Nutrition in children with CRF and on dialysis

The objectives of this study are: (1) to understand the importance of nutrition in normal growth; (2) to review the methods of assessing nutritional status; (3) to review the dietary requirements of normal children throughout childhood, including protein, energy, vitamins and minerals; (4) to review recommendations for the nutritional requirements of children with chronic renal failure (CRF) and on dialysis; (5) to review reports of spontaneous nutritional intake in children with CRF and on dialysis; (6) to review the epidemiology of nutritional disturbances in renal disease, including height, weight and body composition; (7) to review the pathological mechanisms underlying poor appetite, abnormal metabolic rate and endocrine disturbances in renal disease; (8) to review the evidence for the benefit of dietetic input, dietary supplementation, nasogastric and gastrostomy feeds and intradialytic nutrition; (9) to review the effect of dialysis adequacy on nutrition; (10) to review the effect of nutrition on outcome

Organometallic chemistry of mononuclear tungsten aryloxide compounds

Room temperature sodium amalgam reduction (4 Na/Hg) of (\rm WCl\sb4(OAr-2,6Ph\sb2)\sb2) in the presence of phosphine gives the bis cyclo-metallated compound, (\rm W(OC\sb6H\sb3 Ph-\rm C\sb6H\sb4)\sb2(L)\sb2) (L = \rm PMe\sb2Ph, PMePh\sb2, PEtPh\sb2) which contains the W(IV) in an octahedral central coordination environment. Reaction of (\rm W(OC\sb6H\sb3Ph-\rm C\sb6H\sb4)\sb2(L)\sb2\rbrack with ethylene ($\u3e$1atm) gives the corresponding olefin complex (\rm W(OC\sb6H\sb3Ph-\rm C\sb6H\sb4)\sb2 (L) (C\sb2H\sb4)). The crystal structure confirms an octahedral arrangement about the metal and the presence of a metallacyclopropane ring. Reduction of either (\rm W(OC\sb6H\sb3Ph\sb2 -\rm 2,6)\sb2Cl\sb4) or (\rm W(OC\sb6H\sb3Pr\sb2\sp{i}-\rm 2,6)\sb2Cl\sb4) in toluene with sodium amalgam in the presence of alkynes (EtC$\equiv$CEt; PhC$\equiv$CPh; 4Me-PhC$\equiv$CPh-4Me) leads to a series of alkyne adducts of general formulae ((ArO)\sb2WCl\sb2(ac)) and ((ArO)\sb2W(ac)\sb2). The \sp{13}C NMR spectra of ((ArO)\sb2WCl\sb2(ac)) and ((ArO)\sb2W(ac)\sb2) show large downfield shifts for the alkyne carbon atoms. A single X-ray diffraction analysis shows five coordinate ((ArO)\sb2WCl\sb2(ac)) to adopt a square pyramidal geometry about tungsten with trans aryloxide ligands and an axial 3-hexyne. The solid state structure of ((ArO)\sb2W(ac)\sb2) shows a pseudo-tetrahedral environment about tungsten with two 3-hexyne ligands arranged parallel with each other. The bis-cyclometallated compounds (\rm W(OC\sb6H\sb3Ph-\rm C\sb6H\sb4)\sb2(L)\sb2\rbrack\ (L = PMe\sb2Ph, PMePh\sb2 and py) react with alkyne to form a number of products. From the reaction with 3-hexyne, two new compounds of formula (\rm W(OC\sb6H\sb3Ph-\rm C\sb6H\sb4)\sb2 (C\sb4Et\sb4)) and (\rm W(OC\sb6H\sb3Ph-\rm C\sb6H\sb4)\sb2(C\sb6Et\sb6)) are produced. Structural studies of both complexes show them to contain metallacyclic rings formed by transfer of one of the W-C(metallated aryloxide) to an $\alpha$-carbon of an intermediate tungstacyclopenta-2,4-diene. The product (\rm W(OC\sb6H\sb3Ph-\rm C\sb6H\sb4)\sb2(C\sb4Et\sb4)) contains a tungstacyclopenta-1,3-diene ring which can also add 3-hexyne to the tungsten-alkylidene bond to form (\rm W(OC\sb6H\sb3Ph-\rm C\sb6H\sb4)\sb2(C\sb6Et\sb6)). Reaction of (\rm W(OC\sb6H\sb3Ph-\rm C\sb6H\sb4)\sb2(L)\sb2\rbrack\ (L = PMe\sb2Ph, PMePh\sb2) with various monodentate and bidentate pyridine complexes resulted in the substitution of both phosphines to form (\rm W(OC\sb6H\sb3Ph-\rm C\sb6H\sb4)\sb2 (py)\sb2) or (\rm W(OC\sb6H\sb3Ph-\rm C\sb6H\sb4)\sb2 (py\sp2)) (py = various monodentate pyridines) (py\sp2 = various bidentate pyridines). The paramagnetic compounds exhibited sharp contact shifted \sp1H NMR consistent with the spin density being transferred through the aromatic ring by a hyperconjugative mechanism. Structural studies of (\rm W(OC\sb6H\sb3Ph-\rm C\sb6H\sb4)\sb2(C\sb5H\sb5N)\sb2) shows an octahedral arrangement about the metal center with cis pyridines. Included in this study is the determination of hyperfine coupling constants, as well as the singlet-triplet energy gaps for the various compounds isolated, utilizing the Van Vleck equation

The Effect of Monochromatic Infrared Energy and Interferential Stimulation on Hamstring Pain

