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  1. Article ; Online: Validation of an equation for energy expenditure that does not require the respiratory quotient.

    Kaiyala, Karl J / Wisse, Brent E / Lighton, John R B

    PloS one

    2019  Volume 14, Issue 2, Page(s) e0211585

    Abstract: Background: Energy expenditure (EE) calculated from respirometric indirect calorimetry is most accurate when based on oxygen consumption (VO2), carbon dioxide production (VCO2) and estimated protein metabolism (PM). EE has a substantial dependence of ~7% ...

    Abstract Background: Energy expenditure (EE) calculated from respirometric indirect calorimetry is most accurate when based on oxygen consumption (VO2), carbon dioxide production (VCO2) and estimated protein metabolism (PM). EE has a substantial dependence of ~7% on the respiratory quotient (RQ, VCO2/VO2) and a lesser dependence on PM, yet many studies have instead estimated EE from VO2 only while PM has often been ignored, thus reducing accuracy. In 1949 Weir proposed a method to accurately calculate EE without using RQ, which also adjusts for estimated PM based on dietary composition. This RQ- method utilizes the calorimeter airflow rate (FR), the change in fractional O2 concentration (ΔFO2) and the dietary protein fraction. The RQ- method has not previously been empirically validated against the standard RQ+ method using both VO2 and RQ. Our aim was to do that.
    Methods: VO2 and VCO2 were measured repeatedly in 8 mice fed a high protein diet (HPD) during exposure to different temperatures (n = 168 measurements of 24h gas exchange). The HPD-adjusted RQ+ equation was: EE [kcal/time] = VO2 [L/time]×(3.853+1.081RQ) while the corresponding RQ- equation was: EE = 4.934×FR×ΔFO2. Agreement was analyzed using the ratios of the RQ- to RQ+ methods along with regression and Bland-Altman agreement analyses. We also evaluated the standard equation using the dietary food quotient (FQ) of 0.91 as a proxy for RQ (FQ+ method).
    Results: Ratio analysis revealed that the mean error of the RQ- method was only 0.11 ± 0.042% while the maximum error was only 0.21%. Error using the FQ+ method was 4 -and 10-fold greater, respectively. Bland-Altman analysis demonstrated that the RQ- method very slightly overestimates EE as RQ decreases. Theoretically, this error can be eliminated completely by imposing an incurrent fractional oxygen concentration at a value only slightly greater than the atmospheric level.
    Conclusions: The Weir 'RQ-free' method for calculating EE is a highly valid alternative to the 'gold standard' method that requires RQ. The RQ- approach permits reduced cost and complexity in studies focused on EE and provides a way to rescue EE measurement in studies compromised by faulty CO2 measurements. Practitioners of respirometry should consider adjusting EE calculations for estimated protein metabolism based on dietary composition.
    MeSH term(s) Algorithms ; Animals ; Carbon Dioxide/metabolism ; Diet, High-Protein ; Energy Metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Oxygen Consumption ; Proteins/metabolism ; Temperature
    Chemical Substances Proteins ; Carbon Dioxide (142M471B3J)
    Language English
    Publishing date 2019-02-01
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0211585
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Evaluating the Impact of Inadequate Meal Consumption on Insulin-Related Hypoglycemia in Hospitalized Patients.

    Atkinson, Ben / Corl, Dawn / Pergamit, Ronald / Weaver, Kathryn W / Tylee, Tracy / Wisse, Brent E

    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

    2020  Volume 27, Issue 5, Page(s) 443–448

    Abstract: Objective: Meal intake is sometimes reduced in hospitalized patients. Meal-time insulin administration can cause hypoglycemia when a meal is not consumed. Inpatient providers may avoid ordering meal-time insulin due to hypoglycemia concerns, which can ... ...

