The detection and quantification of feline immunodeficiency provirus in peripheral blood mononuclear cells using the polymerase chain reaction

The polymerase chain reaction method (PCR) was used to detect feline immunodeficiency virus proviral DNA in peripheral blood mononuclear cells (PBMC) of a group of 8 experimentally infected cats. The proportion of PBMC containing provirus was determined from 6 to 32 weeks post inoculation (p.i.) by performing PCR on serially diluted samples of PBMC. Primers from the p15 and p24 regions of the gag gene were used and Southern hybridization using an end-labelled probe was required to confirm primer-specific products. Provirus was detected in 5 of 8 cats by 6 weeks p.i. in 50000 PBMC, and in all 8 infected cats by 8 weeks p.i. Provirus was not detected in PBMC from any of 3 FIV negative cats. The proportion of PBMC containing provirus in individual cats ranged from 1 in 70 to 1 in 99600 PBMC. There was no significant decline over time in the proportion of PBMC containing provirus. Sequencing of a segment (287 bases) of the gag region of a West Australian FIV isolate (T90) revealed only slight nucleotide divergence from the North American Petaluma and PPR isolates and wider divergence from the Japanese TM2 clone.

Do high fetal catecholamine levels affect heart rate variability and meconium passage during labour?

OBJECTIVES

To determine the relationship between umbilical arterial catecholamine levels and fetal heart rate variability and meconium passage.

STUDY DESIGN

A prospective descriptive study was performed. Umbilical artery catecholamine levels were measured in 55 newborns and correlated with fetal heart rate before delivery, umbilical arterial pH, base excess and the presence of meconium-stained liquor.

RESULTS AND CONCLUSION

The range of catecholamine levels was enormous, with very high epinephrine or norepinephrine levels in several fetuses. We were unable to demonstrate an association between high catecholamine levels and the presence of normal fetal heart rate variability despite acidaemia. We postulate that high catecholamine levels may inhibit fetal meconium passage.

Methods for determining the internal volume of central venous catheters

A prevalent problem associated with central venous catheters (CVCs) is occlusion with clotted blood or drug precipitate. When an occlusion occurs, the inability to determine a CVC's internal volume may seriously delay instillation of a precise quantity of a corrective drug. A lack of standards for CVC measurements and confusion about terminology for describing catheter geometry are partly to blame. This article aims to alleviate the problem, providing three methods for determining CVC internal volume with two reference tables and mathematical support for all calculations. A glossary of CVC terms is also included.

Autonomic dysfunction in systemic sclerosis: sympathetic overactivity and instability

PURPOSE

This study was designed to assess the prevalence and nature of autonomic dysfunction (AD) in 34 patients with systemic sclerosis (SSc).

PATIENTS AND METHODS

Patients were questioned for current symptoms possibly related to AD. Five noninvasive cardiovascular autonomic function tests and sequential plasma catecholamine estimations at rest, during standing, and during sustained handgrip were performed. Seven patients with manometrically documented esophageal involvement and high resting plasma adrenaline levels were treated with clonidine (75 to 375 micrograms/d). One month later, resting plasma catecholamine estimations and esophageal motility studies were repeated.

RESULTS

Autonomic testing revealed AD in each patient, while symptoms were experienced by 33 of them. Findings on two of the three heart rate tests and both blood pressure tests were significantly impaired as compared with those in 25 matched control subjects. Mean resting plasma adrenaline levels were 18 times higher than in 10 matched controls (p less than 0.001). Plasma catecholamine (adrenaline, noradrenaline, and dopamine) concentrations and mean arterial blood pressures fluctuated inappropriately during standing and sustained handgrip in 28 (82%) of the patients. The presence of headaches correlated significantly with sympathetic overactivity and instability (p less than 0.05). Resting plasma adrenaline concentrations correlated inversely with disease duration (p less than 0.05). Significant suppression of sympathetic overactivity and increases in resting lower esophageal sphincter pressures were observed in the seven patients treated with clonidine.

CONCLUSION

AD is extremely common in SSc. It is characterized by parasympathetic impairment and marked sympathetic overactivity, particularly in early disease. The potential role of AD in the pathogenesis of SSc deserves further study.

