Hemodialysis-associated protein catabolism with and without glucose in the dialysis fluid

Hemodialysis-associated protein catabolism with and without glucose in the dialysis fluid. The effects of hemodialysis on protein and energy metabolism were studied in eight hemodialysis patients. The leg exchange of amino acids (AA) was measured during hemodialysis using a dialysis fluid with 10 mmol/liter glucose (GD) or without glucose (GFD). Arterial AA concentrations decreased by about 30% in GD and GFD. During dialysis, similar increases in the efflux of AA from leg tissues (mainly muscle) were observed in GD and GFD (basal 105 ± 104, vs. 71 ± 62 nmol/min/100 g tissue; dialysis 295 ± 46 vs. 289 ± 60 nmol/min/100 g tissue). The efflux of AA remained largely unchanged at one hour after the end of GD and GFD. Losses of AA to the dialysate were similar during GD (8.3 ± 0.9 g) and GFD (7.9 ± 0.4; NS). GFD resulted in a loss of 26 g of glucose whereas 30 of glucose was absorbed during GD. The amount of urea removed by dialysis and the post-dialysis increase in plasma urea were similar in GD and GFD. In conclusion, the addition of glucose to the dialysis fluid may help the energy balance, but it does not appear to reduce the negative effects of hemodialysis on protein metabolism

Protein and energy intake, nitrogen balance and nitrogen losses in patients treated with continuous ambulatory peritoneal dialysis

Protein and energy intake, nitrogen balance and nitrogen losses in patients treated with continuous ambulatory peritoneal dialysis. The aim of this investigation was to analyze factors which influence the dietary protein intake (DPI), the energy intake and the utilization of ingested protein, and to determine the relationship between various types of nitrogen losses in stable continuous ambulatory peritoneal dialysis (CAPD) patients. We performed 23 nitrogen balance (NB) studies of 6 to 11 days duration in 12 CAPD patients. One study was performed in all patients 3.4 ± 1.2 months after starting CAPD (early studies). The study was then repeated in nine patients after 12.1 ± 2.6 months, and two of these patients were studied again after 16 and 24 months, respectively (late studies). Before each NB study, the dietary intakes prior to the study were assessed in diaries and interviews. During a few days preceding the NB periods and during the NB periods each patient received an individualized diet composed so as to resemble the patients' spontaneously chosen diet regarding DPI and dietary energy intake (DEI). Total nitrogen, protein, urea and creatinine were analyzed in the dialysate and urine collected daily. Total nitrogen was also analyzed in the feces, collected over the whole NB period. Total nitrogen appearance (TNA), non-protein nitrogen appearance (NPNA) and urea nitrogen appearance (UNA) were calculated by correcting total nitrogen output, non-protein nitrogen output, that is, TNA minus the total protein losses (PL) and urea nitrogen output for changes in total body urea nitrogen. Glucose was determined in the collected dialysate and the daily glucose absorption was calculated. DPI varied between 0.62 and 2.09 g/kg/day, DEI between 21 and 42 kcal/kg/day and the peritoneal energy (glucose) intake (PEI) between 4 and 13 kcal/kg/day. DPI (but not DEI) correlated with Kt/Vurea and Kt/VCr and with total and renal clearances for urea and creatinine. NB (not corrected for “unmeasured” nitrogen losses) was positive in most studies, and it correlated with DPI and the total energy intake (TEI) in the early studies, but only with TEI in the late studies. DPI correlated with TNA, NPNA, UNA, non-protein-non-urea nitrogen loss and fecal nitrogen loss. UNA was highly correlated with TNA and NPNA (r = 0.95). We used data from 33 NB studies in CAPD patients (our present data combined with data from the literature) to calculate regression equations describing the relationship between TNA and NPNA, respectively, and UNA. Equations were derived by which the protein equivalent of TNA (PNA), that is, 6.25 TNA, and the protein equivalent of NPNA (PNPNA), that is, 6.25 NPNA, may be calculated from UNA which is directly measured. In stable CAPD patients, who are not strongly catabolic or anabolic, PNA may be used to estimate DPI and PNPNA may be used to estimate the net protein intake (DPI – PL)

