Comparison of multiple-pass 24-hour recall estimates of energy intake with total energy expenditure determined by the doubly labeled water method in young children

OBJECTIVE

This study determined the accuracy of the multiple-pass 24-hour recall method for estimating energy intake in young children by comparing it with measurements of total energy expenditure made using the doubly labeled water method.

DESIGN

Three multiple-pass 24-hour recalls were obtained over a 14-day period to estimate mean energy intake. Total energy expenditure was measured over the same 14-day period under free-living conditions using the doubly labeled water technique.

SUBJECTS/SETTING

Twenty-four children between the ages of 4 and 7 years were tested at the General Clinical Research Center/Sims Obesity Nutrition Research Center at the University of Vermont.

STATISTICAL ANALYSIS

t Tests, paired t tests, Pearson product-moment correlation coefficients, pairwise comparison to show relative bias and limits of agreement, and regression analysis were used to test the relationships among study variables.

RESULTS

No difference was found between 3-day mean energy intake and total energy expenditure for the group (t = 2.07, P = .65). The correlation between individual measures of energy intake and total energy expenditure was not statistically significant (r = .25, P = .24).

CONCLUSIONS

Data from 3 days of multiple-pass 24-hour recalls were sufficient to make valid group estimates of energy intake. The method was not precise for individual measurements of energy intake.

Trauma care in China: challenge and development

The People's Republic of China has significantly improved the general health of its people by a concerted effort in primary health care but trauma care and its prevention remains a problem. This paper provides an overview of the strengths and weaknesses of the trauma-care system in China and proposes a strategy for its future development. This includes public-health legislation, the integration of military and civilian practice to provide comprehensive care from the scene of the incident through to rehabilitation, medical audit, the introduction of postgraduate trauma-management training courses and international academic exchanges.

The locus of origin of augmenting and reducing of visual evoked potentials in rat brain

Humans who are high sensation seekers and cats who demonstrate comparable behavioral traits show increasing amplitudes of the early components of the cortical visual evoked potential (VEP) to increasing intensities of light flash; low sensation seekers show VEP reducing. Roman high-avoidance (RHA) and Roman low-avoidance (RLA) rats have behavioral traits comparable to human and cat high and low sensation seekers, respectively. Previously, we showed that RHA and RLA rats are cortical VEP augmenters and reducers, respectively. The goal of this study was to determine if augmenting-reducing is in fact a property of the visual cortex or if it originates at the lateral geniculate nucleus and is merely reflected in recordings from the cortex. EPs to five flash intensities were recorded from the visual cortex and dorsal lateral geniculate of RHA and RLA rats. As in the previous study, the slope of the first cortical component as a function of flash intensity was greater in the RHA than in the RLA rats. The amplitude of the geniculate component that has a latency shorter than the first cortical component was no different in the two lines of rats. The finding from the cortex confirms the earlier finding of augmenting and reducing in RHA and RLA rats, respectively. The major new finding is that the augmenting-reducing difference recorded at the cortex does not occur at the thalamus, indicating that it is truly a cortical phenomenon.

Ontogenesis of prolactin receptor gene expression in the rat olfactory system: potential roles for lactogenic hormones in olfactory development

