Nutritional Status of Functionally Dependent and Nonfunctionally Dependent Elderly in Taiwan

OBJECTIVE

The purpose of this study was to measure and compare nutritional status of the functionally dependent elderly with those nonfunctionally dependent elderly by assessing nutrient intake, anthropometric measurements, hematological and biochemical parameters, and the nutritional risk index (NRI).

METHODS

Ninety-six volunteers (42 functionally dependent elderly, 54 nonfunctionally dependent elderly) participated in this study. The items of activity of daily living (ADL) were assessed to determine functional status. Demographic and health data were collected at the time of interview. Subjects completed 24-hour diet recall and food frequency questionnaires. Height, weight and skinfold thickness measurements were taken. Hematological and biochemical parameters were measured. The NRI was then calculated.

RESULTS

Osteoporosis and hypertension were the most frequently reported chronic diseases. A small proportion of the elderly with functional dependence (9.5%) and with nonfunctional dependence (13%) had a body mass index (BMI) (< or = 21 kg/m2), indicating they were underweight. There were no significant differences in nutrient intake between the two groups. However, a higher percentage of the functionally dependent elderly had a nutrient intake of less than 75% of the Taiwan Recommended Daily Nutrient Allowance (RDNA). The functionally dependent group had a higher prevalence of malnutrition than the nonfunctionally dependent group (44.7% vs. 25%) based on the NRI.

CONCLUSIONS

These functionally dependent elderly people exhibited a poorer nutritional status than the nonfunctionally dependent elderly. The elderly with functional dependence were at risk for inadequate iron intake and abnormal serum triglyceride concentrations: they were also at greater risk for chronic diseases and had a greater need for medications.

Inhibitory effect of DCDC on lipopolysaccharide-induced nitric oxide synthesis in RAW 264.7 cells

In the present study we have examined the effect of DCDC (2',5'-dihydroxy-4-chloro-dihydrochalcone) on lipopolysaccharide (LPS)-induced responses in murine macrophage cell line RAW 264.7. Exposure of LPS-stimulated cells to DCDC inhibited the nitrite accumulation in culture medium. DCDC also concentration-dependently inhibited LPS-stimulated increase of iNOS expression; however, it had little effect on iNOS enzyme activity, suggesting that the inhibitory action to DCDC is mainly due to the inhibition on iNOS expression rather than iNOS enzyme activity. DCDC significantly inhibited LPS-evoked degradation of IkappaB-alpha and the nuclear translocation of NF-kappaB; it also exhibited the activity of scavenging the stable free radical 1,1-diphenyl-2-picrylhydrazyl (DPPH). DCDC also inhibited cyclooxygenase-2 activity in RAW 264.7 cells with an IC50 of 3.0 microM; furthermore, it also significantly decreased LPS-induced mortality rate in mice. Taken together, we demonstrate that DCDC exhibits inhibitory effects on nitric oxide production through the inhibition of IkappaB-alpha degradation and NF-kappaB activation, and therefore the suppression of iNOS expression. DCDC also shows the antioxidant activity and COX-2 inhibitory action. Moreover, it improves survival in a murine model of endotoxaemia suggesting that DCDC may be potential in the therapy of septic shock.

Kawasaki disease presenting as cervical lymphadenitis or deep neck infection

OBJECTIVE

To describe a group of patients with Kawasaki disease who had cervical lymphadenopathy as their dominant initial presentations.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of 14 children who were admitted to Chang-Gung Children's Hospital between May 1996 and July 1998 with the initial impression of cervical lymphadenitis, cellulitis, and/or deep neck infection but for which a diagnosis of Kawasaki disease was established later.

RESULTS

Five (35.7%) patients were less than 5 months of age, and 8 (57.1%) patients were more than 53 months of age. The mean duration for establishing a diagnosis of Kawasaki disease from the onset of illness was 8.2 (6 to 20) days. Initially, empiric antibiotics were prescribed in each case with unsatisfactory response. Intravenous immune gamma globulin (2 g/kg) was administered in 13 patients. Three (21.4%) patients developed coronary artery lesions.

