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BACKGROUND AND AIMS: Triaxial accelerometry may provide a simple measure of physical activity in older people, but the effect of different walking aids and accelerometer placements on measurement is not known. This study aimed to examine the effect of accelerometer placement, use of walking aids, and different types of physical activity on Stay- Healthy RT3 triaxial accelerometer readings in older people. METHODS: Twenty subjects aged over 65 years and five younger volunteers were recruited from Medicine for the Elderly services. Subjects performed six minutes each of standardized standing activity, sitting activity, sitting at rest, walking, and stair climbing. Counts generated from RT3 accelerometers worn anteriorly over both hips were recorded in subjects using different walking aids during these standardized activities. RESULTS: There were significant differences between counts generated by the left and right hip positions. The intraclass correlation coefficient of RT3 counts between left and right hip positions was 0.48, 0.39 and 0.99 for sedentary tasks (standing, sitting and rest), stair and walking tasks respectively. Counts ranged between 250-3000 min-1 during the walking task. Counts were proportional to the distance walked. Resting, sitting or standing all generated counts below 250 min-1, but there was no clear demarcation between these activities. The use of different walking aids did not affect the counts generated for any activity. CONCLUSIONS: Walking can be distinguished from other activities by upper and lower cutoffs. The RT3 accelerometer should be used on the same side of the body. Different walking aids do not appear to affect RT3 counts in older people. [ABSTRACT FROM AUTHOR]

Peritoneal clearances and dialysate protein losses occurring in paediatric patients undergoing different continuous cycling peritoneal dialysis (CCPD) regimens have not been well defined. We, therefore, evaluated 10 children aged 15.8±2.5 (SD) years who were maintained on home peritoneal dialysis for 20.5±10 months. All patients had at least 3 months of CCPD. The patients were admitted to the Clinical Research Center for 48 hours and allocated to five different dialysis protocols. In protocol I, the frequency of exchanges was 10 per 10 hours; in Protocol II it was 5 per 10 hours; and in Protocol III it was 3 per 10 hours. Protocol II D and III D had, in addition, a daytime dwell of one-half the night-time vol ume. A 1.5% glucose dialysate solution was used for night-time dialysis, and 4.25% glucose dialysate solution for the daytime dwell. The mean inflow dialysate volume per exchange was 36.7±5.6 ml/kg body weight and was constant in each patient for each study protocol. BUN and creatinine clearances for each protocol were calculated and dialysate protein losses were measured. The data indicate that hourly night-time dialysis (Protocol I) provides best solute clearance. A daytime dwell further enhances the total solute clearance and should be used preferably in anuric patients. Residual urine output contributes significantly to the total solute clearance. Protein losses are maximum with low-frequency exchanges and a daytime dwell. No significant differences in the serum albumin concentrations were found during the different protocols; however, the long-term effect of the protein loss on the nutritional status of the patients requires further evaluation. [ABSTRACT FROM PUBLISHER]

Introduction: With advancing age, frailty, multi-morbidity and need for care, elderly patients are some of the most vulnerable to Covid-19 disease. In NHS Tayside, a dedicated Covid-19 Medicine for the Elderly (MFE) Team was formed to care for patients identified as frail and likely to benefit from comprehensive geriatric assessment. Methods: All Covid-19 patients meeting frailty criteria1, cared for by the Covid-19 MFE Team were identified. Data on outcomes and clinical characteristics for all (140) patients admitted during the first pandemic wave (March–July 2020) was collected using electronic patient records and analysed. Results: Patients were predominantly male (58.6%). Ages ranged from 65–99 years, with 43.6% aged ≥85 years. 82.1% had one or more of cough, fever and anosmia on admission fitting Covid-19 case definition 2. Lymphopenia was present in 92.1%. Of note, 26.5% of patients had a normal or unchanged chest x-ray report, with only 10.2% showing bilateral peripheral infiltrates. 28-day mortality was 37.1% with Covid-19 Disease listed as primary cause of death in 90.4%. Conclusion(s): Entering further “waves” of infection, it is vital that we understand the clinical presentation and course of Covid-19 disease in elderly patients. Our data highlights that any Covid-19 symptom, even in isolation, should raise suspicion of disease. Chest xrays should not be used alone as a diagnostic tool.The presence of lymphopenia should raise suspicion of Covid-19 infection. In developing an understanding of how elderly patients with Covid-19 present, we can ensure early identification and initiation of appropriate infection control measures. [ABSTRACT FROM AUTHOR]

