hour and 1.50 hours, respectively, and those following 40 mg/kg SBT/CPZ were 0.95 hour and 1.53 hours, respectively. There was no significant difference between 20 mg/kg and 40 mg/kg administrations. When compared between SBT and CPZ, CPZ had slightly longer half-lives. At the termination of 1 hour drip infusion of 20 mg/kg SBT/CPZ, the serum concentrations of SBT and CPZ were 16.7 micrograms/ml and 40.1 micrograms/ml, respectively. In the case of 40 mg/kg, the levels of SBT and CPZ were 38.6 micrograms/ml and 94.9 micrograms/ml, respectively. The concentrations were found to be dose-related as were following intravenous bolus injections. The SBT half-lives obtained after 20 mg/kg and 40 mg/kg SBT/CPZ administrations were 1.39 hours and 0.89 hour, respectively; those of CPZ, 2.00 hours and 1.44 hours, respectively. The highest urinary concentration occurred 0-2 hours after intravenous bolus injections of 20 mg/kg or 40 mg/kg SBT/CPZ. Urinary excretion of SBT over 6 hours was 60.0% and 67.7%, and that of CPZ, 21.2% and 25.0%, indicating higher urinary excretion for SBT. When 20 mg/kg SBT/CPZ or 40 mg/kg was administered over 1 hour by drip infusion, urinary excretion became the highest at 1-3 hours after administration. Urinary excretion of SBT over 7 hours following 20 mg/kg and 40 mg/kg SBT/CPZ was 68.8% and 80.3%, respectively, and that of CPZ, 24.4% and 27.3%. The results were similar to those observed following intravenous bolus injections.

Adolescent↗
PubMed1997

Treatment with an HLA-peptide and cyclosporine A prolongs rat small bowel allograft survival.

BACKGROUND: The ultimate treatment for severe short bowel syndrome is small bowel transplantation (SBT). Current immunosuppression for SBT is relatively ineffective and toxic. Peptides derived from residues 75-84 of the HLA-B7 molecule are immunomodulatory in vitro, and in rodents, when combined with subtherapeutic doses of cyclosporine (CsA), prolong cardiac and skin allograft survival without altering the recipient's rejection kinetics to third party allografts. We investigated the effects of HLA-B7 peptide fragment in a rat model of SBT. METHODS: Heterotopic allogeneic SBT was performed in Dagouti (RT1a) to Lewis (RT1l) high-responder rat strain combination. B7.75-84 (40 mg/kg/d) and subtherapeutic CsA (10 mg/kg/d) were administered alone, or in combination, by gavage to allograft recipients on days 0 to 4 after SBT. Recipient pretreatment with B7.75-84 on days -14, -12, -10, and -7 followed by subtherapeutic CsA on days 0 to 4 after SBT was also carried out. Graft rejection was determined by the presence of a palpable abdominal mass on daily examination or by loss of more than 10% initial body weight. RESULTS: Without immunosuppression allografts rejected at a median time of 6 days (range, 5 to 7; n = 7). This was not significantly altered with either CsA therapy alone (median 6 days; range, 6 to 7; n = 6) or B7.75-84 alone (median, 5 days; range, 5 to 6; n = 6). Recipient combination therapy with B7.75-84 and CsA after allografting significantly prolonged allograft survival (median, 11 days; range, 9 to 13; n = 9), as did recipient B7.75-84 pretransplant therapy (median, 10 days; range, 9 to 12; n = 6), when administered over a 2-week period before allografting. CONCLUSION: Post-SBT recipient treatment with B7.75-84 produced statistically significant improvement in allograft survival only after combination with subtherapeutic CsA. Recipient pre-SBT treatment with B7.75-84 alone however, resulted in statistically significant improvement in allograft survival in combination with post-SBT subtherapeutic CsA. These synergistic effects may be valuable in achieving improved SBT survival clinically and warrant further exploration.

Animals↗
PubMed2003

Early protective effect of ischemic preconditioning on small intestinal graft in rats.

