Five cases of iatrogenic duodenal perforation occurring between 2

Five cases of iatrogenic duodenal perforation occurring between 2002 and 2007 at Cairns Base Hospital are presented for comparison, with reference to a review of ERCP at Cairns Base Hospital for the years 2005/2006. Further, a focused review of the literature was undertaken to inform discussion of the surgical management of such cases. Methods Cairns Base Hospital is a secondary referral hospital in Far North Queensland, Australia. It serves a catchment population of approximately 250 000, 15% of which identify as Indigenous Australian. Hospital surgical audit and endoscopy records for the period 2002–2008

were searched for cases of duodenal perforation following endoscopy or ERCP. Age, sex, indication for endoscopy/ERCP, timing or delay to diagnosis and definitive management, type of perforation, surgical management, complications, length of stay, and late morbidity were recorded for each case. An audit of ERCP at Cairns Base Hospital for the two year period 2005/2006 was utilized to determine incidence of complications of ERCP and is presented in Tables 1 and 2. Table Autophagy inhibitor 1 Complications of ERCP procedures for 2005–6

at Cairns Base Hospital (N = 211) Complication N (%) Pancreatitis 9 (4.3%) Cholangitis 7 (3.3%) Bleeding 4 (1.9%) Perforation 2 (0.95%) Death 3 (1.4%) Other: Stroke 1 (0.5%) Total (with complications) 22 (12.3%) Adapted from Cotton et al. 1991 [3]. Table 2 Indications for ERCP 2005–06, Cairns Base Hospital (N = 202) Indication N (%) CBD stone (s) 115 (57%) Cholangitis 6 (3%) Malignant jaundice 29 (14%) Stent change or unblocking 33 (16%) Abdominal pain, abnormal LFTs, dilated duct 5 (2.5%) Chronic pancreatitis 10 (10%) Abnormal CT 1 (0.5%) Bile leak 3 (1.5%) For the focused literature review, a PubMed search was undertaken using the terms “duodenal

perforation”, “endoscopic” and “retroperitoneal OICR-9429 molecular weight necrosis”. Case-based articles cited by reviews were secondarily sourced. Articles with English language abstracts were considered, and excluded if endoscopy was not the cause of the perforation (rather Oxymatrine a treatment) or if specific operative details were not reported. Similarly, only cases that underwent some form of surgical management were included. Approval to access and analyze de-identified patient records for this study was given by the Human Research Ethics Committee of the Cairns and Hinterland Health Service District. Results Five patients sustaining iatrogenic duodenal perforation were identified. The clinical data pertaining to these are presented in Table 3. All four of the ERCP cases had an associated pre-cut sphincterotomy. No significant bleeding was noted, and no additional procedures such as lithotripsy or stenting were performed. In two cases, there was no specific evidence of choledocholithiasis, with the ERCP being intended solely for diagnostic purposes. Figure 1 shows a representative CT image from Case 2 prior to surgical intervention.

​2009 ​06 ​017 CrossRef Girardin P, Bockstaller

C, Van de

​2009.​06.​017 CrossRef Girardin P, Bockstaller

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policy and science: an introduction. Sci Technol Human Values 26:399–408CrossRef Hansen JW (1996) Is agricultural sustainability a useful concept? Agric Syst 50:117–143CrossRef Hollander RD (1986) Values and making decisions about agricultural research. Agric Hum Values 3:33–40CrossRef Hopfinger H, Boeckler M (1996) Step by step to an open economic system: Syria sets course for liberalization. Br J Middle East Stud 23:183–202CrossRef Huff HB (2004) Options for reforming Syrian agricultural policy support instrument in view of WTO accession. FAO-Italy Government Cooperation Programme, Project GCP/SYR/006/ITA. Ministry of see more agriculture and Agrarian Reform, National Agricultural Policy Center (NAPC), Damascus, Syria. Available online at: http://​www.​napcsyr.​net/​pubs/​studies/​policy_​studies.​htm Jalili S, Fathi G, Fathi Y, Al-Rijabo AS, Piggin BVD-523 supplier C, Desbiolles J (2011) Farmer innovation: seeder fabrication and uptake of zero-tillage in Iraq. In: Proceedings of the 5th World Congress on Conservation mafosfamide Agriculture and 3rd Farming Systems Design Conference. WCCA/FSD Local Organising Committee, c/o Australian

