bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Administration of Different Intravenous Lipid Emulsions on Plasma LP‐X Concentrations in the Rat
Authors: Tomsits Erika , Rischák Katalin , Molnár Miklós , Filiczky István , Szollár Lajos
Published: May 2008

Background: Prolonged parenteral nutrition with lipid emulsions is essential to provide sufficient energy supply and to avoid essential fatty acid deficiency in preterm infants. However, chronic administration of lipid emulsions may lead to the development of pathological plasma lipid and LP‐X concentrations. The aim of this study was to evaluate the relative importance of the phospholipid‐triglyceride (PL‐TG) ratio and the source of phospholipid in lipid emulsions, with respect to plasma lipid and LP‐X levels. Methods: Rats were infused for 9 days with IV lipid emulsion containing 10% (IL‐10) or 20% (IL‐20) egg lecithin or Lipofundin containing 20% soya lecithin (LF), with PL‐TG ratios of.12,.06, and.075, respectively. Results: LF significantly increased plasma triglyceride concentration (p <.01), whereas the rise in cholesterol levels observed with all emulsions was primarily caused by the increase in low‐density lipoprotein cholesterol concentrations. The plasma phospholipid concentration was increased most by IL‐10 (p <.005). There was a strong correlation between the PL‐TG ratio of emulsions and the developing plasma phospholipid and LP‐X concentrations (r2 =.91 and.96, respectively), despite the different origin of phospholipids in the emulsions, suggesting that it is the PL‐TG ratio, rather than the source of phospholipids in lipid emulsions that primarily influences developing plasma lipid and LP‐X concentrations. Conclusion: These results indicate that the administration of lipid emulsions with lower PL‐TG ratios should be considered, to avoid the development of pathological plasma lipoprotein concentrations. (Journal of Parenteral and Enteral Nutrition 19:369–372, 1995)
Early Nutrition Support Modifies Immune Function in Patients Sustaining Severe Head Injury
Authors: Sacks Gordon S. , Brown Rex O. , Teague Debbie , Dickerson Roland N. , Tolley Elizabeth A. , Kudsk Kenneth A.
Published: May 2008

Background: Immunosuppression after severe head injury has been characterized by a depressed CD4 (T‐helper/inducer)‐CD8 (T‐suppressor/cytotoxic) ratio and decreased T‐lymphocyte responsiveness. Some investigators propose that this immunocompromized state is the result of an injury‐associated hypermetabolic response and inadequate nutrient delivery during the immediate postinjury recovery phase. Previous observations from our institution demonstrated a preserved CD4‐CD8 ratio in severe closed‐head injury (CHI) patients receiving early parenteral nutrition (PN). It was unclear whether early PN or other aspects of patient care eliminated the characteristic depression in cellular immunity. The purpose of this study was to further investigate the effect of early PN on the immune function of CHI patients. Methods: Nine patients sustaining severe CHI were prospectively randomized to either early PN (n = 4) at day 1 or delayed PN (n = 5) at day 5. Total nutrient administration was delivered at 2 g of protein/kg per day and 40 nonprotein kcal/kg per day for at least the first 14 days of hospitalization. Analysis for T‐lymphocyte expression of CD4 and CD8 cell surface antigens and interleukin‐6 was performed on days 1, 3, 7, and 14 of hospitalization. T‐lymphocyte activation in response to stimulation by concanavalin A (Con A), phytohemagglutinin (PHA), and pokeweed mitogens (PWM) was also assessed on these days. Results: Significant increases in total CD4 cell counts (2048 ± 194 to 2809 ± 129 vs 1728 ± 347 to 1825 ± 563, p <.05) and CD4% (42.6 ± 4.4% to 56.2 ± 2.6% vs 36.6 ± 6.6% to 36.6 ± 11.3%, p <.05) were observed at day 14 in patients receiving early vs delayed PN. An improved lymphocyte response from baseline to day 14 after Con A stimulation was demonstrated in the early PN group (3850 ± 1596 to 16144 ± 5024 cpm, p <.05). A significant rise in the CD4‐CD8 ratio over baseline to day 14 was also noted in the early PN group (1.43 ± 0.17 to 2.38 ± 0.54, p <.05). Conclusions: The early aggressive nutrition support of CHI patients appears to modify immunologic function by increasing CD4 cells, CD4‐CD8 ratios, and T‐lymphocyte responsiveness to Con A. (Journal of Parenteral and Enteral Nutrition 19:387–392, 1995)
Treatment of Central Venous Catheter Occlusions With Ethanol and Hydrochloric Acid
Authors: Werlin Steven L. , Lausten Thomas , Jessen Suzanne , Toy Lisa , Norton Ann , Dallman Lori , Bender Julie , Sabilan Lillian , Rutkowski Diane
Published: May 2008