AIM: To investigate the early protective effect of ischemic preconditioning on small intestinal graft in rats. METHODS: SD rats were randomly divided into the following groups: sham operation group (S group, n=6), small bowel transplantation group (SBT group, n=12), ischemic preconditioning plus small bowel transplantation group (ISBT group, n=12). Heterotopic SBT was performed with a technique modified from that described by Monchik et al. When the graft was revascularized successfully and reperfused for 1 h, samples were obtained from the different groups. Laminin was analyzed with immunohistochemical staining. Quantitative analysis of laminin positive signals was performed using image acquiring analysis system. Apoptotic epithelia of small intestinal graft were detected by the TdT-mediated dUTP nick end labeling method. The morphological change of epithelial basement membrane was observed by transmission electron microscopy. RESULTS: The mean optical density value of laminin positive signals was 39.52+/-2.60, 13.53+/-0.44, 25.40+/-1.79, respectively, in S, SBT and ISBT groups. The average optical density value of laminin positive products in SBT group was sharply lower than that in S group (P<0.05). However, the mean optical density value of laminin positive products in ISBT group was significantly higher than that in SBT group (P<0.05). The apoptotic index (AI) in S, SBT and ISBT group was 2.2+/-0.83,30.8+/-3.2, 13.2+/-2.86, respectively. The AI in SBT group was significantly higher than that in S group (P<0.05), and AI in ISBT group was sharply lower than that in SBT group (P<0.05). On transmission electron microscopy, the epithelial basement membrane in S group stayed normal, but in SBT group it became disrupted and collapsed, even disappeared. The lesion of epithelial basement membrane in ISBT group was slighter compared with that in SBT group. CONCLUSION: Ischemic preconditioning has an early protective effect on epithelial cells and extracellur matrix of small intestinal graft. Inhibition of epithelial cell apoptosis may be one of the mechanisms of ischemic preconditioning.

Animals↗
PubMed2005

Evaluation of a simplified transseptal mitral valvuloplasty technique using over-the-wire single balloons and complementary femoral and jugular venous approaches in 1,407 consecutive patients.

The over-the-wire double balloon technique (DBT) of balloon mitral valvuloplasty (BMV) has been decreasingly used in recent years because of its relative complexity and potential for left ventricular perforation. We attempted to make over-the-wire BMV simpler and safer by developing: (a) a single balloon technique (SBT) using a rapidly inflating, over-the-wire, cylindrical balloon having abrupt distal taper and short blunt tip to prevent left ventricular perforation, and (b) an alternative jugular approach to reduce technical difficulty in patients with cardiac anatomic distortion. SBT-BMV was evaluated over seven years in 1,407 consecutive patients (femoral approach: 1,277 patients, jugular approach: 130 patients), and compared with 954 patients who underwent DBT-BMV earlier at the same center. Results of SBT-BMV were comparable to those of DBT-BMV: optimal outcomes (91.0% versus 87.8%), fluoroscopy time (12.4 +/- 6.8 minutes versus 17.6 +/- 7.2 minutes), significant right heart oxygen step-up (4.8% versus 10.7%), and major complication rates (3.7% versus 5.6%) were significantly better with SBT-BMV; whereas mean post-BMV mitral valve area (1.92 +/- 0.31 cm2 versus 2.03 +/- 0.42 cm2), and post-BMV hemodynamic parameters were inferior with SBT-BMV. Balloon-related left ventricular perforation did not occur in SBT-BMV. Fluoroscopy time in jugular approach SBT-BMV (9.0 +/- 4.2 minutes) was significantly lower than in the femoral approach SBT-BMV (12.4 +/- 6.8 minutes) despite cardiac anatomic distortion. SBT-BMV reduced procedural costs considerably. SBT-BMV was effective, safe, technically simple and economical; it was comparable to, and overcame several limitations of DBT-BMV.

Adolescent↗
PubMed2006

[Comparison of SmartCare and spontaneous breathing trials for weaning old patients with chronic obstructive pulmonary diseases].

