bluuebunny/crossref_metadata_2025 huggingface dataset:
Total Parenteral Nutrition Increases Serum Leptin Concentration in Hospitalized, Undernourished Patients
Authors: LeGall‐Salmon Elizabeth , Stevens Wayne D. , Levy James R.
Published: May 2008

Background: The hormone leptin has putative roles in both body weight homeostasis (chronic) and satiety (acute). To determine if this dual regulation is observed in hospitalized, undernourished patients, serum leptin concentration was measured before and during total parenteral nutrition (TPN) infusion. Methods: Six consecutive patients were considered undernourished, as assessed by an independent multidisciplinary nutrition team, and TPN was prescribed at an initial rate of between 5023.2 and 7333.2 kJ in the first 24 hours. Serum leptin, insulin, and glucose were measured before the infusion and at 3 and 22 hours after initiation of TPN. Results: Baseline serum leptin concentrations correlated well with the patient's body mass index (BMI; r 2 =.85, p <.05). Three hours of TPN infusion produced only modest changes in circulating leptin. However, after 22 hours, leptin concentrations increased by 1.8 ± 0.5‐fold (p <.05), and this increase was independent of any change in body weight. Conclusions: Basal leptin concentrations correlate well with BMI. TPN induces a rise in leptin concentration independent of body weight. Leptin secretion is dually regulated in hospitalized, undernourished patients. (Journal of Parenteral and Enteral Nutrition 23:38–42, 1999)
Metabolic and Monetary Costs of Avoidable Parenteral Nutrition Use
Authors: Trujillo Elaine B. , Young Lorraine S. , Chertow Glenn M. , Randall Sheldon , Clemons Traci , Jacobs Danny O. , Robinson Malcolm K.
Published: May 2008

Background: We prospectively collected data on in patients receiving parenteral nutrition to determine the magnitude of potentially preventable metabolic and monetary costs associated with parenteral nutrition. Methods: Parenteral nutrition was prescribed by the treating physicians with optional consultation from a multidisciplinary metabolic support service. Days on parenteral nutrition, appropriateness of parenteral nutrition, metabolic complications, and avoidable parenteral nutrition charges were determined. Parenteral nutrition use was considered “indicated” or “not indicated” based on the American Society for Parenteral and Enteral Nutrition guidelines and “preventable” if the gastrointestinal tract was functional but not accessed when possible. Results: Of the 209 parenteral nutrition starts, 62% were indicated, 23% were preventable, and 15% were not indicated. Parenteral nutrition starts were deemed indicated in 82% of instances in which a metabolic support service consult was obtained, compared with 56% in which a consultation was not obtained (p =.004). Hyperglycemia was the most common metabolic complication, with an overall incidence of 20%. Metabolic complications occurred less frequently in patients who received a metabolic support service consultation compared with patients who did not (34% us 66% of parenteral nutrition days, respectively; p =.004). Parenteral nutrition use of s5 days duration was significantly less frequent among patients who received metabolic support service consultation (16% us 35%; p =.002). Parenteral nutrition that was not indicated or preventable resulted in excess annualized patient charges of more than one half million dollars not accounting for charges related to treatment of potentially avoidable parenteral nutrition complications. Conclusions: This study illustrates that not‐indicated and preventable parenteral nutrition initiation, short‐term parenteral nutrition use, and metabolic complications are less likely when patients receive consultation by a multidisciplinary team with expertise in nutrition and metabolic support. Furthermore, the avoidance of inappropriate parenteral nutrition use translates into substantial cost savings. (Journal of Parenteral and Enteral Nutrition 23:109–113, 1999)
Peripherally Inserted Central Catheters for Parenteral Nutrition: A Comparison With Centrally Inserted Catheters
Authors: Duerksen Donald R. , Papineau Noreen , Siemens Janice , Yaffe Clifford
Published: May 2008

Background: Central venous access is crucial for the provision of adequate parenteral nutrition (PN). The type of central venous access device (CVAD) has evolved over the past 10 years. The most recent trend has been to use peripherally inserted central catheters (PICCs). This development has occurred without controlled clinical trials. Methods: Over a 10‐year period, the nutrition support service at a single institution has prospectively collected data on CVADs used for providing PN. The types of CVAD used for providing PN were analyzed, and the major complications associated with CVADs, thrombosis and line sepsis, were compared over three different time periods: 1988–1989; 1992–1993; 1996–1997. In addition, complications associated with PICCs were compared with other CVADs. Results: The following were the dominant CVADs over each of the three time periods: 1988—1989: tunneled catheters, 80%; 1992–1993: nontunneled catheters, 46%; and 1996–1997: PICCs, 48%. There was a decreased incidence of sepsis and pneumothorax in 1996—1997 and an increase in severed or leaking catheters and phlebitis. In a comparison of PICC and non‐PICC catheters over the past 3 years, there was a trend toward decreasing sepsis with PICC catheters but an increase in malposition, inadvertent removal, and severed or leaking catheters. Conclusions: PICCs have replaced tunneled and nontunneled central catheters as the most commonly used CVAD for providing PN. PICCs do not result in increased line sepsis or thrombosis but have an increased incidence of local complications such as leaking catheters, phlebitis, and malposition. (Journal of Parenteral and Enteral Nutrition 23:85–89, 1999)
Structured Versus Long‐Chain Triglycerides: A Safety, Tolerance, and Efficacy Randomized Study in Colorectal Surgical Patients
Authors: Bellantone Rocco , Bossola Maurizio , Carriero Concetta , Malerba Marina , Nucera Paolo , Ratto Carlo , Crucitti Pierfilippo , Pacelli Fabio , Battista Doglietto Giovanni , Crucitti Francesco
Published: May 2008