    Abstract Objective: Meal intake is sometimes reduced in hospitalized patients. Meal-time insulin administration can cause hypoglycemia when a meal is not consumed. Inpatient providers may avoid ordering meal-time insulin due to hypoglycemia concerns, which can result in hyperglycemia. The frequency of reduced meal intake in hospitalized patients remains inadequately determined. This quality improvement project evaluates the percentage of meals consumed by hospitalized patients with insulin orders and the resulting risk of postmeal hypoglycemia (blood glucose [BG] <70 mg/dL, <3.9 mmol/L).
    Methods: This was a retrospective quality improvement project evaluating patients with any subcutaneous insulin orders hospitalized at a regional academic medical center between 2015 and 2017. BG, laboratory values, point of care, insulin administration, diet orders, and percentage of meal consumed documented by registered nurses were abstracted from electronic health records.
    Results: Meal consumption ≥50% was observed for 85% of meals with insulin orders, and bedside registered nurses were accurate at estimating this percentage. Age ≥65 years was a risk factor for reduced meal consumption (21% of meals 0%-49% consumed, P < .05 vs age < 65 years [12%]). Receiving meal-time insulin and then consuming only 0% to 49% of a meal (defined here as a mismatch) was not rare (6% of meals) and increased postmeal hypoglycemia risk. However, the attributable risk of postmeal hypoglycemia due to this mismatch was low (4 events per 1000) in patients with premeal BG between 70 and 180 mg/dL.
    Conclusion: This project demonstrates that hospitalized patients treated with subcutaneous insulin have a low attributable risk of postmeal hypoglycemia related to inadequate meal intake.
    MeSH term(s) Aged ; Blood Glucose ; Humans ; Hyperglycemia ; Hypoglycemia/chemically induced ; Hypoglycemia/epidemiology ; Hypoglycemic Agents/adverse effects ; Insulin/adverse effects ; Meals ; Retrospective Studies
    Chemical Substances Blood Glucose ; Hypoglycemic Agents ; Insulin
    Language English
    Publishing date 2020-12-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1473503-9
    ISSN 1530-891X
    ISSN 1530-891X
    DOI 10.1016/j.eprac.2020.11.007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Validation of an equation for energy expenditure that does not require the respiratory quotient.

    Karl J Kaiyala / Brent E Wisse / John R B Lighton

    PLoS ONE, Vol 14, Iss 2, p e

    2019  Volume 0211585

    Abstract: BACKGROUND:Energy expenditure (EE) calculated from respirometric indirect calorimetry is most accurate when based on oxygen consumption (VO2), carbon dioxide production (VCO2) and estimated protein metabolism (PM). EE has a substantial dependence of ~7% ... ...

    Abstract BACKGROUND:Energy expenditure (EE) calculated from respirometric indirect calorimetry is most accurate when based on oxygen consumption (VO2), carbon dioxide production (VCO2) and estimated protein metabolism (PM). EE has a substantial dependence of ~7% on the respiratory quotient (RQ, VCO2/VO2) and a lesser dependence on PM, yet many studies have instead estimated EE from VO2 only while PM has often been ignored, thus reducing accuracy. In 1949 Weir proposed a method to accurately calculate EE without using RQ, which also adjusts for estimated PM based on dietary composition. This RQ- method utilizes the calorimeter airflow rate (FR), the change in fractional O2 concentration (ΔFO2) and the dietary protein fraction. The RQ- method has not previously been empirically validated against the standard RQ+ method using both VO2 and RQ. Our aim was to do that. METHODS:VO2 and VCO2 were measured repeatedly in 8 mice fed a high protein diet (HPD) during exposure to different temperatures (n = 168 measurements of 24h gas exchange). The HPD-adjusted RQ+ equation was: EE [kcal/time] = VO2 [L/time]×(3.853+1.081RQ) while the corresponding RQ- equation was: EE = 4.934×FR×ΔFO2. Agreement was analyzed using the ratios of the RQ- to RQ+ methods along with regression and Bland-Altman agreement analyses. We also evaluated the standard equation using the dietary food quotient (FQ) of 0.91 as a proxy for RQ (FQ+ method). RESULTS:Ratio analysis revealed that the mean error of the RQ- method was only 0.11 ± 0.042% while the maximum error was only 0.21%. Error using the FQ+ method was 4 -and 10-fold greater, respectively. Bland-Altman analysis demonstrated that the RQ- method very slightly overestimates EE as RQ decreases. Theoretically, this error can be eliminated completely by imposing an incurrent fractional oxygen concentration at a value only slightly greater than the atmospheric level. CONCLUSIONS:The Weir 'RQ-free' method for calculating EE is a highly valid alternative to the 'gold standard' method that requires RQ. The RQ- ...
    Keywords Medicine ; R ; Science ; Q
    Subject code 518
    Language English
    Publishing date 2019-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Perioperative Glycemic Control During Colorectal Surgery.

    Thompson, Rachel E / Broussard, Elizabeth K / Flum, David R / Wisse, Brent E

    Current diabetes reports

    2016  Volume 16, Issue 3, Page(s) 32

    Abstract: Hyperglycemia occurs frequently among patients undergoing colorectal surgery and is associated with increased risk of poor clinical outcomes, especially related to surgical site infections. Treating hyperglycemia has become a target of many enhanced ... ...