The PRL receptor (PRLR) is expressed at very low levels in the olfactory bulb of the adult rat but is detected in abundance in the olfactory epithelium and olfactory bulb of the fetal rat in late gestation. To explore potential roles for the lactogenic hormones in olfactory differentiation and development, we have used in situ hybridization and immunohistochemistry to examine the ontogeny of PRLR gene expression in the rat olfactory system. At midgestation (embryonic day 12.5), messenger RNAs (mRNAs) encoding the long and short isoforms of the rat PRLR were detected in the medial and lateral nasal processes, the epithelial lining of the olfactory pit, and the neuroepithelium lining the cerebral ventricles in the region of the rhinencephalon. PRLR mRNA was also expressed prominently in the frontonasal mesenchyme and in mesenchymal tissue underlying the developing brain and overlying the pontine flexure in the interpeduncular fossa. The distribution of PRLR immunoreactivity was similar to that of PRLR mRNA, indicating that the PRLR gene is translated to that of PRLR mRNA, indicating that the PRLR gene is translated to lactogenic binding protein in the rat embryo in vivo. With advancing gestation, the PRLR was expressed intensely, although discontinuously, in the olfactory epithelium and was detected in the cartilage primordia of the ethmoid, sphenoid, temporal, and mandibular bones. PRLR expression in the vomeronasal organ was confined to the luminal epithelial surface. PRLR mRNA and immunoreactive protein were first detected in the olfactory bulb on embryonic day 18. PRLR expression was most intense initially in the periventricular neuroepithelium; subsequently, robust staining of the mitral and tufted cell neurons became apparent, accompanied by intense PRLR expression in the sensory neuronal cell bodies of the olfactory epithelium. By postnatal day 5, the PRLR was expressed in abundance in mitral and tufted cells of the olfactory bulb and in neuronal cell bodies of the anterior olfactory nucleus and the piriform cortex. PRLR mRNA was also detected in the mitral cells of the olfactory bulb of the lactating rat, although at levels far lower than those in the fetal or neonatal rat. The expression of the PRLR in the olfactory system of the fetal and neonatal rat implicates novel roles for the lactogenic hormones in olfactory differentiation and development and may provide new mechanisms by which the lactogens may regulate neonatal behavior and maternal-infant interactions.

Cross-calibration of body-composition techniques against dual-energy X-ray absorptiometry in young children

Using dual-energy X-ray absorptiometry (DXA) as a standard method for determining body composition in children, we evaluated the accuracy of skinfold-thickness measurements (with the Slaughter et al equations, which are based on triceps and calf skinfold-thickness measurements), bioelectrical resistance (BR; with the Kushner el al equations and age-specific hydration constants), and other clinical measurements (individual skinfold thicknesses and body mass index) for the assessment of body fat in children. We studied a heterogenous group of 49 boys and 49 girls, aged 6.6 +/- 1.4 y and weighing 24.1 +/- 5.9 kg. Fat mass estimated by DXA was significantly lower than fat mass measured by skinfold thickness, even though fat mass measurements by these two techniques were strongly related to each other. Fat mass estimated by DXA was also significantly lower than fat mass measured by BR, and the model R2 and SEE were not as strong as for the skinfold-thickness technique. Fat mass estimated by DXA also correlated with other clinical indexes such as triceps skinfold thickness, body mass index, body weight, and subscapular skinfold thickness. In forward-regression analysis, subscapular skinfold thickness, body weight, triceps skinfold thickness, sex, and height2/resistance estimated the value for fat mass measured by DXA with a model R2 of 0.91 and an SEE of 0.94 kg fat mass. These studies suggest that existing techniques for assessing body fat in children may be inaccurate. We provide new anthropometric equations based on the use of DXA as a criterion that provide accurate and precise measures of body fat and fat-free mass in white children aged 4-9 y. This approach provides estimates of body fat standardized to a known laboratory standard of chemical analysis of carcasses.

Functional significance of the early component of the human blink reflex

The relationship between the size of the first electromyographic (EMG) component of the cutaneous blink reflex (R1) and onset of eyelid closure in human adults was determined in 4 experiments in which R1 size was varied by different means: change in stimulus intensity, paired stimulation, and warning. Two-phase lid movements were frequently seen, with an early small movement followed by a large rapid movement. All experiments showed that larger R1s were associated with shorter latencies of both movements. This covariation was general across participants and was independent of shifts in the excitability of the blink reflex pathways indexed by R1 latency, R2 latency, and R2 area (R2 is the more prolonged, later EMG component). The results indicate that R1 acts first to evoke an early lid movement and second to facilitate eyelid closure by the later R2 burst. Identification of this second behavioral function for R1 aids the interpretation of other findings and encourages its use as a model system.

Functional significance of the early component of the human blink reflex

The relationship between the size of the first electromyographic (EMG) component of the cutaneous blink reflex (R1) and onset of eyelid closure in human adults was determined in 4 experiments in which R1 size was varied by different means: change in stimulus intensity, paired stimulation, and warning. Two-phase lid movements were frequently seen, with an early small movement followed by a large rapid movement. All experiments showed that larger R1s were associated with shorter latencies of both movements. This covariation was general across participants and was independent of shifts in the excitability of the blink reflex pathways indexed by R1 latency, R2 latency, and R2 area (R2 is the more prolonged, later EMG component). The results indicate that R1 acts first to evoke an early lid movement and second to facilitate eyelid closure by the later R2 burst. Identification of this second behavioral function for R1 aids the interpretation of other findings and encourages its use as a model system.

