Plasma response to fish oil in the elderly

Little information is available concerning whether incorporation of dietary omega-3 fatty acids into plasma lipids changes during healthy aging. Elderly (74 ± 4 years old) and young (24 ± 2 years old) adults were given a fish oil supplement for 3 weeks that provided 680 mg/day of docosahexaenoic acid and 320 mg/day of eicosapentaenoic acid, followed by a 2 week wash-out period. Compliance was monitored by spiking the capsules with carbon-13 glucose, the excretion of which was measured in breath CO2. In response to the supplement, plasma docosahexaenoic acid rose 42% more in the elderly but eicosapentaenoic responded similarly in both groups. Despite raising docosahexaenoic acid intake by five to tenfold, the supplement did not raise plasma free docosahexaenoic acid (% or mg/dL) in either group. We conclude that healthy aging is accompanied by subtle but significant changes in DHA incorporation into plasma lipids

Successful bone marrow transplantation in a patient with DNA ligase IV deficiency and bone marrow failure

BACKGROUND: DNA Ligase IV deficiency syndrome is a rare autosomal recessive disorder caused by hypomorphic mutations in the DNA ligase IV gene (LIG4). The clinical phenotype shows overlap with a number of other rare syndromes, including Seckel syndrome, Nijmegen breakage syndrome, and Fanconi anemia. Thus the clinical diagnosis is often delayed and established by exclusion. METHODS: We describe a patient with pre- and postnatal growth retardation and dysmorphic facial features in whom the diagnoses of Seckel-, Dubowitz-, and Nijmegen breakage syndrome were variably considered. Cellular radiosensitivity in the absence of clinical manifestations of Ataxia telangiectasia lead to the diagnosis of DNA ligase IV (LIG4) deficiency syndrome, confirmed by compound heterozygous mutations in the LIG4 gene. At age 11, after a six year history of progressive bone marrow failure and increasing transfusion dependency the patient was treated with matched sibling donor hematopoetic stem cell transplantation (HSCT) using a fludarabine-based conditioning regimen without irradiation. RESULTS: The post-transplantation course was uneventful with rapid engraftment leading to complete and stable chimerism. Now at age 16, the patient has gained weight and is in good clinical condition. CONCLUSION: HSCT using mild conditioning without irradiation qualifies as treatment of choice in LIG4-deficient patients who have a matched sibling donor

Metabolic response to a ketogenic breakfast in the healthy elderly.

OBJECTIVE: To determine whether the metabolism of glucose or ketones differs in the healthy elderly compared to young or middle-aged adults during mild, short-term ketosis induced by a ketogenic breakfast. DESIGN AND PARTICIPANTS: Healthy subjects in three age groups (23 +/- 1, 50 +/- 1 and 76 +/- 2 y old) were given a ketogenic meal and plasma beta -hydroxybutyrate, glucose, insulin, triacylglycerols, total cholesterol, non-esterified fatty acids and breath acetone were measured over the subsequent 6 h. Each subject completed the protocol twice in order to determine the oxidation of a tracer dose of both carbon-13 (13C) glucose and 13C-beta-hydroxybutyrate. The tracers were given separately in random order. Apolipoprotein E genotype was also determined in all subjects. RESULTS: Plasma glucose decreased and beta-hydroxybutyrate, acetone and insulin increased similarly over 6 h in all three groups after the ketogenic meal. There was no significant change in cholesterol, triacylglycerols or non-esterified fatty acids over the 6 h. 13C-glucose and 13C-beta-hydroxybutyrate oxidation peaked at 2-3 h postdose for all age groups. Cumulative 13C-glucose oxidation over 24 h was significantly higher in the elderly but only versus the middle-aged group. There was no difference in cumulative 13C-beta-hydroxybutyrate oxidation between the three groups. Apolipoprotein E (epsilon 4) was associated with elevated fasting cholesterol but was unrelated to the other plasma metabolites. CONCLUSION: Elderly people in relatively good health have a similar capacity to produce ketones and to oxidize 13C-beta-hydroxybutyrate as middle-aged or young adults, but oxidize 13C-glucose a little more rapidly than healthy middle-aged adult

A systematic review of the association between urinary biomarkers and pain

There are many clinical situations where it is not possible to be certain if a patient is experiencing pain. A urinary biomarker of pain would expedite diagnosis and treatment. The collection of urine is non-invasive, which makes it an ideal choice in situations where patients are stressed and already suffering pain. This systematic review aims to determine if there is a urinary biomarker that has consistently been associated with changing levels of pain, and may reflect underlying biological mechanisms associated with the production of pain. Materials and Methods A literature search was conducted of Embase, Medline, PubMed, Web of Science, and Scopus using the search keywords urine, biomarker and pain. There were no limitations on publication dates. The search was limited to English language and human studies. Results 1251 articles were screened. 833 were eliminated by title or abstract as not fulfilling the search criteria. After elimination of duplicates, 277 studies were identified as uniquely fulfilling the search characteristics composed of 22 randomized controlled trials (RCTs), 44 controlled observational studies, and 211 case studies or series. In order to fulfill the selection criteria, the 22 RCTs had to include both pain and urinary measurements as outcomes in the abstract of the article. The RCTS involved 2177 patients with varied pain conditions and urinary biomarkers. Discussion The research involving urinary biomarkers in painful conditions of bone turnover have found statistically significant correlations between disease progression and pain. The biomarkers chosen may reflect the mechanism of the disorder rather than pain. Conclusion High quality long duration RCTs using interventions with proven efficacy are required to investigate the association between urinary biomarkers and pain

Electroencephalography in the diagnosis and therapeutic monitoring of chronic pain

Electroencephalography (EEG) has been used to investigate cortical mechanisms involved in pain, to diagnose pain conditions, and to monitor therapeutic outcomes. The purpose of this systematic review is to determine if EEG has been validated for use in the investigation of the mechanisms, diagnosis, and monitoring of therapeutic indices involving changes in chronic pain. Materials and Methods: A literature search was conducted of Embase, Medline, PubMed, Web of Science, and Scopus databases using the search keywords chronic, pain, and EEG, from all publication dates. This review includes only publications in English, and studies done on human subjects. Randomized Controlled Trials (RCTs) were included in the final sample if they displayed data involving both EEG and chronic pain in their abstracts. Results: 1150 articles were screened. After elimination of duplicates 242 studies were identified as uniquely fulfilling the search characteristics, 9 RCTs, 100 controlled observational studies, and 132 case studies or series. There was heterogeneity in the assessment and types of chronic pain conditions studied, the therapeutic interventions used, the sleep/wake state of the subjects, the pain measurements and the EEG outcomes assessed. Discussion: Most of the studies used had methodological issues relating to bias and sample size which make it difficult to draw definite conclusions about the utility of EEG in a clinical patient population with chronic pain. Conclusion: More high quality RCTs are required to investigate the role of EEG in the diagnosis and therapy of chronic pain conditions