Background: Occluded central venous lines (CVLs) is a major problem in pediatric patients. Methods: To relieve obstructed catheters, infusions of ethanol (up to 3 mL of a 70% solution) for presumed lipid occlusions and hydrochloric acid (HCl, 0.1 N, up to 3 mL) for presumed mineral and drug precipitates were given in an attempt to relieve obstructed catheters. Results: Patency was restored in 34 of 39 occluded catheters over an 18‐month period. Conclusions: Clearing occluded CVLs with ethanol and HCl is not only beneficial to the patient but also offers considerable cost savings compared to CVL replacement. (Journal of Parenteral and Enteral Nutrition 19:416–418, 1995)
Early Enteral Nutrition Support in Patients Undergoing Liver Transplantation
Authors: Hasse Jeanette M. , Blue Linda S. , Liepa George U. , Goldstein Robert M. , Jennings Linda W. , Mor Eytan , Husberg Bo S. , Levy Marlon F. , Gonwa Thomas A. , Klintmalm Goran B.
Published: May 2008

Background: The purpose of this study was to determine the effects of early postoperative tube feeding on outcomes of liver transplant recipients. Methods: Fifty transplant patients were randomized prospectively to receive enteral formula via nasointestinal feeding tubes (tube‐feeding [TF] group) or maintenance IV fluid until oral diets were initiated (control group). Thirty‐one patients completed the study. Resting energy expenditure, nitrogen balance, and grip strength were measured on days 2, 4, 7, and 12 after liver transplantation. Calorie and protein intakes were calculated for 12 days posttransplant. Results: Tube feeding was tolerated in the TF group (n = 14). The TF patients had greater cumulative 12‐day nutrient intakes (22,464 ± 3554 kcal, 927 ± 122 g protein) than did the control patients (15,474 ± 5265 kcal, 637 ± 248 g protein) (p <.002). Nitrogen balance was better in the TF group on posttransplant day 4 than in the control group (p <.03). There was a rise in the overall mean resting energy expenditure in the first two posttransplant weeks from 1487 ± 338 to 1990 ± 367 kcal (p =.0002). Viral infections occurred in 17.7% of control patients compared with 0% of TF patients (p =.05). Although other infections tended to occur more frequently in the control group vs the TF group (bacterial, 29.4% vs 14.3%; overall infections, 47.1% vs 21.4%), these differences were not statistically significant. Early posttransplant tube feeding did not influence hospitalization costs, hours on the ventilator, lengths of stay in the intensive care unit and hospital, rehospitalizations, or rejection during the first 21 posttransplant days. Conclusions: Early posttransplant tube feeding was tolerated and promoted improvements in some outcomes and should be considered for all liver transplant patients. (Journal of Parenteral and Enteral Nutrition 19:437–443, 1995)
Insulin‐Like Growth Factor‐I Enhances Immune Response in Dexamethasone‐Treated or Surgically Stressed Rats Maintained With Total Parenteral Nutrition
Authors: Hinton Pamela S. , Peterson Catherine A. , Lo Hui‐Chen , Huan Yang  , Mccarthy Donna , Ney Denise M.
Published: May 2008

