bluuebunny/crossref_metadata_2025 huggingface dataset:
Cholesterol oxidation in intravenous lipid emulsions: safety of preparations before and after experimental hyperoxia
Authors: Scopesi F , Zunin P , Bellini C , Sacchi R , Boggia R , Evangelisti F , Serra G
Published: May 2008

The aim of this preliminary study was to assess the possible presence of cholesterol oxidation products in 2 i.v. lipidic emulsions with different fatty acid compositions (long‐chain triglyceride, medium‐chain triglyceride‐long‐chain triglyceride). Because these emulsions are currently used in neonatal parenteral nutrition, their direct venous introduction might be potentially dangerous because of the possible atherogenic role of cholesterol oxidation products. The emulsions were analyzed when bottles were opened (ie, under normal condition of administration) and after a 12‐hour direct experimental exposure to air and high (90%) oxygen concentrations. 7‐Ketocholesterol and 5alpha‐epoxycholesterol were chosen as markers of cholesterol oxidation and detected by gas chromatography‐mass spectrometry of their trimethylsilyl ethers. The detected amounts were always very low and in some cases below the detection limit of the analytical method for the 2 cholesterol oxidation products (COPs; 0.1 and 0.3 microg/g of extracted lipids). Immediately after opening the bottles, their concentrations were lower in the emulsions containing the higher amounts of polyunsaturated fatty acids. Experimental hyperoxic exposure generally determined only a mild increase in the content of cholesterol oxidation biomarker, and after exposure to oxygen, the amounts of COPs were slightly higher than after exposure to air. The results of the present study are undoubtedly reassuring for the safety of neonates, although caution is always required when drawing conclusions from in vitro data.
Effects of a nutritional supplement on the immune response and cytokine production in free‐living Chilean elderly
Authors: Bunout D , Barrera G , Hirsch S , Gattas V , de la Maza MP , Haschke F , Steenhout P , Klassen P , Hager C , Avendano M , Petermann M , Munoz C
Published: May 2008

BACKGROUND: Immune response is impaired in the elderly. Our aim was to study the effects of a special nutritional formula on the immune response and response to influenza and pneumococcal vaccination in elderly subjects. METHODS: Sixty healthy subjects aged > or = 70 years, with a Mini Mental score > or = 22 were studied. Half of the subjects received a special nutritional formula (in addition to the regular diet) providing, among other nutrients, 480 kcal, 31 g proteins, 120 IU vitamin E, 3.8 microg vitamin B12, 400 microg folic acid, 10(9) cfu Lactobacillus paracasei (NCC 2461), and 6 g of fructo‐oligosaccharides. At 4 months of follow‐up, subjects were vaccinated against influenza and pneumococcus. Lymphokine production by mononuclear cells (PBMC), lymphocyte subpopulations, and natural killer cell (NK) activity were measured at baseline and 4 months of follow‐up (before vaccination). Antibodies against influenza and pneumococcal antigens and flu‐stimulated production of interferon gamma and interleukin‐2 by PBMC were measured at 4 and 6 months. Skin response to 7 recall antigens and body composition were assessed at baseline and at 4 and 12 months. All infections occurring during the study period were recorded. RESULTS: NK activity increased in supplemented subjects and decreased in nonsupplemented individuals. Interleukin‐2 production by PBMC and the proportion of T cells with NK activity decreased in controls and did not change in supplemented subjects. Supplemented subjects reported less infections than nonsupplemented individuals (in 13% and 22% of scheduled visits, respectively; p =.02). CONCLUSIONS: This nutritional supplement increased innate immunity and protection against infections in elderly people.
Observations on Possible Effects of Daily Vitamin K Replacement, Especially Upon Warfarin Therapy
Authors: Bern Murray
Published: May 2008

Daily parenteral vitamin K supplement is now recommended by the US Food and Drug Administration (FDA) for patients receiving IV hyperalimentation. This is considered as preferable to the previous recommendations of weekly parenteral or oral supplement, or as in some cases no supplement at all. Supplemental vitamin K1 will ensure adequate supplies for hepatic saturation and thus the production of clotting factors II, VII, IX, and X, plus the anticoagulants protein C, protein S, and protein Z. But this is not the entire story. This recommended supplement will affect other physiologic systems that also use vitamin K‐dependent γ‐carboxylation.

Vitamin K is not 1 molecule but rather 2 natural substances, vitamin K1 and K2, and the synthetic K3's. It is not understood, what, if any, effect may occur because of the saturation or competition from the vitamin K1 upon the functioning of vitamins K2 and the derivatives of K3 in vivo upon bone mineralization, cell growth, and blood vessel health, all known to be influenced by the vitamins K. There are probably other physiologic systems yet to be studied relative to vitamins K and γ‐carboxylation.

This review also considers the available research upon warfarin when given to patients receiving hyperalimentation and what effects the vitamin K supplements may have. Because studies to date have not controlled for vitamin K intake, consideration is given to whether one should expect any change in previously reported outcomes when using low‐dose warfarin for prophylaxis against central vein thrombosis. Also considered are possible positive or negative effects that chronic warfarin therapy may have upon the other vitamin K‐dependent systems under discussion.