Background: After trauma or surgery, researchers have suggested that medium‐chain triglycerides have metabolic advantages, although they are toxic in large doses. To try to reduce this potential toxicity, structured lipids, which provide a higher oxidation rate, faster clearance from blood, improved nitrogen balance, and less accumulation in the reticuloendothelial system, could be used. Therefore, we evaluated, through a blind randomized study, the safety, tolerance, and efficacy of structured triglycerides, compared with long‐chain triglycerides (LCT), in patients undergoing colorectal surgery. Methods: Nineteen patients were randomized to receive long‐chain or structured triglycerides as a lipid source. They received the same amount of calories (27.2/kg/d), glucose (4 g/kg/d), protein (0.2 g/kg/d), and lipids (11.2 kcal/kg/d). Patients were evaluated during and after the treatment for clinical and laboratory variables, daily and cumulative nitrogen balance, urinary excretion of 3‐methylhistidine, and urinary 3‐methylhistidine/creatinine ratio. Results: No adverse effect that required the interruption of the treatment was observed. Triglyceride levels and clinical and laboratory variables were similar in the two groups. A predominantly positive nitrogen balance was observed from day 2 until day 5 in the LCT group and from day 1 until day 4 in the structured triglycerides group. The cumulative nitrogen balance (in grams) for days 1 to 3 was 9.7 ± 5.2 in the experimental group and 4.4 ± 11.8 in the control group (p =.2). For days 1 to 5 it was 10.7 ± 10.5 and 6.5 ± 17.9 (p =.05), respectively. The excretion of 3‐methylhistidine was higher in the control group but decreased in the following days and was similar to the experimental group on day 5. Conclusions: This study represents the first report in which structured triglycerides are administered in postoperative patients to evaluate safety, tolerance, and efficacy. It suggests that Fe73403 is safe, well tolerated, and efficacious in terms of nitrogen balance when compared with LCT emulsion. (Journal of Parenteral and Enteral Nutrition 23:123–127, 1999)
Rapid Development of Severe Copper Deficiency in a Patient With Crohn's Disease Receiving Parenteral Nutrition
Authors: Spiegel Joan E. , Willenbucher Robert F.
Published: May 2008

A 32‐year‐old man with active Crohn's disease and recurrent small bowel strictures underwent abdominal surgery and was subsequently given total parenteral nutrition (TPN). Severe cholestasis developed and copper was removed from the TPN. Although serum ceruloplasmin levels were within normal limits, 8 weeks after copper removal, he developed pancytopenia. Serum copper levels were severely depressed. Bone marrow biopsy was consistent with copper deficiency; cytoplasmic vacuolization of both myeloid and erythroid precursors, megaloblastic erthropoiesis, and marked hypocellularity were observed. IV replacement with copper sulfate resulted in improvement in the patient's anemia, neutropenia, and thrombocytopenia, but the patient died suddenly from cardiac tamponade. Postmortem examination revealed fibrinous and hemorrhagic pericarditis. Despite the rare occurrence of overt copper deficiency, this case emphasizes the need to recognize copper deficiency as an important etiology of iron‐resistant anemia in patients receiving TPN. Furthermore, the relative rapidity with which our patient developed pancytopenia suggests that, in view of the established recommendation that copper be removed from TPN in cholestatic conditions, serum copper levels must be measured periodically.(Journal of Parenteral and Enteral Nutrition23:169–172, 1999)
The Human Na+ Glucose Cotransporter Is a Molecular Water Pump
Authors: Tappenden Kelly A.
Published: May 2008

The human small intestine absorbs approximately 9 L of water per day, thus establishing this organ as an important contributor to whole‐body water homeostasis. However, the mechanism by which water transport occurs in the small intestine has been an issue of debate for nearly 40 years. To examine the involvement of the human sodium‐glucose transporter (hSGLT1) in water transport across the brush border membrane, hSGLT1 was expressed in Xenopus larvis. 1 These test oocytes were shown to express > 1011 copies of hSGLT1 per cell, and transport activity was quantified with high precision by measuring the inward sodium current stimulated by the addition of α‐methyl‐glucose, a glucose analog that is transported by hSGLT1 but is not metabolized within the enterocyte. Sensitive optical techniques allowed for simultaneous measurement of oocyte volume during hSGLT1 transport. The addition of α‐methyl‐glucose to the media bathing test oocytes results in an immediate increase in hSGLT1 transport and an abrupt swelling of the oocyte. The hSGLT1 transport of two sodium ions and one α‐methyl‐glucose molecule was coupled, within the protein itself, to the influx of 210 water molecules. This stoichiometric relationship between sodium, sugar, and water during hSGLT1 transport was constant and independent of external parameters such as sodium concentrations, sugar concentrations, transmembrane voltages, temperature, and osmotic gradients. In control experiments with oocytes expressing ion channels or oocytes doped with ionophores, only delayed water flow occurred due to increased internal osmolarity.1 This observation demonstrates that the rapid coupling of water transport to sodium and glucose transport occurs within the hSGLT1 protein, rather than as a rapid response to the osmotic gradients generated indirectly by activity of this protein. In summary, hSGLT1 functions not only as a sodium and sugar transporter but also as a molecular water pump. These data suggest that hSGLT1 may account for almost half of the daily water uptake in the small intestine.1
Whole‐Protein‐Based Enteral Formula Stimulates Intestinal Ornithine Decarboxylase Activity More Than Single Amino Acids but Does Not Affect Mucosal Adenosine Triphosphate Content in Early Postsurgical Refeeding
Authors: Yang Hua , Wirén Mikael , Larsson Jörgen , Permert Johan
Published: May 2008