Background: New evidence suggests that insulin‐like growth factor‐I (IGF‐I) is an important regulator of immune response. Our objective was to determine the effects of IGF‐I on immune response during total parenteral nutrition (TPN) using two stress models. Methods: Male, Sprague‐Dawley rats (230 to 250 g) were given TPN with or without coinfusion of recombinant human IGF‐I (800 μg/d for 6 days) and subjected to either dexamethasone, a synthetic glucocorticoid, or surgical stress, in the form of a midline abdominal incision. In the dexamethasone model, immune response was assessed by total cellularity of the thymus and spleen, in vitro assays of lymphocyte proliferation, and interleukin 6 (IL‐6) production, and concentrations of IL‐6 and tumor necrosis factor α (TNF‐α) in serum. In the surgical model, flow cytometry was used to identify and quantify splenic populations of T and B lymphocytes and macrophages. Results: In rats immunosuppressed by dexamethasone, IGF‐I infusion increased mitogen‐induced proliferation of thymocytes, but did not alter cellularity in the thymus; enhanced proliferation and IL‐6 production in peripheral blood mononuclear cells following treatment with concanavalin A or lipopolysaccharide; and reduced the serum concentration of IL‐6, but not TNF‐α. In surgically stressed rats, IGF‐I infusion restored the splenic populations of immature and mature B lymphocytes, which were decreased by TPN. Conclusions: Our data demonstrate that IGF‐I enhances immune response during TPN in rats. (Journal of Parenteral and Enteral Nutrition 19:444–452, 1995)
Dietary Long‐Chain Polyunsaturated Fatty Acids Influence the Recovery of Thioacetamide‐Induced Liver Cirrhosis in Rats
Authors: Moreira Eliane , Fontana Luis , Torres María Isabel , Fernández Isabel , Ríos Antonio , Sánchez de Medina Fermín , Gil Ángel
Published: May 2008

Background: The aim of this study was to evaluate the dietary supplementation with ω‐3 and ω‐6 long‐chain polyunsaturated fatty acids on the fatty acid composition of plasma and red blood cell membranes in rats with thioacetamide‐induced liver cirrhosis. Methods: Thirty‐eight female Wistar rats were given 300 mg thioacetamide/L in drinking water for 4 months to induce the experimental liver cirrhosis. Sixteen rats were used as controls. After treatment with thioacetamide, nine rats of each group were killed. Then, thioacetamide‐treated rats were divided into three new groups, each receiving a different diet for 2 weeks: a semipurified diet (n = 9), the same diet supplemented with ω‐3 long‐chain polyunsaturated fatty acids (n = 10), or the same semipurified diet supplemented with ω‐3 and ω‐6 long‐chain polyunsaturated fatty acids simultaneously (n = 10). The remaining control rats were fed the semipurified diet. Liver histology and plasma and erythrocyte fatty acid composition were assessed. Results: An apparent improvement of the histological damage took place in the rats fed the ω‐3+ ω‐6 ‐supplemented diet. The diet supplemented with polyunsaturated fatty acids of the ω‐3 series induced increases in the ω‐3 long‐chain polyunsaturated fatty acid levels in total plasma lipids, plasma lipid fractions and in erythrocyte phospholipids, and decreases in ω‐6 long‐chain polyunsaturated fatty acids in erythrocyte phospholipids during the recovery of rats with thioacetamide‐induced liver cirrhosis. The administration of the diet supplemented with both ω‐3 and ω‐6 long‐chain polyunsaturated fatty acids contributed to increase the levels of total plasma saturated, monounsaturated, and ω‐6 long‐chain polyunsaturated fatty acids from cirrhotic rats. Conclusion: We conclude that the simultaneous supply of long‐chain fatty acids of the ω‐3 and the ω‐6 series can be beneficial to improve the fatty acid status of this experimental model of liver cirrhosis. (Journal of Parenteral and Enteral Nutrition 19:461–469, 1995)
Effect of Glutamine Supplementation on Protein Metabolism and Glutathione in Tumor‐Bearing Rats
Authors: Yoshida Shogo , Kaibara Atsushi , Yamasaki Kokushi , Ishibashi Nobuya , Noake Toshihiro , Kakegawa Teruo
Published: May 2008