En vraklagstiftning på djupt vatten? Om den oidentifierade ägarens ansvar vid miljöfarliga vrak och Vrakborttagningskonventionens eventuella påverkan på det svenska rättsläget

Uppskattningsvis ligger idag mellan 2,5 till 20 miljoner ton olja i vrak runt världens kuster. Under tusentals år har den kommersiella sjöfarten dominerat haven. Det var dock inte förrän industrialiseringen på 1800-talet som olja började användas i allt större utsträckning. I den kommersiella sjöfarten är frakt av miljöfarliga ämnen inte något ovanligt, varje dag skeppas cirka en halv miljon ton olja förbi Sveriges kuster. I Sverige är det, generellt sett, lätt att identifiera ägaren till ett vrak. I de fall en identifiering av ägaren kan göras, kan ägaren eller dess företrädare trots allt ibland vara omöjliga att hitta. Då vrakansvaret, inklusive betalnings-ansvaret för vrakåtgärder, tillkommer ägaren av vraket kan det ibland, med utgångspunkt i nyss nämnda, vara svårt eller till och med omöjligt att få betalt. Vrakrättens akilleshäl är således situationen då en ägare till ett miljöfarligt vrak inte går att identifieras eller hittas samt i slutändan är i stånd att betala. Idag finns ingen uttömmande lagstiftning på området och ett flertal rapporter har visat att rättsläget är oklart. Detta till trots att det år 2007 antogs en ny internationell konvention rörande vrakborttagning av IMO, den så kallade Vrakborttagningskonventionen. Konventionen har till syfte att försöka harmonisera vrakrätten och främja ett skyndsamt borttagande av vrak. Konventionen trädde i kraft den 14 april 2015. Trots ett flertal positiva utredningar och rapporter om en svensk ratificering av konventionen har detta inte ännu skett. Arbetet syftar till att analysera och redogöra för det internationella och nationella svenska rättsläget som ligger till grund för ansvaret vid miljöfarliga vrak. Vidare är syftet att analysera vilken påverkan Vrakborttagningskonventionen kan ha på vårt svenska rättsläge efter en eventuell ratificering av konventionen. Trots att världens ögon idag är inriktade på vilka förändringar som kan göras för vårt klimat är det på vrakrättens område mycket som återstår. En enhetlig och tydlig lagstiftning är eftersträvansvärd när det rör ansvar för miljöfarliga vrak. Vrakägaren är som huvudregel ansvarig för de åtgärder som åligger denne. I de fall ägaren inte vidtar åtgärder som denne är skyldig att utföra enligt internationell eller svensk nationell lag, har ansvaret kanaliserats genom analogier av lagstiftning, praxis, doktrin och sedvänja till stat och kommun. Konsekvenserna av detta och deras oklara ansvarighetsområden kan medföra stora risker för olika ekosystem generationer framöver. Nyligen framförda utredningar och rapporter förordar en ratificering av Vrakborttagningskonventionen. Jag ansluter mig till dessa slutsatser. Min mening är att säkerheten i våra svenska vatten på så sätt ökas.Currently, between 2,5 and 20 million tons of oil are found in shipwrecks around the world. For thousands of years, commercial sea transport has dominated the seas. However, it was not until the industrial revolution in the 19th century that oil started being used extensively. Within commercial sea transport, the shipping of environmentally hazardous substances is not uncommon. About half a million tons of oil are transported by the Swedish coastline every day. In Sweden, it is normally rather easy to identify the owner of a shipwreck. In cases where the owner can be identified, the owner or the representative may nevertheless be impossible to find. The responsibility and liability of shipwrecks, including liability for payment of shipwreck measures, are primarily connected to the shipwreck owner. With this in mind, it may be difficult, or in some cases even impossible, to get paid for these measures. The Achilles’ heel of shipwreck law is therefore when an owner of a hazardous shipwreck cannot be identified or found, and in the end is able to pay. Even though a new Convention on the Removal of Wrecks was adopted in 2007 and entered into force on April the 14th 2015, there is no comprehensive legislation in this area today. Several reports have shown that the legal situation is unclear. The purpose of the Convention is to try to harmonize shipwreck law and promote the expeditious removal of shipwrecks. Despite several positive studies and reports on a future ratification of the Convention, Sweden has not yet ratified it. This work aims to analyze and describe the international and national Swedish legal position in regards to the liability of hazardous shipwrecks. Furthermore, the purpose is to analyze the impact that a possible ratification of the Convention on the Removal of Wrecks would have on Swedish legislation. Although the eyes of the world today are focused on what kind of changes can be made for our climate, in the field of shipwrecks there is much more to be done. Regarding responsibilities for environmentally hazardous shipwrecks it is desirable to have a clear and coherent legislation. As a rule, the owner of a shipwreck is responsible for actions placed upon him. In case the owner does not undertake measures that he is obliged to carry out under international or Swedish national law, the responsibility lies with the state or local government through analogies of law, practice, doctrine and customary law. The consequences of this and the ambiguities regarding liability can entail great risks for different ecosystems for generations to come. The conclusions of recent investigations and reports point to a Swedish ratification of the Wreck Removal Convention in the near future. I agree with the conclusions drawn in these investigations and reports. In my point of view, this ratification would increase the safety of Swedish waters