OBJECTIVE: To compare the outcome of the SmartCare and spontaneous breathing trials (SBT) for weaning old patients with chronic obstructive pulmonary diseases (COPD). METHODS: Thirty-eight COPD patients were enrolled in Department of Respiratory Medicine on the South Building, General Hospital of People's Liberation Army from January, 2003 to April, 2005. They mechanically ventilated for at least 3 d (age: 70 - 91 year, average: 83.3 +/- 4.3), randomly assigned to receive SmartCare (SC group, n = 13) or SBT (SBT group, n = 25). All patients were considered clinically and biologically stable, and therefore ready to be weaned from mechanical ventilation. In SC group, patients were ventilated with an inspiratory pressure (IPAP) support adjusted to achieve pH value > or = 7.35, saturation of oxygen in arterial blood (SaO2) > or = 90%, respiratory frequency (RR) > or = 10 and < or = 30 breaths/min, and fraction of inspired oxygen (FiO2) < or = 45%. In SBT group, the patients were placed in a weaning protocol utilizing increasing duration of spontaneous breathing. The following data were recorded at weaning: the acute physiology and chronic health evaluation II (APACHE II) score, arterial blood gases under mechanical ventilation, serum calcium, magnesium, and phosphorus, the days of ventilation before weaning and the duration of weaning. The patients of both groups were considered as successfully weaned when they were able to tolerate at least 48 consecutive hours of spontaneous breathing. Failure was defined in a patient who died during the weaning process or who still needed mechanical ventilation after at least 40 consecutive days of weaning. RESULTS: No significant differences were found between the groups at the onset of weaning from mechanical ventilation regarding APACHE II, serum albumin, calcium, magnesium, phosphorus, partial pressure of carbon dioxide in arterial blood (PaCO2), and the days of mechanical ventilation (t = 0.834, 0.696, 1.384, 0.682, 0.467, 0.816, 0.384, all P > 0.05). The pH value of the SBT group (7.45 +/- 0.05) was higher than the SC group (7.40 +/- 0.04, t = 3.263, P < 0.05). Although patients in the SC group spent less time in weaning than those in the SBT group, the difference was not significant [(8.54 +/- 2.09), (13.32 +/- 2.19) d for the SC and SBT groups, respectively, t = 1.320, P = 0.251]. The 7-d weaning success rate was greater in the SC group than the SBT group (77%, 40%, chi(2) = 4.677, P = 0.031). No significant difference was found in 14-d weaning success rate (77%, 64% in the SC and SBT groups, chi(2) = 0.661, P = 0.416). Fewer arterial blood analyses were performed in the SC group (3.5 +/- 3.1, 6.6 +/- 3.7, t = 2.710, P = 0.011). CONCLUSION: The SmartCare is better than SBT in weaning patients with COPD within 7 days.

Aged↗
PubMed1984

[Fundamental and clinical studies of sulbactam/cefoperazone in the pediatric field].

Fundamental and clinical studies were carried out on sulbactam/cefoperazone (SBT/CPZ) in the field of pediatrics. The following results were obtained: A total of 185 clinical isolates that had been stocked at our department was employed to determine the minimum inhibitory concentrations (MICs) of SBT/CPZ against various bacterial species. SBT/CPZ showed strong antibacterial potency against E. coli, Salmonella, Klebsiella and P. mirabilis, and relatively strong potency against S. marcescens, P. aeruginosa and S. aureus. Antibacterial potency of SBT/CPZ was stronger than that of CPZ alone against E. coli, and it also showed strong activity against strains of Salmonella, S. marcescens and S. aureus, moderately or highly resistant to CPZ. SBT/CPZ was administered by intravenous bolus infusion to pediatric patients to determine the serum concentrations of SBT and CPZ. At a dose of 10 mg/kg the mean serum levels of SBT and CPZ were as follows; 17.8 micrograms/ml, 40.7 micrograms/ml at 15 minutes and 0.3 microgram/ml at 6 hours, respectively. The half-lives of SBT and CPZ in the serum were 1.05 hours and 1.76 hours, respectively. Similarly, at a dose of 20 mg/kg the mean serum levels of SBT and CPZ were; 31.9 micrograms/ml, 81.0 micrograms/ml at 15 minutes and 0.5 microgram/ml, 6.1 micrograms/ml at 6 hours, and the half-lives were 1.00 hour and 1.72 hours, respectively. At a dose of 40 mg/kg, only 1 case was determined. The serum levels of SBT and CPZ were 34.4 micrograms/ml, 74.8 micrograms/ml at 30 minutes and 0.2 microgram/ml at 6 hours, and the half-lives were 0.78 hour and 1.38 hours, respectively. SBT/CPZ was drip-infused intravenously over a period of 1 hour, and the serum concentrations of SBT and CPZ were determined. At the dose of 10 mg/kg or 20 mg/kg, the peak serum levels of SBT and CPZ were observed at 1 hour or at the end of drip infusion. At a dose of 10 mg/kg the mean serum levels of SBT and CPZ were 14.4 micrograms/ml, 33.7 micrograms/ml at 1 hour and 1.4 micrograms/ml, 4.6 micrograms/ml at 7 hours, respectively. The half-lives was 1.86 hours for SBT and 2.23 hours for CPZ, respectively. Similarly at a dose of 20 mg/kg, the mean serum levels of SBT and CPZ were, 22.2 micrograms/ml, 34.6 micrograms/ml at 1 hour and 0.5 microgram/ml, 2.8 micrograms/ml at 7 hours, and the half-lives was 1.17 hours and 1.75 hours, respectively. The urinary recovery rate was determined for the 6 hours period after administration.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗
PubMed2004

Pelvic washing cytology in serous borderline tumors of the ovary using ThinPrep: are there cytologic clues to detecting tumor cells?