    Abstract Hyperglycemia occurs frequently among patients undergoing colorectal surgery and is associated with increased risk of poor clinical outcomes, especially related to surgical site infections. Treating hyperglycemia has become a target of many enhanced recovery after surgery programs developed for colorectal procedures. There are several unique considerations for patients undergoing colorectal surgery including bowel preparations and alterations in oral intake. Focused protocols for those with diabetes and those at risk of hyperglycemia are needed in order to address the specific needs of those undergoing colorectal procedures.
    MeSH term(s) Blood Glucose ; Colorectal Surgery ; Diabetes Mellitus ; Humans ; Hyperglycemia/drug therapy ; Perioperative Care ; Risk Factors ; Surgical Wound Infection
    Chemical Substances Blood Glucose
    Language English
    Publishing date 2016-03
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2065167-3
    ISSN 1539-0829 ; 1534-4827
    ISSN (online) 1539-0829
    ISSN 1534-4827
    DOI 10.1007/s11892-016-0722-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity.

    Wisse, Brent E

    Journal of the American Society of Nephrology : JASN

    2004  Volume 15, Issue 11, Page(s) 2792–2800

    Abstract: The metabolic effects of obesity have made this highly prevalent disease one of the most common risk factors for diabetes, hypertension, and atherosclerosis, the leading causes of end-stage renal failure. However, obesity per se, as defined by body mass ... ...

    Abstract The metabolic effects of obesity have made this highly prevalent disease one of the most common risk factors for diabetes, hypertension, and atherosclerosis, the leading causes of end-stage renal failure. However, obesity per se, as defined by body mass index, is less predictive of the development of these diseases than is the presence of a constellation of obesity-related abnormalities now known as the metabolic syndrome. Recognition of this syndrome, which can readily be identified in clinical settings using defined threshold values for waist circumference, BP, fasting glucose, and dyslipidemia, allows for earlier intervention in these high-risk patients. Systemic insulin resistance has been implicated as one possible factor that links visceral obesity to adverse metabolic consequences; however, the mechanism whereby adipose tissue causes alterations in insulin sensitivity remains unclear. Infection and inflammation are commonly associated with insulin resistance, and visceral obesity is associated with a chronic, low-grade inflammatory state, suggesting that inflammation may be a potential mechanism whereby obesity leads to insulin resistance. Moreover, adipose tissue is now recognized as an immune organ that secretes numerous immunomodulatory factors and seems to be a significant source of inflammatory signals known to cause insulin resistance. Therefore, inflammation within white adipose tissue may be a crucial step contributing to the emergence of many of the pathologic features that characterize the metabolic syndrome and result in diabetes and atherosclerosis. This review describes the role of proinflammatory cytokines and hormones released by adipose tissue in generating the chronic inflammatory profile associated with visceral obesity.
    MeSH term(s) Adipose Tissue/metabolism ; Animals ; Cytokines/metabolism ; Humans ; Inflammation/complications ; Metabolic Syndrome/complications ; Metabolic Syndrome/metabolism ; Obesity/complications ; Syndrome
    Chemical Substances Cytokines
    Language English
    Publishing date 2004-11
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1085942-1
    ISSN 1533-3450 ; 1046-6673
    ISSN (online) 1533-3450
    ISSN 1046-6673
    DOI 10.1097/01.ASN.0000141966.69934.21
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Does hypothalamic inflammation cause obesity?

    Wisse, Brent E / Schwartz, Michael W

    Cell metabolism

    2009  Volume 10, Issue 4, Page(s) 241–242

    Abstract: Obesity-induced inflammation causes cellular resistance to both insulin and leptin. In this issue, Brüning and colleagues (Kleinridders et al., 2009) add to growing evidence that this response occurs in the hypothalamus, as well as in peripheral tissues, ...

    Abstract Obesity-induced inflammation causes cellular resistance to both insulin and leptin. In this issue, Brüning and colleagues (Kleinridders et al., 2009) add to growing evidence that this response occurs in the hypothalamus, as well as in peripheral tissues, which helps to explain how high-fat feeding induces a gradual increase in defended body weight.
    MeSH term(s) Animals ; Body Weight/physiology ; Dietary Fats/pharmacology ; Energy Metabolism ; Hypothalamus/drug effects ; Hypothalamus/immunology ; Hypothalamus/pathology ; Insulin/metabolism ; Leptin/metabolism ; Mice ; Myeloid Differentiation Factor 88/metabolism ; Obesity/etiology
    Chemical Substances Dietary Fats ; Insulin ; Leptin ; Myeloid Differentiation Factor 88
    Language English
    Publishing date 2009-04-11
    Publishing country United States
    Document type Comment ; Journal Article
    ZDB-ID 2176834-1
    ISSN 1932-7420 ; 1550-4131
    ISSN (online) 1932-7420
    ISSN 1550-4131
    DOI 10.1016/j.cmet.2009.09.003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: What Can We Learn From Point-of-Care Blood Glucose Values Deleted and Repeated by Nurses?

