Protein Enrichment of Familiar Foods as an Innovative Strategy to Increase Protein Intake in Institutionalized Elderly.

OBJECTIVE: To increase the protein intake of older adults, protein enrichment of familiar foods and drinks might be an effective and attractive alternative for oral nutritional supplements (ONS). We performed a pilot study to test whether these products could help institutionalized elderly to reach a protein intake of 1.2 gram per kg body weight per day (g/kg/d). DESIGN: Intervention study with one treatment group (no control group). Dietary assessment was done before and at the end of a 10-day intervention. SETTING: Two care facilities in Gelderland, the Netherlands: a residential care home and a rehabilitation center. PARTICIPANTS: 22 elderly subjects (13 women, 9 men; mean age 83.0±9.4 years). INTERVENTION: We used a variety of newly developed protein enriched regular foods and drinks, including bread, soups, fruit juices, and instant mashed potatoes. MEASUREMENTS: Dietary intake was assessed on two consecutive days before and at the end of the intervention, using food records filled out by research assistants. Energy and macronutrient intake was calculated using the 2013 Dutch food composition database. Changes in protein intake were evaluated using paired t-tests. RESULTS: Protein intake increased by 11.8 g/d (P=0.003); from 0.96 to 1.14 g/kg/d (P=0.002). This increase is comparable to protein provided by one standard portion of ONS. The intake of energy and other macronutrients did not change significantly. At the end of the intervention more elderly reached a protein intake level of 1.2 g/kg/d than before (9 vs 4). Protein intake significantly increased during breakfast (+3.7 g) and during the evening (+2.2 g). CONCLUSION: Including familiar protein enriched foods and drinks in the menu helped to meet protein recommendations in institutionalized elderly.

Elaboration of microbiological guidelines as an element of codes of hygienic practices for small and/or less developed businesses to verify compliance with hazard analysis critical control point.

Effective assurance of microbiological food safety practices in small and/or less developed businesses is not yet resolved. Although a start has been made by drafting hygiene codes, feasible methods for verifying manufacturing processes that rely on strict and meaningful criteria to be applied to process points are still lacking. This investigation is a model study with various types of ready-to-eat foods aimed at verifying adequate processing for safety and subsequent meticulous hygienic handling and safe storage of foods in small and/or less developed businesses by the use of quantitative methods for selected indicator organisms, as standardized by the International Organization for Standardization. The manufacture of the foods that were used in this study invariably included (i) a heat processing step that ensured a level of lethality of nonsporing organisms at least equivalent to the reduction of such organisms attained in the pasteurization of milk and (ii) effective means of prevention of postprocess recontamination and recolorization. The results of this study indicate that simple microbiological criteria used for this purpose, including aerobic mesophilic colony (standard plate) counts, Enterobacteriaceae counts, and, in some instances, enumeration of yeast propagules, allow adequate verification of good practices throughout. This verification through monitoring of samples taken during processing in small and/or less developed businesses was found to be an attractive alternative to the conventional examination of end products.

Expression of major histocompatibility complex antigens and replacement of donor cells by recipient ones in human liver grafts.

The disappearance of certain cell populations of donor origin and their replacement by recipient-specific cells constitutes a possible explanation for the relatively mild course of acute rejection despite lack of MHC compatibility in human orthotopic liver transplantation (OLT). In the present report, graft biopsies of 12 OLT patients from a total of 42 patients were studied for expression of MHC antigens after transplantation using monoclonal antibodies to HLA-ABC and HLA-DR. The patients were selected based upon donor-recipient mismatching for HLA-A2, B7, Drw52, or DQw1. Monoclonal antibodies to these 4 polymorphic HLA antigens and monoclonal antibodies to HLA-ABC and -DR were applied to frozen tissue sections and visualized using an immunoperoxidase technique. Expression of HLA-ABC and -DR on, respectively, hepatocytes and bile duct epithelium were observed in posttransplant graft conditions such as viral infections, cholangitis, and acute rejection. However, no specific pattern of MHC antigen distribution was observed for these various pathological graft conditions. Disappearance of DR-positive Kupffer cells of donor origin and immigration of recipient ones was encountered in the early posttransplant biopsies. This Kupffer cell replacement coincided with a reversible episode of acute rejection. The disappearance of highly immunogenic cellular components as HLA-DR positive Kupffer cells of graft origin may be one of the mechanisms contributing to the mild rejection response observed in human liver transplantation.