This study compared two treatments used for rehabilitative purposes following injury with attention on practical application in a sports medicine setting. The two treatments under investigation involved different approaches 10 rehabilitation. The Anodyne system used a monochromatic infra-red energy source (MIRE) whereas the Interferential Current Stimulation (IFC) used two electrically generated interference waves to facilitate tissue response. The investigation was designed to detem1inc if there was a significant difference in (1) the reduction of pain resulting from induced eccentric hamstring injury following the five day treatment protocols using MIRE or IFC, (2) the reduction of pain resulting from induced eccentric hamstring injury immediately following each treatment protocol using the MIRE or IFC, and (3) in the number of days required to achieve the reported pre injury levels of pain using the MIRE or IFC. Currently there is limited research on the use of Anodyne Therapy in a Sports Medicine setting. Data obtained through this study should indicate effectiveness of treatment using the Anodyne Therapy System when compared to IFC. The participants of this study included 14 male and 16 female college students with ages ranging from 18 to 22 years. Each volunteer participant was assigned to a treatment protocol based upon the order in which the participant signed up to equalize the numbers within each group. Groups consisted of (1) Anodyne treatment, (2) IFC treatment, and (3) the control group. Participants were asked to perform single leg dumbbell lunges sufficient to induce a simulated eccentric hamstring injury. The following day the participants began their assigned treatment protocol of five consecutive days. A single analysis of variance (ANOVA) and Tukey Post-Hoc statistics were utilized to determine if there was a significant difference in the three variables. The ANOVA revealed a significant difference in the (1) reduction of pain after the five day treatment protocol and (2) reduction of pain following each treatment. No significant difference was noted in the numbers of days to achieve the reported pre-injury level of pain. Upon further examination using the Tukey post-hoc test, the source of the significant differences (ANOYA) was due to comparisons with the control group only. No significant differences existed between the Anodyne treatment group and the IFC treatment group

Feasibility and effectiveness of MATCH-ADTC on ninth-grade students presenting symptoms of depression, and anxiety

Doctor of PhilosophyDepartment of Special Education, Counseling and Student AffairsJudith K. HugheyAnxiety and depression symptoms in school-aged children are highly prevalent and can be comorbid. Mental health interventions are promising in decreasing anxiety and depression symptoms as well as learning healthy coping techniques. MATCH-ADTC is a transdiagnostic intervention grounded in cognitive-behavioral therapy and designed for children ages 6 to 15. The current study investigates the feasibility and effectiveness of MATCH-ADTC intervention on 15 ninth grade students that included both student self-reports and teacher reports. Students found MATCH-ADTC to be feasible (M = 1.89, SD = 0.34). Individual graphs of Internalizing Problem and Total Problem from the Brief Problem Monitor (BPM) found eight and seven student self-reports decreased over the course of MATCH-ADTC intervention, respectively. Individual graphs of Internalizing Problem and Total Problem from the Brief Problem Monitor (BPM) found five and ten teacher reports decreased over the course of MATCH-ADTC intervention, respectively. Results from the longitudinal multilevel modeling found an intercept range of 59.42 – 66.7. Intercepts below 65 indicate individuals did not have severe enough symptom of depression or anxiety as indicated by the Brief Problem Monitor. No statistically significant difference was found on the pre-and-post-test Beck Depression Inventory (t (14) = 0.68, p = 0.51) and Beck Anxiety Inventory (t(14) = 1.17, p = 0.26). The transdiagnostic intervention of MATCH-ADTC has provided evidence of potential for reduction in symptoms of anxiety and depression in school-aged children. However, more research should be completed on the effectiveness of MATCH-ADTC of school-aged children

Neoadjuvant chemotherapy is associated with improved outcomes in patients with stage 1A and 1B pancreatic cancer undergoing surgery: An NCDB study

Background: The use of neoadjuvant chemotherapy (NAC) for pancreatic ductal adenocarcinoma (PDAC) has shown clear advantages in locally advanced and borderline resectable disease. The benefit in upfront resectable PDAC is debated. Moreover, in early clinical stages IA/IB, potential benefits including improved R0 resection rate, decreased tumor upstaging, and survival, are not clear. We hypothesize that NAC will be associated with improved outcomes and survival compared to adjuvant therapy in patients with clinical stage IA/IB PDAC. Methods: The National Cancer Database (NCDB) PUFs (2004-2017) were used to perform a retrospective review of patients with clinical stage IA or IB PDAC undergoing surgery. Treatment groups were selected based on timing of chemotherapy. Patients receiving chemotherapy or surgery alone were excluded. Results: We identified 6,613 patients with clinical stage IA or IB PDAC who underwent surgery. The neoadjuvant therapy group (NAT) included 1,533 patients who received neoadjuvant or perioperative chemotherapy, and the adjuvant therapy group (AT) contained 5080 patients who received chemotherapy after surgery. Patients in the NAT had higher rates of T1 and T2 disease and lower rates of T3 pathology compared to the AT (pT1: 18.7% vs 7.8%; pT2: 20.1 vs 18.6%; pT3: 59.3% vs 72.1%, pConclusions: NAC is beneficial in patients with stage IA/IB PDAC undergoing surgical resection as it is associated with improved oncologic outcomes including increased R0 resection rate, decreased tumor upstaging, lymph node metastasis, and LVI. Furthermore, patients receiving NAC were found to have improved survival over those getting adjuvant therapy. Based on these results, we recommend all patients diagnosed with PDAC be considered for NAC prior to surgery