Recent developments in an animal model of visual evoked potential augmenting/reducing and sensation seeking behavior

The early research on an animal (cat) model and biological marker (visual evoked potential augmenting and reducing) of sensation seeking behavior is briefly described. Recent findings with selectively bred lines of rats show that (1) the relationship between sensation seeking behavior and augmenting vs. reducing is also present in the rat; (2) augmenting and reducing is a cortical, not a subcortical, phenomenon, and (3) augmenting/reducing and related sensation seeking behaviors are heritable traits. This paper also discusses evidence for the relative contributions of genetic and environmental factors in determining the sensation seeking trait.

Behavior of the Roman/Verh high- and low-avoidance rat lines in anxiety tests: relationship with defecation and self-grooming

The Swiss sublines of Roman high- and low-avoidance (RHA/Verh and RLA/Verh) rats have been selected and bred for rapid (RHA/Verh) vs. extremely poor (RLA/Verh) acquisition of two-way active avoidance. Behavioral and physiological measures of emotionality, or reactivity to stress, appear to be among the most prominent characteristics differentiating both rat lines. The present study shows that RLA/Verh rats are more sensitive, as compared to their RHA/Verh counterparts, to the conflict involved in the shock-induced suppression of drinking paradigm, as well as in a hyponeophagia test. RLA/Verh rats also showed higher defecation values which were significantly correlated with the main hyponeophagia test variables. Likewise, self-grooming was more frequent in RLA/Verh rats than in their RHA/Verh counterparts and showed significant correlations with conflict-related behaviors (i.e., latency to start eating and time spent eating) from the hyponeophagia test. These results give additional support to the contention that RLA/Verh rats present higher anxiety (emotionality) than their RHA/Verh counterparts.

Effects of prenatal diazepam on two-way avoidance behavior, swimming navigation and brain levels of benzodiazepine-like molecules in male Roman high- and low-avoidance rats

Utilizing psychogenetically selected Roman high- and low-avoidance rats (RHA/Verh and RLA/Verh), the present experiments investigated the effects of prenatally administered vehicle and diazepam (1 and 3 mg/kg per day, SC) on the behavior and neurochemistry of adult, male offspring. Active, two-way avoidance behavior was analyzed in 96 rats, at 6 months of age, and swimming navigation in 68 others, at 11 months. Three weeks after testing, selected brain areas from the latter animals were immunoassayed for benzodiazepine (BZD)-like molecules. The 3 mg/kg dose of diazepam both decreased freezing behavior in the shuttle box and reduced the hippocampal content of BZD-like molecules in the RLA/Verh male rats. Swimming navigation (spatial learning), at which the RLA/Verh rats were more adept, was not specifically affected by prenatal diazepam in either rat line. The possibility exists that an increased hippocampal release of BZD-like substances may be necessary to alter shuttle box behavior in RLA/Verh rats.

The prolactin receptor in the fetal rat: cellular localization of messenger ribonucleic acid, immunoreactive protein, and ligand-binding activity and induction of expression in late gestation