This review offers a platform for further discussion and derived clinical research provoked by this new FDA recommendation.
Citrulline Can Preserve Proliferation and Prevent the Loss of CD3 ζ Chain Under Conditions of Low Arginine
Authors: Bansal Vishal , Rodriguez Paulo , Wu Guoyao , Eichler Duane C. , Zabaleta Jovanny , Taheri Faramarz , Ochoa Juan B.
Published: May 2008

Background: Arginine depletion by the enzyme Arginase I, decreases expression of the TCR ζ chain preventing T‐cell activation and causing T‐cell dysfunction. We hypothesized that citrulline could substitute for arginine under conditions of increased arginase expression. Thus, the goal was to establish a possible mechanism of how citrulline could overcome arginine depletion caused by arginase. Methods: Jurkat cells were cultured, with or without arginase, in media containing different amino‐acid constituents: complete RPMI containing arginine (C‐RPMI) (arginine), Arginine‐Free‐RPMI (Arg‐Free RPMI) and Citrulline‐containing RPMI (Cit RPMI). Incorporation of citrulline was measured via uptake of 3H‐citrulline, whereas proliferation was measured via 3H‐thymidine incorporation. ζ Chain was analyzed by 2‐color flow cytometry. Argininosuccinate synthase (AS) and argininosuccinate lyase expression was detected using Northern blots, RT‐PCR, and Western blots. Results: Jurkat cells exhibited a significant decrease in proliferation and ζ chain expression when cultured in the presence of arginase or in the absence of arginine. With citrulline, ζ chain expression and proliferation were maintained in the absence of arginine or in the presence of the enzyme arginase. Jurkat cells, cultured in the absence of arginine, were associated with a 5‐fold increase in citrulline uptake. The absence of arginine was also associated with increased expression of AS. Conclusions: T cells exhibit the molecular capability of increasing citrulline membrane transport and up‐regulating AS expression, thus exhibiting the necessary mechanisms for converting citrulline into arginine and escaping the ill effects of arginine depletion. Therefore, citrulline has the potential to be a substitute for supplemental arginine in diseases associated with arginase‐mediated T cell dysfunction.
Urinary Oxalate Excretion Increases in Home Parenteral Nutrition Patients on a Higher Intravenous Ascorbic Acid Dose
Authors: de la Vega Lourdes Peña , Lieske John C. , Milliner Dawn , Gonyea Janelle , Kelly Darlene G.
Published: May 2008

Background: Vitamin C can be metabolized to oxalate. Case reports have suggested an association between IV vitamin C and urinary oxalate excretion. Recently, the US Food and Drug Administration required the dose of vitamin C in IV multivitamin preparations to be increased from 100 mg to 200 mg/d. We compared the urinary oxalate excretion level in stable home total parenteral nutrition (TPN) patients receiving both doses of vitamin C. Methods: Each participant provided a 24‐hour urine sample for oxalate determination on the vitamin C dose (100 mg/d), and again after at least 1 month on the increased vitamin C dose (200 mg/d). A 2‐day diet diary was completed covering the day before and the day of the urine collection and was analyzed for oxalate and vitamin C content. Comparisons were made using Student paired t test and Wilcoxon signed rank. Results: Thirteen patients (7 males/6 females) aged 63.1 ± 12.2 years who had no history of nephrolithiasis and had received TPN for 55.9 ± 78.8 months were enrolled. The most common indication for TPN was short bowel syndrome (38.5%). Eight patients had an intact colon. Urinary oxalate excretion increased on the 200‐mg vitamin C dose, from 0.34 ± 0.13 to 0.44± 0.17 mmol/d (mean increase = 0.10 mmol/d; p = .04; 95% confidence interval 0.004 to 0.19 mmol/d). Oral intake of vitamin C and oxalate did not differ between the 2 collection periods. Conclusions: In therapeutically used doses, IV vitamin C increases urinary oxalate excretion, potentially predisposing susceptible individuals to nephrolithiasis. This factor should be considered in patients receiving home TPN.
Effects of Carrier Solution on Insulin Bioavailability
Authors: Rušavý Zdenek , Sramek Vladimir , Sucha Renata , Lacigova Silvie , Topolcan Ondrej
Published: May 2008

Background: The aim of our study is to assess the influence of the base solution on the availability of biologic insulin expressed in the value of total insulin using the radioimmunoassay method and to monitor the influence of the base solution on the total insulin concentration over time. Methods: Total insulin in a saline and in a total nutrient admixture was measured using the RIA method. In 15 experiments, the application of the saline by a perfusor (8 IU Actrapid HM, 100 IU/1 mL + 20 mL saline) was carried out at time intervals of baseline, 5, 10, 30, 60, 90, and 210 minutes. The application of the total nutrient admixture (8 IU Actrapid HM + 20 mL total nutrient admixture) was carried out in the same way. The MANOVA, ANOVA and paired t test with Bonferroni correction were then used for statistical evaluation. Results: The average values of insulin concentration in saline at given time intervals were 21.5 ± 11.3 mIU/L (5.4% of the theoretically calculated concentration). The level of insulin in the total nutrient admixture did not change over time, and it reached the values of 115.2 ± 22.3 (28.8% of the theoretically calculated concentration). Changes in insulin concentration in time were found only in the saline (ANOVA time effect p < .001 for saline; p = .26 for total nutrient admixture). Conclusions: The availability of insulin was significantly higher in the total nutrient admixture solution than in the saline in the 3.5‐hour experiment. The dependence of insulin concentration on time is present only in saline, and the main changes in insulin bioavailability are within first 60 minutes. The difference could be caused by smaller insulin absorption to the syringe walls and to the set, owing to the amino acids in the mixture. The question whether the amino acid concentration affects insulin bioavailability stays opened to other studies.
Microbiologic Quality‐Control Study for the Purpose of Extending the Use of Transfer Sets on the Automix 3+3 and Micromix Automated Total Nutrient Admixture Compounding Pumps
Authors: Chung Kenneth , Head Greg
Published: May 2008