Centre for International Agricultural Research, Brisbane. Available online at: http://​aciar.​gov.​au/​files/​node/​13993/​farmer_​innovation_​seeder_​fabrication_​and_​uptake_​_​23210.​pdf Kane M (1999) Sustainability concepts: from theory to practice. In: Köhn J, Gowdy J, Hinterberger F, van der Straaten J (eds) Sustainability in question. Edward Elgar Publishing Ltd., Cheltenham Kassam SN, Lalani B, Al-Eter B (2011) Conservation agriculture: perspectives from Salamieh district, Syria. In: Proceedings of the 5th World Congress on Conservation Agriculture and 3rd International Farming Systems Design Conference. WCCA/FSD Local Organising Committee, c/o Australian Centre for International Agricultural Research, Brisbane. Available online at: http://​aciar.​gov.​au/​files/​node/​13994/​ca_​syria_​kassam_​pdf_​19882.​pdf Kassam A, Friedrich T, Derpsch R, Lahmar R, Mrabet R, Basch G, González-Sánchez EJ, Serraj R (2012) Conservation agriculture in the dry Mediterranean climate. Field Crops Res 132:7–17. doi:10.​1016/​j.​fcr.​2012.​02.

5 × 10−9 and 7 × 10−9

5 × 10−9 and 7 × 10−9 selleck screening library F as the best-fit parameters, respectively. Knowing the interface capacitance C, the thickness of the Al oxide interfacial layer, d = ε 0 εS / C, can be estimated, where ε 0, ε, and S are the vacuum permittivity, the dielectric constant of aluminum oxide, and the electrode area, respectively [33]. With ε 0 = 8.85 × 10−14 F/cm, ε = 10, and S = 2 × 10−3 cm2, d is obtained to be 7 and 2.5 nm in the high and low resistance states, respectively. The thickness of the Al oxide interfacial layer obtained by impedance spectroscopy in this work was in good agreement with that estimated by HRTEM

and XPS [18–20]. The oxidation of the Al electrode plays a dominant role selleck kinase inhibitor in the bipolar resistance switching in the PCMO-based

devices. On the contrary, the resistance change at the interface might not give a dominant contribution to the overall resistance change of Ni/PCMO/Pt and Ag/PCMO/Pt MK-0457 concentration devices because with Ni and Ag, it is difficult to form the oxide interface layer as compared with Al. As a result, the resistance change ratio of Ni/PCMO/Pt and Ag/PCMO/Pt devices is smaller than that of the Al/PCMO/Pt device. It is rather difficult to categorize Ni and Ag into the group of top electrode materials that cause the ReRAM effect. Conclusions The electric-pulse-induced resistance switching in manganite film-based devices with various metal electrodes of Al, Ni, Ag, and Au was studied by dc current–voltage measurements and ac impedance spectroscopy. The hysteretic I-V characteristics and resistance switching were observed in the PCMO-based devices with top electrode of Al, Ni, and Ag. The Al/PCMO/Pt device showed larger resistance switching than other PCMO-based Dolutegravir order devices with top electrode of Ni and Ag. The electrode material dependence of the