CONCLUSION

If a child less than 6 months or more than 4 years of age has a fever and an enlarged cervical lymph node and is unresponsive to empiric antibiotics, Kawasaki disease should be considered.

Measurement of the CP violation parameter sin2 phi(1) in B(0)(d) meson decays

We present a measurement of the standard model CP violation parameter sin2 phi(1) (also known as sin2beta) based on a 10.5 fb(-1) data sample collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric e(+)e(-) collider. One neutral B meson is reconstructed in the J/psiK(S), psi(2S)K(S), chi(c1)K(S), eta(c)K(S), J/psiK(L), or J/psipi(0) CP-eigenstate decay channel and the flavor of the accompanying B meson is identified from its charged particle decay products. From the asymmetry in the distribution of the time interval between the two B-meson decay points, we determine sin2 phi(1) = 0.58(+0.32)(-0.34)(stat)+0.09-0.10(syst).

Antibody to intercellular adhesion molecule 1 (CD54) decreases survival and not lung injury in baboons with sepsis

Neutrophil influx into the lung is an important event in the pathogenesis of acute lung injury in gram-negative sepsis. We hypothesized that administration of a monoclonal antibody to intercellular adhesion molecule 1 (ICAM-1, CD54), a molecule mediating neutrophil adhesion to endothelial cells, would decrease neutrophil sequestration and transmigration in the lung and attenuate lung injury in Escherichia coli sepsis. Sepsis was induced in 12 baboons primed with heat-killed E. coli (1 x 10(9) CFU/kg) 12 h before infusion of live bacteria (1 x 10(10) CFU/kg). Six animals received monoclonal antibody to CD54 (1 mg/kg) intravenously at the time of live E. coli infusion. After 48 h or when blood pressure could not be maintained, tissues were harvested and bronchoalveolar lavage (BAL) samples were obtained. Median survival time was decreased in anti-CD54-treated animals. This group also had decreased mean arterial pressure, increased metabolic acidosis, and decreased urine output. Measures of lung injury including gas exchange, lung lavage protein and lactate dehydrogenase (LDH), lung thiobarbituric acid-reactive species, and lung histology, including alveolar neutrophil volumes, were unaffected by treatment. The effect of anti-CD54 on neutrophil influx into tissues as measured by myeloperoxidase was organ specific. These data show that monoclonal antibody to CD54 does not ameliorate acute lung injury in E. coli sepsis, and septic primates given anti-CD54 have worsened metabolic parameters and decreased survival.

Postnatal depression -- biological or cultural? A comparative study of postnatal women in the UK and Taiwan

AIM

The aim of the study was to compare the factors which are associated with postnatal depression in the UK (United Kingdom) and Taiwan.

BACKGROUND/RATIONALE

A comparative study of postnatal women in the UK and Taiwan was undertaken to investigate postnatal care and the prevalence of postnatal depression.

DESIGN/METHODS

The Edinburgh Postnatal Depression Scale (EPDS) was used to determine the prevalence of postnatal depression. A semistructured interview and validated questionnaire were used to collect data on maternal satisfaction with postnatal care and the factors associated with postnatal depression. A one in three random sample of women from two community midwife teams in Sheffield, UK and three public health stations in Keelung, Taiwan took part in the study.

RESULTS/FINDINGS

Fifty (94% response rate) women from Sheffield and 101 (83% response rate) women from Keelung, who were at low risk for maternal or foetal problems during labour and the postnatal period, agreed to participate. The prevalence of postnatal depression in the British and Taiwanese women was almost equal; 18% in the UK and 19% in Taiwan. In Taiwan, the prevalence of postnatal depression had a negative association with relationship with partner (Spearman correlation=-0.34, P < 0.001) and self-confidence (Spearman correlation=-0.28, P < 0.01, Spearman correlation). In addition Taiwanese women who felt more anxious after birth (10.9 +/- 7.9, P < 0.001, t-test) had a higher chance of postnatal depression. In the UK, there was a significant negative association between adaptation to the new role of motherhood and score on the EPDS (Spearman correlation=-0.47, P < 0.001). The overall scores for maternal satisfaction were 28.1 and 24.3 in the UK and Taiwan, respectively (P < 0.001, t-test). British women reported a better quality of care during the postnatal period in terms of emotional support and physical care.