Background: A quality‐control study was undertaken by the departments of pharmacy and microbiology at St. Paul's Hospital (Vancouver, British Columbia, Canada) to evaluate the microbiologic safety of total nutrition admixtures (TNA) compounded by automated compounding pumps when the use of disposable transfer sets was extended from 1 day to 2 days. This study also evaluates the potential annual cost savings of this extended use. Methods: Transfer sets and unused part containers of ingredients were left to sit overnight on the automated compounders after daily TNA manufacturing before a TNA sample was compounded for culturing. These TNA samples were cultured using a biphasic system consisting of a tryptic soy broth component and an agar slide component. Positive results were subcultured and isolates were identified by standard methods. Forty samples were collected and evaluated. Results: Four bags grew Bacillus species, and 1 bag grew coagulase‐negative staphylococci. The potential annual cost savings of this extended use was estimated to be ∼$35,000. Conclusions: The extended use of the disposable transfer sets cannot be instituted at the present time and should be reexamined when the cause(s) of the positive results are identified and corrected.
Assessment of Ascorbic Acid Stability in Different Multilayered Parenteral Nutrition Bags: Critical Influence of the Bag Wall Material
Authors: Dupertuis Yves M. , Ramseyer Sihan , Fathi Marc , Pichard Claude
Published: May 2008

Background: The recent development of multilayered bags has minimized ascorbic acid oxidation in parenteral nutrition (PN) admixtures. However, the gas‐barrier property of multilayered bags depends on their plastic material. This study compared ascorbic acid stability in different multilayered bags under experimental conditions. Methods: Oxygen permeability of a newly developed 6‐layered bag (6‐L) was compared with a highly mechanical‐resistant 3‐layered bag (3‐LR) and a highly flexible 3‐layered bag (3‐LF) using gas chromatography. Ascorbic acid stability was assessed by iodine titration in bags filled with 2.5 L H2O and 40 g carbohydrates after setting residual O2 content at ≤1 or ≥5 ppm. The effect of storage at 4°C, 21°C, and 40°C on ascorbic acid stability was assessed over 48 hours in a complete PN admixture (ie, 330 g carbohydrates, 100 g lipids, 96 g amino acids and trace elements) using high‐pressure liquid chromatography. Results: Oxygen permeability was markedly reduced in 6‐L bags (0.5 mL O2 /m2/d) compared with 3‐LR (150 mL O2 /m2/d) and 3‐LR (1500 mL O2/m2/d). Accordingly, ascorbic acid was more stable in 6‐L bags (half‐life [T1/2] = 16 days up to 40°C) than in 3‐LR (T1/2 = 9 days at 4°C, 47 hours at 21°C and 29 hours at 40°C) and 3‐LF (T1/2 = 15 hours at 4°C, 10 hours at 21°C, and 6 hours at 40°C). During the first 6 hours after PN admixture compounding, an additive ascorbic acid loss of 4.6 ± 0.5 mg/L/ppm O2 occurred because of residual O2 in the bag. Conclusions: The new combination of plastic layers and careful O2 monitoring during the filling process allowed near to complete prevention of ascorbic acid degradation in multilayered PN bags during 48 hours, regardless of the storage temperature.
Late Regeneration of Infarcted Small Bowel Mucosa: A Case Report
Authors: Zmora Oded , Khaikin Marat , Rosin Danny , Shabtai Moshe , Bar‐Zakai Barak , Ayalon Amram
Published: May 2008

Ischemic injury of the small bowel may recover after revascularization, provided that full‐thickness infarction did not occur. Animal studies showed that if the mucosal crypts remain viable, rapid mucosal restitution occurs hours after injury. The treatment of transmucosal infarction that does not extend to full wall thickness, however, was not investigated thoroughly. The patient presented had a mesenteric event leading to resection of about half of his small bowel. The unresected segment had severe ischemic injury, which seemed to cause transmucosal, but not transmural, infarction. Imaging of the remaining small bowel revealed a seromuscular layer denuded of mucosa. The ischemic damage was too deep to allow rapid regeneration, and the patient had short‐bowel syndrome. A year later, during operation for stricture complications, new mucosa covered parts of the small‐bowel surface, encouraging the surgeon to elect a conservative approach. Sixteen months after the injury, normal mucosa covered the entire small bowel, and enteral feeding resumed successfully. This report shows that infarcted small‐bowel mucosa may regenerate even months after injury.
The Impact of Parenteral Nutrition on the Body Composition of Patients With Acute Pancreatitis
Authors: Chandrasegaram Manju D. , Plank Lindsay D. , Windsor John A.
Published: May 2008

Background: Nutrition support by the enteral route is now the preferred modality in patients with severe acute pancreatitis. Parenteral nutrition is now required to supplement enteral nutrition when the latter is not able to provide the full nutritional requirement. We report the changes in body composition, plasma proteins, and resting energy expenditure (REE) during 14 days of parenteral nutrition (PN) in patients with acute pancreatitis. Methods: Total body protein (TBP), total body water (TBW), and total body fat (TBF) were measured by neutron activation analysis and tritium dilution before and after PN. Fat‐free mass (FFM) was derived as the difference between body weight and TBF. REE was measured by indirect calorimetry. Protein index (PI) was the ratio of measured TBP to TBP, calculated from healthy volunteers. Results: Fifteen patients with acute pancreatitis (11 men, 4 women; median age 56, range 30–80 years) were studied. Thirteen patients had severe acute pancreatitis (Atlanta criteria), and 1 patient died. The gains in body weight (1.05 ± 0.77 kg), TBW (0.49 ± 0.87 kg), TBP (0.20 ± 0.22 kg), FFM (0.73± 0.92 kg), TBF (0.32 ± 0.95 kg), and REE (146 ± 90 kcal/d) after 14 days of PN were not significant. Plasma prealbumin increased by 46.5% (p = .020). When patients (n = 6) with intercurrent sepsis and recent surgery were excluded, there were significant increases in TBP (0.65 ± 0.17 kg, p = .005) and PI (0.060 ± 0.011, p = .0006). Conclusions: Body composition is preserved in acute pancreatitis during 14 days of PN. In patients without sepsis or recent surgery, PN is able to significantly increase body protein stores.
Glucagon‐Like Peptide 2 Is an Endogenous Mediator of Postresection Intestinal Adaptation
Authors: Perez Alexander , Duxbury Mark , Rocha Flavio G. , Ramsanahie Anthony P. , Farivar Robert S. , Varnholt Heike , Ito Hiromichi , Wong Helen , Rounds Jan , Zinner Michael J. , Whang Edward E. , Ashley Stanley W.
Published: May 2008