The cellular distribution and developmental expression of the PRL receptor (PRLR) in the late gestational fetal rat were examined by in situ hybridization, immunohistochemistry, and radioligand binding. Antisense and sense strand RNA probes encoding the long and short isoforms of the rat PRLR were hybridized to tissue sections under stringent conditions. Messenger RNA (mRNA) encoding the two isoforms of the receptor was expressed widely in tissues derived from all three germ layers; these included various tissues not known previously to contain lactogenic receptors, such as the olfactory neuronal epithelium and olfactory bulb, trigeminal and dorsal root ganglia, cochlear duct, brown adipose tissue, submandibular glands, whisker follicles, tooth primordia, and proliferative and maturing chondrocytes of developing bones. Prominent expression of PRLR mRNA was also detected in the fetal adrenal cortex, gastrointestinal and bronchial mucosae, renal tubular epithelia, choroid plexus, thymus, liver, pancreas, and epidermis. Immunohistochemical studies using monoclonal anti-PRLR antibodies demonstrated that the distribution of PRLR immunoreactivity was similar to that of PRLR mRNA, suggesting that the PRLR mRNA is translated to receptor protein in the fetus in vivo. The encoding of functional PRL receptor proteins by fetal PRLR mRNA was revealed by the presence of specific rat placental lactogen II-binding sites in fetal adrenal cortex, renal tubules, small intestinal villi, pancreatic ductules and islets, hepatic parenchymal cells, choroid plexus ependymal cells, and microsomal fractions of fetal lung and thymus. Levels of expression of PRLR mRNA and protein increased between days 17.5 and 20.5 of gestation in a number of fetal tissues, including the adrenal, pancreas, small intestine, pituitary, thymus, liver, and submandibular gland. The widespread expression of the PRLR in the fetal rat and the induction of receptor expression in late gestation suggest novel roles for the lactogenic hormones in fetal and neonatal development.

Teaching in accident and emergency medicine: 10 commandments of accident and emergency radiology

One of the many attractions of accident and emergency medicine is the wide and varied opportunities it provides for education. This is because of the acute nature of the work, which necessitates prompt and accurate decision making. However, in many instances the decisions have to be made by inexperienced senior house officers. Departments therefore need a safe system of practice that can be remembered and adhered to under stress. The 10 commandments is one such system for analysing emergency radiographs of all the regions of the body. This system lays down guidelines to protect both staff and hospitals from the inevitable mistakes that inexperienced doctors will make.

Diet and body composition as determinants of basal lipolysis in humans

Determinants of basal lipolysis were investigated in a group of 23 volunteers of both sexes. Body composition was measured by underwater weighing and resting metabolic rate with indirect calorimetry. Insulin sensitivity was determined by using the minimal model of Bergman. The rate of appearance of palmitic acid in the blood was measured with 14C-1-palmitate as the tracer administered as a nonprimed constant infusion. Simple and stepwise-regression analyses were performed to determine correlations and to generate a multivariate model to examine the determinants of basal lipolysis. Fat intake (as a percent of total energy intake) was correlated with basal lipolysis (r = 0.57, P < 0.005) as well as protein intake (as a percent of energy intake) (r = -0.46, P = 0.03) in univariate analysis. Body weight (r = 0.56, P = 0.005) explained a greater portion of the variance in lipolysis than fat-free mass (r = 0.44, P < 0.05) or fat mass (NS). Independent predictors of basal lipolysis were determined by stepwise regression. The best model generated included fat intake, fat-free mass, carbohydrate intake, and daily energy intake as significant determinants of lipolysis (r = 0.89, P < 0.001). The insulin sensitivity index and sex were not independent predictors of basal lipolysis. Thus, our data support either body weight or fat-free mass as more appropriate indexes than fat mass to normalize basal rates of lipolysis in humans. Furthermore, the macronutrient composition of the diet is an important determinant of lipolysis and thus should be considered in future experimental designs.

Corticotropin-releasing factor and vasopressin mRNA levels in roman high- and low-avoidance rats: response to open-field exposure

Roman high- (RHA) and low- (RLA) avoidance rats are selected and bred for rapid versus non-acquisition of two-way, active avoidance behavior in a shuttle box. They also show a number of other behavioral differences which appear to be essentially related to emotional factors, the RLA rats being emotionally more sensitive. The ACTH secretory response to stressors is also augmented in RLA rats. We thus raised the question whether the expression of corticotropin-releasing factor (CRF) and vasopressin (VP), two neurohormones exerting a synergistic action on ACTH release from corticotropic cells, is different in the two strains. Steady-state mRNA levels were examined in the parvicellular neurons of the paraventricular nucleus under basal conditions and 4 h after a single 8-min exposure to an open-field stressor. In situ hybridization histochemistry with 35S-labeled oligonucleotide probes was followed by quantitative cell by cell autoradiography. When basal CRF and VP mRNA levels were compared in the two lines, we found that the RLA rats had a significantly higher VP-labeling density than the RHA rats. No difference was found for CRF mRNA. During open-field exposure, we observed behavioral differences paralleled by elevated corticosterone compatible with an increased emotional response in RLA rats. Open-field exposure produced a significant increase in CRF but not VP mRNA in both RHA and RLA rats (by 43 and 57%, respectively). These results suggest that differences in basal VP expression in CRF neurons may participate in the mechanisms underlying the hyperactivity of the hypothalamo-pituitary-adrenal (HPA) axis in the emotionally more sensitive RLA rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Pre-hospital cardiac arrest: room for improvement