Plasma metronidazole concentrations after single and repeated vaginal pessary administration

Metronidazole concentrations in plasma were measured by h.p.l.c. in 12 healthy female volunteers after single and repeated vaginal administration of 500 mg metronidazole pessaries. The area under the plasma concentration-time curve (AUC(0,12 h) was 8.4 +/- 3.9 micrograms ml-1 h (mean +/- s.d.) on day 1 and 20.6 +/- 7.1 micrograms ml-1 h (mean +/- s.d.) on day 5. The peak plasma drug concentration on day 1 was 1.2 +/- 0.6 micrograms ml-1 (mean +/- s.d.) and on day 5 it was 2.0 +/- 0.7 micrograms ml-1 (mean +/- s.d.). The plasma concentration of metronidazole at steady state was above the minimum inhibitory concentration (MIC) for anaerobic Streptococci and Clostridium tetani. These results demonstrate much lower systemic exposure than after oral administration.

Aberrant expression of intestinal mucin antigens associated with colorectal carcinoma defined by a panel of monoclonal antibodies

Small intestine mucin antigen (SIMA) is an oncofoetal antigen for the colon and is distinct from the normal large intestinal mucin antigen (LIMA). In the present study, a panel of anti-SIMA and anti-LIMA monoclonal antibodies (MAb) was used to charaterise altered mucin expression in colorectal adenocarcinomas, by immunohistochemistry and quantitative immunoassays of tissue extracts. These results are compared with CEA expression and correlated with various clinicopathological indices. All mucin MAb reacted with a high proportion of the 100 colon cancers of every stage, histological type (including non-mucinous cancers), differentiation, site, or size. Inappropriate SIMA production was detected by either anti-SIMA MAb 4D3 or 4A1, even in 85% of early stage cancers. MAb 4D3 reacted with a higher proportion of cancers of smaller size and better differentiation. At the subcellular level, both anti-SIMA MAb showed reactivity typical of normal mucin, i.e., goblet cell and extracellular mucin. The normal colonic antigen, LIMA, was also detectable in the majority of cases, but quantitatively overproduced in some cases and reduced in others. However, in contrast to SIMA, LIMA was detected in predominantly undifferentiated cancer cells but not in goblet cells. Heterogeneity of MAb reactivity between cases and complementarity within each cancer was frequently observed. Mucin reactive with at least one of the MAb was detected in all of the CEA-negative cancers. A high rate of inappropriate SIMA expression was also detected in the perineoplastic transitional mucosa (88%, c.f. CEA, 35%) and adjacent, morphologically normal mucosa (80% c.f. CEA, 24%), indicating biochemical changes similar to the cancer. This panel of anti-mucin MAb demonstrated altered mucin glycoprotein metabolism associated with the development and progression of most colorectal cancers, which emphasises their utility as indicators of neoplastic change in the colon, and their superiority to CEA.

Interaction of ketoprofen and frusemide in man

The effects of ketoprofen on frusemide-induced diuresis, natriuresis and renin release were studied in 12 healthy male volunteers. Each received frusemide 40 mg once daily with either ketoprofen 100 mg twice daily or placebo for two periods of 5 days separated by a treatment-free period according to a randomized, double-blind, cross-over study design. Ketoprofen significantly reduced frusemide-induced diuresis on Day 1 but not on Day 5 of treatment. The natriuresis induced by frusemide on Day 1 or Day 5 of treatment did not differ significantly whether ketoprofen or placebo was administered, although the mean urinary sodium excretion values were consistently lower following ketoprofen. Ketoprofen did not affect the kaliuretic response to frusemide on Day 1 or Day 5 of treatment. The increase in plasma renin activity after frusemide was inhibited by ketoprofen on both Day 1 and Day 5. These results suggest that ketoprofen reduces the diuresis and renin release induced by frusemide, but that the reduction in diuretic response may become less important after their repeated coadministration.

Partial occlusion of indwelling central venous catheters

Partial occlusion of indwelling central venous catheters (CVCs) developed as a clinical problem following the trend to leave CVCs in place for the duration of intravenous therapy, which can last for more than 1 year in some cases. The primary manifestation of partial catheter occlusion is the ability to infuse but not aspirate fluids through an indwelling CVC. There is evidence that the problem is at least partially related to a residue of blood products deposited within some CVCs and implanted ports each time blood is aspirated or infused. Over time, these deposits may act as a ball valve when aspiration from the CVC is attempted while still allowing fluid or drug infusions. A preliminary investigation has indicated that this partial occlusion can be corrected by the use of a fibrinolytic drug to "cleanse" the CVC of residual blood products through lysis, thus restoring full CVC patency. Controlled studies are still needed to determine how often the CVC should be cleansed to prevent buildup of blood products in the indwelling CVC.