Background: After massive small bowel resection, the remnant intestine undergoes compensatory adaptation. We tested the hypothesis that glucagon‐like peptide‐2 (GLP‐2) is an endogenous mediator of postresection intestinal adaptation. Methods: Rats were allocated to 1 of 4 groups: groups 1 and 2 rats underwent mid‐small bowel transection and reanastomosis; groups 3 and 4 rats underwent 75% mid‐small bowel resection and reanastomosis. Groups 2 and 4 rats were administered 1.8 mg of antirat GLP‐2 antibody twice daily beginning immediately after the surgical procedure; groups 1 and 3 rats were administered rabbit serum (control). Ileal specimens were harvested on postoperative day 7. Results: Ileal mucosa from group 3 animals displayed morphologic and proliferative indices of adaptation. Each of these indices of adaptation was inhibited by GLP‐2 immunoneutralization (group 4). Morphologic and proliferative parameters in the ileum from animals that had undergone transection with reanastomosis were unaffected by GLP‐2 immunoneutralization. Conclusions: These results suggest that GLP‐2 is an endogenous mediator of postresection intestinal adaptation.
The Effects of Immediate Enteral Feeding with a Formula Containing High Levels of ω‐3 Fatty Acids in Patients After Surgery for Esophageal Cancer
Authors: Aiko Satoshi , Yoshizumi Yutaka , Tsuwano Shinichi , Shimanouchi Masaoki , Sugiura Yoshiaki , Maehara Tadaaki
Published: May 2008

Background:We investigated whether supplementation of enteral nutrition (EN) with ω‐3 polyunsaturated acids (PUFAs) affected platelet aggregation, coagulation activity, and inflammatory response in the early stages after esophageal cancer surgery.Methods:Twenty‐eight patients with esophageal cancer who underwent the same surgical procedure were selected for this study. All patients received EN, which was started immediately after the operation and was increased to a maximum volume of 1500 ml/day by the third postoperative day (POD). Eleven patients received a conventional EN formula (Ensure Liquid), while the remaining 17 patients received a different formula rich in ω‐3 PUFAs (Racol [RAC]). Several markers of coagulation and fibrinolysis were determined in POD 2, while the concentrations of interleukin (IL)‐6, IL‐8, 6‐keto‐PGF1α and thromboxane B2 were determined on PODs 1, 3, and 5.Results:A total of 27 patients completed the study, 11 in the Ensure Liquid group and 16 in the RAC group. Administration of RAC significantly inhibited the postoperative decrease in platelet count. The level of D‐dimer was attenuated significantly in the RAC group. Plasma IL‐8 levels were decreased significantly in the RAC group on PODs 1 and 3. The anti‐inflammatory effects of ω‐3 PUFAs were confirmed by the clinical findings of lower body temperature. The plasma concentration of 6‐keto‐PFG1α also tended to decrease in the RAC group with a significant difference on POD 5.Conclusions:Early EN with a large amount of ω‐3 PUFAs in reduced platelet aggregation, coagulation activity, and cytokine production. All these effects would be expected to be beneficial in patients following esophageal cancer surgery. The clinical significance of the changes in eicosanoid production remains to be established.
Per2 Gene Expressions in the Suprachiasmatic Nucleus and Liver Differentially Respond to Nutrition Factors in Rats
Authors: Iwanaga Hiroshi , Yano Masahiko , Miki Hirofumi , Okada Kazuyuki , Azama Takashi , Takiguchi Syuji , Fujiwara Yoshiyuki , Yasuda Takushi , Nakayama Mitsuo , Kobayashi Masaru , Oishi Katsutaka , Ishida Norio , Nagai Katsuya , Monden Morito
Published: May 2008

Background: We previously reported that parenteral nutrition (PN) altered the circadian rhythm of clock gene expression in the suprachiasmatic nucleus (SCN) and liver of rats. The present study was designed to investigate what factor(s) in the PN solution causes the alteration. Methods: Male Wistar rats, kept under light and dark conditions, were divided into 4 groups after cannulation. The sham operation group received saline solution from 8 am to 8 pm at the rate of 36 mL/kg/12 hours. The glucose, amino acid, and saline groups received a glucose solution (20% wt/vol glucose, 261 kcal/kg/d, Na+ 50 meq/L and Cl– 50 meq/L), an amino acid solution (4.3% wt/vol 1.78 gN/kg/d, Na +50 meq/L and Cl– 50 meq/L) and a saline solution from 8 am to 8 pm at a rate of 240 mL/kg/12 hours, respectively. Rats were killed every 4 hours (9 am = Zeitgeber Time (ZT) 02, 1 pm = ZT06, 5 pm = ZT10, 9 pm = ZT14, 1 am = ZT18, 5 am = ZT22, n = 3 at each point), and brain and liver samples were removed. rPer2 expression in the SCN and liver was analyzed by in situ hybridization and Northern blotting, respectively. Results: Compared with the sham‐operation rats, the peak time of rPer2 expression in the SCN was significantly affected by glucose, amino acid, and saline solutions. Among them, glucose‐group rats showed the rPer2 expression most similar to that of diurnal PN. On the other hand, the rPer2 expression in the liver was shifted in the glucose and amino‐acid‐solution groups. The pattern of rPer2 expressions in the amino acid group was most similar to that of the diurnal PN group. Conclusions: These results indicate that the most potent entrainer for the SCN clock is glucose, whereas that for the liver is amino acid.
Long‐Term Enteral Nutrition Facilitates Optimization of Body Weight
Authors: Schattner Mark A. , Willis Holly J. , Raykher Alexandra , Brown Patricia , Quesada Ofelia , Scott Burma , Shike Moshe
Published: May 2008