CONCLUSIONS

The findings of this study suggest that further cross cultural investigation could shed light on the relative balance of biological and cultural factors which may be associated with the onset of postnatal depression. As the prevalence of postnatal depression is similar in both cultures despite large differences in culture and postnatal care systems, some support is given to a hypothesis that postnatal depression has at least some biological determinants as well as cultural/social ones.

Prophylaxis of intravenous immunoglobulin and acyclovir in perinatal varicella

Maternal chickenpox around the time of delivery can cause severe and even fatal illness in the newborn but an effectively preventive method has not yet been established. We proposed that a combination of intravenous immunoglobulin (IVIG) and acyclovir (ACV) intravenously could effectively prevent perinatal varicella. A group of 24 newborn infants whose mother had developed a varicella rash within 14 days before and after delivery were studied. Some 15 infants whose mothers' rash appeared within 7 days before and 5 days after delivery were categorised as an at-risk group and received IVIG prophylaxis (500 mg/kg) administered soon after birth or post-natal contact either alone or with intravenous acyclovir (5 mg/kg every 8 h) for a total of 5 days starting from 7 days after the onset of maternal rash. Of four infants receiving IVIG alone, two developed clinical varicella. None of ten infants receiving both IVIG and ACV contracted varicella. One infant receiving ACV alone had no varicella vesicles either. Of nine infants in the not at-risk group four had undetectable varicella-zoster virus antibody on admission and developed clinical varicella subsequently.

CONCLUSION

The combination of intravenous immunoglobulin given soon after birth and prophylactic acyclovir intravenously administered 7 days after the onset of maternal rash can effectively prevent perinatal varicella.

Compact, 220-ps visible laser employing single-pass, cascaded frequency conversion in monolithic periodically poled lithium niobate

We report the first demonstration to our knowledge of 220-ps visible laser generation from passively Q-switched-laser pumped periodically poled lithium niobate (PPLN) in a single-pass, cascaded frequency-conversion process. The monolithic PPLN consists of a 1-cm section for frequency doubling the 1064-nm Nd:YAG pump laser to a 532-nm laser and a subsequent 4-cm section for generating the visible laser in a 532-nm-pumped optical parametric generation (OPG) process. In generating the 622.3-nm OPG signal wavelength we measured a 3.0-microJ/pulse pump threshold at the 1064-nm wavelength, 16% overall efficiency, and 35% slope efficiency at two times threshold. At 10(-6) pump duty cycle and 20-mW average power in the visible, photorefractive damage was not observed at the phase-matching temperature of 40.3 degrees C.

Embolization of cerebral arteriovenous malformations with n-butyl-2-cyanoacrylate

PURPOSE

To determine the safety and effectiveness of arteriovenous malformation (AVM) embolization using liquid adhesives in a series of 103 patients with cerebral AVMs who underwent embolization with n-butyl-2-cyanoacrylate (NBCA).

METHODS

All embolization procedures were performed using NBCA and a lipiodol mixture delivered by a flow-directed and/or guide-wire directed microcatheter.

RESULTS

Using the Spetzler-Martin grading system, there were two cases of grade I AVM, 23 of grade II AVM, 31 of grade III AVM, 37 of grade IV AVM, and 10 of grade V AVM. Eleven patients underwent embolization only; these patients either had evidence of morphologic cure on follow-up angiogram, or showed evidence of a stable condition at 2-years follow-up. Seven patients were not treated owing to technical problems or a positive functional test. All other patients underwent preoperative embolization; 75%-99% obliteration was noted in 39 of these patients, 50%-74% obliteration in 33, and less than 50% obliteration in 13. Embolization-related complications occurred in nine patients, and two patients died as a result of the procedure. Severe neurologic complications occurred in two patients and five patients developed mild or transient neurologic deficit.