Background: To restore intestinal integrity after starvation and trauma, luminal nutrients are essential. Specific nutrients such as glutamine support mucosal proliferation and energy metabolism. The aim of this study was to compare effects of enteral formula vs specific amino acids on ornithine decarboxylase (ODC) activity and adenine nucleotide metabolism in jejunal mucosa. Methods: Male Wistar rats (240 to 280 g) were starved for 48 hours and subjected to intestinal transection, gastrotomy, and jejunal instillation of 5‐mL nutrient solution. In the first experiment, standard enteral formula (EF) was compared with isonitrogenous formula supplemented with the glutamine precursor, α‐ketoglutarate (α‐KG). In a second experiment, 2% glutamine was compared with isonitrogenous ornithine α‐KG, arginine α‐KG, glycine and diluted standard enteral formula (EF), or saline. The ODC activity, adenosine triphosphates (ATP), and RNA and protein in the jejunal mucosa were analyzed 2 hours after surgery. Results: The ODC peak in jejunal mucosa in animals treated with EF was higher than when supplemented with α‐KG (p <.05). Compared with specific amino compounds, EF resulted in a significantly higher ODC peak and no differences were seen between the different specific amino acids. Differences seen in ATP or energy charge between the groups were not significant. Conclusions: Immediate postoperative enteral feeding by standard EF results in rapid increase of ODC activity. This response was attenuated when the enteral nutrition was supplemented with α‐KG and was absent when isonitrogenous single amino acids were administered. We found no significant effects on ATP content in the small bowel mucosa by supplementing the diet with α‐KG. (Journal of Parenteral and Enteral Nutrition 23:207–212, 1999)
Assessment of Drug‐Related Problems in Clinical Nutrition Patients
Authors: Cerulli Jennifer , Malone Margaret
Published: May 2008

Background:Medication use in clinical nutrition patients is affected by concomitant disease states and alterations in medication administration and delivery. The purpose of this evaluation was to document the number and type of drug‐related problems that occurred and to evaluate the effect pharmacists had on the care of nutrition patients.Methods:Patients were evaluated by a pharmacist who was part of the clinical nutrition team. Drug‐related problems were identified and recommendations were made to resolve them. Acceptance of the recommendations and patient outcomes were documented.Results:After the evaluation of 440 patients, 220 pharmacist interventions were made. Interventions included 35 drug information requests and 185 recommendations made to solve identified drug‐related problems in 126 patients. The most frequent drug‐related problems were drug interactions (33/185) and untreated indications (24/185). Of 185 recommendations, 166 were accepted, and 19 were accepted with a modification. A total of 132 of 155 recommendations that were accepted or accepted with modification had a positive outcome: 45 patients responded, and 87 patients developed no complications. Six patients did not respond to the recommendation, and in 17 patients the outcome was unknown. Fifty‐eight recommendations avoided potential adverse drug events.Conclusions:Pharmacist intervention identified drug‐related problems in almost 30% of clinical nutrition patients. The identification and resolution of the problems had a positive effect on patient care, as indicated by patient outcome and the avoidance of adverse drug events. The drug‐related problem approach identified areas in which pharmacists can educate the health care team and ensure proper medication use in this patient population.(Journal of Parenteral and Enteral Nutrition23:218–221, 1999)
Effects of Pseudomonas Colonization on Body Composition and Resting Energy Expenditure in Children With Cystic Fibrosis
Authors: Vinton Nancy E. , Padman Raj , Davis Mary , Harcke H. Theodore
Published: May 2008

Background: To determine the extent and effects of increased metabolic demand represented by Pseudomonas colonization on body composition and resting energy expenditure in children with cystic fibrosis (CF). Methods: The study comprised 18 stable children with CF, of whom 10 (6 male/4 female) were colonized with Pseudomonas species and 8 (4 male/4 female) were not. The groups were of similar age range and genotype. Measured resting energy expenditure (REE) was performed by open circuit indirect calorimetry and compared with predicted REE calculated from standard equations. Body composition was determined by dual‐energy x‐ray absorptiometry, including lean body mass (LBM), fat mass (FM), bone mineral density (BMD), and anterior‐posterior spine density (APS); these were compared using z‐scores. Routine pulmonary function testing assessed forced vital capacity, forced expiratory volume in 1 second (FEV1), and forced expiratory flow over middle half of vital capacity (FEF25% to 75%); these were compared as percent predicted. Results: As expected, results of pulmonary function testing showed significant deterioration among the children colonized with Pseudomonas species when compared with the children who were not, while standard anthropometry showed no differences in weight, height, or weight‐for‐height percentile and respective z‐scores. Although a trend of lower LBM was noted among the children colonized with Pseudomonas species, no significant differences were found between these children and children who were not colonized with Pseudomonas species when z‐scores for LBM, FM, BMD, or APS were compared during body composition analysis. In addition, neither REE as kilocalories per day (kcal/d) nor REE expressed as a percent predicted by standard equations discriminated between subgroups of children colonized with Pseudomonas species and children who were not. However, metabolic demand, expressed as resting energy expenditure in kilocalories per kilogram (kcal/kg) of LBM (REE/LBM), revealed significant differences between children colonized with Pseudomonas species and children who were not (75.4 ± 4.4 us 58.6 ± 2.9 kcal/kg, p <.05). Conclusions: The effect of Pseudomonas colonization on metabolic demand in children with CF can be accurately assessed by expressing resting energy expenditure as kilocalorie per kilogram of LBM, the active metabolic component of the body. The 50% increase in REE/LBM seen in the children colonized with Pseudomonas species represents the metabolic demand from the inflammatory burden and work of breathing resulting from the effects of the Pseudomonas colonization. The trend of a lower LBM in the children colonized with Pseudomonas species makes this finding even more dramatic. (Journal of Parenteral and Enteral Nutrition 23:233–236, 1999)
Accelerated Glutamine Synthesis in Critically III Patients Cannot Maintain Normal Intramuscular Free Glutamine Concentration
Authors: Mittendorfer Bettina , Gore Dennis C. , Herndon David N. , Wolfe Robert R.
Published: May 2008

