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Cardiovascular PET-CT
Published in Yi-Hwa Liu, Albert J. Sinusas, Hybrid Imaging in Cardiovascular Medicine, 2017
Etienne Croteau, Ran Klein, Jennifer M. Renaud, Manuja Premaratne, Robert A. Dekemp
The ability of FDG to image plaque within the coronary arteries, however, is limited, both by the spatial resolution of PET as well as surrounding myocardial uptake despite suppression measures (low-carbohydrate, high-protein diet, prolonged fasting, and heparin) (Wykrzykowska et al. 2009). A recent observational study performed PET-CT imaging of the coronary arteries using both FDG and 18F-sodium fluoride (NaF), a marker of active calcification in patients with a history of recent MI or stable angina, and they found localization of maximal NaF uptake to the culprit plaques in 93% of acute MI patients. Furthermore, they found significant correlation between NaF uptake and high-risk plaque morphology on intravascular ultrasound. FDG uptake was most commonly not discernible in the coronary arteries due to high background activity (Joshi et al. 2014). However, it should be noted that while these findings are of significant interest, their potential impact on clinical practice remains to be established.
Biotransformation of Xenobiotics in Living Systems—Metabolism of Drugs: Partnership of Liver and Gut Microflora
Published in Peter Grunwald, Pharmaceutical Biocatalysis, 2020
An important example of a drug affected by gut microflora reductases is digoxin, a drug used to treat heart failure and atrial fibrillation. Reduction of lactone ring brings about the formation of cardioinactive metabolite, dihydrodigoxin (Fig. 6.22) (Lindenbaum et al., 1981). A specific intestinal bacteria Eubacterium lentum (or Eggerthella lenta) was found to be responsible for this reduction (Saha et al., 1983). Increased amount of amino acid arginine was shown to act inhibitory on the conversion of digoxin by E. lenta; thus high-protein diet has been proposed to prevent digoxin deactivation and lack of therapeutic effect (Haiser et al., 2014).
Other Preventive Methods
Published in J G Webster, Prevention of Pressure Sores, 2019
Chapter 3 discussed the importance of nutrition as a risk factor in the various scores used for predicting pressure sores. As such, it is reasonable to expect nutrition to be a useful preventive technique. Collins (1983) reported the findings of various investigators who established the relationship between protein and ascorbic acid deficiencies and pressure sore formation. Other dietary requirements, like zinc and iron (Williams et al 1988) are important not only to the prevention, but also to the healing of pressure sores (Chapter 14). It is also a common practice at hospitals to put patients on a high-protein diet before surgery to reduce the chance of pressure sores. Mechanic and Perkins (1988) even went so far as to suggest that for patients who are unable or unwilling to maintain adequate nutritional intake, exogenous means of nutritional support should be given. Freyone also cited that Agris (1979) advocated a positive nitrogen balance through a high caloric and vitamin supplementation program. As mentioned earlier, positive nitrogen balance is important to the synthesis of proteins. More specifically, their program aimed at achieving a serum protein of greater than 6 mg/100 ml, and a hemoglobin of greater than 10 g/ml. They did not mention how such high levels of protein and hemoglobin were to be maintained. However, Pinchofsky-Devin and Kaminsky (1986) suggested that oral supplements such as canned polymeric diets be given in addition to a well-balanced meal. They also noted that patients with a serum protein level of less than 3.5 mg/100 ml are considered as mildly deficient; and those with less than 2.5 mg/100 ml as severely deficient in nutrition. The best strategy, as suggested by Pinchofsky, was to have constant nutritional assessment to be performed at least twice a month, and make recommendations for nutritional requirements accordingly. Natow (1983) suggested a high carbohydrate, high protein, moderately low fat diet with adequate calories. In addition, he recommended that sufficient vitamin and mineral intake and daily fluid intake of 800–1000 ml to ensure optimal nutritional and hydration state. We believe that the difficulty in finding a “one-diet-fits-all” program for pressure sore prevention is difficult, if not evasive. This is because patients do not fall neatly into discrete categories of nutritional state. Furthermore, because of differences in metabolism, mobility, state of health, age and other factors, different patients will not have a similar response to any given diet. From the various papers surveyed, the dietician plays an important role in correctly determining the nutritional requirements of patients. Although there was no one standard diet that all investigators agreed on, they agreed to the fact that good nourishment is an important factor in the prevention of pressure sores.
High-protein diets in trained individuals
Published in Research in Sports Medicine, 2019
An error that is often made is that investigators define “high” protein intakes based on the percentage of calories it comprises (Wycherley et al., 2013, 2010). In two investigations that use the term “high-protein,” it is clear that the intake of dietary protein in these individuals is not high. Wycherley et al. had 56 men randomized to a high protein or standard protein diet. The high-protein diet was defined as 35% protein, 40% carbohydrate and 25% fat which is approximately 586 kcals of protein or 147 grams. These subjects were also energy restricted (~ 1,673 kcals/day). At baseline, subjects weighed ~ 103 kg thus corresponding to a protein intake of 1.4 g/kg/d. Another study similarly defined a “high” intake of protein as 27% of total energy consumed (Farnsworth et al., 2003). In this study, the “energy-restricted” portion had subjects consume 6.3 MJ/d (~ 1,504 kcal). In male subjects averaging 108 kg of body weight at baseline, this translates into a protein intake of ~ 102 grams daily or 0.9 g/kg/d which is an exceedingly low amount. Nonetheless, it is apparent that increasing intake from a very low level (i.e., 0.8 g/kg/d) to a higher amount may have beneficial metabolic effects with no adverse effects (Farnsworth et al., 2003). However, these studies do not use exercise-trained or athletic individuals. Thus, the vast majority of studies using sedentary populations (and low protein intakes) have questionable relevance to trained or exercising individuals. For the purposes of this review, high-protein intakes will be defined as exceeding the typical guidelines for athletes or exercise-trained individuals provided by other investigators as well as various academic organizations (i.e., the ISSN suggests 1.4–2.0 g/kg/d) (Jager et al., 2017; Morton et al., 2017; Phillips, 2012). Thus, any intake exceeding 2.2 g/kg/d will be operationally defined as a “high.” This review will focus on randomized controlled trials that have examined the influence of high-protein consumption with a minimum duration of at least four weeks.