Background: Since tumor‐bearing rats are deficient in glutamine, we investigated whether (1) glutamine and glutathione deficiency occur in tumor‐bearing rats, (2) glutamine supplementation caused an increase of glutathione levels in host tissues and tumor, (3) glutamine enhances protein synthesis in host tissues, and (4) glutamine stimulated the tumor to synthesize protein and DNA. Methods: Male Donryu rats were randomized into four groups: (1) non‐tumor‐bearing rat (NTB) + standard total parenteral nutrition (STPN); (2) NTB + glutamine‐supplemented TPN (GTPN); (3) tumor‐bearing rat (TB)+STPN; (4) TB+GTPN. On day 0 AH109A rat hepatoma cells were subcutaneously injected into the backs of rats to induce tumor. The animals were maintained on TPN for 6 days from day 10 through day 15. On day 15, 1‐14C‐leucine was given by a 5‐hour continuous infusion (2.0 μ‐Ci/h per rat) to determine the fractional synthesis rate and endogenous leucine production. The levels of glutamine and glutathione were measured by HPLC. The tumor DNA synthesis was estimated by bromodeoxyuridine labeling index. Results: Tumor development led to a significant weight loss, but this weight loss was significantly lessened by glutamine supplementation because of an increase in muscle protein synthesis. Glutamine did not enhance tumor weight, protein, and DNA synthesis in the tumor. Tumor development caused a significant reduction of glutathione in the muscle, jejunum, and liver, but supplemented glutamine increased the levels of glutathione in the jejunum. Conclusion: Glutamine supplementation is beneficial in preventing deficiencies of glutamine and glutathione and in improving protein metabolism in tumor‐bearing rats. (Journal of Parenteral and Enteral Nutrition 19:492–497, 1995)
Do Heparin, Hydrocortisone, and Glyceryl Trinitrate Influence Thrombophlebitis During Full Intravenous Nutrition via a Peripheral Vein?
Authors: Tighe M.J. , Wong C. , Martin I.G. , McMahon M.J.
Published: May 2008

The aim of this prospective, randomized study was to determine if the addition of heparin and hydrocortisone, and the application of a topical glyceryl trinitrate patch over the catheter site (triple therapy) would result in a reduced incidence of thrombophlebitis during IV nutrition through a peripheral vein. Forty‐six patients were randomized to receive either standard IV nutrition (IVN) (1200 mosm/kg) (control group, n = 23), or IVN plus triple therapy (study group, n = 23). The patient's arm was examined daily, and the catheter was removed if signs of thrombophlebitis were evident. The two groups were well matched in terms of age and gender, as well as indication for feeding and total days of IVN supplied. The catheters in the study group survived longer (p <.0001), and resulted in a lower incidence of thrombophlebitis (p <.05). The time of onset of thrombophlebitis was delayed in the study group (p <.0001). It is recommended that heparin, hydrocortisone, and a glyceryl trinitrate patch should be administered to all patients receiving IV nutrition via a fine‐bore peripheral catheter. (Journal of Parenteral and Enteral Nutrition 19:507–509, 1995)
Substrate Metabolism in Humans: 1995 A.S.P.E.N. Research Workshop
Authors: Klein Samuel , Miles John
Published: May 2008

Background: The 1995 A.S.P.E.N. Research Workshop was held at the annual meeting in Miami Beach, Florida, on January 15, 1995. The workshop focused on substrate metabolism in humans. Methods: State‐of‐the‐art presentations on the regulation of energy, carbohydrate, lipid, and protein metabolism during health and disease were made by the preeminant leaders in the field. The presentations concentrated on in vivo studies performed in humans and included both recently published and unpublished data. Results: Using sophisticated research methodology, such as nuclear magnetic resonance spectroscopy, compartmental modeling, stable isotope tracers, microdialysis, and abdominal vein catheterization, the investigators presented data that clarified unresolved issues, challenged many previously held dogmas, and raised new questions for future investigation in human intermediary metabolism. Conclusions: This workshop demonstrated that in vivo investigation remains the best approach for providing physiologically relevant data in humans. An understanding of normal human physiology and the metabolic alterations caused by disease is critical for optimal nutritional and metabolic management of patients. (Journal of Parenteral and Enteral Nutrition 20:13–19, 1996)
Plasma Clearance and Oxidation of Dodecanedioic Acid in Humans
Authors: Mingrone Geltrude , De Gaetano Andrea , Greco Aldo V. , Benedetti Giuseeppe , Capristo Esmeralda , Castagneto Marco , Gasbarrini Giovanni
Published: May 2008

