Nutrition education for physicians in the United States is limited in scope, quality, and duration due to a variety of factors. As new data and quality improvement initiatives highlight the importance of nutrition and a generation of nutrition experts retire, there is a need for new physician educators and leaders in clinical nutrition. Traditional nutrition fellowships and increased didactic lecture time in school and postgraduate training are not feasible strategies to develop the next generation of physician nutrition specialists in the current environment. One strategy is the development of short immersion courses for advanced trainees and junior attendings. The most promising courses include a combination of close mentorship and adult learning techniques such as lectures, clinical experiences, literature review, curricular development, research and writing, multidisciplinary interactions, and extensive group discussion. These courses also allow the opportunity for advanced discourse, development of long-term collaborative relationships, and continued longitudinal career development for alumni after the course ends. Despite these curricular developments, ultimately the field of nutrition will not mature until the American Board of Medical Specialties recognizes nutrition medicine with specialty board certification.

Endothelial cells encounter oxidant stress due to their location in the vascular wall, and because they generate reactive nitrogen species. Because ascorbic acid is likely involved in the antioxidant defenses of these cells, we studied the mechanisms by which cultures of EA.hy926 endothelial cells recycle the vitamin from its oxidized forms. Cell lysates reduced the ascorbate free radical (AFR) by both NADH- and NADPH-dependent mechanisms. Most NADH-dependent AFR reduction occurred in the particulate fraction of the cells. NADPH-dependent reduction resembled that due to NADH in having a high affinity for the AFR, but was mediated largely by thioredoxin reductase. Reduction of dehydroascorbic acid (DHA) required GSH and was both direct and enzyme dependent. The latter was saturable, half-maximal at 100 microM DHA, and comparable to rates of AFR reduction. Loading cells to ascorbate concentrations of 0.3-1.6 mM generated intracellular DHA concentrations of 20-30 microM, indicative of oxidant stress in culture. Whereas high-affinity AFR reduction is the initial and likely the preferred mechanism of ascorbate recycling, any DHA that accumulates during oxidant stress will be reduced by GSH-dependent mechanisms.

No abstract

Objectives: To evaluate the improvement in lung donation and immediate lung function after the implementation of a 360° rotational positioning protocol within an organ procurement organization in the Midwest. Design: Retrospective observational study. Setting: The Midwest Transplant Network from 2005 to 2017. Rotational positioning of donors began in 2008. Subjects: Potential deceased lung donors. Interventions: A 360° rotational protocol. Presence of immediate lung function in recipients, change in Pao 2:Fio 2 ratio during donor management, initial and final Pao 2:Fio 2 ratio, and proportion of lungs donated were measured. Outcomes were compared between rotated and nonrotated donors. Measurements and Main Results: A total of 693 donors were analyzed. The proportion of lung donations increased by 10%. The difference between initial Pao 2:Fio 2 ratio and final Pao 2:Fio 2 ratio was significantly different between rotated and nonrotated donors (36 ± 116 vs 104 ± 148; p < 0.001). Lungs transplanted from rotated donors had better immediate function than those from nonrotated donors (99.5% vs 68%; p < 0.001). Conclusions: There was a statistically significant increase in lung donations after implementing rotational positioning of deceased donors. Rotational positioning significantly increased the average difference in Pao 2:Fio 2 ratios. There was also superior lung function in the rotated group. The authors recommend that organ procurement organizations consider adopting a rotational positioning protocol for donors to increase the lungs available for transplantation.