Bone mineral content after renal transplantation

Forearm bone mineral content (BMC), as evaluated by photonabsorption densitometry, was measured in 28 cadaver kidney donor recipients who entered the study 8 weeks postoperatively and were followed up for 18 months. BMC decreased signifiantly (p<0.05) but marginally in placebo-treated patients (n=14) (initial BMC 1.09±0.25 g/cm; final BMC 1.05±0.24). Fourteen patients were prophylactically given 1,25(OH)2vitamin D3 in a dose which avoided hypercalcemia and hypercalciuria (sim0.25 µg/day); under 1,25(OH)2 vitamin D3 prophylaxis a significant decrease of forearm BMC was observed no longer (initial BMC 0.94±0.21 g/cm; final BMC 0.95±0.21), but the difference between placebo and 1,25(OH)2 vitamin D3 narrowly missed statistical significance (p=0.066). It is concluded that the decrease of forearm BMC is negligible in transplant recipients with low steroid regimens. The data suggest a trend for prophylaxis with 1,25(OH)2 vitamin D3 to slightly ameliorate forearm (cortical) BMC loss

Guidelines for using the multiplexing features of RTP to support multiple media streams

The Real-time Transport Protocol (RTP) is a flexible protocol that can be used in a wide range of applications, networks, and system topologies. That flexibility makes for wide applicability but can complicate the application design process. One particular design question that has received much attention is how to support multiple media streams in RTP. This memo discusses the available options and design trade-offs, and provides guidelines on how to use the multiplexing features of RTP to support multiple media streams

The Effect of Dialysis Membrane Flux on Amino Acid Loss in Hemodialysis Patients

We examined whether high flux membranes (HF) may induce a greater loss of amino acids compared to low flux membranes (LF). Ten hemodialysis patients participated in this study. Pre- and post-hemodialysis plasma amino acid profiles were measured by reverse-phase high pressure liquid chromatography for both HF and LF. We measured the dialysate amino acid losses during hemodialysis. The reduction difference for plasma total amino acid (TAA), essential amino acid (EAA), and branch chained amino acid (BCAA) was not significantly different in comparisons between the two membranes. (HF vs. LF; TAA 66.85±30.56 vs. 53.78±41.28, p=0.12; EAA 14.79±17.16 vs. 17.97±28.69, p=0.12; BCAA 2.21±6.08 vs. 4.16±10.98 mg/L, p=0.13). For the HF, the reduction in plasma amino acid levels for TAA and EAA were statistically significant. Although it was not statistically significant, the dialysate losses of BCAA were greater than the reduction in plasma (plasma reduction vs. dialysate loss; HF 2.21±6.08 vs. 6.58±4.32, LF 4.16±10.98 vs. 7.96±3.25 mg/L). HF with large pores and a sieving coefficient do not influence dialysate amino acid losses. Hemodialysis itself may influence the dialysate amino acid losses and may have an effect on protein metabolism