Background : Dicarboxylic acids are water‐soluble, contrary to monocarboxylic acids, and have a metabolic pathway intermediate between those of lipids and carbohydrates. Our goal was to investigate the plasma turnover and oxidation rate of dodecanedioic acid (C12) in eight healthy male volunteers. Methods: A simultaneous infusion of both cold (0.24 mmol/ min corresponding to 0.396 kcal/min) and radiolabeled (1.62 μCi/min) C12 free acid was performed. Blood specimens were sampled over a period of 360 minutes, and 24‐hour urine samples were collected to measure the levels of C12 by high‐performance liquid chromatography and liquid scintillation. Indirect calorimetry was continuously performed, and expired 14CO2 was collected. Binding of C12 in human plasma was determined in separate experiments using equilibrium dialysis. Results:A linear one‐compartment model was used to describe the kinetics of labeled C12. Its volume of distribution was 139.02 ± 10.84 mL/kgbw (mean ± SE), and its plasma elimination constant was 0.01 ± 0.004 min−1. The 24‐hour urinary excretion of C12 was 3.14 ± 0.96 mmol, corresponding to about 7% of the administered dose. The amount of C12 oxidized, expressed as percent oxidation, was equal to 35.44 ± 1.64%. The mean basal value of npRQ (0.80 ± 0.006) significantly (p <.02) decreased during the infusion to 0.78 ± 0.01, which is a value close to that theoretically calculated (0.77). The oxidation of free fatty acids was significantly increased at the end of the C12 infusion, whereas the glucose oxidation was reduced to about 50%. Conclusions: The experimental data suggest that C12 might represent a fuel substrate immediately available for tissue energy requirements, because a relevant amount of C 12 is promptly oxidized. Its prompt oxidation and its conversion to succinic acid support the use of dodecanedioic acid in parenteral nutrition, especially in insulin‐resistance conditions in which glucose uptake and oxidation is impaired. (Journal of Parenteral and Enteral Nutrition 20:38–42, 1996)
Dietary Fish Oil and Cytokine and Eicosanoid Production During Human Immunodeficiency Virus Infection
Authors: Bell Stacey J. , Chavali Sambasiva , Bistrian Bruce R. , Connolly Christine Apour , Utsunomiya Tohru , Forse R. Armour
Published: May 2008

Background : Dietary fish oil (FO) has been shown to modulate the immune system. The purpose of this study was to explore the effects of FO supplementation on the production of dienoic eicosanoids and cytokines in patients with human immunodeficiency virus (HIV) infection. Methods: This was a randomized, prospective, double‐blind study that included homosexual males with HIV infection. Patients were asked to consume voluntarily five food bars daily containing FO (n = 10) or safflower oil (SO) (n = 9) for 6 weeks. At baseline and week 6, plasma was obtained to measure incorporation of ω‐3 fatty acids. At baseline, week 3, and week 6, measurements were made of changes in dienoic eicosanoids and cytokines from lipopolysaccharide (LPS)‐stimulated peripheral blood mononuclear cells (PBMC) or spontaneously releasing cells. Results: In the FO group but not the SO group, there was increased incorporation of the ω‐3 fatty acid docosahexaenoic acid (DHA) into the phospholipids of the fatty acids of the plasma. In the FO group, there was a significant decrease (p =.01) in 6‐keto prostaglandin (PG) F1α released from PBMC. There was a significant increase (p =.01) in interleukin (IL)‐6 released from the PBMC in the FO group between baseline and week 3 and between week 3 and week 6. At week 6, there was significantly more IL‐6 (p =.01) released from the PBMC in the FO group compared with the SO group. There was no change in CD4 cell counts by analysis of variance. Conclusions: The FO‐containing food bars were well tolerated and allowed incorporation of ω‐3 fatty acids to occur. Despite evidence of significant metabolic effects on eicosanoid and cytokine production, widespread clinical use of FO for HIV‐infected patients is not warranted without further study, particularly given the trend toward a decline in CD4 cell numbers at this dose and with this type of fish oil. (Journal of Parenteral and Enteral Nutrition 20:43–49, 1996)
The Solubility of Calcium and Phosphate in Two Specialty Amino Acid Solutions
Authors: Mackay Mark W. , Fitzgerald Kristie A. , Jackson Daniel
Published: May 2008

