Determinants of Resting Energy Expenditure in Very Old Nursing Home Residents

OBJECTIVES

This study aimed to measure resting energy expenditure (REE) in institutionalized old persons and to determine factors possibly related to change in REE as a basis for estimating energy requirements.

DESIGN AND SETTINGS

A monocentric cross-sectional study was conducted. Statistical approaches were conducted to determine independent factors associated with REE. Various published predictive equations of REE were compared to our population.

PARTICIPANTS

72 residents of a nursing home, mostly women (80.5%) aged 87.4±6.6 years were included.

MEASUREMENTS

REE (indirect calorimetry), body composition (bio-impedance analysis), biological and anthropometric data were collected.

RESULTS

Mean REE was 1006±181 kcal/d and was higher in men than in (1227±195 vs. 953±131 kcal/d, p<0.05). According to criteria adapted from the Global Leadership Initiative on Malnutrition consensus, 65.3 % of the institutionalized population were malnourished. In multivariate analysis adjusted on gender and age, REE was positively associated with calorie intake, fat-free mass (FFM), functional abilities (French Autonomie Gérontologie Groupe Iso Ressources scale), and elevated CRP level (> 25 mg/l). Significant differences (p<0.05) appeared between measured REE and predicted REE by using various published equations.

CONCLUSION

REE of very old nursing home residents is influenced by FFM, calorie intake, functional abilities, and CRP levels and is poorly predicted by classical equations based on age, gender, height, and weight. This suggests a metabolic adaptation to caloric restriction and inflammation and prompts to consider the level of physical activity and muscle loss when assessing caloric requirements in this population.

24.0 kyr cal BP stone artefact from Vale da Pedra Furada, Piauí, Brazil: Techno-functional analysis

Current archaeological paradigm proposes that the first peopling of the Americas does not exceed the Last Glacial Maximum period. In this context, the acceptance of the anthropogenic character of the earliest stone artefacts generally rests on the presence of projectile points considered no more as typocentric but as typognomonic, since it allows, by itself, to certify the human character of the other associated artefacts. In other words, without this presence, nothing is certain. Archaeological research at Piauí (Brazil) attests to a Pleistocene human presence between 41 and 14 cal kyr BP, without any record of lithic projectile points. Here, we report the discovery and interpretation of an unusual stone artefact in the Vale da Pedra Furada site, in a context dating back to 24 cal kyr BP. The knapping stigmata and macroscopic use-wear traces reveal a conception centred on the configuration of double bevels and the production in the same specimen of at least two successive artefacts with probably different functions. This piece unambiguously presents an anthropic character and reveals a technical novelty during the Pleistocene occupation of South America.

Earliest occupation of the Central Aegean (Naxos), Greece: Implications for hominin and Homo sapiens' behavior and dispersals

We present evidence of Middle Pleistocene activity in the central Aegean Basin at the chert extraction and reduction complex of Stelida (Naxos, Greece). Luminescence dating places ~9000 artifacts in a stratigraphic sequence from ~13 to 200 thousand years ago (ka ago). These artifacts include Mousterian products, which arguably provide first evidence for Neanderthals in the region. This dated material attests to a much earlier history of regional exploration than previously believed, opening the possibility of alternative routes into Southeast Europe from Anatolia (and Africa) for (i) hominins, potentially during sea level lowstands (e.g., Marine Isotope Stage 8) permitting terrestrial crossings across the Aegean, and (ii) Homo sapiens of the Early Upper Paleolithic (Aurignacian), conceivably by sea.

Depression Severity as a Risk Factor of Sarcopenic Obesity in Morbidly Obese Patients

SETTING

Etiopathogenic factors of physical disability in obesity are numerous, underestimated and not sought in the non-geriatric population. Amongst these factors, depression may favor the development of sarcopenic obesity by reducing strength and physical performance even in the absence of overt muscle loss. Objectives and participants: To study the link between depression status and muscle functional disorders (dynapenia) in a population of adult subjects with severe and morbid obesity.

MEASUREMENTS

Patients were assessed for body composition, grip strength, the Short Physical Performances Battery test (SPPB), for depression according to the Beck II score as well as for metabolic parameters through biological tests.

RESULTS

In 373 obese subjects (mean age 44 ± 13y and BMI 43 ± 6 kg/m²), the prevalence of depression was 53% with 18% having mild depression, 18% moderate depression and 16% severe depression. Depression was significantly related to dynapenia: 62% of dynapenic (D) patients suffered from depression compared to 50% of non-dynapenic (ND) patients (p = 0.036). The Beck questionnaire score for D patients was 20 ± 13 and 15 ± 10 for ND patients (p = 0.001). The depression intensity was significantly correlated with dynapenia with D patients having a higher severe depression degree than ND patients (30% versus 11%; p < 0.0001). Fat-free to fat mass ratio was also significantly correlated with dynapenia (p = 0.01). In multivariate analysis, the presence of depression was twice as likely to be associated with dynapenia.

CONCLUSIONS

Depression is associated with a reduction of muscle function in severe obesity in relation to its severity and to changes in fat to fat-free mass, suggesting that screening and prevention of sarcopenic obesity should be considered in adult obese patients with depression.