The detection of tumor cells in pelvic washings of patients with serous borderline tumors of the ovary (SBT) remains a diagnostic challenge. Accurate diagnosis of pelvic washings is important in determining therapeutic regimens and assessing patient prognosis. No study has exclusively examined pelvic washing cytology of patients with SBT using only ThinPrep methodology. The purpose of this study is to examine whether cytologic clues exist in detecting tumor cells of SBT in pelvic washings processed with ThinPrep. Using previously established criteria, we reviewed the pelvic washes of 37 patients with SBT and correlated them with the histologic findings in the omentum. We also compared their cytoarchitectural features with pelvic washes in patients with benign ovarian disease and serous carcinoma. Cytoarchitectural features that achieved statistical significance in distinguishing cells of a SBT from reactive mesothelial cells include the following findings: presence of a two-cell population (P = 0.001), psammoma bodies (P = 0.001), cytoplasmic vacuolization (P = 0.001), smooth group contours (P = 0.004), nuclear size >2x neutrophils (P = 0.004), high nuclear-to-cytoplasmic (N/C) ratio (P = 0.004), absent intercellular windows (P = 0.007), and course nuclear chromatin (P = 0.032). Psammoma bodies were the only statistically significant feature distinguishing SBT from serous carcinoma, being more common in SBT than serous carcinoma (P = 0.035). The prominent number of associated psammoma bodies seen in the SBT group was a notable finding that may aid as a valuable cytologic clue in detecting tumor cells. Overall cellularity remains a source of false-negative diagnosis. Correlation with histologic findings remains crucial given our inability to reliably distinguish tumor cells of SBT from endosalpingiosis or serous adenocarcinoma.

Adult↗
PubMed1999

Syntrophus aciditrophicus sp. nov., a new anaerobic bacterium that degrades fatty acids and benzoate in syntrophic association with hydrogen-using microorganisms.

Strain SBT is a new, strictly anaerobic, gram-negative, nonmotile, non-sporeforming, rod-shaped bacterium that degrades benzoate and certain fatty acids in syntrophic association with hydrogen/formate-using microorganisms. Strain SBT produced approximately 3 mol of acetate and 0.6 mol of methane per mol of benzoate in coculture with Methanospirillum hungatei strain JF1. Saturated fatty acids, some unsaturated fatty acids, and methyl esters of butyrate and hexanoate also supported growth of strain SBT in coculture with Desulfovibrio strain G11. Strain SBT grew in pure culture with crotonate, producing acetate, butyrate, caproate, and hydrogen. The molar growth yield was 17 +/- 1 g cell dry mass per mol of crotonate. Strain SBT did not grow with fumarate, iron(III), polysulfide, or oxyanions of sulfur or nitrogen as electron acceptors with benzoate as the electron donor. The DNA base composition of strain SBT was 43.1 mol% G+C. Analysis of the 16 S rRNA gene sequence placed strain SBT in the delta-subdivision of the Proteobacteria, with sulfate-reducing bacteria. Strain SBT was most closely related to members of the genus Syntrophus. The clear phenotypic and genotypic differences between strain SBT and the two described species in the genus Syntrophus justify the formation of a new species, Syntrophus aciditrophicus.

Base Composition↗
PubMedDate not supplied

Contractile activity of circular smooth muscle in rats one year after small bowel transplantation: differing adaptive response of the jejunum and ileum to denervation.