resistance switching in polycrystalline manganite films was investigated in more detail by impedance spectroscopy. Two semicircular arcs were observed in the impedance spectra of the Al/PCMO/Pt device, while the Cole-Cole plots in the devices with Ni, Ag, and Au showed only one semicircular arc. These two distinctive features of the Al/PCMO/Pt device could be assigned to the PCMO bulk and to the interface between the PCMO film and the Al electrode, respectively. By comparing the impedance spectra between the high and low resistance states in the Al/PCMO/Pt device, we suggested that the resistance switching in the PCMO-based devices was mainly due to the resistance change in the interface between the film and the electrode. According to the theoretical simulation of impedance spectra, the interface component observed by impedance spectroscopy in the Al/PCMO/Pt device might be due to Al oxide layer formed by oxidation of Al top electrode. The interfacial transition layer of Al oxides is possibly responsible for the large resistance change in the Al/PCMO/Pt device.


planning programs are very important for preventio


planning programs are very important for prevention of unwanted pregnancy. Lack of education, social stigma and other barriers to abortion, force women to seek abortion in secrecy at a high cost, leaving the poorest, least educated women to unskilled and highly unscrupulous executors and hence the greatest risk of injury [8]. Complications resulting from unsafe induced abortion are a major cause of maternal mortality, morbidity, prolonged hospitalization and reproductive failure in developing countries including Tanzania [4]. The most common complications of induced abortion EPZ015938 include genital sepsis, haemorrhage, pelvic infection with peritonitis and abscess formation, uterine and bowel perforations [9, 10]. Bowel perforation is a rare but serious complication of induced abortion, which is often performed illegally by persons without any medical training in developing countries [11]. The incidence of bowel injury has varied between 5 to 18% cases in different studies [12–14]. The high incidence of perforation in most developing countries has been attributed to late CBL0137 manufacturer diagnosis resulting from late presentation to health facilities [15]. The bowel may be injured with the curette, ovum forceps or uterine sound, or even the plastic canula. Bowel perforation occurs when the posterior vaginal wall is violated, allowing the instrument to pierce

the underlying structures [16]. The ileum and sigmoid colon are the most commonly injured portions of the bowel due to their anatomic location [9, 16–20]. The management of cases with intestinal injuries following induced abortion poses some major challenges to general surgeons and gynecologists practicing in resource-limited countries [9]. Surgery is considered the treatment of choice in order to improve the chances of survival of patients with this condition. However, late presentation and diagnosis TH-302 cell line coupled with lack of diagnostic only facilities, inadequate preoperative resuscitation and

delayed operation are among the hallmarks of the disease in most developing countries including Tanzania [9, 18]. Early recognition and prompt surgical treatment of bowel perforation following illegally induced abortion is of paramount importance if morbidity and mortality associated with bowel perforation are to be avoided [9]. A successful outcome is obtained by prompt recognition of the diagnosis, aggressive resuscitation and early institution of surgical management. Despite the documented increasing safety of the procedure, many women have limited access to abortion services due to logistic and social obstacles [21]. Hence, complications related to illegally induced abortion such as bowel perforations are believed to still be rampant in our environment. A sudden increase in the number of admissions of patients with bowel perforation following illegally induced abortions in our setting prompted the authors to analyze this problem.

As a result, part of the carbon is channeled through the glyoxyla

As a result, part of the carbon is channeled through the glyoxylate pathway, less CO2 is produced EVP4593 mw in the TCA cycle and the extra CO2 saved is not lost in the oxaloacetate to PEP reaction, contributing to the higher biomass yield observed in these strains. This corresponds with the lower CO2 yields of these strains in Figure 1A. Under glucose limitation, relative fluxes around the PEP-pyruvate-oxaloacetate node are higher as opposed to under glucose excess. Not only the flux converting pyruvate to acetyl-CoA at

the entrance of the TCA cycle is increased, but also the glyoxylate pathway is active and gluconeogenic fluxes from malate to pyruvate and from oxaloacetate to PEP are higher compared to under batch conditions. These reactions create the PEP-glyoxylate Ruboxistaurin cycle. This novel metabolic cycle was identified quite recently [21] and functions as an alternative to the TCA cycle for the oxidation of carbohydrates. Similar to the TCA cycle, this pathway produces CO2, i.e. in the reaction