OBJECTIVE

To audit the outcome from pre-hospital cardiac arrest managed by ambulance personnel, and to assess their proficiency by analysing the time to initiate basic and advanced cardiac life support, the compliance with national guidelines, and the overall success of resuscitation.

DESIGN

A retrospective analysis of ambulance service report forms of pre-hospital cardiac arrests, where active resuscitation was attempted by ambulance personnel between October 1992 and May 1993.

SETTING

The City of Salford.

SUBJECTS

100 consecutive patients who suffered cardiac arrest out-of-hospital and who were brought to the accident and emergency department of Hope Hospital alive, or with resuscitation still in progress.

RESULTS

Only 4 of 100 patients were successfully resuscitated out of hospital, of whom 2 survived to leave hospital. Detailed analysis of pre-hospital performance was performed on 89 patients only, as 11 report forms were missing (no successful pre-hospital resuscitations in this 11). Ventricular fibrillation was the first recorded rhythm in 51.7%, but 85.7% were in asystole or electromechanical dissociation on arrival at hospital. No patient who was still in cardiac arrest on arrival at hospital was successfully resuscitated. 11 patients received 'bystander CPR'. The median time to basic life support was 6 min; the median call-to-response interval was 8 min; the median call-to-advanced cardiac life support interval was 21 min; the median on-scene time was 31 min (paramedics), or 15 min (technicians). The dose of drugs given by the intravenous route did not comply with the contemporary recommendations in 43.2%, and those doses given by the endotracheal route were inadequate in 37.9% of the cases. Endotracheal intubation was attempted in all paramedic resuscitations (91.4% success); intravenous access was attempted in 60.3% (91.7% success).

CONCLUSIONS

The survival from pre-hospital cardiac arrest in this community is worse than the national average. There is no single explanation for this. Better community CPR training, greater efficiency at the scene through additional personnel, and stricter compliance with national ACLS guidelines, facilitated by extended refresher training, are all required if outcome is to be improved.

Effects of training, early handling, and perinatal flumazenil on shuttle box acquisition in Roman low-avoidance rats: toward overcoming a genetic deficit

The present series of studies investigated the effects of intensive training, postnatal handling-stimulation and/or perinatal flumazenil (Ro 15-1788, benzodiazepine receptor antagonist) on the acquisition of two-way active avoidance by Roman low-avoidance (RLA/Verh) rats. This rat line has been selectively bred for poor avoidance in the shuttle box, while their Roman high-avoidance counterparts (RHA/Verh) have been selectively bred for their extremely good performance in that task. In the first experiment, RLA/Verh rats submitted to a long and intensive training procedure (unlike those submitted to short training) were able to achieve a performance of 56% of avoidances per session. In the second experiment both postnatal handling and perinatal flumazenil treatments increased avoidance responding in another group of RLA/Verh rats tested at the age of 18 months. Finally, in the last experiment, the performance of a third stock of RLA/Verh rats of the same age which had received perinatal flumazenil did not differ, on the later phases of training, from that shown by RHA/Verh animals. The results are discussed in terms of the "warm up" phenomena which seems to be highly involved in the selection of RLA/Verh rats, as well as on the possibility that central benzodiazepine receptors could play a role in the genetic deficit shown by RLA/Verh rats, which apparently confers a greater emotivity.