Background: The purpose of this study was to determine precipitation limits and construct curves for calcium and phosphorus in parenteral nutrition solutions compounded with specialty amino acid solutions. Methods: The effect of temperature, concentration of amino acids, and pH on the solubility of calcium and phosphate was studied for two specialized amino acid solutions: NephrAmine and HepatAmine. Ten amino acid solutions were manufactured with NephrAmine and 12 with HepatAmine at amino acid concentrations of 0.8%, 1.5%, and 2%. The fmal dextrose concentration was 10%. Some of the solutions were tested with the additive cysteine hydrochloride, 40 mg cysteine/g of protein, and some were buffered with sodium bicarbonate or hydrochloric acid to model the pH of a combined fat emulsion and total parenteral nutrient (TPN) solution. Calcium gluconate and potassium phosphate were added to test samples of each TPN solution. A range of calcium concentrations of 2.5 to 40 mEq/L and phosphate concentrations of 2.5 to 40 mmol/L were tested. After storage at room temperature (25°C) for 18 hours, solutions were inspected for precipitation. At the end of the 18‐hour period, the solutions were held in a water bath at 37°C for 30 minutes and inspected for precipitation and microcrystallization. Results: Solubility curves were plotted to represent Ca‐PO4 solubility limits before visual or microscopic precipitation. These curves depend on the variables of time, temperature, concentration, and pH. Conclusions: These data and graphs will help the clinical pharmacist estimate Ca‐PO4 solubility limits and prevent precipitation of TPN solutions formulated with NephrAmine or Hepatamine. (Journal of Parenteral and Enteral Nutrition 20:63–66, 1996)
The Effects of Glutamine‐Supplemented Parenteral Nutrition in Premature Infants
Authors: Lacey Janet M. , Crouch Jean B. , Benfell Kathleen , Ringer Steven A. , Wilmore C. Kristann , Maguire Donnamarie , Wilmore Douglas W.
Published: May 2008

Background: Glutamine (GLN) is the primary fuel for rapidly dividing cells, yet it is not a constituent of parenteral nutritional formulas administered to newborns. The aims of this prospective, randomized, double‐blind trial were (1) to confirm the safety of glutamine supplementation for premature infants and (2) to examine the effects of glutamine‐supplemented parenteral nutrition on length of stay, days on total parenteral nutrition (TPN), days on the ventilator, and other clinical outcomes. Methods: Premature infants received either standard or glutamine‐supplemented TPN and were monitored throughout length of stay for various health and biochemical indices. The group was examined as a whole (n = 44; birth weight range: 530 to 1250 g) and in two weight subgroups, <800 and ≥800 g. Results: Serum ammonia, blood urea nitrogen, and glutamate tended to be higher in the GLN groups, but the levels were well within normal limits. In the <800‐g cohort (n = 24), glutamine‐supplemented infants required fewer days on TPN (13 vs 21 days, p =.02), had a shorter length of time to full feeds (8 vs 14 days, p =.03), and needed less time on the ventilator (38 vs 47 days, p =.04). There was a tendency toward a shorter length of stay in the NICU (73 vs 90 days, NS). These findings were not observed in the infants ≥800 g (n = 20). Conclusions: Glutamine appears to be safe for use in premature infants and seems to be conditionally essential in premature infants with extremely low birth weights. Larger multicenter trials are needed to confirm these observations and further evaluate the efficacy of GLN in these high‐risk premature infants. (Journal of Parenteral and Enteral Nutrition 20:74–80, 1996)
Glucose Response to Discontinuation of Parenteral Nutrition in Patients Less Than 3 Years of Age
Authors: Bendorf Kathy , Friesen Craig A. , Roberts Charles C.
Published: May 2008