CONCLUSIONS

Endovascular treatment of brain AVMs with an NBCA mixture has a lower complication rate than shown in previous studies using other materials. The percentage of obliteration of the nidus is increased because NBCA penetrates AVMs better than polyvinyl alcohol particles. NBCA can be used at a lower concentration than other acrylates, and therefore causes almost no catheter gluing. The embolic mass formed by NBCA is more biocompatable than that formed by other acrylates.

Factors associated with intestinal perforation in children's non-typhi Salmonella toxic megacolon

BACKGROUND

To evaluate the risk factors for intestinal perforation in children with toxic megacolon caused by non-typhi Salmonella infection.

METHODS

During an 11-year period we reviewed the records of children treated for non-typhi Salmonella infection. All of the subjects had positive stool culture for non-typhi Salmonella and were treated with intravenous ceftriaxone during hospitalization. Clinical data reviewed included demographic features, clinical manifestations, laboratory findings, radiologic findings, microbiology, therapeutic effect of hydration and rectal tube placement and the operative findings. Patients with toxic megacolon were defined as those having toxic appearance, diarrhea, high fever (>39 degrees C) and marked colon dilatation with maximal diameter > 1.5 times the width of the vertebra body of the first lumbar spine (L1-VB). To define the risk factors for patients with toxic megacolon complicated by intestinal perforation, patients were divided into two groups for analysis: P group, those complicated with intestinal perforation; and NP group, those without intestinal perforation. Differences in age, sex, severity of diarrhea, duration of fever, hemogram and its differential, culture, stool analysis, serum C-reactive protein (CRP), electrolytes, maximal colon diameter, medical therapy and timing of rectal tube insertion between the two groups were analyzed. Statistical analyses were conducted with chi square tests and multiple logistic regression.

RESULTS

A total of 75 patients (P group, 27 patients; NP group, 48 patients) ages 4 months to 6 years were evaluated. With chi square analysis 7 variables were found to be significantly associated with intestinal perforation: age >1 year; fever >5 days; ratio of immature to total neutrophils >20%; serum CRP >200 mg/l; colon diameter >2.5 times the width of L1-VB; inadequate early hydration; and delay in rectal tube insertion. With multivariate analysis age >1 year, serum CRP >200 mg/l and colon diameter >2.5 times of width of L1-VB, inadequate early hydration and delay in rectal tube insertion were the most significant factors associated with intestinal perforation.

CONCLUSION

Identification of patients with toxic megacolon associated with non-typhi Salmonella infection at risk for further intestinal perforation is possible. Early effective fluid resuscitation and rectal tube insertion may be helpful to prevent the occurrence of intestinal perforation.

Sonographic evaluation of cellulitis in children

Within a 3 year period from July 1996 to July 1999, a total of 105 children with clinical diagnosis of cellulitis were evaluated by ultrasonography. Eighty-six children (age range, 17 days to 15 years) fulfilling the sonographic criteria for diagnosis of cellulitis were enrolled into the study. The sonographic features were used to correlate with clinical symptoms and their duration, the peripheral leukocyte count, and the serum C-reactive protein level. Pus aspiration for immediate microscopic and later bacteriologic studies was carried out under sonographic guidance. Ultrasonographic features of cellulitis included subcutaneous tissue thickening without distortion and pus (25 cases, 29%), distortion of subcutaneous tissue without pus accumulation (26 cases, 30%), distortion of subcutaneous tissue with pus accumulation (19 cases, 23%), and distortion of tissue with abscess formation (16 cases, 18%). The presence of sonographic features of tissue distortion with or without pus accumulation, including abscess formation in children with cellulitis, correlated with a longer duration of symptoms (greater than 4 days), the presence of high-grade fever, higher peripheral leukocyte count, and higher serum C-reactive protein levels. Those patients who underwent sonographically guided aspiration or surgical intervention showed a shorter hospital stay and fever duration than those without such aspiration. Our results indicated that ultrasonography is of great value in managing cellulitis by providing information regarding the progression of inflammation. Sonographically guided aspiration of pus may be a treatment of choice, as it may decrease the need for operation.