from OAA to PEP. As a result of the simultaneous activity of the TCA cycle and the PEP-glyoxylate cycle, more glucose is oxidized to CO2 compared to batch cultures in order to produce energy and meet the higher maintenance demand [36]. This is in accordance with the higher CO2 production and O2 consumption observed in glucose limited cultures (see Figure 1B vs 1A). Another effect observed between glucose limiting and abundant growth conditions is the reduced flux from 6-phosphogluconate to Silibinin pentose-5-P

by 6-phosphogluconate dehydrogenase (Gnd) for all strains in glucose limiting conditions (see Figure 5B vs 5A), which could be explained by the reduced transcription of gnd at lower growth rates [54–56]. Glyoxylate pathway flux data and regulation of the Lazertinib aceBAK operon The glyoxylate pathway flux data can also be used to investigate the interplay of different regulators on the aceBAK operon. Under batch conditions, when Crp-cAMP levels are low and Crp cannot perform its activating role, no aceBAK transcription occurs and the glyoxylate pathway is inactive. However when the aceBAK repressor IclR is absent (i.e. in the ΔiclR strain), the glyoxylate pathway is active. This is illustrated by calculating the AceA/(AceA + Icd) flux ratio, which is much higher in the ΔiclR strain (32%) compared to the wild type (0%). This shows that Crp activation is not absolutely necessary for transcription. The absence of the repressor IclR is sufficient to obtain glyoxylate pathway activity. On the contrary, under glucose limitation, Crp-cAMP levels are high [2], the aceBAK transcription is enhanced and the glyoxylate bypass is active even in the presence of the repressor IclR. This is in line with the high value of the AceA/(AceA + Icd) flux ratio of the wild type (55%) compared to under batch conditions (0%).

The mutant in lane 2 was therefore named Δku70 Figure 3 KU70 del

The mutant in lane 2 was therefore named Δku70. Figure 3 KU70 deletion

strategy and Southern blot results. (A) Schematic illustration of KU70 deletion strategy. LB and RB are the left border and right border sequences of T-DNA derived from pPZP200, respectively; P GPD1 : R. toruloides GPD1 promoter; hpt-3: codon-optimized hygromycin phosphotransferase gene; T nos : transcriptional terminator of A. tumefaciens nopaline synthase see more gene; LoxP: recognition sequences of Cre recombinase; Rg70Lf and Rg70Rr: primers to amplify KU70 gene deletion region; Rg70f3 and Rg70r2: primers for fungi colony PCR; Rt100 and Rt101: primers to amplify probe used for Southern blot analysis. Unique restriction enzyme digest sites used are shown. (B) Southern blot results of putative ∆ku70 transformants. Genomic DNA was digested with PvuI and a band shift from 2.2 kb (WT) to 2.7 kb indicates successful deletion of KU70. Gene deletion frequency was improved in the ∆ku70 mutant While the deletion of KU70 was obtained with a relatively high frequency (5.2%), deletion of the mating-type

specific gene STE20 and orotidine 5-phosphate decarboxylase gene URA3[24, 25] proved to be very difficult (Table 2). The low deletion frequency of STE20 and URA3 highlighted a need for an improved gene deletion system. To investigate if the Δku70 strain generated earlier could be utilized for this purpose, the hygromycin selection cassette (P GPD1 ::hpt-3::T nos ) was excised to generate a marker-free R. toruloides KU70-deficient learn more derivative (∆ku70e) by activating the Cre recombinase using human hormone 17β-estradiol (Liu et al., unpublished data). As we found that high percentage of 5-fluoroorotic acid (5-FOA) resistant transformants were not true deletion mutants of URA3 previouly, we decided to evaluate the deletion of CAR2 homologue as a fast assay for gene deletion frequency because it encodes a bifunctional