Background: Muscle glutamine is severely depleted in critically ill patients (by ~50% to 80% of normal). Because muscle protein breakdown, and thus the release of glutamine from muscle protein, is enhanced in response to metabolic stress, the depletion of intramuscular glutamine could be due to its impaired synthesis or accelerated outward transport or both. Methods: To distinguish these possibilities, we measured skeletal muscle glutamine metabolism in five critically ill patients by means of primed, continuous infusions of 5‐15N‐glutamine and ring‐2H5‐phenylalanine and compared them to values we previously reported for healthy volunteers. Results: The intramuscular free glutamine concentration in patients was ~70% of that in healthy volunteers (5.8 ± 0.6 mmol/L intracellular free water vs 21.5 ± 2.8 mmol/L). Whole‐body glutamine rate of appearance was 5.8 ± 1.0 μmol · kg−1 body wt · min−1, and whole‐body clearance was 19.3 ± 3.3 mL · kg−1 · min−1. Despite the low intramuscular glutamine concentration in the patients, the rate of unidirectional outward transport from skeletal muscle into venous blood (1.1. ± 0.2 μmol · 100 mL · leg−1 · min−1) was similar to that observed in healthy volunteers (1.6 ± 0.2 μmol · 100 mL · leg 1 · min 1); intramuscular synthesis was 2.7 ± 0.9 μmol · 100 mL · leg−1 · min−1 compared with a normal value of 0.6 ± 0.06 μmol · 100 mL · = leg−1 · min−1. Net balance across the leg was normal. Conclusions: The depletion of intramuscular glutamine in critically ill patients is not due to an impairment of the rate of synthesis. In fact, accelerated glutamine production cannot maintain normal intramuscular glutamine levels because of accelerated outward transport. (Journal of Parenteral and Enteral Nutrition 23:243–252, 1999)
Epinephrine Transiently Increases Amino Acid Disappearance to Lower Amino Acid Levels in Humans
Authors: Ratheiser Klaus M. , Pesola Gene R. , Campbell Robert G. , Matthews Dwight E.
Published: May 2008

Background: Infusion of epinephrine decreases plasma amino acid concentrations. However, the mechanism by which this decrement occurs is not well characterized. Methods: Epinephrine was infused (40 ng/kg/min) for 2 hours into eight normal healthy adults. The essential amino acid tracers L‐[1‐13C]leucine and L‐[phenyl‐2H5]phenylalanine were infused before and during the epinephrine infusion and blood samples obtained to determine amino acid rates of appearance and disappearance from the time course of change in amino acid concentration and tracer enrichments. Results: Epinephrine infusion decreased plasma leucine and phenylalanine concentrations over a period of 30 to 90 minutes after the start of the epinephrine infusion. Epinephrine infusion induced an immediate decrement in tracer enrichments. These changes defined sharp increases in both rate of appearance and rate of disappearance. By 30 minutes of epinephrine infusion, the rate of amino acid appearance from proteolysis had returned to baseline, but the rate of amino acid disappearance remained elevated for 90 minutes before returning to baseline. It was the protracted increase in amino acid disappearance that was responsible for the lowering of plasma amino acid concentrations. After this acute response, rates of amino acid appearance and disappearance returned to normal whereas plasma amino acid levels remained suppressed. Conclusions: Epinephrine transiently affects both rates of amino acid appearance and disappearance, with the net effect being increased in amino acid disappearance. However, epinephrine lowers amino acid concentrations beyond the period that it affects kinetics. These results suggest that the effect of epinephrine on amino acid metabolism is not detrimental and that epinephrine allows amino acid metabolism to proceed normally but at lower concentrations of amino acids. (Journal of Parenteral and Enteral Nutrition 23:279–287, 1999)
Effect of Growth Hormone, Glutamine, and Diet on Body Composition in Short Bowel Syndrome: A Randomized, Controlled Study
Authors: Scolapio James S.
Published: May 2008

