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Continuous changes in the healthcare reimbursement criteria require executives across the industry to focus on enterprise-wide changes that have a positive effect on supply chain savings. It's a complex problem and it's easy to get distracted on one issue when having the ability to see a clear BIG picture of your entire supply chain is what can lead to the most dramatic results and return on investments. Register for MHS' webinar on November 01 (2:00pm EST) to learn about how their customers experience an average 4:1 ROI with continual savings into the millions and a positive financial impact to their bottom line through inventory reduction, avoidance of obsolete and expired inventory, improved charge capture for each patient, and physician preference card optimization. Click on http://bit.ly/UvD3nq Presenters *Michael Ferris: Co-Founder, MHS with over 30 years of supply chain management experience *Steve Basiliere: Former Director of Supply Chain Services at Saints Medical Center, Lowell, MA *Art Kozyrovicius: Finance and Procurement Systems Support at New York-Presbyterian Hospital, New York, NY WHY ATTEND? Join a unique discussion with healthcare supply chain thought leaders and understand how to drive significant and sustainable supply chain operational improvements. Get a jump on making an immediate and positive impact on your bottom line as you head into 2013. Register by clicking on http://bit.ly/UvD3nq Note: Event will be online, through WebEx Please Register at http://bit.ly/UvD3nq

great review of medium chain triglycerides.

Rat study found that High fat and high branch chain amino acid intake long-term leads to insulin resistance.  This occurred through phosphorylation of insulin signaling downstream and differed between lean versus obese individuals.  

long chain fatty acids (LCFA), associated with decreased calorie intake.  This occurs through up regulation/release of cholecystokinin.

Branched chain amino acids for those with liver cirrhosis.  This is deficiency is due to the hyperglucoganemia that results from the catabolic metabolism.  It is interesting that peripheral metabolism also sets up.  

Branched-chain amino acids play role in cancer. Sugar is not the only player and glutamine is not the only amino acid involved.

gut bacteria differentiate obese versus non-obese.  Association found b/t firmicutes:bacteroidetes, increased Bacteroidetes, and Actinobacteria; in addition, acute, propionate, and butyrate (all medium chain fatty acids) were found to be associated with obesity.

Those with Alzheimer's disease have associated dysfunction of glucose metabolism in the brain, particularly in the hippocampus. It has been reported that a ketogenic diet can improve cognitive function in these individuals. In this study, the ketone bodies were initiated through a diet high in medium chain fatty acids. The ketone bodies served as an alternative fuel source for the brain.

High branch chain amino acids can promote insulin resistance.  This study points out that long-term high protein dietary intake can actually have significant deleterious effects and lead to disease.  A high fat diet appears to be required for this effect.

great review of cirrhosis and BCCA supplementation.

Leucine, a branch chain amino acid, important in promoting protein synthesis and thus muscle growth.  Very important post-exercise and in athletes

Study found that elevated kappa and lambda light chains (sFLC's), as well as cytopenias, elevated Beta-2 macroglobulinemia correlated with poor response.

Free Light Chains are useful in monitoring treatment success in Waldenstrom's Macroglobulinemia. On average, a response was seen 1 month earlier with the sFLC's than in the IgM. Also, appx 50% of patients receive rituxin had an IgM flare early in treatment.

Serum Free light chains helpful in the determination of prognosis and therapeutic response in patients with Waldenstrom's Macroglobulinemia.

Great review of the role of SCFA in gut health and body metabolism

BCAA improve NH3 metabolism.  This is via muscle metabolism as reported in other studies.  This study highlighted the differences in BCAA supplementation.  One caveat is that high glutamine is the result from glutamate and this can increase hepatic encephalopathy.

BCAA aid NH3 metabolism in the muscle in those with liver cirrhosis.  This specifically can aid hepatic encephalopathy and mild hepatic encephalopathy.

Good review of the effects of BCAA on ammonia metabolism.  BCAA increase intramuscular NH3 production through the production of alpha-ketoglutarate.

Muscle becomes the primary mode of NH3 metabolism in liver cirrhosis.  The authors here propose that it is via an increase in muscle mass rather than specifically lowering NH3.  In fact, there is an early increase in NH3 production.