protein catalyzing phytoene synthase and carotene cyclase that is essential in the biosynthesis of β-carotene [25, 26]. Table 2 Gene deletion frequency crotamiton in WT and ∆ku70e strains Gene target Homolgy lengtha(bp) Gene deletion frequencyb WT ∆ku70e STE20 800 0 (560) 2.1% (48) URA3 1000 0 (48) 95.8% (48) CAR2 750 10.5% (6152) 75.3% (885) Note: aHomology sequence length on each side of the hygromycin selection cassette; bNumber in parenthesis indicate number of transformants screened. Using U. maydis Car2 [26] as a query for tBLASTn search against the R. toruloides ATCC GDC-0449 mouse 204091 genome database, a DNA fragment sharing high sequence homology to the query (GenBank acc. no. AVER02000018 from 396838 to 399094-nt, E-value = 1E-23) was identified. CAR2 was successfully amplified using DNA template of R. toruloides ATCC 10657 using oligos Rt079 and Rt080.

PBP2a detection was performed using monoclonal PBP2a antibody (1:

PBP2a detection was performed using monoclonal PBP2a antibody (1:20000) from the MRSA-screen kit (Denka Seiken). Acknowledgements We would like to thank Frances O’Brien (School of Biomedical Sciences, Curtin University of Technology) for determining the MLST types of strains ZH44 and ZH73. We would also like to thank Sibylle Burger for technical assistance and Dr. P. Hunziker, of the Functional Genomics Centre

Zurich, University of Zurich, for protein analysis. We are also grateful to T. Bae (Department of Microbiology, University of Chicago) for providing the plasmid pKOR1. This study was supported by the Swiss National Science Foundation grant NF31-117707/1. References 1. Kirby WMM: Extraction of a highly potent penicillin inactivator from penicillin resistant styaphylococci. Science 1944,99(2579):452–453.CrossRefPubMed 2. Hartman BJ, Tomasz A: Low-affinity penicillin-binding protein PI3K Inhibitor Library screening associated with beta-lactam resistance in Staphylococcus aureus. J Bacteriol 1984,158(2):513–516.PubMed 3. Reynolds PE, Brown FJ: Penicillin-binding proteins of β-lactam-resistant strains of Staphylococcus aureus . Effect of growth conditions. FEBS Lett 1985,192(1):28–32.CrossRefPubMed 4. Lim D, Strynadka NC: Structural basis for the β-lactam resistance of PBP2a from methicillin-resistant Staphylococcus aureus. Nat Struct Biol 2002,9(11):870–876.PubMed 5. Sharma VK, Hackbarth CJ, Dickinson

TM, Archer GL: Interaction of native and mutant MecI repressors with sequences that regulate mecA , the gene encoding penicillin binding protein 2a in methicillin-resistant staphylococci. J Bacteriol 1998,180(8):2160–2166.PubMed 6. Gregory PD, Lewis RA, Curnock SP, Dyke KG: Studies of the repressor (BlaI) of beta-lactamase synthesis in Staphylococcus aureus. Mol Microbiol 1997,24(5):1025–1037.CrossRefPubMed 7. Zhang HZ, Hackbarth CJ, Chansky KM, Chambers HF: A

proteolytic transmembrane signaling pathway and resistance to β-lactams in staphylococci. Science 2001,291(5510):1962–1965.CrossRefPubMed 8. Golemi-Kotra D, Tolmetin Cha JY, Meroueh SO, Vakulenko SB, Mobashery S: Resistance to beta-lactam antibiotics and its mediation by the sensor domain of the transmembrane BlaR signaling pathway in Staphylococcus aureus. J Biol Chem 2003,278(20):18419–18425.CrossRefPubMed 9. Fuda CCS, Fisher JF, Mobashery S: β-lactam resistance in Staphylococcus aureus : The adaptive resistance of plastic PXD101 concentration genome. Cell Mol Life Sci 2005,62(22):2617–2633.CrossRefPubMed 10. de Lencastre H, Figueiredo AM, Tomasz A: Genetic control of population structure in heterogeneous strains of methicillin resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1993,12(Suppl 1):S13-S18.CrossRefPubMed 11. de Lencastre H, de Jonge BL, Matthews PR, Tomasz A: Molecular aspects of methicillin resistance in Staphylococcus aureus. J Antimicrob Chemother 1994,33(1):7–24.CrossRefPubMed 12.