Background: A previous controlled study of ten patients with short bowel syndrome (SBS) reported human recombinant growth hormone resulted in a significant increase in body weight and lean body mass (LBM) without clinical edema. The aim of this study was to assess the effect of growth hormone, glutamine, and diet on body composition. Methods: A randomized, 6‐week, double‐blind, placebo‐controlled, crossover study was performed in eight patients. Active treatment was 21 days of growth hormone, oral glutamine, and a high‐carbohydrate‐low‐fat (HCLF) diet. Body composition was determined by dual‐energy x‐ray absorptiometry (DEXA) scan. Treatments were compared by paired t test. Results: Active treatment resulted in significant increases in body weight (mean 3.02 ± 0.7 kg, p <.05) and lean body mass, (mean 3.96 ± 0.5 kg, p <.001). Percent body fat was significantly reduced in the actively treated group (mean ‐2.51% ± 0.4, p <.001). Body weight returned to baseline within 2 weeks of discontinuing active treatment. Macronutrient and fluid absorption did not increase with active treatment. Conclusions: Treatment with growth hormone, glutamine, and HCLF diet resulted in decreased percent body fat and increased body weight and LBM in patients with SBS, without an increase in macronutrient or fluid absorption. The positive findings are most likely a reflection of increased extracellular fluid because all eight patients developed peripheral edema on active treatment. Furthermore, the positive effect of active treatment does not appear to be sustained once discontinued. (Journal of Parenteral and Enteral Nutrition 23:309–313, 1999)
The Dimer and Trimer of 3‐Hydroxybutyrate Oligomer as a Precursor of Ketone Bodies for Nutritional Care
Authors: Tasaki Osamu , Hiraide Atsushi , Shiozaki Tadahiko , Yamamura Hitoshi , Ninomiya Norihisa , Sugimoto Hisashi
Published: May 2008

Background: Ketone bodies have been considered as a means of providing energy because of their good penetration and rapid diffusion in peripheral tissues. However, because the currently available form of 3‐hydroxybutyrate is the sodium salt, the sodium load is problematic. To avoid it, a mixture of dimer and trimer has been prepared as a precursor of D‐3‐hydroxybutyrate. The purpose of this study was to investigate whether and how the solution would be converted to monomers. Methods: The plasma concentration of 3‐hydroxybutyrate monomer was measured in 10 rats during infusion of dimer and trimer. Stepwise dilutions of the solution were incubated with serum and liver homogenates from five rats, serum samples from five volunteers, and a liver sample from one patient with liver injury. The solution also was incubated with carboxylesterase and triacylglycerol lipase. The concentration of monomer in the medium was measured after incubation. Results: The plasma concentration of 3‐hydroxybutyrate monomer reached 572 ± 11 μmol/L 15 minutes after beginning infusion of the mixture at a rate of 25 μmol·kg 1 · min −1 and 270 ± 40 μmol/L at a rate of 12.5 μmol · kg−1· min 1. The solution was converted completely to monomers when incubated with rat serum or liver homogenate for 10 minutes. The mixture also was hydrolyzed by human liver homogenate but not by serum. Conclusions: The dimer and trimer of 3‐hydroxybutyrate can be converted rapidly to monomer in rat and human tissues. 3‐Hydroxybutyrate oligomers could be an energy substrate for injured patients. (Journal of Parenteral and Enteral Nutrition 23:321–325, 1999)
Total Parenteral Nutrition Alters Molecular and Cellular Indices of Intestinal Inflammation in Neonatal Piglets
Authors: Ganessunker Deshanie , Gaskins H. Rex , Zuckermann Federico A. , Donovan Sharon M.
Published: May 2008

Background:The adverse effects of TPN on systemic immunity are well‐documented; however, the impact of IV feeding on neonatal intestinal immunity is unknown.Methods:A piglet TPN model was used to compare immune cell composition within the intestinal epithelium and lamina propria of parenterally and orally fed piglets.Results:Small intestinal weight of piglets maintained intravenously was reduced 50% after 7 days. Intestinal atrophy in piglets fed parenterally was evidenced by decreased width of intestinal villi and colon cuffs and reduced intestinal crypt depth. The numbers of CD4+and CD8+T lymphocytes were threefold greater within the lamina propria of jejunal and ileal villi of piglets supported intravenously. Inverse correlations were observed between villus height or width and T‐lymphocyte numbers(r= ‐.80;p<.05). Major histocompatibility complex class II mRNA expression, an indicator of localized inflammation, was increased in the ileum and colon of piglets receiving parenteral nutrition. Goblet cell numbers were twofold greater in jejunal and ileal villi, and mast cells were more abundant in the colon of piglets fed parenterally. Furthermore, jejunal T‐lymphocyte numbers were correlated with goblet cell numbers (r =.80;p=.O1).Conclusions:These data identify molecular and cellular indices of intestinal inflammation that are responsive to IV feeding in neonates and provide a novel framework to investigate mechanisms underlying gut atrophy during TPN.(Journal of Parenteral and Enteral Nutrition23:337–344, 1999)
Jejunostomy Tube Feedings Should not Be Stopped in the Perioperative Patient
Authors: Moncure Michael , Samaha Elaine , Moncure Kimberly , Mitchell Jocelyn , Rehm Christina , Cypel David , Eydelman Julia , Ross Steven E.
Published: May 2008