Background: Optimization of body mass index (BMI) among cancer survivors is a priority. Long‐term enteral nutrition is required by many head and neck cancer survivors and may be utilized to affect changes in BMI. Methods: We used a retrospective review of head and neck cancer survivors dependent on enteral nutrition. Patients were grouped according to their BMI at initiation of enteral feeding. Patients with normal, low, or elevated BMI were assigned a goal of weight maintenance, weight gain, or weight reduction, respectively. Changes in BMI over time were recorded. Results: We identified 39 head and neck cancer survivors requiring enteral nutrition. Median time on enteral nutrition was 32 ± 39.6 months. At the initiation of enteral feeding, 51% of patients had a normal BMI and were assigned to the weight maintenance group, 84% successfully maintained a normal BMI (mean 22.4 ± 1.7 kg/m2), and 18% had a low BMI and were assigned to the weight gain group. In all, 85% achieved or trended toward a normal BMI (from 16.5 ± 1.9 to 19.2 ± 1.6 kg/m2; p = .02). When enteral feedings began, 31% of patients had an elevated BMI and were assigned a goal of weight reduction; all were able to reduce their BMI (from 30.2 ± 5 to 27.3 ± 6 kg/m2; p < .001). Conclusions: Long‐term enteral feeding facilitates body weight optimization among ambulatory head and neck cancer survivors. These findings may potentially be generalized to all ambulatory patients who are dependent on enteral nutrition.
Preoperative Oral Supplementation with Long‐Chain Ω‐3 Fatty Acids Beneficially Alters Phospholipid Fatty Acid Patterns in Liver, Gut Mucosa, and Tumor Tissue
Authors: Senkal Metin , Haaker Rolf , Linseisen Jakob , Wolfram Günther , Homann Heinz‐Herbert , Stehle Peter
Published: May 2008

Background: The uptake of ω‐3 polyunsaturated fatty acids (PUFAs) into the liver, gut mucosa, and tumor tissue and plasma levels after preoperative administration of supplemented enteral nutrition was investigated in patients with malignancies of the upper gastrointestinal tract. The objective of the study was to evaluate the incorporation of preoperatively administrated PUFAs, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) into cell phospholipids. Methods: Patients undergoing major gastrointestinal surgery (n = 40) were prospectively randomized to receive a PUFA‐supplemented liquid oral diet 5 days preoperatively or an isocaloric control diet. The planned diet intake was 1000 mL/d providing 3.7 g of PUFA. The diet was given in addition to the usual hospital diet. The phospholipid fractions in plasma were analyzed on the day of surgery. Tissue samples of liver, gut mucosa (small intestine), and tumor were taken during surgery and homogenized. EPA and DHA content was analyzed using liquid gas chromatography. Results: Both patient groups (PUFA group: n = 20; control group: n = 20) were similar in age, weight, and surgical procedures. As compared with the control group, the PUFA group had significantly increased levels of EPA in liver tissue (0.4 vs 1.3 weight %), gut mucosa (0.3 vs 1.0 weight %), and tumor tissue (0.3 vs 0.8 weight %). Also, the DHA levels in the PUFA group were significantly higher than the control group: liver tissue (4.1 vs 7.5 weight %), gut mucosa (2.1 vs 3.7 weight %) and tumor tissue (1.9 vs 4.2 weight %). Conclusions: This study suggests that administration of PUFA‐enriched diets leads to increased incorporation of EPA and DHA not only in liver and gut mucosa tissue, but also in tumor tissue in patients with solid gastrointestinal tumors. Thus, preoperative administration of oral PUFA‐enriched diets could have an impact on the postoperative inflammatory response after major abdominal surgery.
Importance of Parenteral Nutrition in Patients Undergoing Hemopoietic Stem Cell Transplantation Procedures in the Autologous System
Authors: Skop A. , Kolarzyk Emilia , Skotnicki A.B.
Published: May 2008

Objective: The aim of this study was to assess the frequency of parenteral nutrition and to compare the impact of parenteral and oral feeding on the nutrition and clinical status of adults undergoing autologous hemopoietic stem cell transplantation. Methods: The study involved 35 patients with neoplasm of the hemopoietic system who underwent hemopoietic cell autotransplantation at the Hematology Clinic (Jagiellonian University, Krakow, Poland). The patients' nutrition status was assessed using body mass index (BMI) values, body mass components, concentration of albumin, and total protein in blood serum. The clinical status evaluation included duration of hematologic reconstruction, concentration of bilirubin, enzyme activity (alanine aminotransferase and aspartate aminotransferase), severity of infections, and duration of hospitalization. Results: Parenteral nutrition was required in 19 patients. Oral feeding was used in 16 patients. Symptoms of malnutrition on the day preceding the introduction of conditioning treatment were recorded only in patients requiring parenteral nutrition (31.6%). In the posttransplantation period, a statistically significant decrease in body mass was observed in both groups, whereas the share of fatty tissue in total body mass was significantly less in patients (men and women) fed parenterally. Conclusion: A supply of 25–30 kcal/kg and 1–1.5 g protein/kg/day as an element of parenteral nutrition (where 20%–30% of the energy requirement was covered by fats, 15%–20% by amino acids, and 50%–55% by glucose) helped prevent the development of malnutrition and restore the functions of the hemopoietic system at a level comparable to that for patients fed naturally.
Effect of Amino Acid Infusion on Human Postoperative Colon Protein Synthesis in Situ
Authors: Rittler Peter , Schiefer Beatrice , Demmelmair Hans , Koletzko Berthold , Roscher Adelbert A. , Jacobs Rita , Krick Maximiliane , Jauch Karl‐Walter , Hartl Wolfgang H.
Published: May 2008