Fasting plasma amino acid levels were measured in 78 patients with chronic renal insufficiency (glomerular filtration rate [GFR], 8.0 to 56.0 mL/min), who had been enrolled in phase II of the Modification of Diet in Renal Disease study, prior to their beginning the experimental portion of the protocol. Alterations in many plasma amino acid levels were observed in the patients with the mildest degrees of renal insufficiency, and the number and severity of abnormalities tended to be greater in the patients with more severe renal failure. In patients with GFRs greater than 24.5 mL/min, 15 to 24.5 mL/min, and less than 15 mL/min, statistically significant abnormalities were observed in the concentrations or ratios of 9, 14, and 18 amino acids, respectively. The following correlations of amino acid levels or ratios with GFR were observed (all P < 0.001): citrulline, r = -0.41; citrulline to arginine ratio, r = -0.42; glycine to serine ratio, r = -0.37; N-tau methylhistidine, r = -0.65; and cystine, r = -0.37. Other weaker correlations observed were valine, r = 0.26 (P < 0.025); valine to glycine ratio, r = 0.32 (P = 0.004); and sum of isoleucine, leucine, and valine, r = 0.21 (P = 0.061). N-tau methylhistidine and the essential to nonessential amino acid ratio became altered with declining GFR in a nonlinear fashion. Thus, many of the characteristic alterations in the plasma amino acid profile that are observed in chronic end-stage renal disease are already present in mild renal insufficiency. Progressive loss of renal function generally results in increasing abnormalities; these changes in plasma amino acid concentrations with reduction in GFR were usually linear.

When a patient presents with renal failure, it is often difficult to ascertain whether the individual is suffering from acute or chronic renal failure. Fingernail creatinine might help to differentiate between the two. To test this possibility, the relationship between the fingernail creatinine and the serum creatinine obtained concurrently or 1 or more months previously was examined in 22 normal adults, nine patients with acute renal failure, seven patients with chronic renal failure not undergoing dialysis, 16 maintenance hemodialysis patients, and 33 patients with a functioning renal transplant who had been transplanted 0.2 to 3.9 months (n = 21) or 4.3 to 33 months previously (n = 12). Fingernail creatinine was significantly greater than normal in the patients with chronic renal failure, patients undergoing maintenance hemodialysis, and patients who had a functioning renal transplant implanted 0.2 to 3.9 months previously. In contrast, fingernail creatinine was not different from normal in the patients with acute renal failure and in patients who had a functioning renal transplant placed 4.3 to 33 months previously. In the maintenance hemodialysis patients, fingernail creatinine showed the strongest correlation with the serum creatinine obtained between 5 and 10 months previously, with the highest correlation at 9 months. In the renal transplant recipients, the fingernail creatinine decreased to normal or near normal values within approximately 90 to 120 days after transplantation. These findings indicate that fingernail creatinine may reflect the serum creatinine values several months previously. The fingernail creatinine may help to identify whether patients have recent onset as compared with longstanding renal failure.

We compared taurine levels in plasma, erythrocytes, platelets, lymphocytes, and granulocytes from 11 normal adults and 11 maintenance hemodialysis (MHD) patients immediately before and following a routine hemodialysis treatment. Taurine concentrations were elevated in plasma predialysis, as compared with normal subjects (90 +/- 16 [SEM] v 54 +/- 2 mumol/L [1.1 +/- 0.2 v 0.7 +/- 0.03, mg/dL]), but decreased with a dialysis treatment (to 34 +/- 3 mumol/L [0.4 +/- 0.04 mg/dL]). Erythrocyte taurine levels tended to be higher in MHD patients predialysis (1.2 +/- 0.2 v 0.7 +/- 0.1 nmol/10(9) cells, P less than 0.05 where P less than 0.025 is significant) as compared with controls; erythrocyte taurine was increased after dialysis (to 1.8 +/- 0.3 nmol/10(9) cells, P less than 0.006). In contrast, platelet taurine concentrations in MHD patients were lower than normal predialysis (18 +/- 2 v 27 +/- 2 nmol/10(9) cells) and declined further during the dialysis procedure (to 14 +/- 1). Granulocyte and lymphocyte taurine levels were not different in MHD patients, as compared with normal adults, either before or after dialysis. The observed differences in blood cell taurine content (expressed per 10(9) cells) could not be explained by variation in cell volumes among the groups examined. Thus, both chronic renal failure and a routine hemodialysis treatment produce changes in cell and plasma taurine levels that tend to be specific for the individual cell type.