For environments that lack cultured isolates or are relatively un

For environments that lack cultured isolates or are relatively underexplored, researchers are often unable to find an appropriate training set to reveal the taxonomic identity of the extracted sequences [11–13]. However, if previous clone libraries have generated full length, high-quality 16S rRNA gene sequences, then these sequences can be utilized in a training set and taxonomy framework, potentially increasing the precision of the classification provided by the RDP-NBC. Our primary goal in this study was to test the effect of training set on the RDP-NBC-based classification of Apis mellifera (European honey bee) gut derived 16S rRNA gene sequences. Insect guts are SN-38 mouse relatively

underexplored and host novel bacterial groups for which there do not exist close, cultured relatives, making taxonomic assignments for 16S sequences and metatranscriptomic data difficult [14–16]. We also sought to improve the classification of sequences from the honey bee gut by the RDP-NBC EPZ015938 through the creation of training sets

that include full-length sequences identified as core honey bee microbiota as part of a phylogenetic framework first put forward by Cox-Foster et al., 2006 and extended by Martinson et al., 2010 [17, 18]. Below we compare the precision and reproducibility of classification of the honey bee gut microbiota using six different training sets: RDP, Greengenes, arb-silva, and custom, honey bee specific databases Mirabegron generated from each. Methods Generating a bee-specific seed alignment Sequences that corresponded to accession numbers published in analyses of bee-associated microbiota and that were near full

length (at least 1250 bp) were used to generate the seed alignment for our subsequent analyses (A total of 5,713 sequences were downloaded and 5,158 passed the length threshold) [18–22]. These sequences were clustered at 99% identity, reducing the dataset to 276 representatives. This set of sequences is referred to as the honey bee database (HBDB) throughout and were aligned using the SINA aligner (v 1.2.9, [23]) to the arb-silva SSU database (SSURef_108_SILVA_NR_99_11_10_11_opt_v2.arb) and visually inspected using ARB [24]. We refer to this custom seed alignment as the arb-silva SSU + honey bee alignment (ASHB). To generate a phylogeny we used the ASHB as input to RAxML (GTR + γ with 1,000 bootstrap Foretinib replicates) using a maximum likelihood framework (Stamatakis 2006). This phylogeny was used to inform the taxonomic designations (see below). In addition, we used the RAxML evolutionary placement algorithm to identify the placement of short reads within this framework (raxmlHPC-SSE3 –f v –m GTRGAMMA –n Placement). Alignment (ASHB) and phylogeny are available in TreeBase at http://​purl.

Clones were sequenced with an ABI PRISM 3730 DNA Sequencer (ABI B

Clones were sequenced with an ABI PRISM 3730 DNA Sequencer (ABI Big Dye Terminator Cycle Sequencing Kit, Perkin-Elmer). The obtained sequences were used in a BLAST search against the NCBI (http://​blast.​ncbi.​nlm.​nih.​gov/​Blast.​cgi) database with default blastn settings and assigned to specific taxa using MEtaGenome Analyzer (MEGAN) software (Huson et al. 2011). With MEGAN software, the lowest common ancestor (LCA) algorithm was used