Transarterial embolisation of complex cavernous sinus dural arteriovenous fistulae with low-concentration cyanoacrylate

We report the effectiveness of low-concentration n-butyl-2-cyanoacrylate (NBCA)-Lipiodol-tungsten mixture (10-15 %) in the management of patients with aggressive or recurrent complex cavernous dural arteriovenous fistulae (CSDAVF). We treated five patients with complex CSDAVF with a low concentration of an NBCA-Lipiodol-tungsten mixture after catheterisation of the feeding arteries arising from the external carotid artery. Three had a recurrent CSDAVF after transarterial particulate embolisation. Three refused transvenous treatment or could not be treated in this way; two patients had also feeding dural branches of the internal carotid artery. All patients had complete resolution of symptoms and signs within a month of the procedure. No definite neurological complication was found during follow-up ranging from 12 to 36 months. Transarterial embolisation with low-concentration cyanoacrylate appears to be an effective alternative management of aggressive or recurrent CSDAVF.

Graft failure caused by pulmonary venous obstruction diagnosed by intraoperative transesophageal echocardiography during lung transplantation

IMPLICATIONS

Intraoperative transesophageal echocardiography can be useful to diagnose pulmonary venous anastomotic stenoses during lung transplantation.

Necrotising pneumonitis in children

We retrospectively analysed the clinical features and outcome of children under 17 years of age with necrotising pneumonitis (NP). The radiographs and CT scans of the chest of children under 17 years of age between July 1995 and March 1999 who had complicating community-acquired pneumonia were reviewed. CT scans were obtained for persistent fever, respiratory distress and sepsis despite empiric antibiotic therapy and closed tube drainage. A total of 21 children had the radiographic features of NP of whom 11 (52%) patients were successfully managed using antibiotic therapy with or without closed tube drainage. Ten patients required thoracoscopic decortications and/or lysis of pleural adhesions or debridement of empyema due to refractory pleural sepsis, failure of pulmonary re-expansion and persistent air-leaks. The most common pathogens identified were Streptococcus pneumoniae (n = 3), Staphylococcus aureus (n = 2), and Haemophilus influenzae type b (n = 2). The days of hospital stay, duration of fever and days of C-reactive protein return to normal were significantly less for the medically versus the surgically treated children (P < 0.05).

CONCLUSION

The clinical course of necrotising pneumonitis in children following complicated pneumonia is often prolonged despite adequate antibiotic therapy. Necrotising pneumonitis with co-existing multiple loculations, pneumothorax/ bronchopleural fistula in the empyema and extensive pleural peel are poor prognostic factors for medical therapy. Thoracoscopic removal of loculated empyema, lysis of adhesions and/or decortication are effective in relieving tachypnoea, chest pain, and controlling fever and improve the outcome, especially in children with empyema.

Infected cephalohematoma associated with sepsis and skull osteomyelitis: report of one case

Osteomyelitis is rarely complicated by an infected cephalohematoma. We report a case of an infected cephalohematoma associated with Escherichia coli sepsis and osteomyelitis of the skull. This 37-day-old boy had E. coli sepsis, which had a poor response to antibiotic treatment. An infected cephalohematoma was found when he was 43 days old. Cranial computed tomography (CT) scanning showed cephalohematoma with abscess formation and underlying bony destruction over the left parietal region. Antibiotics alone could not eradicate the infection. Extensive incision, drainage, and debridement of the necrotic bone resulted in prompt improvement. Three weeks of ceftizoxime administered intravenously, followed by 3 weeks of cefixime given orally completed the treatment course.

Expression of capsid [correction of caspid] protein VP1 for use as antigen for the diagnosis of enterovirus 71 infection

To produce enterovirus 71 antigen for diagnostic purposes, the gene encoding the entire capsid protein VP1 was amplified by reverse transcription-polymerase chain reaction (RT-PCR), cloned and expressed in Escherichia coli as a poly-histidine fusion protein. Western blotting experiments with sera from patients with enterovirus 71 infection indicated that immunoglobulin G (IgG) and IgM antibodies bound to a single polypeptide VP1. According to these results, IgM anti-VP1 appeared in sera of patients with a symptomatic enterovirus 71 acute infection, whereas IgG anti-VP1 was present in sera of past infection. This finding suggests that detecting IgG and IgM immune responses against linear epitopes of recombinant VP1 is an effective means of determining the different phases of enterovirus 71 infection. In addition, sera containing coxsackie virus 16 (CA16) antibodies did not cross-react with the recombinant VP1 of enterovirus 71, despite the homology between VP1 proteins of both viruses. Comparison with reference PCR and neutralization assays showed these antibody tests to be appropriate for the serodiagnosis of enterovirus 71 infection.

