A comparison of renal phosphorus regulation in thermally-injured and multiple trauma patients receiving specialized nutrition support

To compare phosphorus intake and renal phosphorus regulation between thermally injured patients and multiple trauma patients, 40 consecutive critically ill patients, 20 with thermal injury and 20 with multiple trauma, who required enteral tube feeding were evaluated. Phosphorus intakes were recorded for 14 days from the initiation of tube feeding which was started 1 to 3 days post-injury. Serum for determination of phosphorus concentrations was collected at days 1, 3, 7, and 14 of the study period. A 24-hour urine collection was obtained during the first and second weeks of nutrition support for urinary phosphorus excretion, fractional excretion of phosphorus, renal threshold phosphate concentration, and phosphorus clearance. Average total daily phosphorus intake during the 14-day study for thermally injured patients and multiple trauma patients was 0.99 ± 0.26 mmol/kg/d vs 0.58 ± 0.21 mmol/kg/d, respectively, p \u3c .001. Serum phosphorus concentration on the third day of observation was significantly lower in the thermally injured group than those with multiple trauma (1.9 ± 0.8 mg/dL vs 3.0 ± 0.8 mg/dL, p ≤ .01). A trend toward hypophosphatemia in the thermally injured group persisted by the seventh day of feeding (2.7 ± 1.2 mg/dL vs 3.3 ± 0.6 mg/dL, p ≤ .04). Differences in urinary phosphorus excretion was not statistically significant between the thermally injured and multiple trauma groups (271 ± 213 mg/d vs 171 ± 181 mg/d for week 1, and 320 ± 289 mg/d vs 258 ± 184 mg/d for week 2, respectively). Urinary phosphorus clearance, fractional excretion of phosphorus, or renal threshold phosphate concentrations were also not significantly different between thermally injured and multiple trauma patients. During nutrition support, serum phosphorus concentrations are lower in thermally injured patients compared with multiple trauma patients despite receiving a significantly greater intake of phosphorus. Renal phosphorus regulation does not significantly contribute to the profound hypophosphatemia observed in thermally injured patients when compared with multiple trauma patients during nutrition support

Accuracy of predictive methods to estimate resting energy expenditure of thermally-injured patients

Background The purpose of this study was to evaluate the bias and precision of 46 methods published from 1953 to 2000 for estimating resting energy expenditure (REE) of thermally injured patients. Methods Twenty-four adult patients with ≥20% body surface area burn admitted to a burn center who required specialized nutrition support and who had their REE measured via indirect calorimetry (IC) were evaluated. Patients with morbid obesity, human immunovirus, malignancy, pregnancy, hepatic or renal failure, neuromuscular paralysis, or those requiring a FiO2 \u3e50% or positive end expiratory pressure (PEEP) ≥10 cm H2O were excluded. One steady-state measured REE measurement (MEE) was obtained per patient. The methods of Sheiner and Beal were used to assess bias and precision of these methods. The formulas were considered unbiased if the 95% confidence interval (CI) for the error (kilocalories per day) intersected 0 and were considered precise if the 95% CI for the absolute error (%) was within 15% of MEE. Results MEE was 2780 ± 567 kcal/d or 158% ± 34% of the Harris Benedict equations. None of the methods was precise (≤15% CI error). Over one-half (57%) of the 46 methods had a 95% confidence interval error \u3e30% of the MEE. Forty-eight percent of the methods were unbiased, 33% were biased toward overpredicting MEE, and 19% consistently underpredicted MEE. The pre-1980s methods more frequently overpredicted MEE compared with the 1990 to 2000 (p \u3c .01) and 1980 to 1989 (p \u3c .05) published methods, respectively. The most precise unbiased methods for estimating MEE were those of Milner (1994) at a mean error of 16% (CI of 10% to 22%), Zawacki (1970) with a mean error of 16% (CI of 9% to 23%), and Xie (1993) at a mean error of 18% (CI of 12% to 24%). The conventional 1.5 times the Harris Benedict equations was also unbiased and had a mean error of 19% (CI of 9% to 29%). Conclusions Thermally injured patients are variably hypermetabolic and energy expenditure cannot be precisely predicted. If IC is not available, the most precise, unbiased methods were those of Milner (1994), Zawacki (1970), and Xie (1993)

A Comparative Study of the ReCell® Device and Autologous Spit-Thickness Meshed Skin Graft in the Treatment of Acute Burn Injuries.