Background: Amino acids are an integral part of parenteral nutrition because of their anabolic action helping to conserve body protein after surgical stress. At the gastrointestinal tract, an adequate supply of amino acids may be particularly important because of the gut's high rate of protein turnover, cell division, and proliferation. However, no information is available about the effects of amino acids on human intestinal protein metabolism after surgery. Methods: Studies were performed in postabsorptive patients 8–10 days after major abdominal surgery. Mass spectrometry techniques (capillary gas chromatography/combustion isotope ratio mass spectrometry) were used to directly determine the incorporation rate of 1‐[13C]‐leucine into colon mucosal protein. All subjects had a colostomy, which allowed easy access to the colon mucosa, and consecutive sampling from the same tissue was performed during continuous isotope infusion (0.16 μmol/kg min). Isotopic enrichments were determined at baseline and after a 4‐hour infusion of amino acids or after infusion of saline (control group). Results: Compared with baseline, infusion of amino acids reduced fractional colon protein synthesis significantly by –29.2± 8.3%. This decrease was also significantly different from the corresponding (insignificant) change during saline infusion (+19.4 ± 26.9%, p < .05 vs amino acid group). Conclusions: After surgery, an amino acid infusion acutely reduces postoperative colon protein synthesis. This effect possibly may be attributed to interactions of specific amino acids (glutamine) with an altered intestinal immune system and enterocyte activity.
Effects of Parenteral Nutrition Supplemented with Alanyl‐Glutamine on Nutrition Status in Rats
Authors: de Urbina Juan J. Ortíz , Jorquera Francisco , Culebras Jesús M. , Villares Carmen , González‐Gallego Javier , Tuñón María J.
Published: May 2008

Background: Glutamine, a nonessential amino acid, has received increasing attention because it becomes essential during stress and catabolic conditions. Many investigations have shown that during severe stress, the consumption of glutamine exceeds glutamine synthesis, resulting in depletion of glutamine stores. The aim of this study was to evaluate the effects of supplementing parenteral diets with a glutamine‐containing dipeptide, L‐alanyl‐l‐glutamine, on rat nutrition status. Methods: Male Wistar rats were used. Animals (n = 36) were centrally catheterized and randomly assigned to 1 of the following groups based on method of parenteral nutrition (PN): control group with oral nutrition and IV infusion of a saline solution; standard parenteral nutrition (SPN) group; or alanyl‐glutamine‐supplemented PN (ALA‐GLN PN) group (20 g/L). Parenteral nutrition was isocaloric and isonitrogenous. Infusions were administered at a rate of 2.0 mL/h over 5 days. Nutrition status was assessed by body weight change, plasma proteins, accumulated urinary creatinine, and nitrogen balance. Results: Accumulated urinary creatinine increased significantly after day 4 in the ALA‐GLN PN group, compared with the SPN group and the controls. Body weight change significantly differed on day 5 between the ALA‐GLN PN and SPN groups. After 3 days, nitrogen balance was significantly lower and nitrogen retention higher in the ALA‐GLN PN group when compared with the SPN group. Albumin and transferrin concentrations decreased significantly in the SPN group, but did not differ from the controls in the ALA‐GLN PN group. Conclusions: Weight, plasma proteins, urinary accumulated creatinine, and nitrogen retention showed a better evolution in the group supplemented with the glutamine dipeptide when compared with the SPN group. Our results suggest a more suitable nutrition support in animals receiving L‐alanyl‐l‐glutamine.
Preoperative Fasting: An Outdated Concept?
Authors: Diks J. , van Hoorn D.E.C. , Nijveldt R.J. , Boelens P.G. , Hofman Z. , Bouritius H. , van Norren Klaske , van Leeuwen P.A.M.
Published: May 2008

Recent studies have shown that fasting during the preoperative period for elective surgery induces a metabolic state that seems unfavorable for patients. Results from animal studies indicate that rapid depletion of liver glycogen before surgery leads to mobilization of muscle glycogen after surgery, in turn leading to reduced muscle strength. Depletion of liver glycogen also influences the function of the mononuclear phagocytic system (MPS), which is located predominantly in the liver. The MPS is essential in restricting endotoxin, which may translocate from the gut. In addition, surgery per se puts a substantial physical strain on the patient, and fasting may adversely affect the metabolic response to surgery. This paper presents experimental and clinical data that, when combined together, prove that fasting before surgery has adverse consequences for the patient.
Dietary Supplementation With Orotate and Uracil Increases Adaptive Growth of Jejunal Mucosa After Massive Small Bowel Resection in Rats
Authors: Evans Mary E. , Tian Junqiang , Gu Li H. , Jones Dean P. , Ziegler Thomas R.
Published: May 2008