Outpatient percutaneous central venous access in cancer patients

A 1-year experience of percutaneous subclavian catheterization in outpatients with cancer was reviewed to document reliability, safety, and cost. There were 763 catheter insertions attempted with prospective documentation of complications in 664 consecutive patients. Catheter insertion was successful in 722 attempts (95%). There were only 13 pneumothoraces (2%). Thirty catheters required repositioning (4%). The average catheter duration was 191 days (range: 0 to 892 days). Fifty-six catheters (8%) were removed because of suspected infection. Documented catheter sepsis occurred in 21 patients (3%); catheter site infection occurred in 8 patients (1%). Thus, only 0.22 infections per catheter year occurred during this 382 catheter-year experience. The estimated cost of catheter insertion was $562, which is one-third the estimated cost for tunneled catheters ($1,403) and for reservoir devices ($1,738). In our experience, percutaneous subclavian catheterization is a reliable, cost-effective method compared with tunneled or reservoir devices, with an equivalent incidence of catheter-related infections. The cornerstone of our success with this program is a staff dedicated to catheter care and intensive patient education. In centers where a large number of patients require central venous access, percutaneous catheterization should be the technique of choice.

Identification of a domain in cytochrome C that displaces [3H]TCP binding from rat brain membrane receptors: synthesis of beta-neuroprotectin

1. A stereospecific radioreceptor binding assay for the phencyclidine analogue, [3H]TCP, was utilized to screen for inhibition of binding in extracts of rat brain. 2. Extracts were prepared from rat cerebral cortex and hippocampus by methods employing aqueous acid. The extracts were fractionated by reversed phase-HPLC (RP-HPLC) and tested for activity in the radioreceptor assay. Three zones of activity were detected. The middle zone was further purified by high performance-size exclusion chromatography (HP-SEC). 3. Size exclusion chromatography revealed a single zone of activity corresponding to mol. wts of ca 12,000-31,000 daltons. A fraction from this zone was digested with trypsin, and the resulting enzyme fragments, isolated by a combination of HP-SEC and RR-HPLC, were identified as fragments of rat cytochrome C. 4. Horse cytochrome C was digested with trypsin and the fragments were similarly purified on the basis of the [3H]TCP binding displacement assay. The fragments were sequenced and found to be trypsin cleavage products of a single largely invariant domain of the cytochrome C molecule: Lys-Lys-Lys-Asp-Glu-Arg-Ala-Asp-Leu-Ile-Ala-Tyr-Leu-Lys-Lys. 5. beta-neuroprotectin (D)-Ala-Asp-Leu-Ile-Ala-Tyr-Leu-NH2, inhibits [3H]TCP binding and provides protection against NMDA mediated neuronal cell death at low concentrations.

Isolation and identification of a peptide from rat brain which inhibits [3H]TCP binding

1. A stereospecific radioreceptor binding assay for the phencyclidine analogue [3H]TCP was utilized to screen for inhibitors of binding in extracts of rat brain. 2. Extracts were prepared from rat cortex and hippocampus by methods employing aqueous acid or acidified methanol. Samples were fractionated by reversed phase-HPLC (RP-HPLC) and tested for activity in the radioreceptor assay. Three zones of activity were detected. The most active fraction was further purified by high performance-size exclusion chromatography. 3. Size exclusion chromatography revealed two zones of activity, corresponding to mol. wts of 4000-8000 Da and 1000-2000 Da. Final purification of the lower molecular weight material was achieved by RP-HPLC. 4. Two well-separated peaks were shown to be homogeneous. Their amino acid sequences were determined by automated Edman degradation and data base searching identified these two peaks as the undecapeptide Substance P and its oxidized counterpart (Substance P sulfoxide). 5. Comparative HPLC of synthetic Substance P, or its sulfoxide, as well as spectral analysis confirmed the identity of the isolated peptides. 6. Synthetic Substance P inhibits specific [3H]TCP binding in the radioreceptor assay.