Repeated post-exercise administration with a mixture of leucine and glucose alters the plasma amino acid profile in Standardbred trotters

<p>Abstract</p> <p>Background</p> <p>The branched chain amino acid leucine is a potent stimulator of insulin secretion. Used in combination with glucose it can increase the insulin response and the post exercise re-synthesis of glycogen in man. Decreased plasma amino acid concentrations have been reported after intravenous or per oral administration of leucine in man as well as after a single per oral dose in horses. In man, a negative correlation between the insulin response and the concentrations of isoleucine, valine and methionine have been shown but results from horses are lacking. This study aims to determine the effect of repeated per oral administration with a mixture of glucose and leucine on the free amino acid profile and the insulin response in horses after glycogen-depleting exercise.</p> <p>Methods</p> <p>In a crossover design, after a glycogen depleting exercise, twelve Standardbred trotters received either repeated oral boluses of glucose, 1 g/kg body weight (BW) at 0, 2 and 4 h with addition of leucine 0.1 g/kg BW at 0 and 4 h (GLU+LEU), or repeated boluses of water at 0, 2 and 4 h (CON). Blood samples for analysis of glucose, insulin and amino acid concentrations were collected prior to exercise and over a 6 h post-exercise period. A mixed model approach was used for the statistical analyses.</p> <p>Results</p> <p>Plasma leucine, isoleucine, valine, tyrosine and phenylalanine concentrations increased after exercise. Post-exercise serum glucose and plasma insulin response were significantly higher in the GLU+LEU treatment compared to the CON treatment. Plasma leucine concentrations increased after supplementation. During the post-exercise period isoleucine, valine and methionine concentrations decreased in both treatments but were significantly lower in the GLU+LEU treatment. There was no correlation between the insulin response and the response in plasma leucine, isoleucine, valine and methionine.</p> <p>Conclusions</p> <p>Repeated post-exercise administration with a mixture of leucine and glucose caused a marked insulin response and altered the plasma amino acid profile in horses in a similar manner as described in man. However, the decreases seen in plasma amino acids in horses seem to be related more to an effect of leucine and not to the insulin response as seen in man.</p

Case Nortura/Norilia.Improving the utilisation of co-streams in poultry processing

Industrialised chicken production is far from organic agriculture prinicples. Still of interest is a more sustainable utilisation of by-products, e.g. hydrolysation of feathers for proteins, or extraction of food grade oil from chicken bones. Such approaches were studied in the bioeconomy-project "CYCLE" (2013-2017)

Protein-Energy Wasting and Mortality in Chronic Kidney Disease

Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with an increased death risk from cardiovascular diseases. However, while even minor renal dysfunction is an independent predictor of adverse cardiovascular prognosis, PEW becomes clinically manifest at an advanced stage, early before or during the dialytic stage. Mechanisms causing loss of muscle protein and fat are complex and not always associated with anorexia, but are linked to several abnormalities that stimulate protein degradation and/or decrease protein synthesis. In addition, data from experimental CKD indicate that uremia specifically blunts the regenerative potential in skeletal muscle, by acting on muscle stem cells. In this discussion recent findings regarding the mechanisms responsible for malnutrition and the increase in cardiovascular risk in CKD patients are discussed. During the course of CKD, the loss of kidney excretory and metabolic functions proceed together with the activation of pathways of endothelial damage, inflammation, acidosis, alterations in insulin signaling and anorexia which are likely to orchestrate net protein catabolism and the PEW syndrome