Background: Massive small‐bowel resection (SBR) increases adaptive growth of residual intestine in animal models of short‐bowel syndrome (SBS). Pyrimidine nucleotides are critical for DNA and RNA synthesis, but no previous study has evaluated whether supplementation of pyrimidines or their precursors in the diet enhances adaptive gut growth after SBR. This study determined growth responses in jejunal mucosa after 7 days of dietary supplementation with uracil, or its precursor, orotate, after massive SBR in rats. Methods: Sprague‐Dawley rats (∼200 g) underwent 80% jejunoileal resection (RX) or ileal transection (TX; control). Rats were pair‐fed a purified (AIN‐93G) powdered diet supplemented with or without 1% (wt/wt) orotate or uracil until killing at 7 days postsurgery. Defined jejunal segments were obtained for analysis of mucosal villus height (VH), crypt depth (CD), total mucosal height, bromodeoxyuridine (BrdU) incorporation, an index of cell proliferation, and full‐thickness DNA and protein content as measures of intestinal adaptive growth. Results: Jejunal VH increased significantly with SBR, as expected, and orotate further stimulated this response. Jejunal CD and total mucosal height increased significantly with both orotate and uracil supplementation compared with resected animals receiving standard diet. Orotate administration also increased jejunal DNA content compared with the increase observed with SBR alone. Finally, orotate, but not uracil, supplementation increased BrdU incorporation compared with resected rats fed standard or uracil‐supplemented diet after SBR. Conclusions: Supplementation of oral diet with the pyrimidine precursor orotate and uracil stimulated adaptive jejunal growth after massive SBR in rats. Dietary orotate had more potent growth‐stimulatory effects than uracil in this animal model. Dietary supplementation with orotate and uracil represents a novel nutrition approach to enhance small‐bowel mucosal adaptive growth and absorptive capacity in SBS.
Improved Care and Reduced Costs for Patients Requiring Peripherally Inserted Central Catheters: the Role of Bedside Ultrasound and a Dedicated Team
Authors: Robinson Malcolm K. , Mogensen Kris M. , Grudinskas Gina F. , Kohler Sharon , Jacobs Danny O.
Published: May 2008

Background: We conducted a prospective quality assurance (QA) study to determine if a team dedicated to placing peripherally inserted central catheters (PICCs) would improve patient care and reduce costs. Methods: In April 2000, a dedicated team of physicians, physician assistants, nurses, and interventional radiologists (IR) was established to coordinate and approve all PICC placements at our hospital. Ultrasound (US) became available in November 2000 to assist with bedside PICC placement. A QA database was created allowing data from 3 time periods reflecting initiation of the PICC service (April–June 2000), initial implementation of bedside US‐guided PICC placement (October–December 2000), and the current service (October–December 2002) to be analyzed and compared. Results: For all time periods analyzed, the PICC team found that one‐third of PICC requests was inappropriate and, therefore, disapproved placement. With addition of US, the bedside PICC placement rate increased to 94% compared with 73% at service initiation. This was associated with an overall 80% decrease in average patient waiting time for a PICC, facilitating more timely discharges from the hospital. Finally, placement costs were reduced by 9% six months after initiation of our service and by 24% after US became available. Conclusions: A dedicated PICC team improves patient care by preventing inappropriate PICC placements and decreasing patient waiting times. A PICC team with US capability also reduces costs by minimizing expensive use of IR facilities and reducing hospital lengths of stay. A dedicated PICC service should become the standard of care for all hospitals with high‐volume PICC use.
Do pH and Temperature Play a Role in Gastrostomy Tube Deterioration?
Authors: Roorda Andrew K. , Rider Dean L. , Rider J. Alfred , Conroy Brigitte F.
Published: May 2008

The effects of pH and temperature over time on percutaneous endoscopic gastrostomy (PEG) tube longevity were examined in an in vitro model. Two sets of tubes were obtained from 7 major US PEG manufacturers. Using scissors, each PEG tube was cut cross‐sectionally 8 cm from the bumper end of the tube. Both qualitative (photographs) and quantitative (mass) measurements were taken at baseline. Median physiologic gastric acidity was approximated by completely submerging 1 set of each cut PEG tube in a 250‐mL glass jar containing a 0.050‐N (pH 1.3) solution of hydrochloric acid. As a control, another set of each PEG tube was completely submerged in a 250‐mL glass jar containing a buffer solution of pH 6. Each jar was then submerged in the waterbath so that the water completely covered the tube but did not enter the jar. The waterbath was covered and maintained at a constant temperature of 37°C. Measurements taken at baseline were repeated at 168 days and again at 375 days. On qualitative examination, no dilations, brittleness, obstruction, nodularity, tears, loss of elasticity, color changes, tube fracturing, kinking, loss of resilience, or variation in external diameter was observed. Quantitative examination showed no change in mass. Tubes removed from the pH 1.3 solution appeared identical to the tubes removed from the pH 6 solution. In all cases, there were no apparent changes from baseline. These findings suggest that temperature and pH can be excluded as predominant factors in tube deterioration and lend further support to a microbial hypothesis of PEG tube deterioration.
A Randomized Controlled Trial Comparing Three Different Techniques of Nasojejunal Feeding Tube Placement in Critically Ill Children
Authors: Phipps Lorri M. , Weber Mark D. , Ginder Beth R. , Hulse Michael A. , Thomas Neal J.
Published: May 2008

