Should GPs provide spiritual care?

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Dose–response effect of a whey protein preload on within-day energy intake in lean subjects

The effect of consuming different amounts of whey protein on appetite and energy intake was investigated in two separate studies using randomised, crossover designs. Healthy-weight men and women (range: BMI 19·0–25·0 kg/m2, age 19·4–40·4 years) consumed one of four 400 ml liquid preloads, followed by an ad libitum test meal 90 min later. In study 1, preloads were 1675 kJ with 12·5, 25 or 50 % of energy from protein, and in study 2, preloads were 1047 kJ with 10, 20 or 40 % energy from protein. Flavoured water was used as the control in both the studies. Appetite ratings were collected immediately before 30, 60 and 90 min after consuming the preloads; and immediately, 30 and 60 min after consuming the test meal. In study 1, energy intake following the control preload (4136 (sem 337) kJ) was significantly higher than each of the 12·5 % (3520 (sem 296) kJ), 25 % (3384 (sem 265) kJ) and 50 % (2853 (sem 244) kJ) protein preloads (P < 0·05). Intake after the 12·5 % preload was significantly higher than following 25 and 50 % preloads (P < 0·05). In study 2, energy intake following the control preload (4801 (sem 325) kJ) was higher than following the 10 % (4205 (sem 310) kJ), 20 % (3988 (sem 250) kJ) and 40 % (3801 (sem 245) kJ) protein preloads (P < 0·05). There were no differences in subjective appetite ratings between preloads in either study. These findings indicate a dose–response effect of protein content of the preload on energy intake at a subsequent meal

Glutamate transporter dysfunction associated with nerve injury-induced pain in mice

Dysfunction at glutamatergic synapses has been proposed as a mechanism in the development of neuropathic pain. Here we sought to determine whether peripheral nerve injury-induced neuropathic pain results in functional changes to primary afferent synapses. Signs of neuropathic pain as well as an induction of glial fibrillary acidic protein in immunostained spinal cord sections 4 days after partial ligation of the sciatic nerve indicated the induction of neuropathic pain. We found that following nerve injury, no discernable change to kinetics of dl-α-amino-3-hydroxy-5-methylisoxazole-propionic acid (AMPA) or N-methyl-d-aspartate receptor (NMDAR)-mediated evoked excitatory postsynaptic currents (eEPSCs) could be observed in dorsal horn (lamina I/II) neurons compared with those of naïve mice. However, we did find that nerve injury was accompanied by slowed decay of the early phase of eEPSCs in the presence of glutamate transporter inhibition by the competitive nontransportable inhibitor dl-threo-β-benzyloxyaspartic acid (TBOA). Concomitantly, expression patterns for the two major glutamate transporters in the spinal cord, excitatory amino acid transporters (EAAT) 1 and EAAT2, were found to be reduced at this time (4 days postinjury). We then sought to directly determine whether nerve injury results in glutamate spillover to NMDARs at dorsal horn synapses. By employing the use-dependent NMDAR blocker (±)MK-801 to block subsynaptic receptors, we found that although TBOA-induced spillover to extrasynaptic receptors trended to increased activation of these receptors after nerve injury, this was not significant compared with naïve mice. Together, these results suggest the development of neuropathic pain involves subtle changes to glutamate transporter expression and function that could contribute to neuropathic pain during excessive synaptic activity.NHMRC grant: 0569927 & 35144

Responses to supplementation by dairy cows given low pasture allowances in different seasons 2. Milk production