Thirty-four adults undergoing long-term parenteral nutrition (TPN) were treated either with or without intravenous taurine for less than or equal to 24 mo. Statistical comparisons were carried out in eight patients randomly assigned to receive intravenous taurine, usually 10 mg.kg-1.d-1, and 10 patients not receiving taurine. Compared with normal adults, baseline plasma taurine and urine taurine-creatinine ratios were decreased in both groups and platelet taurine was reduced in the taurine-treated group. During taurine treatment the mean of the mean values for taurine became normal in plasma and platelets and remained normal in erythrocytes, granulocytes, and lymphocytes; urine taurine-creatinine ratios rose to approximately five times normal. During follow-up, patients not given taurine had plasma, erythrocyte, and granulocyte taurine and urine taurine-creatinine ratios below normal values and the concentrations of taurine-treated patients. Their platelet taurine was also subnormal. Thus, 10 mg taurine.kg-1.d-1 intravenously normalizes plasma and blood cell taurine concentrations in long-term TPN patients.

People in developed nations such as the United States and Canada have an increased risk of colon cancer. Fecal mutagens have been detected in the feces of individuals at high risk for colon cancer. We describe a rapid, sensitive, reliable, reproducible high-pressure liquid chromatography (HPLC) method for detecting fecapentaenes, the most active and chief mutagen found in human stool. We found fecapentaene in all the stool samples of adults on typical high-fat, low-fiber Western diets. These fecapentaene concentrations remained largely constant when subjects consumed constant diets. Fecapentaene concentrations were reduced for total-parenteral-nutrition (TPN) patients with severe intestinal malabsorption. This finding with TPN patients may reflect changes in important variables of gut microflora in fecapentaene production. Studies with newborns and children showed that fecapentaenes appeared very early in life but are not present in stool at birth.

Chronic renal failure is associated with many abnormalities in plasma amino acids. Since patients with renal failure are frequently deficient in vitamin B-6, this study examined whether vitamin B-6 deficiency may be a cause of any of the abnormal plasma amino acid concentrations observed in chronic renal failure. Sham-operated and chronically azotemic rats were pair-fed diets deficient in or replete with vitamin B-6 for 21 d. By the end of 21 d, the EGOT index rose significantly in the B-6-deficient rats but not in the B-6-replete animals. There were several differences in plasma amino acid concentrations between azotemic and control rats. Azotemia and B-6 deficiency each lowered the plasma serine concentration and raised the glycine-to-serine ratio. Plasma glycine was affected by a two-way interaction between azotemia and vitamin B-6 deficiency whereby the highest values were found in the sham-operated vitamin B-6-deficient animals. Plasma alanine and asparagine were reduced by B-6 deficiency and unchanged by azotemia. These results suggest that vitamin B-6 deficiency may contribute to several of the abnormalities in the plasma aminograms observed in chronic renal failure.

The effects of beta-endorphin and various enkephalins on protein synthesis in eukaryotic cell-free systems have been examined. Beta-Endorphin, Leu-enkephalin, and Met-enkephalin inhibit the incorporation of radioactive leucine into globin in the presence of reticulocyte poly(A)+ RNA and of radioactive phenylalanine into polyphenylalanine in the presence of poly(U); however, the poly(U)-dependent synthesis of polyphenylalanine from Phe-tRNA is not inhibited. the aminoacylation of tRNAPhe is markedly inhibited by enkephalin, indicating that the sensitive component is Phe-tRNA synthetase. Other aminoacyl-tRNA synthetases are not significantly affected. The interaction between enkephalin and Phe-tRNA synthetase is reversible; activity is restored by dialysis of enzyme-enkephalin reaction mixtures. Morphine, vasopressin and analogues of vasopressin, and enkephalin analogues such as [D-Ala2,D-Leu5]enkephalin and [D-Ala2,Met]enkephalinamide have no effect on translation. The results suggest that the effects on protein synthesis are probably not related to opiate effects.