Many intensive care unit (ICU) patients do not achieve target protein intakes particularly in the early days following admittance. This period of iatrogenic protein undernutrition contributes to a rapid loss of lean, in particular muscle, mass in the ICU. The loss of muscle in older (aged >60 years) patients in the ICU may be particularly rapid due to a perfect storm of increased catabolic factors, including systemic inflammation, disuse, protein malnutrition, and reduced anabolic stimuli. This loss of muscle mass has marked consequences. It is likely that the older patient is already experiencing muscle loss due to sarcopenia; however, the period of stay in the ICU represents a greatly accelerated period of muscle loss. Thus, on discharge, the older ICU patient is now on a steeper downward trajectory of muscle loss, more likely to have ICU-acquired muscle weakness, and at risk of becoming sarcopenic and/or frail. One practice that has been shown to have benefit during ICU stays is early ambulation and physical therapy (PT), and it is likely that both are potent stimuli to induce a sensitivity of protein anabolism. Thus, recommendations for the older ICU patient would be provision of at least 1.2-1.5 g protein/kg usual body weight/d, regular and early utilization of ambulation (if possible) and/or PT, and follow-up rehabilitation for the older discharged ICU patient that includes rehabilitation, physical activity, and higher habitual dietary protein to change the trajectory of ICU-mediated muscle mass loss and weakness.
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The capacity to utilize ingested protein for optimal support of protein synthesis and lean body mass is described within the paradigm of anabolic competence. Protein synthesis can be stimulated by physical exercise, however, it is not known if physical exercise affects post-exercise protein oxidation. Characterization of the driving forces behind protein oxidation, such as exercise, can contribute to improved understanding of whole body protein metabolism. The purpose of this study is to determine the effect of two levels of aerobic exercise intensity on immediate post-exercise exogenous protein oxidation. Sixteen healthy males with a mean (SD) age of 24 (4) years participated. The subjects' VO2-max was estimated with the Åstrand cycling test. Habitual dietary intake was assessed with a three-day food diary. Exogenous protein oxidation was measured by isotope ratio mass spectrometry. These measurements were initiated after the ingestion of a 30 g 13C-milk protein test drink that was followed by 330 minutes breath sample collection. On three different days with at least one week in between, exogenous protein oxidation was measured: 1) during rest, 2) after 15 minutes of aerobic exercise at 30% of VO2-max (moderate intensity), and 3) after 15 minutes of aerobic exercise at 60% of VO2-max (vigorous intensity). After vigorous intensity aerobic exercise, 31.8%±8.0 of the 30 g 13C-milk protein was oxidized compared to 26.2%±7.1 during resting condition (p = 0.012), and 25.4%±7.6 after moderate intensity aerobic exercise compared to resting (p = 0.711). In conclusion, exogenous protein oxidation is increased after vigorous intensity aerobic exercise which could be the result of an increased protein turnover rate.
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Purpose of reviewSkeletal muscle mass with aging, during critical care, and following critical care is a determinant of quality of life and survival. In this review, we discuss the mechanisms that underpin skeletal muscle atrophy and recommendations to offset skeletal muscle atrophy with aging and during, as well as following, critical care.Recent findingsAnabolic resistance is responsible, in part, for skeletal muscle atrophy with aging, muscle disuse, and during disease states. Anabolic resistance describes the reduced stimulation of muscle protein synthesis to a given dose of protein/amino acids and contributes to declines in skeletal muscle mass. Physical inactivity induces: anabolic resistance (that is likely exacerbated with aging), insulin resistance, systemic inflammation, decreased satellite cell content, and decreased capillary density. Critical illness results in rapid skeletal muscle atrophy that is a result of both anabolic resistance and enhanced skeletal muscle breakdown.SummaryInsofar as atrophic loss of skeletal muscle mass is concerned, anabolic resistance is a principal determinant of age-induced losses and appears to be a contributor to critical illness-induced skeletal muscle atrophy. Older individuals should perform exercise using both heavy and light loads three times per week, ingest at least 1.2 g of protein/kg/day, evenly distribute their meals into protein boluses of 0.40 g/kg, and consume protein within 2 h of retiring for sleep. During critical care, early, frequent, and multimodal physical therapies in combination with early, enteral, hypocaloric energy (ﰅ10–15kcal/kg/day), and high-protein (>1.2 g/kg/day) provision is recommended.
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Using stable isotope techniques, this study shows that plasma free fatty acid oxidation is not impaired during exercise in non-obese type II diabetic patients.