Subentities within adult primary IgA-nephropathy.

Since its definition is purely descriptive, IgA-nephropathy (IGAN) may comprise more disease entities which share the (epi)phenomenon of mesangial IgA-depositions. IGAN patients with macroscopical hematuria (macro-H) differ from the other IGAN patients in 9 aspects: history, HLA-DR, Gm-allotypes, actuarial kidney survival, initial creatinine clearance, initial proteinuria, initial microhematuria, age at presentation and light microscopy of the renal biopsy. The difference in the last five parameters may either be explained by the existence of subentities or by earlier detection of patients with macro-H. The dissimilarity in the first four parameters can only be due to the former theory. Therefore, we conclude that IGAN probably comprises at least two disease entities.

[Transmission of multiresistant tuberculosis in a Dutch hospital]. / Transmissie van multiresistente tuberculose in een Nederlands ziekenhuis.

Nosocomial transmission of multiresistant tuberculosis in the Netherlands is described for the first time in this article. It was detected by systematic country-wide DNA-fingerprinting. By the time the contact case (a man aged 35) developed disease he was residing in another part of the country. Contact-investigation by the Municipal Health Services involved revealed that the (HIV negative) contact case had been in contact with the index case (a man aged 27) during hospitalisation two years earlier. An analysis of the infection control measures applied, showed that inadequate treatment, early discharge from isolation and lack of bacteriological control (no sputum conversion documented) led to this hospital transmission.

[Limited tuberculin screening participation amongst travellers to countries with high tuberculosis incidence; reason to consider BCG vaccination for some travellers]. / Beperkte deelname aan tuberculinescreening onder reizigers naar landen met hoge tuberculose-incidentie; reden om voor sommigen BCG-vaccinatie te overwegen.

OBJECTIVE: To determine the compliance amongst Dutch travellers to high tuberculosis-incidence countries with a screening procedure involving a tuberculin skin test before and after the trip. DESIGN: Prospective study. METHOD: Nine hundred and eighty-eight tuberculin-negative Dutch people who travelled to high tuberculosis-incidence countries for 3 to 12 months were studied for their compliance with an advised screening procedure of repeat tuberculin skin testing 2 to 4 months after return. At 2 of the 4 participating health services, data were also collected on extra calls made and the pertinent time investments. RESULTS: Five hundred and ninety-nine travellers (61%) were compliant with the screening procedure. Of those for whom the data was available (n = 417), 33% (98/300) of the compliant travellers required extra calls. These took an average of 30 min per extra traveller tested as a result. Compliance varied according to health service and was better amongst travellers to Africa. In addition, non-compliance was independently associated with male sex, work being the main travel purpose, and an undecided duration of travel on departure. CONCLUSIONS: Compliance of Dutch travellers with tuberculin skin-test screening is limited, particularly if no extra calls are issued. Bacillus Calmette-Guérin vaccination appears to be preferable for travellers with undecided travel duration and persons travelling for work on a frequent basis.

[Social function of pets (author's transl)]. / Het kleine huisdier in zijn sociale functie.

The present paper is an abridged version of one written in 1974. Only one of several functions of small pets, viz. their social function, is discussed, both the positive and the negative aspects being considered. A test developed in Great Britain serves to show how important a pet may be. The reasons for which man regards his animals as important are more within the scope of the psychologist bus are also referred to in the paper. An entirely new social function, especially of dogs, is the role of therapeutic aids in the psychotherapy of children. This method is used specifically by the American psychiatrist B. M. Levinson. Drawbacks to pets are inadequate hygiene, agressiveness and zoonoses, though veterinarians may play an important role in overcoming these disadvantages.

Erythrocyte antibody screening in solid-phase: a comparison of two solid-phase microplate assays with the indirect antiglobulin test in polyethylene glycol for the detection of irregular erythrocyte antibodies.