Background: Anesthetic standard of care is to restrict oral intake for 8 hours before elective surgery. There is no research addressing appropriate preoperative discontinuation of jejunostomy tube (J‐tube) feedings. We hypothesized that patients could be fed safely, via a J‐tube, until the time of surgery. Methods: Patients admitted to a Level I Trauma Center, having J‐tubes and undergoing a nonabdominal operation, were prospectively evaluated. Group I patients received J‐tube feedings until transport to the operating room. Group II patients had tube feedings discontinued for at least 8 hours before surgery. Data were compared using the Student's t test and contingency table analysis. Results: There were 46 patients in group I and 36 in group II. There was no incidence of aspiration. Patient groups did not differ in age, mortality, length of stay, injury severity score, or ventilator days. Group I patients had tube feedings discontinued for fewer hours before and after surgery than group II patients (before surgery: 1.40 ± 1.20 vs 11.61 ± 5.01, respectively; p <.001; after surgery: 2.99 ± 7.49 us 7.11 ± 9.03, respectively; p =.043); received more kilocalories/ grams of protein on the day of surgery (group I vs group II, 1676.15/89.57 ± 1133.21/38.04 us 791.14/57.58 ± 498.66/79.87, respectively; p =.001/p =.032) and more kilocalories/grams of protein on the first postoperative day (group I us group II, 1580.74/92.57 ± 600.53/37.96 vs 1152.47/63.53 ± 733.96/39.40, respectively; p =.006/p =.001). Conclusions: Patients receiving J‐tubes who are undergoing nonabdominal operations may safely continue enteral nutrition at maximum protein and caloric intake until surgery. (Journal of Parenteral and Enteral Nutrition 23:356–359, 1999)
Ultrasonic Investigation of the Effect of Topical Glyceryl Trinitrate on Peripheral Arm Vein Diameter: Implications for Intravenous Nutrition
Authors: Everitt Nicholas James
Published: May 2008

Background: It has been suggested that topical glyceryl trinitrate (GTN) ointment may cause venodilatation and hence deter thrombophlebitis. However, objective evidence of an increase in vein diameter has not been demonstrated. Methods: B mode ultrasonography was used to measure arm vein diameter. In a prospective study, measurements were taken before and after 24 hours of exposure to topical GTN. Results: Reproducibility of vein diameter measurement was demonstrated. Basilic veins were larger than cephalic veins, but exposure to GTN ointment for 24 hours was not associated with measurable venodilatation. Conclusions: Ultrasonography enabled noninvasive measurement of intraluminal vein diameter. It is unlikely that GTN prevents thrombophlebitis in superficial arm veins by causing venodilatation. (Journal of Parenteral and Enteral Nutrition 23:360–362, 1999)
Tunneled Right Atrial Catheter Infection Presenting as Renal Failure
Authors: Yared George , Seidner Douglas L. , Steiger Ezra , Hall Phillip M. , Nally Joseph V.
Published: May 2008

We report two cases of progressive renal failure secondary to membranoproliferative glomerulonephritis associated with subclinical septicemia from a tunneled right atrial catheter used for home parenteral nutrition administration. Although the occurrence of line infection and septicemia is a common complication of central venous catheters, a review of the literature reveals only one case report of renal failure secondary to an infected implanted central venous device. Both patients presented with azotemia and had biopsy‐proven membranoproliferative glomerulonephritis, accompanied by leukocytoclastic vasculitis. In both cases, removal of the right atrial catheter and prolonged antibiotic therapy was effective in resolving the ongoing infection and resulted in marked improvement in renal function. A high index of suspicion for catheter sepsis should be maintained in patients with tunneled right atrial catheters presenting with subacute renal failure. (Journal of Parenteral and Enteral Nutrition 23:363–365, 1999)
Effects of Residual Oil Fly Ash (ROFA) in Mice with Chronic Allergic Pulmonary Inflammation
Authors: Arantes-Costa Fernanda M. , Lopes Fernanda D.T.Q.S. , Toledo Alessandra C. , Magliarelli-Filho Pedro A. , Moriya Henrique T. , Carvalho-Oliveira Regiane , Mauad Thais , Saldiva Paulo H. N. , Martins Milton A.
Published: May 2008

Exposure to particulate matter (PM) air pollution is associated with increased asthma morbidity. Residual oil flash ash (ROFA) is rich in water-soluble transition metals, which are involved in the pathological effects of PM. The objective of this study was to investigate the effects of intranasal administration of ROFA on pulmonary inflammation, pulmonary responsiveness, and excess mucus production in a mouse model of chronic pulmonary allergic inflammation. BALB/c mice received intraperitoneal injections of ovalbumin (OVA) solution (days 1 and 14). OVA challenges were performed on days 22, 24, 26, and 28. After the challenge, mice were intranasally instilled with ROFA. After forty-eight hours, pulmonary responsiveness was performed. Mice were sacrificed, and lungs were removed for morphometric analysis. OVA-exposed mice presented eosinophilia in the bronchovascular space ( p < .001), increased pulmonary responsiveness ( p < .001), and epithelial remodeling ( p = .003). ROFA instillation increased pulmonary responsiveness ( p = .004) and decreased the area of ciliated cells in the airway epithelium ( p = .006). The combined ROFA instillation and OVA exposure induced a further increase in values of pulmonary responsiveness ( p = .043) and a decrease in the number of ciliated cells in the airway epithelium ( p = .017). PM exposure results in pulmonary effects that are more intense in mice with chronic allergic pulmonary inflammation.
What Factors Influence Case Managers' Resource Allocation Decisions? A Systematic Review of the Literature
Authors: Fraser Kimberly D. , Estabrooks Carole
Published: May 2008