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Background: Drug resistance is a major problem in ovarian cancer. Triggering apoptosis using death ligands such as tumour necrosis factor-related apoptosis inducing ligand (TRAIL) might overcome chemoresistance. Methods: We investigated whether acquired cisplatin resistance affects sensitivity to recombinant human (rh) TRAIL alone or in combination with cisplatin in an ovarian cancer cell line model consisting of A2780 and its cisplatin-resistant subline CP70. Results: Combining cisplatin and rhTRAIL strongly enhanced apoptosis in both cell lines. CP70 expressed less caspase 8 protein, whereas mRNA levels were similar compared with A2780. Pre-exposure of particularly CP70 to cisplatin resulted in strongly elevated caspase 8 protein and mRNA levels. Caspase 8 mRNA turnover and protein stability in the presence or absence of cisplatin did not differ between both cell lines. Cisplatin-induced caspase 8 protein levels were essential for the rhTRAIL-sensitising effect as demonstrated using caspase 8 small-interfering RNA (siRNA) and caspase-8 overexpressing constructs. Cellular FLICE-inhibitory protein (c-FLIP) and p53 siRNA experiments showed that neither an altered caspase 8/c-FLIP ratio nor a p53-dependent increase in DR5 membrane expression following cisplatin were involved in rhTRAIL sensitisation. Conclusion: Cisplatin enhances rhTRAIL-induced apoptosis in cisplatin-resistant ovarian cancer cells, and induction of caspase 8 protein expression is the key factor of rhTRAIL sensitisation. © 2011 Cancer Research UK All rights reserved.
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Malnutrition, especially among the elderly in the healthcare environment, is a prevalent problem in The Netherlands, affecting both patients and the healthcare budget. Although oral nutritional supplements (ONS) are often used to restore the nutritional status of a patient, the evaluated current available literature failed to show a coherent picture of the effectiveness of ONS in malnourished patients. In the present study, we used a qualitative research approach to gain insight in the treatment of malnutrition via ONS and food snacks in a single non-academic teaching hospital. Twelve semi-structured interviews with stakeholders (such as dieticians, nurses, care-assistants, physician) were held. Results indicated opportunities for further improvement, for example through the introduction of a screening tool for malnutrition in cognitive impaired patients, better timing for handing out the daily meal plan forms, and improved range and provision of snacks. The stakeholders indicated that taste and physical properties of ONS, but also social environment as well as the physical/mental state and motivation of a patient are important facilitators which should be considered during the prescription. In conclusion, to optimize treatment of malnutrition using ONS and food snacks, the above mentioned opportunities to better match the needs of malnourished patients have to be tackled. Involvement of the different stakeholders within the healthcare facility will be important to implement required changes in nutritional practice.
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This paper descibes a study that shows that glycogen-lowering exercise, performed the evening before an exercise bout in combination with glycogen restriction leads to a reduction of the oxidation rate of ingested glucose during moderate-intensity exercise
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In this publication, the four authors provide several solution directions to shape that transition to a new, sustainable agricultural system. With a different relationship between food production and nature and the environment. It is the - necessary - basis for a good agricultural agreement. And the way to work towards a sustainable future for our agricultural sector and food system.
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With this project we strived to contribute to structural reduction of post-harvest food losses and food quality improvement in the Kenyan avocado and dairy value chains through the application of technical solutions and tools as well as improved coordination in those food chains. The consortium had four types of partners: 1. Universities (2 Kenyan, 4 Dutch), 2. Private sector actorsin those chains, 3. Organisations supporting those chains, and 4. Network partners. The applied research has been implemented in cooperation with all partners, whereby students at involved universities conducted most of the field studies and all other consortium partners support and interact depending on the phases.The FORQLAB project targeted two areas in Kenya for both commodities, a relatively well-developed chain in the central highlands and a less-develop chain in Western-Kenya. The research methods were the business to business and multi-stakeholder (living lab) approaches to increase the potential for uptake of successful interventions in the chain. The project consisted of four phases: 1. Inventory and inception, 2. Applied research, 3. Spreading research outputs through living lab networks, 4. Translation of project output in curricula and trainings. The outcomes were: two knowledge exchange platforms (Living Labs) supported with some advice for sustainable food loss reduction, a research agenda, proposals for ICT and other tech solutions and an implementation strategy; communication and teaching materials for universities and TVETs; and knowledge transfer and uptake.
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Business innovation is a multidisciplinary area of expertise that bridges the gap between traditional areas of study such as business administration, organizational studies, marketing, design, engineering and entrepreneurship. Business innovation focuses on creating, accelerating and managing new and sustainable business models through innovation (Crossan and Apaydin, 2010; Keeley, Walters, Pikkel, and Quinn, 2013).
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