Assessing and Managing Unintentional Weight Loss: A Global Survey of Geriatrician Practice and Their Use of Ice Cream to Address It.

OBJECTIVES: Unintentional weight loss (UIWL) is common among older adults but lacks standardized methods for its diagnosis and management. With a limited understanding on how geriatricians actually address UIWL, we conducted a survey to examine how they diagnose and manage it, and their opinions regarding the use of ice cream to address it. DESIGN, SETTING, AND PARTICIPANTS: An international descriptive, cross-sectional, online survey conducted over a 16-week period in 2019 involving 1131 geriatricians in clinical practice across 51 countries. MEASUREMENTS: We collected information around respondent demographics, use of screening tools and diagnostic investigations, and pharmacological and non-pharmacological approaches to address UIWL. RESULTS: 89.1% of respondents reported frequently seeing UIWL. The most common methods reportedly used to evaluate UIWL were performing a comprehensive history and physical examination (97.4%) and assessing for cognitive impairment (86.5%). 74.2% noted that they routinely prescribed oral nutritional supplements and 71.6% involved non-medical professional(s) to help manage UIWL. While 50.4% reported recommending ice cream to their patients with UIWL, only 30.6% reported being aware of other colleagues recommending it. Geriatricians in practice for 30+ years were significantly more likely to recommend ice cream (P < 0.05). A thematic analysis of qualitative responses identified that prescribing ice cream tended to align both with patient preferences and socio-economic realities. CONCLUSION: While a majority of geriatricians surveyed routinely prescribe ONS and involve others to manage UIWL, at least half are also recommending ice cream. A key practice amongst experienced geriatricians, the use of ice cream could be better acknowledged as a practical and cost-effective way to address UIWL.

Identification and characterization of Thy-1 homologues from bovine thymocytes.

Two forms of Thy-1 homologues of apparent mol. wt of 25,000 (designated BTp25) and 45,000 (designated BTp45) were isolated from bovine thymocyte membrane by solubilization, affinity chromatography with Con A, and preparative SDS-PAGE. Both forms reacted with a rabbit antiserum to murine Thy-1 in an enzyme-linked immunosorbent assay (ELISA). BTp45 is most likely a dimer of BTp25, since the two are indistinguishable in their amino acid compositions. Comparison of amino acid compositions of BTp25 and BTp45 to that of rodent and human Thy-1 by the S delta Q index revealed significant relatedness among these molecules. BTp25 and BTp45 demonstrate more structural homology to rodent Thy-1 than to human Thy-1. Detailed chemical analyses indicate that bovine Thy-1 homologues contain neutral sugars and fatty acids covalently bound to the polypeptide chain; therefore, they are lipoglycoproteins.

Identification of Thy-1 homologue in rabbit brain by immunoblot, immunohistochemistry and DNA/DNA hybridization.

A membrane glycoprotein with an apparent molecular weight of approximately 26,000 reacted on immunoblot with a monoclonal antibody (HB-3S-17) directed toward human Thy-1. At cellular level, HB-3S-17 reacted with both rabbit and human cerebral cortexes in a similar manner as demonstrated by immunohistochemical staining. Screening of a rabbit brain expression cDNA library with HB-3S-17 resulted in the isolation of a clone designated RBT-2A-1. The rabbit cDNA insert of RBT-2A-1 hybridized in Southern blot with an oligonucleotide probe derived from the mouse Thy-1.2 gene. These data strongly indicate the existence of a glycoprotein in rabbit brain which is the counterpart of human and mouse Thy-1.

Antigenic determinant(s) shared by the human Thy 1 and human IgG.

A human T cell differentiation antigen (p25) previously described as being the mouse theta equivalent has been examined for shared antigenic determinants with immunoglobulin. A strong cross-reactivity of an antiserum prepared against p25 antigen was established with human IgG subclasses. This antiserum does not react with human IgM or IgA, nor with primate immunoglobulins. The shared determinants appear to be associated with the disulphide-bonded cysteines in the first and third constant domains of the IgG molecule and the 9-112 disulfide bond of Thy 1.

An extended 10-day course of clomiphene citrate (CC) in women with CC-resistant ovulatory disorders.