    Corl, Dawn / Yin, Tom / Ulibarri, May / Lien, Heather / Tylee, Tracy / Chao, Jing / Wisse, Brent E

    Journal of diabetes science and technology

    2018  Volume 12, Issue 5, Page(s) 985–991

    Abstract: Background: Hospitals rely on point-of-care (POC) blood glucose (BG) values to guide important decisions related to insulin administration and glycemic control. Evaluation of POC BG in hospitalized patients is associated with measurement and operator ... ...

    Abstract Background: Hospitals rely on point-of-care (POC) blood glucose (BG) values to guide important decisions related to insulin administration and glycemic control. Evaluation of POC BG in hospitalized patients is associated with measurement and operator errors. Based on a previous quality improvement (QI) project we introduced an option for operators to delete and repeat POC BG values suspected as erroneous. The current project evaluated our experience with deleted POC BG values over a 2-year period.
    Method: A retrospective QI project included all patients hospitalized at two regional academic medical centers in the Pacific Northwest during 2014 and 2015. Laboratory Medicine POC BG data were reviewed to evaluate all inpatient episodes of deleted and repeated POC BG.
    Results: Inpatient operators choose to delete and repeat only 0.8% of all POC BG tests. Hypoglycemic and extreme hyperglycemic BG values are more likely to be deleted and repeated. Of initial values <40 mg/dL, 58% of deleted values (18% of all values) are errors. Of values >400 mg/dL, 40% of deleted values (5% of all values) are errors. Not all repeated POC BG values are first deleted. Optimal use of the option to delete and repeat POC BG values <40 mg/dL could decrease reported rates of severe hypoglycemia by as much as 40%.
    Conclusions: This project demonstrates that operators are frequently able to identify POC BG values that are measurement/operator errors. Eliminating these errors significantly reduces documented rates of severe hypoglycemia and hyperglycemia, and has the potential to improve patient safety.
    MeSH term(s) Blood Glucose/analysis ; Data Accuracy ; Diabetes Mellitus/blood ; Diabetes Mellitus/nursing ; Humans ; Point-of-Care Systems/standards ; Point-of-Care Testing ; Quality Assurance, Health Care ; Retrospective Studies
    Chemical Substances Blood Glucose
    Language English
    Publishing date 2018-03-24
    Publishing country United States
    Document type Journal Article
    ISSN 1932-2968
    ISSN (online) 1932-2968
    DOI 10.1177/1932296818763891
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Current controversy related to glucocorticoid and insulin therapy in the intensive care unit.

    Klaff, Lindy S / Wisse, Brent E

    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

    2007  Volume 13, Issue 5, Page(s) 542–549

    Abstract: Objective: To review the controversy related to the widespread use of intensive insulin treatment (IIT) to maintain normoglycemia and of glucocorticoid replacement therapy in patients with sepsis in the intensive care unit (ICU).: Methods: We ... ...

    Abstract Objective: To review the controversy related to the widespread use of intensive insulin treatment (IIT) to maintain normoglycemia and of glucocorticoid replacement therapy in patients with sepsis in the intensive care unit (ICU).
    Methods: We performed a MEDLINE search of the literature using a combination of words (critical/intensive care, endocrinology/endocrine, glucocorticoid/adrenal, insulin) to identify original studies and reviews on glucocorticoid therapy and IIT in the ICU.
    Results: Glucocorticoid replacement therapy is advocated for patients with sepsis who have relative adrenal insufficiency. The current definition of relative adrenal insufficiency is poorly supported, and validated endocrine criteria that consistently identify ICU patients likely to benefit from glucocorticoid therapy are not yet available. IIT benefits postoperative patients at high risk of infection and patients who remain in the ICU more than 3 days. Potential harm caused by early IIT administration in medical ICU patients remains controversial. The role of early nutritional supplementation in major studies about IIT is largely unexplored. Improvements in insulin infusion protocols are needed to reduce the risk of hypoglycemia related to IIT.
    Conclusion: Endocrine therapy in the ICU is entering a new era. Controversies remain related to glucocorticoid and insulin therapy even as interest in new, and old, endocrine therapies is being revived.
    MeSH term(s) Critical Care/methods ; Critical Illness/therapy ; Glucocorticoids/therapeutic use ; Humans ; Hypoglycemic Agents/therapeutic use ; Insulin/therapeutic use ; Intensive Care Units
    Chemical Substances Glucocorticoids ; Hypoglycemic Agents ; Insulin
    Language English
    Publishing date 2007-09
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1473503-9
    ISSN 1934-2403 ; 1530-891X
    ISSN (online) 1934-2403
    ISSN 1530-891X
    DOI 10.4158/EP.13.5.542
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Efficacy of diabetes nurse expert team program to improve nursing confidence and expertise in caring for hospitalized patients with diabetes mellitus.