Comparison of chlortenoxicam and indomethacin on frusemide-induced diuresis

A single oral dose of chlortenoxicam 4 mg, a new non-steroidal anti-inflammatory drug, significantly antagonized the diuretic and natriuretic actions of frusemide when compared with placebo in normal human volunteers. Indomethacin 50 mg significantly reduced the natriuretic, but not diuretic action of frusemide.

How many electrocardiographic leads are required for exercise treadmill tests?

Forty-four consecutive patients who had perfusion defects on thallium-201 scanning and positive exercise treadmill tests were prospectively studied. Thirty-eight (86%) subjects had diagnostic ST segment changes in lead V5, 37 (84%) in lead V4, and 44 (100%) in either lead V4, V5 or both. Thirty patients had ST segment changes in the inferior leads, 20 in lead aVR, and only four in lead I and/or aVL. All of these latter subjects had diagnostic ST segments in lead V4 and/or V5. It is concluded that: combined electrocardiographic leads V4 and V5 detect the vast majority of ischemic changes during exercise treadmill testing, regardless of the site of perfusion defects detected by thallium-201 scanning; and monitoring the inferior and lateral leads rarely provides more diagnostic information.

Local infusion of urokinase for the lysis of thrombosis associated with permanent central venous catheters in cancer patients

We assessed the efficacy of local fibrinolytic therapy in 35 axillary-subclavian vein thromboses (SVT) that occurred in cancer patients with percutaneous central venous catheters (CVC). These catheters were indwelling for a median of 1 month (range, one day to 10 months) before thrombosis developed. Urokinase was administered at a dose of 500 to 2,000 U/kg/h. Complete lysis occurred in 25 of 30 thrombi that were directly infused, after a median of four days. Complete lysis occurred in one of 12 thrombi that could not be directly infused with urokinase and in two of six with associated phlebitis. Eighty-one percent of the thrombi that were symptomatic for less than 1 week before treatment resolved, compared with 56% present for longer than 1 week. Sixteen patients who had complete (12) or partial (four) thrombolysis did not have their CVCs removed. All four patients with partial thrombolysis had recurrent thrombosis at a median of eight days (range, one to 90). Only two patients who had complete thrombolysis had recurrent thrombosis, at 8 and 16 months. Only minor hemorrhagic toxicity was seen.

Effect of 5-aminosalicylic acid (5-ASA) and other salicylates on short-chain fat metabolism in the colonic mucosa. Pharmacological implications for ulcerative colitis

5-Aminosalicylic acid (5-ASA) suppressed nitrite-stimulated oxidation of the fatty acid n-butyrate in a dose-dependent manner in isolated human and rat colonic epithelial cells. 4-ASA had one-sixth of the capacity of 5-ASA and sulphapyridine (SP) little of the capacity of 5-ASA to suppress fatty acid oxidation in human colonic epithelial cells. Sulphasalazine (SASP), azodisalicylic acid (ADS), acetyl-5-ASA and acetyl salicylic acid (ASA) did not suppress fatty acid oxidation in rat colonocytes. The suppression index of fatty acid oxidation (SIFO) of respective salicylic acids correlated with the reported clinical effectiveness of each drug against ulcerative colitis (UC). The capacity of 5-ASA to affect nitrite-stimulated oxidation of fat in the colonic mucosa suggests that nitrite ions and control of fatty acid oxidation play a central role in the development and therapy of active UC.

Gastrointestinal transit time in human pregnancy: prolongation in the second and third trimesters followed by postpartum normalization

Fifty-nine studies of gastrointestinal transit time were performed in 27 healthy women during pregnancy and postpartum. Gastrointestinal transit time was defined as the time of the first sustained rise in breath hydrogen concentration after ingestion of 10 g of lactulose. Gastrointestinal transit time was significantly prolonged in both the second and third trimesters of pregnancy (125 +/- 48 min and 137 +/- 58 min, respectively) when compared with either the first trimester of pregnancy or the postpartum period (99 +/- 39 min and 75 +/- 33 min, respectively). Transit times measured in the first trimester were not significantly different from those postpartum. Because the prolongation of transit time in late pregnancy is transient, it is probably due to hormones (perhaps progesterone) or other metabolic effects of pregnancy.