OBJECTIVE: To evaluate the effectiveness of extended duration clomiphene citrate (CC) (100 mg for 10 days) as an alternative to complex ovulation induction strategies for women who fail to ovulate despite standard incremental doses of CC of > or = 150 mg for 5 days. DESIGN: Retrospective case series. SETTING: University-based infertility practice. PATIENT(S): Thirty women with CC-resistant World Health Organization group II ovulatory disorders. INTERVENTION(S): At least one cycle of 100 mg CC from days 3 to 12. RESULT(S): Fourteen patients (47%) ovulated during 31 of their 48 cycles (65%). Five women (17%) conceived a total of seven singleton pregnancies, including five term deliveries and two spontaneous abortions. Weight, body mass index, and the presence of hyperandrogenism did not predict responsiveness to the extended duration CC. Side effects were similar to those reported during standard CC treatment. CONCLUSION(S): An extended 10-day course of CC provides a simple, noninvasive, and inexpensive alternative for a subset of women with ovulatory disorders that are refractory to standard CC treatment.

Reproductive function and contraception in the postpartum period.

The postpartum period is a time of major cellular and hormonal change enabling the return of pelvic organs and the hypothalamic-pituitary-ovarian axis to the nonpregnant state. Breast-feeding modifies this change and maintains the endocrine profile and uterine endometrium in a "static" state. In nonlactating women, menstruation returns on average by day 55 to 60 postpartum and ovulation returns on average by day 40 to 50 postpartum. Breast-feeding prolongs the return of menstruation to some 8 to 15 months postpartum and the first ovulation on average was between 30 to 40 weeks postpartum. However, in breast-feeding women, the return of menstruation and ovulation can be quite variable and is influenced by the pattern of breast-feeding, in particular, the intensity and pattern of suckling. There is concern that breast-feeding, although an effective contraceptive on a wide population scale, is unpredictable for the individual. An overall pregnancy rate of 2 to 10 per cent during lactational amenorrhea has been reported. Barrier methods, intrauterine contraceptive devices, and progestogen-only contraceptives are some of the highly effective and most commonly used additional methods of contraception by lactating women. Other methods of contraception during this period include the use of periodic abstinence and combined oral contraceptives. This paper provides an overview of postpartum reproductive function in relation to breast-feeding and the use of contraception in this unique period.

Endometrial morphometry in users of intrauterine contraceptive devices and women with ovulatory dysfunctional uterine bleeding: a comparison with normal endometrium.

Copper-bearing intrauterine contraceptive devices (IUCD) are commonly associated with menorrhagia. They cause certain morphological changes in the endometrium. These have been extensively reported and the mechanisms of menorrhagia have been investigated in a number of studies. By contrast, ovulatory dysfunctional uterine bleeding has not been as widely studied and mechanisms of menorrhagia in these patients are still not well understood. In this study, we examined endometrial morphometry in a group of women using IUCD, a group of women with ovulatory dysfunctional bleeding, and a control group of women with entirely normal cycles. There was increased leukocytic infiltration of the endometrium in both groups of women with menorrhagia compared to control cases. In addition, IUCD use was associated with greater luteal phase glandular epithelial height, supporting the concept of a secretory function defect in glandular epithelium. Possible links are postulated between static morphometric observations and dynamic biochemical changes.

PIP: Researchers conducted endometrial morphometry on 23 women suffering from menorrhagia and ovulatory dysfunctional uterine bleeding, 23 users of a copper releasing IUD, and 45 healthy women (controls) to compare their endometrial histology. Cases and controls were patients at Royal Prince Alfred and King George V Hospitals in Sydney, Australia. The endometria of IUD users had many more plasma cells than normal endometria (median, 0.3/1000 stromal cells vs. 0; p 0.05). 12 biopsies from IUD-exposed endometria had no plasma cells at all. Almost all of the remaining biopsies had less than 2/1000 stromal cells. Endometrial gland epithelial height in IUD-exposed users was much greater than that in normal users (26.9 vs. 20.3 mcm; p 0.01). The difference was exclusively due to a change in the secretory phase (29.4 vs. 20.3 mcm; p 0.01), suggesting that there was a secretory function defect in glandular epithelium. All other parameters were not significantly different between IUD users and normal subjects. Women who suffered from menorrhagia and ovulatory dysfunctional bleeding had many more infiltrating leukocytes in their endometrium than those with a normal endometrium (41.1/1000 vs. 30.1/1000; p 0.05). These leukocytes tended to be lymphocytes. All other parameters were not significantly different between menorrhagia sufferers with ovulatory dysfunctional bleeding and normal subjects. Endometrial morphometry of dysfunctional bleeders and of IUD users was not significantly different. These findings suggest that IUD use and ovulatory dysfunctional bleeding may be associated with static morphometric observations and dynamic biochemical changes.