Influenza A virus infection in infants

Influenza A virus causes a variety of respiratory and nonrespiratory illness in children. The symptomatology varies with different age groups. The purpose of this retrospective study was to define the clinical characteristics of influenza A infection in Taiwanese infants. During the period from December 1997 to February 1998, 37 febrile patients younger than 1 year of age, including five newborns, were admitted to our hospital due to suspicion of sepsis or meningitis. The medical records of these patients were retrospectively evaluated. Influenza A virus was isolated from the specimens of the throat swabs in all patients, whereas no bacterial pathogen was detected. The most common clinical manifestations of these infants were lower respiratory tract infections, including pneumonia, bronchiolitis, and croup. There was no significant difference between the clinical characteristics of infants younger than 3 months and those aged from 3 months to 1 year. The mean duration of fever, peak of body temperature, and duration of hospitalization were 3.41 (+/-1.86) versus 4.4 (+/-2.02) days, 39.0 (+/-0.57) versus 39.9 (+/-0.63) oC, 4.9(+/-1.49) versus 6.3 (+/-3.7) days in infants younger than 3 months and infants aged from 3 months to 1 year, respectively. The older infants aged from 3 months to 1 year had a significantly higher peak body temperature than the infants younger than 3 months (p < 0.05). Two patients with croup had a more severe clinical course, however, the outcomes were good in all patients. During an influenza A virus outbreak, influenza A infection should be included in the differential diagnosis of infants with lower respiratory tract infection.

Effects of glucose-free maintenance solution on plasma glucose during anesthesia in patients undergoing long neurologic surgery

BACKGROUND

Using glucose-free solution as fluid maintenance is widely advocated during neurosurgery because of concerns about hyperglycemia aggravating cerebral ischemia. This study evaluated the alterations in plasma glucose concentrations in both adult and pediatric patients undergoing lengthy neurologic surgery, during which they were given glucose-free solutions.

METHODS

This study included 154 patients (ASA class II, aged 3 months-75 years) undergoing elective neurosurgical procedures. They were divided into two groups: group A (15-75 years-of-age) and group P (3 months-14 years-of-age). Groups A (n = 126) and P (n = 28) were further divided into five subgroups, respectively, based on the duration of surgery: 5, 6, 7, 8 and 9 hours. Anesthesia was maintained with isoflurane, fentanyl and vecuronium. Blood sampling was undertaken every hour throughout surgery.

RESULTS

Adult patients differed significantly in body weight (61.5 +/- 10.9 vs 25.6 +/- 14.9 kg), age (58.9 +/- 15.7 vs 7.5 +/- 4.3 years), use of preoperative beta-blocking agents (33/126 vs 1/28) and the need for blood transfusion (58/126 vs 24/28). Neither group had elevated glucose levels. Compared with pediatric patients, the incidence of intraoperative hypoglycemia was statistically higher in adult patients, with a rate that peaked in the eighth (25.9%, group A vs 0% group P) and ninth hours (27.3%, group A vs 0% group P) of surgery. There were no differences in glucose concentrations at other points in time.

CONCLUSIONS

In contrast to pediatric patients, intraoperative hypoglycemia occurred more often in adult patients during prolonged neurosurgical procedures when glucose-free solution was used for fluid maintenance. Therefore, frequent determination of plasma glucose concentrations is mandatory, especially in patients undergoing long-lasting neurosurgical anesthesia.