Evaluation of silicone elastomer catheters for long-term intravenous chemotherapy

We evaluated the efficacy and the complications of 65 silicone elastomer catheters inserted percutaneously for long-term venous access for administration of chemotherapy, antibiotics, and blood products in patients with metastatic cancer. Treatments were administered either in the hospital or in the outpatient clinic, using a portable infusion pump. The median indwelling time of catheters was 238 days (range, two to 521). The projected duration of catheter function, when the electively removed catheters were censured, was 310 days. Twenty-three catheters were removed because of malfunction, while the remaining either were discontinued electively (20) or were functioning at the conclusion of the study (22). The problems necessitating removal of 23 catheters were inadvertent dislodgement from loose sutures (eight), mechanical damage to the catheters (four), sepsis (four), phlebitis (four), intraluminal blockage with a clot (two), and cellulitis (one). We conclude that silicone elastomer catheters are safe and reliable for extended venous access for cancer chemotherapy. They are easy to insert and remove and can be replaced with a guide wire without requiring surgical intervention.

Coordination of gastric and gallbladder emptying after ingestion of a regular meal

The relationship of gallbladder emptying and refilling to gastric emptying of solids, gastrointestinal transit time, and human pancreatic polypeptide response was examined after ingestion of a standard breakfast (40% fat) in 12 healthy men and women. Gallbladder volume, emptying, and refilling was measured by real-time ultrasonography, and gastric emptying of solids was measured scintigraphically by the disappearance from the stomach of egg labeled with 99mTc-sulfur colloid. Gastrointestinal transit time was defined as the time of initial rise in breath hydrogen following ingestion of 10 g of lactulose. Serum human pancreatic polypeptide level was measured by radioimmunoassay. Gallbladder emptying was biphasic, initially 0.015 +/- 0.003 min-1 and later 0.005 +/- 0.001 min-1, and gallbladder volume remained small until refilling began at 249 +/- 67 min. Gallbladder refilling was 70% complete at 335 +/- 57 min. The slower rate of gallbladder emptying and tonic gallbladder contraction occurred during gastric emptying of solids. Gallbladder refilling began when approximately 13% of solids remained in the stomach. Serum human pancreatic polypeptide showed the expected biphasic response to the meal and returned to basal levels at approximately the time of initiation of gallbladder refilling. The gastrointestinal transit time of women was twice that of men (73.6 +/- 20.2 vs. 37.5 +/- 22.7, p = 0.025). No other sex-related differences were detected. We conclude that gastric emptying of the solid portion of a meal containing fat maintains tonic gallbladder contraction through continued release of humoral mediators from small bowel and pancreas. When gastric emptying nears completion, humoral stimulation ceases and the gallbladder refills. Human pancreatic polypeptide does not appear to be responsible for gallbladder refilling.

Gallbladder function in the human female: effect of the ovulatory cycle, pregnancy, and contraceptive steroids

We have previously shown that in pregnancy fasting gallbladder volume is increased and emptying after a small volume liquid meal is incomplete. In this study we measured gallbladder volume throughout day and night in healthy women ingesting regular meals. Pregnant women, postpartum women, contraceptive-steroid users, and controls in both phases of the ovulatory cycle were studied. After an overnight fast gallbladder volume was measured by realtime ultrasonography in the fasting state and every 5-10 min for 90 min after breakfast. Residual volume was the lowest volume achieved and the rate constant of gallbladder emptying was calculated from the ln/linear regression of gallbladder volume vs. time. Gallbladder volume was also measured hourly from 11 AM to midnight while subjects ate regular, standard meals, allowing the determination of an average hourly volume. There was no effect of phase of the ovulatory cycle on any measure of gallbladder function. Fasting, residual, and average hourly volume were increased in all trimesters of pregnancy, but tended to return to normal in the postpartum period. Women taking contraceptive steroids had an increased fasting volume. Two distinct rates of emptying after breakfast, an early and a late one, were identified. The early rate was the same in all groups. Pregnant women had a slower late rate of emptying, but women taking contraceptive steroids had emptying rates similar to controls. Retention of bile in the gallbladder may be one reason for the increased risk of cholesterol cholelithiasis in pregnant women and in those taking contraceptive steroids.

Restoring patency of occluded central venous catheters

Thrombotic occlusion remains a major cause of central venous catheter removal prior to completion of therapy. Injection of a dilute solution of a potent fibrinolytic agent, urokinase or streptokinase, into the occluded Silastic central venous catheter consistently reestablishes its patency. This procedure was performed on 352 occluded silicone elastomer central venous catheters with only one failure and one minor complication. We recommend this technique for restoring patency of occluded silicone elastomer central venous catheters.