Detection of Thy-1 on cell surface of human T lymphoid cell lines by a monoclonal antibody.

A mouse IgG2b(kappa) monoclonal antibody (MAb) HB-2S-1 against human brain Thy-1 was secreted by a hybridoma clone after fusion of mouse myeloma cells with spleen cells from a mouse that went through a prolonged immunization procedure before fusion. When tested against isolated human Thy-1 by the enzyme-linked immunosorbent assay (ELISA), MAb HB-2S-1 in culture supernatant showed a titer of over 100,000, and a titer of over 10 million in ascites of a mouse injected with the hybrid clone. By immunoblotting, this antibody was found to bind a doublet of protein bands of approximately 25,000 daltons among all proteins solubilized by deoxycholate (DOC) from membrane of human brain cells. When tested on human lymphoid cell lines by immunofluorescence, MAb HB-2S-1 strongly stained four T lymphoma cell lines, C91-Pl, HUT-102, HUT-78, and C5-MJ; and weakly two leukemia cell lines, MOLT-3 and Jurkat(clone E6-1). It did not stain a third T leukemia cell line, CCRF-CEM; a human B cell line, Raji; a plasmacytoma cell line, HMy2; or a myelomonocytic cell line, HL-60. Peripheral blood lymphocytes from ten normal human adults and the viable T cells isolated from another normal individual were also negative.

Laparoscopic salpingostomy with electrocautery in the management of tubal pregnancy.

From August, 1990 to May, 1991, all cases of tubal pregnancy presenting to King George V Hospital for Mothers and Infants were considered for laparoscopic salpingostomy. This procedure involved opening the affected Fallopian tube with diathermy, removal of ectopic tissue via the laparoscope, achieving haemostasis and leaving the tubal incision to heal by secondary intention. The procedure was undertaken in 35 patients and was successfully performed in 31 patients with an average operating time of 66.4 minutes (+/- 20.1 minutes). Average hospital stay was 2.1 days (+/- 1.3). This paper examines the technique and results of the initial learning curve for laparoscopic salpingostomy and finds that with knowledge of potential hazards and care in surgery, this operation can be safely carried out in a selected group of patients.

Release of Thy-1 from human and murine T-cell lines by a specific phospholipase.

Proteins on the outer surface of cultured human and murine lymphoblastoid T cells were labelled with 125I. The labelled cells were incubated with the enzyme phosphatidylinositol-specific phospholipase C (PI-PLC). Proteins cleaved from the cell membrane by the enzyme were immunoprecipitated with anti-Thy-1 antibodies, separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), and identified by autoradiography. A doublet of Thy-1 bands of approximately 16,000 daltons were detected. The result suggests that: Thy-1 is present on the human and murine T cells which we tested, and Thy-1 is attached to the cell membrane via a phosphatidylinositol domain.

Chemical and genetic characterization of a monoclonal IgA(lambda) protein with both cryo- and pyro-precipitability.

Studies of a monoclonal IgA (lambda) protein with both cryo- and pyro-precipitability show that it belongs to the IgA2 subclass and is positive for the A2m(2) allotypic marker. Like other cryoglobulins, this protein also has an unblocked light chain, and its heavy chain belongs to the VHI subgroup. The first 22 N-terminal amino acids of the lambda chain of this protein showed less than 65% homology with those of other human lambda chains but showed 86% identity with that of an amyloid fibril protein reported by others. The alpha chain of this protein appears to have more glutamic acid or glutamine, or both, and less isoleucine residues than other human alpha chains.