Two factorial experiments were designed to determine the effects of stage of lactation, and season of the year, on cow responses to supplementary feeding. These experiments were conducted over consecutive years with 128 high genetic merit multiparous Holstein-Friesian cows in early, mid and late lactation in spring, summer, autumn and winter. At each stage of lactation, and in each season of the year, cows were offered a restricted pasture allowance (25 to 35 kg dry matter (DM) per cow per day), either unsupplemented (control) or with supplement at 50 MJ metabolizable energy (ME) per cow per day in experiment 1 and 80 MJ ME per cow per day in experiment 2. The two supplements given in both years were rolled maize grain (MG) and a mixture of foods formulated to nutritionally balance the diet (BR). In experiment 2, another treatment, of a generous pasture allowance (60 to 75 kg DM per cow per day) (AP), was imposed on an additional group of early lactation cows during each season. Direct milk solids (MS) (milk fat plus milk protein) responses in experiment 1 to MG were 169, 279, 195 and 251 g MS per cow per day in spring, summer, autumn and winter, respectively, while those to BR were 107, 250, 192, 289 g MS per cow per day. In experiment 2, however, milk solids responses to both supplements during spring were slightly below the control treatment, with values similar to those in experiment 1 in summer and autumn for cows on the BR but not the MG supplement. Milk solids responses to supplementary foods were largest during seasons of the year when the quantity and quality of pasture on offer resulted in the lowest milk solids yield from unsupplemented cows. When carry-over effects of feeding MG and BR on milk solids production were detected, they were only about half the magnitude of the direct effects. Serum urea concentrations were higher in control cows than those offered MG with a similar effect for BR in all but summer in experiment 1, while serum glucose concentrations were highest in winter and lowest in summer. The most important factor influencing milk solids responses was the relative food deficit (RFD) represented by the decline in milk solids yield of the respective control groups after,changing from a generous pasture allowance to restricted allowance when the feeding treatments were imposed. Total milk solids responses (direct and carry-over) to supplements were greatest when severe food restrictions, relative to the cows' current food demand, resulted in large reductions in milk solids yield of the control groups. The RFD was the best predictor of milk solids response to supplementary foods. Therefore, it is likely that cows are most responsive to supplementary foods during or immediately after the imposition of a severe food restriction

Responses to supplementation by dairy cows given low pasture allowances in different seasons 1. Pasture intake and substitution

Two factorial experiments were designed to determine the effects of stage of lactation, and season of the year, on cow responses to supplementary feeding. These experiments were conducted over consecutive years with 128 high genetic merit multiparous Holstein-Friesian cows in early, mid and late lactation in spring, summer, autumn and winter. At each stage of lactation, and in each season of the year, cows were offered a restricted pasture allowance (25 to 35 kg dry matter (DM) per cow per day), either unsupplemented (control) or supplemented with 50 MJ metabolizable energy (ME) per cow per day in experiment 1 and 80 MJ ME per cow per day in experiment 2. Two different supplements were offered, namely, rolled maize grain (MG) and a mixture of foods (BR) formulated to nutritionally balance the diet. In experiment 2, a fourth treatment consisting solely of a generous pasture allowance (60 to 75 kg DM per cow per day, AP) was introduced. Offering MG and BR increased DM intake (DMI). At the restricted pasture allowance, increasing total ME allowance (MEA) by offering supplementary foods increased ME intake (MEI) by 0.68 (s.e. 0.047) MJ per extra MJ ME offered. This highly significant (P < 0.001) linear relationship was consistent across seasons, and did not diminish at higher MEA. In experiment 2, cows in early lactation had lower substitution rates than mid and late lactation cows irrespective of season. Substitution rate was higher when higher pasture allowance or quality of pasture on offer enabled the unsupplemented cows to achieve higher DMI from pasture than at other times of the year. These results suggest that one of the key factors determining the intake response to supplementary foods is pasture allowance. Within spring calving dairying systems, the largest increases in total DMI per kg of supplement offered is likely when offering supplements to early lactation cows grazing restricted allowances of high quality pasture

Opioid-related (ORL1) receptors are enriched in a subpopulation of sensory neurons and prolonged activation produces no functional loss of surface N-type calcium channels.

The opioid-related receptor, ORL1, is activated by the neuropeptide nociceptin/orphanin FQ (N/OFQ) and inhibits high-voltage-activated (HVA) calcium channel currents (I(Ca)) via a G-protein-coupled mechanism. Endocytosis of ORL1 receptor during prolonged N/OFQ exposure was proposed to cause N-type voltage-gated calcium channel (VGCC) internalization via physical interaction between ORL1 and the N-type channel. However, there is no direct electrophysiological evidence for this mechanism in dorsal root ganglion (DRG) neurons or their central nerve terminals. The present study tested this using whole-cell patch-clamp recordings of HVA I(Ca) in rat DRG neurons and primary afferent excitatory synaptic currents (eEPSCs) in spinal cord slices. DRG neurons were classified on the basis of diameter, isolectin-B4 (IB4) binding and responses to capsaicin, N/OFQ and a μ-opioid agonist, DAMGO. IB4-negative neurons less than 20 μm diameter were selectively responsive to N/OFQ as well as DAMGO. In these neurons, ORL1 desensitization by a supramaximal concentration of N/OFQ was not followed by a decrease in HVA I(Ca) current density or proportion of whole-cell HVA I(Ca) contributed by N-type VGCC as determined using the N-type channel selective blocker, ω-conotoxin CVID. There was also no decrease in the proportion of N-type I(Ca) when neurons were incubated at 37°C with N/OFQ for 30 min prior to recording. In spinal cord slices, N/OFQ consistently inhibited eEPSCs onto dorsal horn neurons. As observed in DRG neurons, preincubation of slices in N/OFQ for 30 min produced no decrease in the proportion of eEPSCs inhibited by CVID. In conclusion, no internalization of the N-type VGCC occurs in either the soma or central nerve terminals of DRG neurons following prolonged exposure to high, desensitizing concentrations of N/OFQ.NHMRC Grant: 056992