The screening of a serum for irregular erythrocyte antibodies in the indirect antiglobulin test is a well-established technique. We compared the test results of two different solid-phase microplate indirect antiglobulin tests with a liquid-phase indirect antiglobulin test in tubes. Antibody screening with both solid-phase microplate techniques proved to be more sensitive than the liquid-phase indirect antiglobulin test. In addition, a difference in sensitivity between the two solid-phase techniques was observed: prior immobilization of test erythrocytes on the microplate followed by incubation with a serum and detection of sensitization with antihuman IgG-coated detector cells gave better test results than secondary immobilization on the microplate of test erythrocytes sensitized with antibodies and an antihuman globulin serum.

Immunoglobulin genes, HLA-B8/DR3, and immune responsiveness to primary immunogen and mitogens in normal subjects.

The genetic regulation of immune responsiveness by genes from two independent, highly polymorphic genetic systems, namely immunoglobulin allotypes and human leukocyte antigens (HLA), was studied in 35 healthy Caucasian volunteers. The in vivo IgG class antibody response to the primary test immunogen alpha-helix pomatia hemocyanin (HPH) was increased in subjects with the Gm1,17;..;21 haplotype compared to that of the non-Gm1,17;..;21 group. The IgM-class response tended to be higher in the former group. Levels of in vivo IgA-class-specific anti-HPH antibodies tended to be higher in the group of individuals positive for HLA-B8/DR3 than in the non-B8/DR3 group. This difference was statistically significant only in the absence of the Gm1,17;..;21 haplotype. The in vitro lymphocyte proliferative response on mitogenic stimulation with phytohemagglutinin (1 micrograms/ml) and pokeweed mitogen (10 micrograms/ml) also appeared to be associated with both systems. The presence of the Gm1,17;..;21 haplotype was associated with decreased lymphocyte reactivity, whereas the B8/DR3 phenotype was associated with high responsiveness to these mitogens. However, in the presence of the Gm1,17;..;21 haplotype subjects positive for HLA-B8/DR3 did not respond better to mitogenic stimulation than those lacking this HLA haplotype. Our results imply that the immunogenetic make-up of test persons should be taken into account in the assessment of the immune status of individuals or groups of patients.

HLA-B8/DR3 phenotype and the primary immune response.

Increased frequency of HLA-B8/DR3 has been reported in many organ-specific and systemic autoimmune diseases. Immune responsiveness in 11 normal subjects with and 22 without the B8/DR3 phenotype was studied. The IgA class immune response after immunization with the primary test immunogen alpha-Helix pomatia hemocyanin (HPH) was increased in B8/DR3-positive subjects compared to the non-B8/DR3 group. Also, IgG class antibody levels tended to be higher in the former group. The in vitro lymphocyte proliferative response to optimal concentrations of HPH did not differ between the groups nor did the response to allogeneic cells. Lymphocyte proliferation on stimulation with pokeweed mitogen and suboptimal concentration of phytohemagglutinin was increased in B8/DR3 individuals. It is concluded that the phenotype B8/DR3 is associated with a high humoral immune response.

Kinetic analysis of the blood clearance and organ uptake curves of IgG-coated red cells in HLA-typed controls and patients with Wegener's granulomatosis.

Reticuloendothelial function and HLA type were studied in 22 controls and 15 patients with Wegener's granulomatosis (WG). IgG-coated red cells were injected intravenously and half-life times of blood disappearance and liver spleen uptake curves were related to the degree of antibody coating. Erythrocytes with 13,990 molecules of IgG per cell gave biexponential blood disappearance curves and were suitable for measuring splenic reticuloendothelial function. Half-life times thus obtained were not significantly different for individuals with the HLA-DR2 or DR3 phenotype. In WG patients with major disease activity, blood clearance of the injected cells was considerably decreased. Kinetic analysis of blood disappearance and spleen uptake curves revealed that this was partly due to a decrease in reversible trapping of the cells in the spleen. This suggests that a blocking effect of circulating immune complexes on splenic Fc receptors is not likely to be the sole cause of the observed hyposplenism.

Predischarge stress test after myocardial infarction in the old age: results and prognostic value.