Objective. Case managers' decisions directly affect the amount and type of services individual clients receive, as well as overall home care program available resources. We know little about the resource allocation decision-making processes of case managers. The question guiding this review was, ``What factors influence case managers' resource allocation decisions in home care?'' Methods. The authors did a systematic literature review to answer the above question. After assessing the articles for inclusion, they assessed the quality (internal validity) of each included study. They described the characteristics of the studies and provided a synthesis of the findings of the primary studies. Results. Five qualitative and 6 quantitative articles met the inclusion criteria for this review. The findings of these studies are equivocal. Despite this, the authors were able to create a preliminary taxonomy of the factors that influence case manager resource allocation decisions. Despite evidence-based decision making receiving so much attention in contemporary health care literature, the authors found a near absence of reference to research use in the context of case manager decision making. Conclusions. Currently, there are relatively few studies in the literature on the factors that influence, and how they are used in, case manager resource allocation decisions. Studies are often lacking in terms of conceptual clarity and theoretical framing. They are often not guided by theoretical frameworks and are not situated within the larger field of decision making or even within the clinical decision-making literature. These issues are impeding progress in this area.
Do Patients' Communication Behaviors Provide Insight into Their Preferences for Participation in Decision Making?
Authors: Hudak Pamela L. , Frankel Richard M. , Braddock Clarence , Nisenbaum Rosane , Luca Paola , McKeever Caitlin , Levinson Wendy
Published: May 2008

Background. The Institute of Medicine report "Crossing the Quality Chasm'' encourages physicians to tailor their approaches to care according to each patient's individual preferences for participation in decision making. How physicians should determine these preferences is unclear. Objective. The objective of this study is to assess whether judgments of patient communication behaviors, either globally or individually, can yield insight into patient preferences for participation in decision making. Methods. Using questionnaire responses to 3 items about the desired level of participation in decision making from a communication study involving 886 audiotaped visits between older patients and surgeons, the authors purposively selected 25 patients who preferred a large role and 25 who preferred a small role in decision making. Two independent raters listened to the audiotapes and coded them for the presence of 7 communication behaviors (question asking, information behavior, initiating, statements of preference, processing, resistance, deference). On the basis of their listening and coding, raters judged patient preferences for participation in decision making. Results. Neither rater accurately judged preferences for participation in decision making beyond chance agreement (kappa statistics: rater 1 = 0.16, rater 2 = 0.20). Inter-rater reliability for the communication behaviors was also generally poor. Area-under-the-curve values for all communication behaviors hovered around 0.50, indicating that none of the behaviors had adequate power to discriminate between patients preferring large versus small roles. Conclusion. Patient preferences for participation in decision making cannot be reliably judged during routine visits based on judgments of patient communication behaviors. Engaging patients in a discussion of preferences for decision making may be the best way to determine the role each wants to play in any given decision.
Time-Tradeoff Utilities for Identifying and Evaluating a Minimum Data Set for Time-Critical Biosurveillance
Authors: Doctor Jason N. , Baseman Janet G. , Lober William B. , Davies Jac , Kobayashi John , Karras Bryant T. , Fuller Sherrilynne
Published: May 2008

Background. Researchers and policy makers are interested in identifying, implementing, and evaluating a national minimum data set for biosurveillance. However, work remains to be done to establish methods for measuring the value of such data. Purpose. The purpose of this article is to establish and evaluate a method for measuring the utility of biosurveillance data. Method. The authors derive an expected utility model in which the value of data may be determined by trading data relevance for time delay in receiving data. In a sample of 23 disease surveillance practitioners, the authors test if such tradeoffs are sensitive to the types of data elements involved (chief complaint v. emergency department [ED] log of visit) and proportional changes to the time horizon needed for receiving data (24 v. 48 h). In addition, they evaluate the logical error rate: the proportion of responses that scored less relevant data as having higher utility. Results. Utilities of chief complaints were significantly higher than ED log of visit, F(1, 21)= 5.60, P < 0.05, suggesting the method is sensitive. Further utilities did not depend on time horizon used in the exercise, F(1, 21) = 0.00, P = ns. Of 92 time tradeoffs elicited, there were 5 logical errors (i.e., 5% logical error rate). Conclusions. In this article, the authors establish a time-tradeoff exercise for valuing biosurveillance data. Empirically, the method shows initial promise for evaluating a minimum data set for biosurveillance. Future applications of this approach may prove useful in disease surveillance planning and evaluation.
Understanding the reproduction of health care: towards geographies in health care work
Authors: Andrews Gavin J. , Evans Josh
Published: May 2008

There has been only a partial geographical engagement with the production of conventional health care. Whilst medical geography maps aggregate supply and demand features, the geography of health focuses more on consumption and social and cultural contexts. More specifically, apart from a handful of published studies, both of these fields have overlooked how health care is continually reproduced in places by workers. In response to these shortfalls in the literature, we call for attention to geographies in health care work. In support, we describe the geographies that characterize the new health care and, using therapeutics as an example, outline how clinical concepts might provide secure foundations for research. A final discussion outlines the multiple people, places and relationships that could be investigated. Developing geographies in health care work would provide sensitive insights into the complexity, diversity and daily operation of health care.
Flame Retardants in Commercial Use or Development for Textiles
Authors: Weil Edward D. , Levchik Sergei V.
Published: May 2008

Non-durable and semi-durable flame retardants based mostly on phosphate or phosphonate salts continue to be used on infrequently washed or disposable goods, and recent improvements have been made to impart better `hand' or some limited wash resistance. Backcoating with insoluble ammonium polyphosphate, usually with additives and binders to provide intumescence, has been found effective on charrable fabrics. However, the leading backcoating effective on a wider range of fabrics, including synthetics and blends, is decabromodiphenyl ether plus antimony oxide. Newer candidates in development for textile coating are polymers and copolymers of pentabromobenzyl acrylate.