Proinflammatory cytokines increase in sepsis after anti-adhesion molecule therapy

Cytokine mediators and leukocyte-endothelial cell adhesion molecules are critical and interdependent components of the acute inflammatory response in sepsis. We hypothesized that the administration of monoclonal antibodies to intercellular adhesion molecule-1 (CD54) or E- and L-selectin (CD62E/L) would decrease serum levels of the proinflammatory cytokines interleukin-1beta (IL-1), IL-6, and IL-8 and tumor necrosis factor receptor (TNFR-1) in baboons during sepsis. Adult male baboons received infusions of 1 x 10(9) colony forming units (CFU)/kg heat-killed Escherichia coli (E. coli) followed 12 h later by live E. coli (1 x 10(10) CFU/kg). At the time of live bacterial infusion, six septic animals were treated with a monoclonal antibody to CD54 and six with an antibody to CD62E and L (1 mg/kg). Eight untreated septic animals served as controls. Sequentially drawn serum samples were assayed for IL-1, IL-6, IL-8, and TNFR-1 using enzyme-linked immunoassay (ELISA). Data were compared using Mann-Whitney U tests and Chi-square analyses. Median survival was decreased in both treatment groups compared to controls (P < 0.05). Peak IL-1 level was higher than controls in septic animals treated with anti-CD54 but not anti-CD62E/L (P < 0.05, P = NS, respectively). Elevations in IL-6, IL-8, and TNFR-1 were increased and prolonged in both antibody treated groups compared to controls (P < 0.05). These results provide the first in vivo evidence that leukocyte-endothelial adhesion molecules CD54 and CD62E/L regulate cytokine production in sepsis.

Nutritional status of mechanically ventilated critically ill patients: comparison of different types of nutritional support

Malnutrition is a common problem in hospitalized patients. Early assessment of nutritional status may help in identifying patients for whom nutritional interventions are needed. The purpose of this study was to assess and compare the nutritional status of mechanically ventilated critically ill patients who were receiving nutritional support. Forty-nine patients were divided into either enteral nutrition, total parenteral nutrition or combined (enteral plus total parenteral nutrition) groups. Anthropometric and biochemical measurements, and medical status (APACHE II score) were assessed at the 1st day and 14th day of admission in the intensive care unit (ICU) of Taichung Veteran General Hospital. The length of ventilator dependency was significantly positively correlated with calorie and carbohydrate intake in the pooled group. Patients receiving enteral and combined nutrition showed significantly lower anthropometric measurements at the 14th day after admission. Patients in all groups had abnormal mean biochemical values at the 1st day of admission. Subjects in the combined group showed a significant increase in prealbumin and the Maastricht Index levels after 14 days. Patients in all three groups were malnourished when admitted to the ICU. Patients showed a slightly improvement of nutritional status after receiving nutritional support for 14 days.

Candidaemia in special care nurseries: comparison of albicans and parapsilosis infection

OBJECTIVES

Candidaemia caused by Candida parapsilosis (CP) is being increasingly reported among infants in neonatal intensive care units (NICU). To assess relative severity, clinical manifestations of candidaemia caused by C. albicans (CA) and CP in a NICU were compared.

METHODS

Between January 1994 and July 1997, episodes of candidaemia occurring among infants hospitalized in the NICU were identified in a children's hospital. The demographic characteristics, associated risk factors, clinical manifestations and outcome of the infants with CP fungaemia were collected and compared with those of the infants with CA fungaemia.

RESULTS

Twenty-four episodes caused by CA and 22 episodes caused by CP were included in this study. No significant differences were found between the two groups for gestational age, birth weight, male gender, post-natal age at onset of candidaemia, frequency of antecedent neonatal events, prior duration of antibiotic therapy and hyperalimentation, as well as presence of central venous catheter (CVC). Infants with CA fungaemia were significantly more likely than those with CP fungaemia to present with hypoxaemia, bradycardia and respiratory distress requiring intubation, and have a longer prior duration of indwelling CVC and a higher dissemination rate. The eradication rate of candidaemia and overall case fatality rate were comparable in both groups. but CP fungaemia did not appear to cause acute lethal events.

CONCLUSION

The presenting signs of CP fungaemia are relatively not so severe, but CP fungaemia, which is relatively difficult to eradicate, increases the morbidity and mortality of the infants.