Exercise metabolism in non-obese patients with type 2 diabetes following the acute restoration of normoglycaemia

This study investigated how acute restoration of normoglycaemia affected energy metabolism during exercise in nonobese patients with type 2 diabetes. Six subjects (mean ± SEM) aged 56.2 ± 2.7 years, with a BMI of 24.5 ± 1.5 kg/m2 and a VO2 peak of 28.7 ml/kg/min, attended the lab on two randomised occasions for a four-hour resting infusion of insulin or saline, followed by 30 minutes cycling at 50% VO2 peak. During the 4 h resting infusion, there was a greater (P < 0 0001) reduction in blood glucose in insulin treatment (INS) (from 11.2 ± 0.6 to 5.6 ± 0.1 mmol/l) than in saline treatment/control (CON) (from 11.5 ± 0.7 to 8.5 ± 0.6 mmol/l). This was associated with a lower (P < 0 05) resting metabolic rate in INS (3.87 ± 0.17) than in CON (4.39 ± 0.30 kJ/min). During subsequent exercise, blood glucose increased significantly in INS from 5.6 ± 0.1 at 0 min to 6.3 ± 0.3 mmol/l at 30 min (P < 0 01), which was accompanied by a lower blood lactate response (P < 0 05). Oxygen uptake, rates of substrate utilization, heart rate, and ratings of perceived exertion were not different between trials. Insulin-induced normoglycaemia increased blood glucose during subsequent exercise without altering overall substrate utilization

Direct measurements of ice-shelf flexure caused by surface meltwater ponding and drainage.

Global sea-level rise is caused, in part, by more rapid ice discharge from Antarctica, following the removal of the restraining forces of floating ice-shelves after their break-up. A trigger of ice-shelf break-up is thought to be stress variations associated with surface meltwater ponding and drainage, causing flexure and fracture. But until now, there have been no direct measurements of these processes. Here, we present field data from the McMurdo Ice Shelf, Antarctica, showing that the filling, to ~2 m depth, and subsequent draining, by overflow and channel incision, of four surface lakes causes pronounced and immediate ice-shelf flexure over multiple-week timescales. The magnitude of the vertical ice-shelf deflection reaches maxima of ~1 m at the lake centres, declining to zero at distances of <500 m. Our results should be used to guide development of continent-wide ice-sheet models, which currently do not simulate ice-shelf break-up due to meltwater loading and unloading.This work was supported by the U.S. National Science Foundation under award PLR-1443126 to the University of Chicago, a Leverhulme Early Career Fellowship (ECF-2014-412) and a CIRES Postdoctoral Visiting Fellowship, both awarded to A.F.B., and a NASA Earth and Space Science Fellowship (NNX15AN44H) awarded to G.J.M

The inferior turbinate flap in skull base reconstruction

BACKGROUND: As the indications for expanded endonasal approaches continue to evolve, alternative reconstructive techniques are needed to address increasingly complex surgical skull base defects. In the absence of the nasoseptal flap, we describe our experience with the posterior pedicle inferior turbinate flap (PPITF) in skull base reconstruction. DESIGN: Case series. SETTING: Academic tertiary care centre. METHODS: Patients who underwent reconstruction of the skull base with the PPITF were identified. Medical records were reviewed for demographic, presentation, treatment, follow-up, surgical and outcomes data. MAIN OUTCOME MEASURES: Flap survival, adequacy of seal, and complications. RESULTS: Two patients with residual/recurrent pituitary adenomas met the inclusion criteria. The nasoseptal flap was unavailable in each case due to a prior septectomy. Salvage of the original nasoseptal flap was not possible, as it did not provide adequate coverage of the resultant defect due to contraction from healing. All PPITFs healed uneventfully and covered the entire defect. No complications were observed in the early post-operative period. Endoscopic techniques and limitations of the PPITF are also discussed. CONCLUSIONS: Our clinical experience supports the PPITF to be a viable alternative for reconstruction of the skull base in the absence of the nasoseptal flap