The aim of the present study was to determine the long-term effects of isogeneic small bowel transplantation (SBT) on jejunal and ileal circular smooth muscle contractile activity in the rat. Transmural strips of circular muscle were prepared from proximal jejunum and distal ileum of 1-year-old control rats and rats 1 year after SBT (SBT-1Y) to measure isometric force. Spontaneous contractile activity and the dose-responses to bethanechol and norepinephrine were studied. Electrical field stimulation (EFS) at varying frequencies (1 to 20 Hz) was evaluated under adrenergic and cholinergic blockade to investigate inhibitory nerves. Spontaneous activity both in the jejunum and ileum in SBT-1Y rats was not different compared to control rats. Sensitivity to bethanechol did not differ between control and SBT-1Y rats in the jejunum or ileum. Sensitivity to norepinephrine, however, was significantly increased after SBT in the ileum but not in the jejunum. During EFS, inhibition was seen at low frequencies, and contractions were induced at high frequencies in all groups. The degree of inhibition did not differ between control and SBT-1Y rats in the jejunum; however, it tended to be increased in the ileum after SBT. The long-term adaptive response of smooth muscle to the extrinsic denervation accompanying SBT differs between the jejunum and the ileum.

Adaptation, Physiological↗
PubMed2001

Food provision as a strategy to promote weight loss.

Intervention strategies used in weight-control programs typically rely on participants to make behavior changes on their own. Better results might be achieved if more direct approaches were taken to make environmental changes by providing food to participants and paying them for weight loss. Two studies on food provision for improving weight loss were conducted. The first study used a five-group design contrasting no treatment, standard behavior therapy (SBT), SBT plus food provision, SBT plus financial incentives, and SBT plus food provision and incentives. At 6, 12, and 18 months, weight losses in the two groups receiving food provision were significantly greater than in the two groups without food provision. The incentives did not affect weight loss. To better understand the reasons for the success of food provision a second study was conducted comparing SBT, SBT plus menus, SBT plus food provision with a copay, and SBT plus free food. Groups 2, 3, and 4 all had better weight losses than SBT and did not differ from each other at the end of the 6-month treatment and at the 18-month follow-up. Food provision and menus were associated with increased behavior compliance, increased nutrition knowledge, more regular meals and fewer snacks, reduced barriers to weight loss, and improved quality of foods in participants' homes. Food provision seems to be a useful strategy for promoting weight loss.

Adult↗
PubMed1999

Comparison of cyclosporin A and tacrolimus concentrations in whole blood between jejunal and ileal transplanted rats.

Most immunosuppresive drugs are absorbed from the intestine after oral administration, although there is some difference of bioavailability between ileum and jejunum. Using an orthotopic segmental small bowel transplantation (SBT) model in rats, we studied the pharmacokinetic profiles of cyclosporin A and tacrolimus concentrations after oral intake, comparing jejunal and ileal transplanted rats. Two types of segmental SBT (jejunal and ileal SBT) in a syngeneic combination were performed. After oral administration of cyclosporin A (10mgkg(-1) or tacrolimus (5 mg kg(-1)), pharmacokinetic data were obtained from the long-surviving rats transplanted with segmental SBT. To determine the effect of additional bile on cyclosporin absorption, an emulsion of cyclosporin A with fresh bile juice was re-challenged on segmental SBT rats before killing. A histological study was also performed by use of the intestinal grafts from the killed SBT rats. A higher concentration of cyclosporin A was observed in the ileum-grafted rats than in the rats which received the jejunal grafts. Oral bioavailability of cyclosporin A in ileal SBT rats tended to be increased by addition of fresh bile juice, but that in jejunal SBT rats did not change. On the other hand, there was no significant difference of tacrolimus concentration between jejunum- and ileum-transplanted rats. Histological studies showed that the superficial mucosal layer of both grafts, but especially the ileal graft, was markedly elongated compared with that of normal intestine. The present study showed that cyclosporin A was more actively absorbed from ileum than from jejunum in SBT, but tacrolimus was absorbed equally from both sites. These data suggest that cyclosporin A concentration is satisfactorily controlled in the segmental ileal graft, while there is no difference of tacrolimus absorption between ileal and jejunal graft.

Administration, Oral↗
PubMed2001

A dedicated craniofacial trauma team improves efficiency and reduces cost.