Background: The goal of this study was to compare 3 different techniques used to place nasojejunal (NJ) feeding tubes in the critically ill or injured pediatric patients. This was a randomized, prospective trial in a university‐affiliated 12‐bed pediatric intensive care unit. Patients were critically ill children requiring placement of an NJ feeding tube. Patient age, weight, medications, use of mechanical ventilation, and patient tolerance were recorded. An abdominal radiograph obtained immediately after the placement determined correct placement. The final placement was recorded, as was the number of placement attempts. Methods: Patients were randomized to 1 of 3 groups: standard technique, standard technique facilitated with gastric insufflation, and standard technique facilitated with the use of preinsertion erythromycin. To ensure equal distribution, all patients were stratified by weight (<10 kg vs ≥10 kg) before randomization. All NJ tubes were placed by one of the investigators. If unsuccessful, a second attempt by the same investigator was allowed. Successful placement of the NJ tube was defined by confirmation of the tip of the tube in the first part of the duodenum or beyond by a pediatric radiologist blinded to the treatment groups. Results: Seventy‐five pediatric patients were enrolled in the study; 94.6% (71/75) of tubes were passed successfully into the small bowel on the first or second attempt. Evaluation of the data revealed no significant association with a specific technique and successful placement (p = .1999). Conclusions: When placed by a core group of experienced operators, the majority of NJ feeding tubes can be placed in critically ill or injured children on the first or second attempt, regardless of the technique used.
Central Venous Access in the Home Parenteral Nutrition Population–You PICC
Authors: DeLegge Mark H. , Borak Gregory , Moore Nicole
Published: May 2008

Background: Central venous access is imperative for the delivery of home parenteral nutrition (HPN). Peripherally inserted central catheters (PICC) are being used more frequently for the delivery of HPN. There is an abundance of short‐term information on the use of PICC in the hospitalized patient. However, there are no data comparing the use of PICC to other central venous access devices (OCVAD; Hickman, port) for the delivery of HPN. Catheter‐related infections (CRI) are the most common cause of hospital readmission for the HPN patients. Methods: A retrospective analysis was performed from the Digestive Disease Center HPN database at the Medical University of South Carolina and the open architecture clinical information system (OACIS) hospital and clinic reporting system. All CRI were analyzed and compared between patients with PICC and OCVAD. The PICC group and the OCVAD group were further broken down into diabetic patients and nondiabetic patients, and the incidence of CRI was compared within those groups. Results: HPN patients with PICC had a statistically significant increase (p < .01) of CRI as compared with OCVAD within our HPN patients. There was no statistically significant increase in CRI between diabetic and nondiabetic patients. Conclusions: The use of PICC for HPN may be associated with an increase in CRI. A prospective, randomized trial in the HPN population between PICC and OCVAD must be performed.
Evaluation of an Artificial Neural Network to Predict Urea Nitrogen Appearance for Critically Ill Multiple‐Trauma Patients
Authors: Dickerson Roland N. , Mason Darius L. , Croce Martin A. , Minard Gayle , Brown Rex O.
Published: May 2008

Background: Computer‐based simulated biologic neural network models have made significant strides in clinical medicine. Methods: To determine the predictive performance of a conventional regression model and an artificial neural network for estimating urea nitrogen appearance (UNA) during critical illness, 125 adult patients admitted to the trauma intensive care unit who required specialized nutrition support were studied. The first 100 consecutive patients were used to develop the 2 models. The first model used stepwise multivariate regression analysis. The second model entailed the use of a feeding‐forward, back‐propagation, supervised neural network. Bias and precision of both methods were evaluated in 25 separate patients. Results: Multivariate regression analysis revealed a significant highly correlative relationship (r 2 = .918, p≤ .01): Predicted UNA (g/d) = (0.29 × WT) + (1.20 × WBC) + (0.44 × SUN) with WT as current body weight in kg, WBC as white blood cell count in cells/mm3, and SUN as serum urea nitrogen concentration (mg/dL). The regression method was biased toward overestimating measured UNA, whereas the neural network was unbiased. Precision (95% confidence interval) of the neural network was significantly better than the regression (3.3–7.2 g vs 7.3–11.6 g, respectively, p < .01). Regression analysis successfully predicted UNA within 3 g of measured UNA in 16% (4 of 25) of patients, whereas the neural network successfully predicted UNA in 44% (11 out of 25) of patients (p < .06). Conclusions: These preliminary data indicate that use of an artificial neural network may be superior to conventional regression modeling techniques for estimating UNA in critically ill adult multiple‐trauma patients receiving specialized nutrition support.
Treatment of Acute Hypocalcemia in Critically Ill Multiple‐Trauma Patients
Authors: Dickerson Roland N. , Morgan Laurie G. , Cauthen April D. , Alexander Kathryn H. , Croce Martin A. , Minard Gayle , Brown Rex O.
Published: May 2008

Background: Recent data indicate that critically ill, adult multiple trauma patients receiving specialized nutrition support commonly experience hypocalcemia (ionized serum calcium [iCa] ≤1.12 mmol/L). However, validated methods for the treatment of acute hypocalcemia are lacking. Methods: The efficacy of a single dose of calcium gluconate using an empiric IV calcium gluconate graduated dosing regimen was evaluated in 37 patients. Patients with an iCa of 1–1.12 mmol/L (mild hypocalcemia) were provided 1–2 g of IV calcium gluconate. Patients with an iCa of <1 mmol/L (moderate to severe hypocalcemia) were given 2–4 g. The calcium gluconate was infused at a rate of 1 g/h in a small‐volume admixture. Serum iCa determination was repeated on the following day. Results: One to 2 g of IV calcium gluconate was effective in normalizing iCa for 23 out of 29 patients (79%) with mild hypocalcemia and 2–4 g was effective for 3 of 8 patients (38%) with moderate to severe hypocalcemia. The individual response to calcium therapy (g/d) or when normalized to body weight (mg/kg/d) was highly variable. Conclusions: One to 2 g of IV calcium gluconate were effective for most patients with mild hypocalcemia; however, treatment of moderate to severe hypocalcemia with 2–4 g of IV calcium gluconate was often unsuccessful. Further study with frequent serial ionized serum calcium and phosphorus determinations and electrocardiographic monitoring appears to be indicated for patients with moderate to severe hypocalcemia.