Fibre content of enteral feeds for the older child.

J Hum Nutr Diet. 2009 Oct; 22(5): 414-21Evans S, Daly A, Davies P, Macdonald ABackground: There is currently a lack of clinical data on fibre requirements in UK children. Subsequently, the ideal fibre profile for enteral formulae designed to meet the requirements of older children is unknown. The present study aimed to investigate the effect of fibre supplementation on gastrointestinal function of children aged 7-12 years (or weight 21-45 kg) receiving an age-specific high-energy enteral feed. Methods: In this double-blind randomised crossover study, 25 home enterally tube-fed children with a range of medical conditions (including cystic fibrosis, neurological conditions, liver transplant and bone marrow transplant) were given a 1.5 kcal mL(-1) formula with or without added dietary fibre (1.13 g per 100 mL). Each formula was taken for 6 weeks, followed by 6 months on the second randomly assigned formula. Anthropometry, blood biochemistry, stool characteristics, tolerance and oral dietary intake were assessed. Results: Despite a higher median fibre intake on the fibre-containing formula (84% versus 26% of recommended intake; P = 0.003), most children did not meet existing international recommendations for fibre as a result of small feed volumes (median 800 mL day(-1); 9 g fibre day(-1)). There was some evidence of reduced constipation, laxative reliance and abdominal pain on the fibre-containing formula. Conclusions: Given the poor fibre intakes and absence of adverse effects, the use of fibre-containing formulae should become standard practice for the majority of children on enteral feeds. Larger trials in children are required to further evaluate the effect of amount and blend of fibre in enteral formulae for older children. However, it is likely that current formulae require higher levels of fibre.

Hepatic Segments and Vasculature: Projecting CT Anatomy onto Angiograms.

Radiographics. 2009 Sep 4; Furuta T, Maeda E, Akai H, Hanaoka S, Yoshioka N, Akahane M, Watadani T, Ohtomo KHepatic transarterial interventional therapies such as chemoembolization and radiation embolization are important treatment options for hepatocellular carcinoma. Understanding the anatomy of individual arterial branches and hepatic segments is critical for selecting the correct embolization technique for treatment and to avoid complications. The authors describe the morphologic characteristics of hepatic arterial branches (and their mimickers) and hepatic segments on conventional angiograms. These vessels and segments include the celiac artery, the common and proper hepatic arteries, the left and right hepatic arteries and branches, the caudate lobe, and the portal vein and branches. Mimickers of hepatic arteries include the cystic, accessory left gastric, and right gastric arteries, as well as branches of the left gastric artery that resemble segmental branches of the replaced left hepatic artery. The authors describe how each segmental branch of the hepatic artery and the area it supplies correlates at computed tomography (CT) and angiography. Finally, the authors demonstrate how the vascular anatomy changes with the respiratory cycle by creating a virtual movie from calculations with dynamic CT data, in which the arterial and venous phases are acquired at end expiration and inspiration, respectively. Each segmental branch of the hepatic artery has morphologic characteristics that help distinguish it from mimickers. The location of each hepatic segment can be estimated if the artery supplying the segment can be correctly identified on angiograms. Notably, morphologic differences in the hepatic artery system caused by respiration should be recognized. Supplemental material available at http://radiographics.rsna.org/cgi/content/full/rg.e37/DC1.

The role of survivin in the resistance of endometriotic stromal cells to drug-induced apoptosis.

Hum Reprod. 2009 Sep 3; Watanabe A, Taniguchi F, Izawa M, Suou K, Uegaki T, Takai E, Terakawa N, Harada TBACKGROUND Decreased susceptibility of endometrial tissue to apoptosis may contribute to the pathogenesis of endometriosis. We investigate the role of survivin in the pathophysiology of endometriosis through the ability of ectopic and eutopic endometrial stromal cells (ESCs) to resist apoptosis. METHODS Ectopic ESCs were obtained from ovarian chocolate cysts in patients undergoing laparoscopic surgery (n = 22). Eutopic ESCs were isolated from endometrial tissue of cyclic premenopausal women undergoing hysterectomy for fibroids (n = 22). Purified stromal cells were studied in vitro. The number of surviving cells and activation of caspases were assessed by WST-8 assay and immunoblotting. Expression of inhibitor of apoptosis proteins (IAP) family members: cIAP1 (birc2), cIAP2 (birc3), XIAP (birc4), survivin (birc5) were examined using cDNA array and real-time RT-PCR. Effects of gene silencing by small inhibitor RNAs (siRNA) were examined by WST-8-assay, Annexin-V staining and immunoblotting. RESULTS After staurosporine (SS) treatment, 55% of eutopic ESCs survived versus 70% of ectopic ESCs. Procaspase-3 or -7 was more intensely activated by SS treatment in eutopic than in ectopic ESCs (P < 0.01). mRNAs for IAP-family genes, such as cIAP-1, XIAP and survivin, were highly expressed in ectopic ESCs before SS treatment. The fold induction of survivin expression after SS treatment was higher in ectopic than eutopic ESCs (2.8 +/- 0.27 versus 0.69 +/- 0.07, respectively). Survivin gene silencing in SS-treated ectopic ESCs led to an increase of apoptotic cells (P < 0.05, versus control siRNA). CONCLUSIONS We demonstrated that survivin plays a critical role in susceptibility of ESCs to apoptosis. Our results indicate that a survivin inhibitor may be effective as a novel treatment for endometriosis.

Detection of pain-related molecules in the subchondral bone of osteoarthritic knees.

Clin Rheumatol. 2009 Sep 3; Ogino S, Sasho T, Nakagawa K, Suzuki M, Yamaguchi S, Higashi M, Takahashi K, Moriya HKnee pain is predominant among osteoarthritis (OA) patients, but the mechanism is poorly understood. We investigated subchondral bone as a source of OA knee pain using immunohistochemistry. Fifteen medial-type OA knees with minimum involvement of the lateral compartment determined by X-ray as well as magnetic resonance imaging that received total knee arthroplasty (TKA) were involved. Each pair of the medial femoral condyle (MFC) and lateral femoral condyle (LFC) was compared obtained at the time of TKA. Osteocartilaginous MFC and LFC specimens were histologically examined and stained with antibodies against cyclooxygenase 1 (Cox-1), cyclooxygenase 2 (Cox-2), substance P, tumor necrosis factor-alpha (TNF-alpha), and neuron-specific class III beta-tubulin (TUJ1), a pan-neuronal marker. Formation of cystic lesions was more frequently seen in the MFC. The lesions were composed of vascular endothelial cells, osteoclasts, and mononuclear cells and were present in similar proportions between the MFC and the LFC. Four out of 15 MFC specimens were positive for Cox-1, 15 for Cox-2, and 13 for TNF-alpha. No LFC specimens were positive for any antibodies. Substance P-positive and TUJ1-positive fibers were found in the subchondral area of the MFC, but not in the LFC. Pathological changes in the subchondral bone can be a source of knee pain, which was detectable by the positive immunoreactivity of substance P, Cox-2, TNF-alpha, and TUJ1, in the subchondral bone of affected compartments. The relatively immediate reduction in pain obtained by TKA might account for the involvement of the subchondral bone in knee pain because most of the affected subchondral plate is excised in TKA (debridement effect of TKA).