Free fatty acid metabolism in aerobically fit individuals

The impact of aerobic fitness level on the production and disposal of serum free fatty acids was investigated in 26 normal young volunteers. The fitness level was ascertained by history and confirmed by determination of maximal aerobic capacity. Energy expenditure and substrate oxidation at rest were measured with indirect calorimetry. Free fatty acid turnover was measured with an infusion of [14C]palmitic acid. All tests were done > or = 48 h after the last bout of exercise. The sedentary (SED) volunteers had higher rates of systemic delivery of fatty acids than aerobically fit (FIT) individuals (532 +/- 53.4 vs. 353 +/- 62.3 mumol/min; P = 0.05). This difference was accentuated when the values were normalized to fat-free mass (9.2 +/- 0.8 and 5.9 +/- 0.98 mumol.kg-1.min-1 for SED and FIT, respectively). Fatty acid oxidation was similar between FIT and SED volunteers in absolute numbers (209 +/- 25 vs. 202 +/- 21 mumol/min, respectively; NS) as well as when normalized to fat-free mass (3.8 +/- 0.9 vs. 3.6 +/- 1.4 mumol.kg-1.min-1, respectively; NS). In contrast, the nonoxidative disposal of serum fatty acids was higher in SED (330 +/- 46.1 mumol/min) than in FIT individuals (144 +/- 52 mumol/min; P = 0.026). Thus, the ratio of nonoxidative to oxidative disposal rates of fatty acids was higher in SED than in FIT individuals (1.65 +/- 0.29 vs. 0.75 +/- 0.17; P = 0.021). The data support the hypothesis that high aerobic fitness level is associated with a low rate of systemic delivery of fatty acids at rest. Nevertheless, subjects with high aerobic fitness levels have fat oxidation at the same rate as unfit individuals.

Evaluating activity and emotional reactivity in a hexagonal tunnel maze: correlational and factorial analysis from a study with the Roman/Verh rat lines

Two hundred forty 30-day-old Roman high- and low-avoidance (RHA/Verh and RLA/Verh) rats (divided equally by line and gender) which had received several peri- and/or postnatal treatments, forming two factorial [line x sex x treatment(s)] experimental designs, were tested in a hexagonal tunnel maze including a brightly illuminated central arena. The present study reports the results of correlational and factorial (principal-components) analyses performed on the data from those two experimental constituencies. The purpose of the study was to evaluate the validity of the hexagonal tunnel maze for testing emotionality, and therefore, the following measures were included in the analysis: entries into the central illuminated arena, total activity during testing, defecation during testing, and defecation during handling and weighing after testing. An overall pattern of negative correlations (or opposite loadings in the principal-components analyses) between defecation (especially during maze testing) and entries into the illuminated center and activity was found, thus giving support to the validity of entries into the illuminated center as being indicative of emotional reactivity.

GABAergic and dopaminergic transmission in the brain of Roman high-avoidance and Roman low-avoidance rats

The GABAergic and dopaminergic pathways in the central nervous system (CNS) play a pivotal role in the control of emotions and in the adaptive responses to stressful stimuli. The present study was aimed at characterizing a range of biochemical markers of GABA- and dopamine-mediated neurotransmission in the CNS of Roman high-avoidance (RHA/Verh) and Roman low-avoidance (RLA/Verh) rats, two psychogenetically selected lines that differ in their level of emotionality. The stimulatory effect of GABA on 36Cl- uptake was less pronounced in the cerebral cortex of RLA/Verh rats as compared to RHA/Verh rats, whereas no line-related changes were detected in [3H]GABA and [3H]flunitrazepam binding. On the other hand, the density of D1 dopamine receptors labeled with [3H]SCH 23390 was lower in the nucleus accumbens of RLA/Verh rats as compared to their RHA/Verh counterparts, whilst no line-dependent changes were observed in the binding parameters of D1 dopamine receptors in the striatum, amygdala, and prefrontal cortex. These biochemical differences may contribute to the distinct emotionality and responsiveness to the effects of psychoactive drugs of RHA/Verh and RLA/Verh rats.

Clorgyline effect on pineal melatonin biosynthesis in Roman high- and low-avoidance rats

Pineal melatonin and related indoles levels were higher in Roman high- than in Roman low-avoidance rats, while 5-HIAA/5-HT ratio, as an index of MAO activity was higher in low- than in high-avoidance rats. Clorgyline stimulated pineal melatonin biosynthesis in both lines of rats. However, melatonin and N-acetylserotonin levels remained higher and 5-HIAA levels remained lower in the high avoidance rats treated with low dose (0.5 mg/kg) while treatment with 1.0 mg/kg of clorgyline eliminated the differences in melatonin production between high- and low-avoidance rats.