Early excision and autografting are standard care for deeper burns. However, donor sites are a source of significant morbidity. To address this, the ReCell® Autologous Cell Harvesting Device (ReCell) was designed for use at the point-of-care to prepare a noncultured, autologous skin cell suspension (ASCS) capable of epidermal regeneration using minimal donor skin. A prospective study was conducted to evaluate the clinical performance of ReCell vs meshed split-thickness skin grafts (STSG, Control) for the treatment of deep partial-thickness burns. Effectiveness measures were assessed to 1 year for both ASCS and Control treatment sites and donor sites, including the incidence of healing, scarring, and pain. At 4 weeks, 98% of the ASCS-treated sites were healed compared with 100% of the Controls. Pain and assessments of scarring at the treatment sites were reported to be similar between groups. Significant differences were observed between ReCell and Control donor sites. The mean ReCell donor area was approximately 40 times smaller than that of the Control (P < .0001), and after 1 week, significantly more ReCell donor sites were healed than Controls (P = .04). Over the first 16 weeks, patients reported significantly less pain at the ReCell donor sites compared with Controls (P ≤ .05 at each time point). Long-term patients reported higher satisfaction with ReCell donor site outcomes compared with the Controls. This study provides evidence that the treatment of deep partial-thickness burns with ASCS results in comparable healing, with significantly reduced donor site size and pain and improved appearance relative to STSG

Accuracy of predictive formulas to estimate resting energy expenditure of thermally injured patients

Abstract from the 25th Clinical Congress of the American Society for Parenteral and Enteral Nutrition, Chicago, IL, January 21-24, 2001

Renal phosphorus regulation in thermally-injured and multiple trauma patients receiving enteral nutrition

Abstract from the 22nd Clinical Congress of the American Society for Parenteral and Enteral Nutrition, Orlando, FL, January 18-21, 1998

Dimensions of Liberal Education at Brockport

Editor: H. Larry Humm (College at Brockport emeritus). Editorial board: Robert W. Strayer (professor emeritus, College at Brockport) ; W. Bruce Leslie, (College at Brockport faculty member) ; Robert S. Getz (professor emeritus, College at Brockport) ; J. Douglas Hickerson (former Director of Student Affairs, College at Brockport), Kenneth L. Jones (former College at Brockport faculty member) ; Charles R. Edwards (professor emeritus, College at Brockport). Also includes chapters by the following emeriti and former faculty members and professionals of The College at Brockport: Donald S. Douglas (former provost), Harold L. Rakov (emeritus), Roger M. Weir (emeritus), Owen S. Ireland (current), Edward J. Gucker (emeritus), Warren Fraleigh (emeritus), Lynn H. Parsons (emeritus), Ian H. Henderson (emeritus), Robert J. Gemmett (emeritus), J. Emory Morris (emeritus), Beth E. VanFossen (former faculty member), Peter L. Marchant (emeritus), Gladdys W. Church (former Director of the Learning Skills Center). An instructional development project of the Educational Communications Center, State University College at Brockport, Brockport, New York. Contents: On coming to college for the first time : Great expectations, yours and ours / Donald S. Douglas -- High school and college, what’s the difference? / Harold L. Rakov -- Living in a college community / Roger M. Weir -- A liberal arts education: what, why and how: The liberating arts and personal freedom / J. Douglas Hickerson -- The liberal arts, preparation for a career / Roger M. Weir -- Liberally educated people, knowing them when you see them: Perspective 1, Gaining knowledge, discipline, and values / Owen S. Ireland -- Perspective 2, Nurturing curiosity, creativity, and commitment / Edward J. Gucker -- Perspective 3, Cultivating freedom / Warren Fraleigh -- Democracy and the liberal arts, Is there a connection? / Lynn H. Parsons -- From Socrates to Brockport, your place in a long tradition / W. Bruce Leslie -- Why study the fine arts? / Ian H. Henderson -- Why study the humanities? / Robert J. Gemmett -- Why study the sciences? / J. Emory Morris -- Why study the social sciences? / Beth E. VanFossen -- More than making it: getting the most out of college : Where am I going? How do I get there? Some thoughts on academic planning / Robert S. Getz -- Thinking about thinking / H. Larry Humm -- How not to be a victim of time, a first letter to an anxious student / Peter L. Marchant -- Reading in college, more than turning pages / Charles R. Edwards -- Going to class-- being there is not enough / H. Larry Humm -- How not to be a victim of essay assignments, a second letter to an anxious student / Peter L. Marchant -- Making the most of tests / Gladdys W. Church.https://digitalcommons.brockport.edu/bookshelf/1328/thumbnail.jp

Dancing for Food in the Deep Sea: Bacterial Farming by a New Species of Yeti Crab

Vent and seep animals harness chemosynthetic energy to thrive far from the sun's energy. While symbiont-derived energy fuels many taxa, vent crustaceans have remained an enigma; these shrimps, crabs, and barnacles possess a phylogenetically distinct group of chemosynthetic bacterial epibionts, yet the role of these bacteria has remained unclear. We test whether a new species of Yeti crab, which we describe as Kiwa puravida n. sp, farms the epibiotic bacteria that it grows on its chelipeds (claws), chelipeds that the crab waves in fluid escaping from a deep-sea methane seep. Lipid and isotope analyses provide evidence that epibiotic bacteria are the crab's main food source and K. puravida n. sp. has highly-modified setae (hairs) on its 3rd maxilliped (a mouth appendage) which it uses to harvest these bacteria. The ε- and γ- proteobacteria that this methane-seep species farms are closely related to hydrothermal-vent decapod epibionts. We hypothesize that this species waves its arm in reducing fluid to increase the productivity of its epibionts by removing boundary layers which may otherwise limit carbon fixation. The discovery of this new species, only the second within a family described in 2005, stresses how much remains undiscovered on our continental margins