for taxonomic classification, with the p38 MAPK signaling pathway required parameters of the LCA assignment set as minimum support = 1, minimum score = 500, top percentage = 1. Metagenomic barcoding of the fungal community in orchid roots Six DNA fragments derived from four DNA regions, namely, nrITS (ITS1/2 and ITS3/4), nrLSU (LR and U), mitochondrial large subunit rDNA (mtLSU), and mitochondrial ATPase subunit 6 (mtATP6), were PCR-amplified using genomic DNA isolated from roots of cultivated Phalaenopsis KC1111. PCR primers and annealing temperatures are listed in Table S1. Amplification was conducted

as described in the gene cloning section. All PCR products of ca. 250–300 bp were purified, pooled, and sequenced with Illumina GAIIx high-throughput paired-end sequencing to survey the composition of fungal community. Raw reads were sorted into six categories according to the primer sequences, and the GS-1101 mw reads with an N residue in the sequences were discarded. Sorted sequences were merged to haplotypes for computing the copy numbers, and single-copy haplotypes were removed to lessen the effect of sequencing errors. These haplotypes were further clustered into operational taxonomic units (OTUs) using the BLASTClust program in the standalone BLAST v2.2.26 package of the NCBI. Because the average minimal divergence between fungal species is around 2.5–3 % (Seena et al. 2010; Stockinger

et al. 2010), the stringency of clustering was set with two parameters at 97 % similarity and 80 % coverage between sequences and referred to as the average Reverse transcriptase minimal divergence of species between fungi. From reads sorting, singleton removal, to OTU generation, all steps were conducted with our own Perl scripts. BLAST analyses were performed on all reads against the NCBI nucleotide database, and the results were further processed for taxonomic assignations using MEGAN. An optional score adjustment was used when paired reads matched the same species. The required parameters of the LCA assignment were set as minimum support = 2, minimum score = 80, top percentage = 1 (Murray et al. 2011; Montaña et al. 2012). Classification results were manually checked to correct the Y-27632 cell line ambiguous assignation caused by synonyms for fungal species or an ambiguous annotation in the NCBI database. Evaluating biodiversity based on metagenomic data As recommended by Haegeman et al.

10 Fontvieille AM, et al : The use of low glycemic index foods i

10. Fontvieille AM, et al.: The use of low glycemic index foods improves metabolic control of diabetes patients in a 10 week study. Diabet Med 1992, 9:444.CrossRefPubMed 11. Wong SHS, Siu PM, Lok A, et al.: Effect of the glycaemic index of pre-exercise carbohydrate meals on running

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and exercise: implications for formulating an oral rehydration solution (ORS). Med Sci Sports Exerc 1994, 26:267.PubMed 20. Duchman SM, et al.: Upper limit for intestinal absorption of a dilute glucose solution in men at rest. Med Sci Sports Exerc 1997, 29:482.PubMed 21. Shi X, Gisolfi CV: Fluid and carbohydrate replacement during intermittent exercise. Med Sci Sports Exerc 1998, 25:157. 22. Emken EA: Metabolism Thalidomide of dietary stearic acid relative to other fatty acids in human subjects. Am J Clin Nutr 1994,60(suppl):1023S.PubMed 23. Byars A, Greenwood M, Greenwood L, Simpson W: The effectiveness of a pre-exercise drink on indices of maximal cardiorespiratory fitness. Int J Sport Nutr 2006, 3:56–59.CrossRef 24. Byars A, Greenwood M, Schneider K, Hesseltine M, Simpson W, Greenwood M: Sports Nutrition: Comparing two sports drinks on aerobic performance. Appl J Coaching Athletics Annual 2007, 226–240. 25. American College of Sports Medicine: Guidelines for exercise testing and prescription. 8th edition. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2009. 26. SPSS: Statistical package for the social sciences. [software version 16.0]. Chicago, IL: SPSS; 2008. 27. Halson SL, Lancaster GI, Achten J, Gleeson M, Jeukendrup AE: Effects of carbohydrate supplementation on performance and carbohydrate oxidation after intensified cycling training. J Appl Physiol 2004, 97:1245–1253.CrossRefPubMed 28.