Inhibition of bacterial growth by granulocytes measured by an automated technique

Granulocytes, collected by several methods, were assayed for antibacterial activity utilizing a technique originally developed for automated antibiotic susceptibility testing. The granulocytes were incubated with either Escherichia coli or Staphylococcus for one hour at 37 degrees C and were then separated from the suspension by gentle centrifugation at 170 g. The bacteria remaining in the supernatant broth were incubated in culture medium (eugonic broth) and their growth density was compared with diluted controls (without granulocytes) by measurement in an Autobac I (an automated nephelometer). Measurements of the density of growth at 30 minute intervals showed a marked delay in the development of density suggesting only small numbers of organisms remained after incubation with granulocytes. Once density was measurable, the rate of growth appeared similar to controls. After 2.5 hours in the Atuobac I, the density of growth was used to determine the inhibitory effect of granulocytes. The density of growth was inversely related to the concentration of granulocytes present during the preincubation phase. Filtered granulocytes showed significantly lower inhibitory effect than centrifuged granulocytes. This rapid, inexpensive method of determining microbial growth appears to be adaptable as a measure of granulocyte function.

Continuous intravenous arabinosyl cytosine infusions delivered by a new portable infusion system

Eighty-six patients with acute leukemia were given 116 continuous intravenous arabinosyl cytosine (Ara-C) infusions (for 24 to 432 hours) with a new portable infusion device. The infusor is powered by interchangeable elastomeric 25 ml balloon reservoirs loaded from standard syringes. The reservoir contents are discharged at nearly constant pressure through an adjustable resistance element, thereby providing flow rates from 0.4 to 2.0 ml/hour. Serum levels of labeled Ara-C delivered by the infusor were found to achieve steady-state therapeutic levels within 24 hours. The average-flow-rate-to-indicator-setting ratio determined for each infusion via scalp vein needles was 0.9 +/- 0.2. Delivery through catheters was more reliable and an average-flow-rate-to-indicator-setting ratio of 0.1 +/- 0.1 was observed. The therapeutic effectiveness of Ara-C in combination with other agents was not compromised by this delivery system. Eleven of 14 patients who received all their induction Ara-C through the infusor achieved complete remission.

Long-term intravenous therapy with peripherally inserted silicone elastomer central venous catheters in patients with malignant diseases

Peripherally inserted central venous silicone elastomer catheters were studied in 81 patients who had malignancy requiring prolonged intravenous therapy. The catheters remained in place from 5 to 171 days, with a median of 30 days. Ninety-one percent of the catheters were unassociated with clinical complications. Six percent of 87 inserted catheters were removed due to peripheral thrombophlebitis. Two patients developed subclavian thrombosis, requiring catheter removal. One patient had catheter-related sepsis with Staphylococcus aureus. Bacteria grew from eleven percent of the cultured catheter tips. Indwelling catheters presence did not appear to influence response to antibiotic therapy. We conclude from this pilot study that long-term central venous access with peripherally inserted silicone elastomer catheters has an acceptably low complication rate in a high-risk patient population.

Luteinizing hormone-releasing hormone and serum growth hormone in insulin-dependent diabetes

Growth hormone (GH) responses were studied in 26 insulin-dependent diabetics after the intravenous administration of 100 microgram of synthetic luteinizing hormone-releasing hormone (LH-RH). Although the mean basal GH concentration was significantly higher than that of 20 matched non-diabetic controls, no significant increment occurred after the LH-RH injection. (The controls also showed no rise in GH.) It seems that the GH hypersecretion of insulin-requiring diabetics does not, as is frequently noted in acromegaly, respond to the injection of LH-RH.

Nutritional value of midday meals of senior schoolchildren

A survey of 565 senior schoolchildren showed that 41% took the school meal. It provided 27% of the daily recommended energy intake and 35% of the daily protein intake set by the Department of Health and Social Security. Of the children who did not take the school meal 4% had a meal which compared favourably with it, though an equal number ate no lunch at all. The remainder either brought snacks from home or bought foods which were found to be both low in protein, iron, and calcium, and high in sugar. Sweets and chips provided the main source of energy for 9% of the subjects.