    Corl, Dawn E / McCliment, Sean / Thompson, Rachel E / Suhr, Louise D / Wisse, Brent E

    Journal for nurses in professional development

    2014  Volume 30, Issue 3, Page(s) 134–142

    Abstract: Nursing care for hospitalized patients with diabetes has become more complex as evidence accumulates that inpatient glycemic control improves outcomes. Previous studies have highlighted challenges for educators in providing inpatient diabetes education ... ...

    Abstract Nursing care for hospitalized patients with diabetes has become more complex as evidence accumulates that inpatient glycemic control improves outcomes. Previous studies have highlighted challenges for educators in providing inpatient diabetes education to nurses. In this article, the authors show that a unit-based diabetes nurse expert team model, developed and led by a diabetes clinical nurse specialist, effectively increased nurses' confidence and expertise in inpatient diabetes care. Adapting this model in other institutions may be a cost-effective way to improve inpatient diabetes care and safety as well as promote professional growth of staff nurses.
    MeSH term(s) Clinical Competence ; Costs and Cost Analysis ; Diabetes Mellitus/nursing ; Humans ; Nursing Staff, Hospital/education ; Patient Care/economics
    Language English
    Publishing date 2014-05
    Publishing country United States
    Document type Journal Article
    ISSN 2169-981X
    ISSN (online) 2169-981X
    DOI 10.1097/NND.0000000000000068
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Cancer-induced anorexia and malaise are mediated by CGRP neurons in the parabrachial nucleus.

    Campos, Carlos A / Bowen, Anna J / Han, Sung / Wisse, Brent E / Palmiter, Richard D / Schwartz, Michael W

    Nature neuroscience

    2017  Volume 20, Issue 7, Page(s) 934–942

    Abstract: Anorexia is a common manifestation of chronic diseases, including cancer. Here we investigate the contribution to cancer anorexia made by calcitonin gene-related peptide (CGRP) neurons in the parabrachial nucleus (PBN) that transmit anorexic signals. We ... ...

    Abstract Anorexia is a common manifestation of chronic diseases, including cancer. Here we investigate the contribution to cancer anorexia made by calcitonin gene-related peptide (CGRP) neurons in the parabrachial nucleus (PBN) that transmit anorexic signals. We show that CGRP
    MeSH term(s) Adenomatous Polyposis Coli Protein/genetics ; Animals ; Anorexia/physiopathology ; Behavior, Animal/physiology ; Body Weight ; Cachexia/physiopathology ; Calcitonin Gene-Related Peptide/antagonists & inhibitors ; Calcitonin Gene-Related Peptide/genetics ; Calcitonin Gene-Related Peptide/physiology ; Carcinoma, Lewis Lung/physiopathology ; Clozapine/analogs & derivatives ; Clozapine/pharmacology ; Energy Metabolism/physiology ; Female ; Illness Behavior/physiology ; Male ; Metalloendopeptidases/pharmacology ; Mice ; Mice, Transgenic ; Neoplasms/physiopathology ; Parabrachial Nucleus/drug effects ; Parabrachial Nucleus/physiology ; Tetanus Toxin/pharmacology ; Tumor Cells, Cultured/transplantation
    Chemical Substances Adenomatous Polyposis Coli Protein ; Calca protein, mouse ; Tetanus Toxin ; adenomatous polyposis coli protein, mouse ; Calcitonin Gene-Related Peptide (83652-28-2) ; Metalloendopeptidases (EC 3.4.24.-) ; zinc-endopeptidase, tetanus neurotoxin (EC 3.4.24.-) ; Clozapine (J60AR2IKIC) ; clozapine N-oxide (MZA8BK588J)
    Language English
    Publishing date 2017-06-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1420596-8
    ISSN 1546-1726 ; 1097-6256
    ISSN (online) 1546-1726
    ISSN 1097-6256
    DOI 10.1038/nn.4574
    Database MEDical Literature Analysis and Retrieval System OnLINE

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