Hahnhickman6318

05). The basal, 6th and 12th month evaluations of three groups showed that mean POMA balance, gait and total scores were better in patients whose 25(OH)D level was ≥20 ng/mL. CONCLUSIONS Vitamin D replacement, especially to severe deficient patients, may improve balance and gait functions in older adults. Therefore, vitamin D deficiency should be screened routinely and treated effectively. BACKGROUND & AIMS Burn patients pose a number of clinical challenges for doctors and dietitians to achieve optimal nutrition practice. The objective of this study was to describe nutrition practices in burn center intensive care units (ICUs) compared to the most recent ESPEN and SCCM/ASPEN guidelines (hereafter referenced as "the Guidelines") and highlight the variation in practice and what is "best achievable." METHODS In 2014-15, we prospectively enrolled 283 mechanically ventilated patients who were admitted to one of 14 burn ICUs for at least 72 h. Data collected included information on the estimation of energy and protein requirements, their actual delivery as well as route and time of feeding, and administration of micronutrients. We describe site practices and data per patient-day. RESULTS Adherence to the Guidelines for the use of enteral nutrition (EN) over parenteral nutrition (PN) was 90.5% of patient-days (site range 79.2%-97.0%). However, adherence to the Guidelines for the measurement of energy requirements was 6.0% of patient-days (site range 0.0%-93.3%), supplementation with glutamine took place in 22.4% of patient-days (site range 0.0%-61.8%). Provision of 80% of energy requirements within 48-72 h was achieved in 35.3% of patients (site range 0.0%-80.0%), and provision of 80% of protein needs within 48-72 h was achieved in 34.3% of patients (site range 0.0%-80.0%). Average nutritional adequacy was 64.9 ± 40.0% for energy (best site 80.2%, worst site 42.0%) and 65.6 ± 42.1% for protein (best site 87.3%, worst site 43.6%). this website CONCLUSION The present findings indicate that despite high adherence to providing EN over PN, there is still a large gap between many recommendations and clinical practice, and the achievement of nutrition goals for patients in burn centers is suboptimal. BACKGROUND Supplementing maternal diet with citrulline or arginine during gestation was shown to enhance fetal growth in a model of IUGR induced by maternal dietary protein restriction in the rat. OBJECTIVE The aims of this study were to determine in the same model whether maternal supplementation with citrulline or arginine would increase 1) citrulline and arginine concentration in fetal circulation; 2) the expression of placental amino acid transporters, and 3) the fetal availability of essential amino acids. METHODS Pregnant rats (n = 8 per group) were fed either an isocaloric control (20% protein, NP) or a low protein (LP, 4% protein) diet, either alone or supplemented with 2 g/kg/d of l-citrulline (LP + CIT) or isonitrogenous Arginine (LP + ARG) in drinking water throughout gestation. Fetuses were extracted by C-section on the 21st day of gestation. The gene expression of system A (Slc38a1, Slc38a2, and Slc38a4) and L (Slc7a2, Slc7a5, Slc7a8) amino acid transporters was measured in placenta and amino aciion. Fetal amino acid concentrations were decreased by LP diet, and were not restored by CIT or ARG supplementation. CONCLUSIONS The current findings confirm supplementation with citrulline or arginine enhances fetal growth in a rat model of IUGR. They further suggest that 1) citrulline and arginine administered orally to the pregnant mother may reach fetal circulation; 2) citrulline effectively raises fetal arginine availability; and 3) although it failed to increase the concentrations of essential amino acids in fetal plasma, citrulline or arginine supplementation upregulates the gene expression of several placental amino acid transporters. BACKGROUND & AIMS Studies analyzing the impact of visceral fat excess on surgical outcomes after resection for colorectal cancer (CRC) have yielded conflicting results. Visceral obesity (VO) and sarcobesity (SO) have been recently addressed as risk factors for poor short-term results while no data are available for recovery goals after surgery. No data are available on the protective effect of ERAS in VO and SO patients. The aim of this study was to assess clinical implications of computed tomography (CT) assessed VO and SO on surgical and recovery outcomes after minimally invasive resection for CRC before and after ERAS protocol implementation. METHODS Visceral adipose tissue (VAT) and skeletal muscle area (SMA) were retrospectively assessed using pre-operative CT studies of 261 patients who underwent laparoscopic resection for CRC between January 2012 and April 2019; ERAS protocol was adopted in 160 patients operated on after March 2014. Patients' surgical and recovery outcomes were compared according to BMns and PPOI after laparoscopic resection for CRC. A reduced number of lymph nodes retrieved is associated to VO and SO. These conditions should then be considered in clinical practice for the risk of down staging the N stage. Effect of VO and SO on recovery items after surgery should be further investigated. ERAS protocol application should be implemented to improve recovery outcomes in VO and SO patients undergoing laparoscopic colorectal resection. Antiarrhythmic drugs are often the last resort for recurrent ventricular tachycardia refractory to catheter ablation in implantable cardioverter-defibrillator carriers. Amiodarone, alone or combined with mexiletine, is usually but not always highly effective, and its use is usually limited by systemic adverse effects. We present the case of a 62 years old man with recurrent ICD shocks due to a VT refractory to an endo-epicardial hybrid ablation. Starting of dronedarone plus mexiletine combination showed an excellent result. The COVID-19 pandemic has brought rapid changes to the way care must be delivered to keep patients and providers safe while simultaneously managing limited resources. Multiple fields have used telemedicine to continue care while maintaining social distancing and quarantine practices in the pandemic. Presented in this paper is a review describing the application of telemedicine in caring for surgical patients, and methods for potential implications of telehealthcare for surgical patients during the COVID-19 pandemic. A review of the PubMed Central and Medline provides articles examining the role of telemedicine for preoperative, postoperative, and follow up evaluation of surgical patients encompassing the past two decades. Additionally, articles examining the financial and legal considerations of telemedicine, and the effect COVID-19 has had on the current legislature were included. We report the summarized findings of these studies, the financial and HIPAA considerations of using telemedicine, potential benefits, pitfalls and strategies for the utilization of telemedicine into the clinical practice of general surgery and its subspecialties during the COVID-19 pandemic.