The leading durable finish for cellulosic fibers, in use for about 50 years, continues to be based on tetrakis(hydroxymethyl)phosphonium salts reacted with urea and cured with gaseous ammonia. Softer versions have been recently developed using chemical or process modifications, or using selected fiber blends. Somewhat less durable phosphonic ester methylolamide finishes, not requiring gaseous curing, are used on cellulosic fabrics, especially overseas. Other competitive wash-durable phosphorus-based finishes for cellulosics and blends are in development.

Polyesters continue to be flame retarded using a phosphonate or hexabromocyclododecane in a `thermosol' process. Polyesters with built-in phosphinate structures are available as specialty fabrics. A dialkylphosphinate salt has been recently introduced as a melt spinning additive in polyester. A tribromoneopentyl phosphate melt spinning additive has been developed for polypropylene fiber.

A number of inherently flame retardant synthetic fibers recently achieving increased usage include melamine-based fiber, viscose rayon containing silicic acid, aramides, oxidized polyacrylonitrile, and polyphenylene sulfide fibers. Some of these are used in protective clothing.

The recent California and Federal mattress open-flame test standards have brought barrier fabrics into prominence. Some of these barriers use boric acid on cotton batting, others are proprietary composites and blends, both woven and nonwoven, comprising inherently flame retarded fibers combined with lower cost non-flame-retardant fibers. Upholstered furniture open-flame standards are pending.
Light-Cured Dimethacrylate-Based Resins and Their Composites: Comparative Study of Mechanical Strength, Water Sorption, and Ion Release
Authors: O'Donnell J.N.R. , Langhorst S.E. , Fow M.D. , Skrtic D. , Antonucci J.M.
Published: May 2008

This study explores how resin type affects selected physicochemical properties of complex methacrylate copolymers and their amorphous calcium phosphate (ACP)-filled and glass-filled composites. Two series of photo-polymerizable resin matrices are formulated employing 2,2-bis[p-(2'hydroxy-3'-methacryloxypropoxy)phenyl]propane (Bis-GMA) or an ethoxylated bisphenol A dimethacrylate (EBPADMA) as the base monomer, unfilled copolymers and composites filled with a mass fraction with 40, 35, and 30%, respectively, of ACP or the un-silanized glass were assessed for biaxial flexure strength (BFS), water sorption (WS), and mineral ion release upon immersion in HEPES-buffered saline solution for up to six months. Substituting EBPADMA for Bis-GMA significantly reduced the WS while only marginally affected the BFS of both dry and wet copolymers. Independent of the filler level, both dry and wet ACP composites formulated with either BTHM or ETHM resins were mechanically weaker than the corresponding copolymers. The BFS of ACP composite specimens after 1 month in saline did not further decrease with further aqueous exposure. The BFS of glass-filled composites decreased with the increased level of the glass filler and the time of aqueous exposure. After 6 months of immersion, the BFS of glass-filled BTHM and ETHM composites, respectively, remained 58 and 41% higher than that of the corresponding ACP composites. Ion release data indicated that a minimum mass fraction of 35% ACP was required to attain the desired solution supersaturation with respect to hydroxyapatite for both the BTHM and ETHM derived composites.
Dynamic Co-Seeding of Osteoblast and Endothelial Cells on 3D Polycaprolactone Scaffolds for Enhanced Bone Tissue Engineering
Authors: Kyriakidou K. , Lucarini G. , Zizzi A. , Salvolini E. , Mattioli Belmonte M. , Mollica F. , Gloria A. , Ambrosio L.
Published: May 2008

Tissue engineered scaffolds must have an organized and repeatable microstructure which enables cells to assemble in an ordered matrix that allows adequate nutriental perfusion. In this work, to evaluate the reciprocal cell interactions of endothelial and osteoblast-like cells, human osteoblast-like cells (MG63) and Human Umbilical Vein Endothelial Cells (HUVEC) were co-seeded onto 3D geometrically controlled porous poly(ε-caprolactone) (PCL) and cultured by means of a rotary cell culture system (RCCS-4DQ). In our dynamic co-culture system, the lack of significant enhancement of osteoblast ALP activity and ECM production indicated that the microgravity conditions of the rotary system affected the cells by favoring their proliferation and cellular cross-talk. These results emphasize how osteoblasts increase endothelial cell proliferate and endothelial cells amplify the growth of osteoblasts but decrease their differentiation. This dynamic seeding of osteoblasts and endothelial cells onto a 3D polymeric scaffold may represent a unique approach for studying the mechanisms of interaction of endothelial and osteoblast cells as well as achieve a functional hybrid in which angiogenesis, furnished by neo-vascular organization of endothelial cells may further support osteoblasts growth. Furthermore, this in vitro model may be useful in examining the applicability of novel material structures for tissue engineering.
The Role of Selenium in Chronic Disease
Authors: Boosalis Maria G.
Published: May 2008

Selenium functions as a part of proteins known as selenoproteins. Through these selenoproteins, selenium functions as a defensive mechanism for oxidative stress, for the regulation of thyroid hormone activity, and for the redox status of vitamin C and other molecules. In several of its roles, selenium functions as a dietary antioxidant and thus has been studied for its possible role in chronic diseases. This article reviews recent studies regarding selenium status or supplementation in hypertension, cardiovascular disease, cancer, and diabetes mellitus. A few studies regarding aging and mortality are also included. What can be ascertained from this current review is that the maintenance of adequate selenium nutriture and, at minimum, the prevention of a deficiency in selenium would be advisable for all individuals. In addition, the indiscriminant use of selenium supplements should be approached with caution until further randomized, controlled trials monitor the effects of such supplementation, especially on a long‐term basis.