The aim of this study was to evaluate the results of predischarge stress testing in the elderly, and to assess the prognostic value of the test during one-year follow-up. The database consisted of 48 patients older than 64 years of age and 109 patients 55-64 years of age, who survived acute myocardial infarction, out of 532 consecutive patients admitted for myocardial infarction. Stress-test results were not different in the two groups. During one-year follow-up mortality was 6% in the younger patients and 4% in the older group, and the incidence of non-fatal reinfarctions was 8% in both groups. Mortality was best predicted by the extent of blood pressure rise (43 +/- 26 mmHg in survivors vs 19 +/- 15 mmHg in non-survivors, P less than 0.001). Stress-test results were no more predictive when non-fatal reinfarction was added to mortality as an end-point. We conclude that for patients in whom the stress test is not contraindicated, age does not affect stress test results, the extent of blood pressure rise during a stress test is the best single predictor of mortality, stress tests are not predictive of reinfarctions.

Immunogenetic differences in subpopulations of patients with IgA nephropathy (Berger's disease).

Gm and Km as well as HLA-A, HLA-B, and HLA-DR phenotype frequencies were examined in 64 well-defined IgA nephropathy patients. The patients were divided into subpopulations according to clinical symptoms, e.g. macrohematuria and chronic renal failure (CRF). In patients with CRF the frequency of the Gm1,3,17;5,13,21 phenotype tended to be increased (p = 0.016; pcorr = 0.08). The frequency of the HLA-DR phenotype with only one antigen (HLA-DR-) was increased in the whole population (p less than 0.001; pcorr less than 0.011), which appeared to be confined to the patients with macrohematuria (p less than 0.001; pcorr less than 0.01) and non-CRF (p less than 0.001; pcorr less than 0.011). Patients with the Gm1,3,17;5,13,21 phenotype developed a CRF significantly earlier (p = 0.009; pcorr = 0.045) than patients with other Gm phenotypes. These data suggest that clinically observed subpopulations of IgA nephropathy patients differ in immunogenetic background.

Maintenance of cytomegalovirus (CMV) latency and host immune responses of long term renal allograft survivors. I. Prolonged suppression of in vitro lymphocyte responses against CMV infected fibroblasts related to previous secondary CMV infection.

Cytomegalovirus (CMV) specific humoral and cellular immunity was investigated in 16 renal allograft recipients with long term graft survival (26-122 months) who were shown to be CMV seropositive before transplantation. Results were compared with healthy individuals with latent CMV infections. Recipients (n = 9) who experienced a symptomatic secondary CMV infection shortly after transplantation (less than 6 months), showed a prolonged but finally temporary suppression of their in vitro lymphocyte memory responses against CMV infected fibroblasts (CMV-FF; median SI: 1.9), a persistence of high antibody titres against intracellular CMV antigens and most of them also had antibodies against CMV membrane antigens (CMV MA). In contrast the recipients (n = 7) who could maintain their CMV in latency after transplantation, had lower antibody titres and their in vitro memory lymphocyte responses against CMV-FF (median SI: 9.3) were comparable to those of the healthy controls (median SI: 11.6). The memory lymphocyte responses against purified CMV virions were depressed in both recipient groups. These results suggest that cellular immunity against CMV infected target cells constitute an important mechanism in maintaining CMV in latency after allografting.

HLA-DRw6 as a risk factor for active cytomegalovirus but not for herpes simplex virus infection after renal allograft transplantation.

To study genetically determined susceptibility to cytomegalovirus and herpes simplex virus infections in patients given renal transplants a prospective study was performed of 68 consecutive patients receiving their first cadaveric kidney allograft. The recipients positive for HLA-DRw6 showed a significantly increased incidence of active cytomegalovirus infection as early as the 10th week after transplantation (p less than 0.05). No relation with other human leucocyte antigens was found, nor did a correlation exist between HLA typing and the incidence of herpes simplex virus infections. Furthermore, recipients positive for HLA-DRw6 with secondary cytomegalovirus infections excreted infectious virus more often (p less than 0.01) and showed more clinical symptoms (p less than 0.01) than a comparable group of recipients negative for HLA-DRw6. These observations may have practical implications for the treatment of patients who have had renal transplant operations.