Structure-activity relationship studies of melanin-concentrating hormone (MCH)-related peptide ligands at SLC-1, the human MCH receptor

Melanin-concentrating hormone (MCH) is a cyclic nonadecapeptide involved in the regulation of feeding behavior, which acts through a G protein-coupled receptor (SLC-1) inhibiting adenylcyclase activity. In this study, 57 analogues of MCH were investigated on the recently cloned human MCH receptor stably expressed in HEK293 cells, on both the inhibition of forskolin-stimulated cAMP production and guanosine-5'-O-(3-[(35)S]thiotriphosphate ([(35)S]- GTPgammaS) binding. The dodecapeptide MCH-(6-17) (MCH ring between Cys(7) and Cys(16), with a single extra amino acid at the N terminus (Arg(6)) and at the C terminus (Trp(17))) was found to be the minimal sequence required for a full and potent agonistic response on cAMP formation and [(35)S]- GTPgammaS binding. We Ala-scanned this dodecapeptide and found that only 3 of 8 amino acids of the ring, namely Met(8), Arg(11), and Tyr(13), were essential to elicit full and potent responses in both tests. Deletions inside the ring led either to inactivity or to poor antagonists with potencies in the micromolar range. Cys(7) and Cys(16) were substituted by Asp and Lys or one of their analogues, in an attempt to replace the disulfide bridge by an amide bond. However, those modifications were deleterious for agonistic activity. In [(35)S]- GTPgammaS binding, these compounds behaved as weak antagonists (K(B) 1-4 microm). Finally, substitution in MCH-(6-17) of 6 out of 12 amino acids by non-natural residues and concomitant replacement of the disulfide bond by an amide bond led to three compounds with potent antagonistic properties (K(B) = 0.1-0.2 microm). Exploitation of these structure-activity relationships should open the way to the design of short and stable MCH peptide antagonists.

Screening of ligand binding on melatonin receptor using non-peptide combinatorial libraries

The screening of combinatorial libraries requires a deconvolution procedure to obtain, in fine, the most active compound of the starting library. The standard screening assays used in regular molecular pharmacology, have been poorly assessed when transposed to combinatorial chemistry-related experiments, particularly those involving large numbers of chemicals in a single assay. One key issue is the effect of the inactive analogs on the identification of the active ligand in mixtures. We chose melatonin receptors to measure the apparent affinity of a single ligand when tested alone or in mixtures of non-peptide low molecular weight compounds. Using ligands with IC50 from the micro- to the picomolar range, mixed with increasingly complex mixtures of 5 to 20 or 25 inactive compounds, we analyzed the displacements from the mt1 and MT2 melatonin receptor subtypes of the radioligand 2-iodomelatonin (KD= 25 pmol/l and 200 pmol/l, respectively) . The behavior of equimolar mixtures in displacement curves led to the conclusion that the observed binding affinity reflects the dilution effect of mixing the active component with inactive compounds but does not reveal noticeable interactions which would interfere with the binding process. From the practical point of view, the concentrations of the active species in the binding assay should be large enough to displace significantly the radioligand, a requirement which may be limited by the solubility of the ligand mixtures. In contrast, previous observations with peptide libraries report that the dilution effect is often compensated by additive or synergic action of structurally related analogs, thus making possible the deconvolution of very large (typically up to 10(7) compounds) peptide libraries.

Characterization of 2-[125I]iodomelatonin binding sites in Syrian hamster peripheral organs

The neurohormone melatonin is a key agent in synchronizing the circadian rhythms. At least three types of binding sites have been described for melatonin: the G-coupled, seven-transmembrane domain receptors mt1 and MT2 and a putative binding site called MT3. The latter has been described in hamster brain membranes, and its binding capacity is optimum at 4 degrees C. We further characterized this binding site on other peripheral hamster tissues, including intestine, liver, kidney, lung, muscle, and heart. We found a high level of binding sites (>30 fmol/mg of protein) in intestine and kidney. Furthermore, we completed the existing pharmacological profile of this site, which can now be described as 2-iodomelatonin > 6-chloromelatonin > methy-isobutyl-amiloride > acridine orange > 5-methylcarbonylamino-N-acetyltryptamine > prazosin > N-acetylserotonin > melatonin. This profile was found in all the hamster organs tested that had a large number of binding sites, namely, brain, intestine, kidney and liver. Furthermore, when comparisons were possible, the MT3 pharmacological characteristics were similar to those described in the literature for hamster brain and testis. This profile was compared to the pharmacology obtained on human cloned mt1 and MT2 receptors and proved to be completely different, as expected. We provide new evidence for an alternate melatonin binding site not only in hamster brain but also in some peripheral organs.

[Acute idiopathic dilatation of the right colon or Ogilvie's syndrome. Apropos of a case encountered after cesarean section]

The syndrome of acute colectasia of the right colon following a caesarean section is a rare disease observed and described for the first time by Ogilvie in 1948. Many etiopathological hypotheses have been formulated but recent studies demonstrate the role of the neuro-vegetative nervous system, causing the functional obstacle responsible for the idiopathic right colon dilatation. The clinical picture of low obstruction is seldom typical, as in our case; however, the abdominal X-Ray easily confirms the diagnosis, since the caecal distention may exceed 10 cm in diameter. Most of the time, the prognosis is favorable after aspiration via colonoscopy; caecal perforation is always the spontaneous outcome, due to the "vicious cycle" perpetuating the functional obstruction.

[Diagnostic value of the determination of serum beta human chorionic gonadotropin in extra-uterine pregnancy]

The methods of immunological diagnosis of pregnancy are described, and their reliability is evaluated according to the results of 35 case files of extrauterine pregnancy clinics. In all these case the beta-hCG results were negative, and there was no extrauterine pregnancy. The analysis of positive cases allows it to be stated that on each occasion in which the reaction is positive there is a pregnancy, but the location of this pregnancy is uncertain, and recourse to a complementary technique is justified.