BACKGROUND: In this era of limited medical resources there is ever increasing pressure to lower costs, while preserving high-quality patient care. A dedicated craniofacial and skull base trauma team (SBT) was established at our Level I trauma center in July 1998. Previously, a rotating call panel of multiple private surgical subspecialists consulted on trauma patients with craniofacial or skull base injuries (Pre-SBT). This study was designed to assess the impact a dedicated craniofacial and skull base trauma team has on the cost and quality of patient care. MATERIALS AND METHODS: A retrospective review of the trauma registry and charts was performed including all craniofacial and skull base trauma cases in the 18 months Pre-SBT and 18 months following the establishment of a SBT. RESULTS: During the Pre-SBT period there were 29 craniofacial and skull base operations, whereas 28 such cases were performed by the SBT. The age, sex, injury severity score (ISS), mechanism of injury, and type of craniofacial/skull base injuries were comparable between groups. The SBT group demonstrated a reduction in the number of patients transferred to other institutions for definitive care (7 vs 1, P = 0.05) and statistically significant reduction in the number of subspecialty consultations (2.4 vs 1.3), time to operation (7.5 vs 3.0 days), and length of hospitalization (11.8 vs 6.8, all with P <or= 0.001). Additionally, hospital charges were markedly reduced in the SBT group (106,424 dollars vs 58,136 dollars, P < 0.01). CONCLUSIONS: The addition of a dedicated craniofacial trauma team to a Level I trauma center provides more comprehensive care, improves efficiency, and reduces cost.

Adult↗
PubMedDate not supplied

Impact of graft length on surgical damage after intestinal transplantation in rats.

BACKGROUND: Intestinal grafts greatly affect nutrition and immunology in the host. The growth of the recipient and incidence of graft-versus-host disease depend on graft length. A larger graft may affect the host immune system, but little is known about how the length of the intestinal graft severely affects surgical intervention. We developed a cervical small bowel transplantation (SBT) rat model that minimized technical variations using a cuff method and studied the effects of graft length on surgical damage in SBT. MATERIALS AND METHODS: We transplanted a whole (70 cm) or partial (15 cm) intestine into a syngeneic rat combination of LEW (MHC haplotype: RT1(l)) to LEW and evaluated changes in perioperative hemodynamics and the endogenous endotoxin level. Natural killer (NK) cell activity in the peripheral blood and the immunologic response of the recipient spleen were also studied. RESULTS: In the whole SBT model, body weight loss was more severe than in the segmental SBT model; the rats in the former model often died, while all in the latter survived indefinitely. The systemic blood pressure markedly decreased in the whole SBT group immediately after reperfusion. The proliferative activity of splenic lymphocytes stimulated by concanavalin A was also more severely inhibited in the former model than in the latter postoperatively. NK cell activity in the whole SBT rats declined more severely than the segmental SBT rats 3 days postoperatively. CONCLUSION: The longer graft severely induced surgical intervention; and influenced host immunosuppression, resulting in the higher mortality in rats undergoing whole SBT.

Animals↗
PubMed2006

A randomized clinical trial testing treatment preference and two dietary options in behavioral weight management: preliminary results of the impact of diet at 6 months--PREFER study.

OBJECTIVE: The PREFER study objectives were to examine potential differences in weight loss during a standard behavioral intervention between subjects assigned to one of two calorie- and fat-restricted diets [standard behavior treatment (SBT) and lacto-ovo-vegetarian ([SBT+LOV)], with or without regard to their preferred dietary treatment. This article reports the differences in outcomes between diet groups after the first 6 months of the intervention. RESEARCH METHODS AND PROCEDURES: The study used a four-group design. Subjects (n = 182) were randomized to a treatment preference group and then to a dietary treatment group. For this report, preference groups were combined to permit comparisons by dietary treatment only (SBT, n = 98; SBT+LOV, n = 84). Additional analyses compared SBT+LOV subjects who were 100% adherent (did not consume any meat, fish, or poultry, n = 47) to those who were <100% adherent (n = 24). RESULTS: Significant differences were seen in the baseline to 6-month change scores between the two groups for carbohydrate consumption (p = 0.013), protein consumption (p < 0.001), polyunsaturated-to-saturated fat ratio (p = 0.009), and low-density lipoprotein-cholesterol (LDL-C) level (p = 0.013). Among SBT+LOV subjects, those who were 100% adherent experienced greater reductions in weight (p < 0.001), total cholesterol (p = 0.026), LDL-C (p = 0.034), and glucose (p = 0.002) and consumed less fat (p = 0.030) compared with those who were <100% adherent. DISCUSSION: Differences between dietary treatment groups at 6 months were minimal, most likely because one-third of the SBT+LOV group did not follow the vegetarian diet and because both groups had the same calorie and fat restrictions. SBT+LOV subjects who were 100% adherent were more successful at both weight loss and cholesterol reduction than those who were <100% adherent, suggesting that vegetarian diets are efficacious for weight and cholesterol control.

Adult↗