Background: The effects of abrupt discontinuation and tapering of total parenteral nutrition (TPN) on glucose concentration were compared in patients < 3 years of age. Methods: Serial glucose concentrations were measured over 120 minutes after abrupt discontinuation as compared with tapering (decreasing infusion rate by 50% for 1 hour before discontinuation). Serial insulin concentrations were measured after abrupt discontinuation. Results: There was a significantly greater decrease in glucose concentration from baseline at 30 minutes after abrupt discontinuation as compared with tapering. Fifty‐five percent (6/11) of the patients developed hypoglycemia (glucose concentration < 40 mg/dL) after abrupt discontinuation. Age, glucose infusion rate, and serum insulin concentrations were not predictive of the development of hypoglycemia. The tapering regimen did not prevent hypoglycemia, which developed in 20% (2/ 10). Conclusion: The high incidence of hypoglycemia after TPN discontinuation in children < 3 years of age requires monitoring of serum glucose concentration when initiating intermittent TPN until tolerance is documented. (Journal of Parenteral and Enteral Nutrition 20:120–122, 1996)
Neurologic Symptoms Due to Possible Chromium Deficiency in Long‐Term Parenteral Nutrition That Closely Mimic Metronidazole‐Induced Syndromes
Authors: Verhage Albert H. , Cheong Wei K. , Jeejeebhoy Khursheed N.
Published: May 2008

Background:We previously described a patient on home parenteral nutrition (HPN) who developed glucose intolerance and neuropathy that only responded to an infusion of chromium. A patient on HPN who had neuropathy and glucose intolerance was studied. He was also on metronidazole, which could have caused the neuropathy, but the symptoms and signs persisted.Methods:Baseline clinical examination, nerve conduction studies, serum vitamin and trace element levels, and glucose tolerance were measured. Then, 250 μg of trivalent chromium as the chloride salt was infused daily for 2 weeks. The above studies were repeated.Results:The patient at baseline had peripheral neuropathy of the axonal type and was glucose intolerant. Serum chromium was raised in this patient above the reference range. Despite raised serum levels, the infusion of chromium resulted in clinical remission that was marked 4 days after starting the infusion. Normalization of nerve conduction also occurred within 3 weeks of the initial study.Conclusions:Neuropathy and glucose intolerance may occur despite increased serum chromium levels and respond to chromium infusion. The previous use of drugs such as metronidazole should not exclude chromium as a potential treatment for neuropathy in HPN patients.(journal of Parenteral and Enteral Nutrition20:123–127, 1996)
Muscle Protein Synthesis Rate Decreases 24 Hours After Abdominal Surgery Irrespective of Total Parenteral Nutrition
Authors: Tjäder I. , Essen P. , Thörne A. , Garlick P.J. , Wernerman J. , McNurlan M.A.
Published: May 2008

Background: Muscle protein synthesis rate is known to decrease postoperatively as a part of the catabolic response to trauma. Conventional total parenteral nutrition (TPN) in the postoperative period does not seem to counteract the decrease in protein synthesis. However, it is still unclear if ongoing TPN given continuously after surgery would inhibit this fall in muscle protein synthesis. Methods: The rate of protein synthesis in skeletal muscle was determined before and 24 hours after open cholecystectomy, used as a standardized human model of trauma. Patients (n = 14) were randomized to receive either TPN continuously throughout the postoperative period or saline as postoperative fluid therapy. The protein synthesis rate was calculated from the increase in enrichment of labeled phenylalanine in protein after an IV flooding dose of [2H5] phenylalanine, 45 mg/kg body weight. Results: The fractional synthesis rate decreased by 31% from 1.74 ± 0.13% to 1.15 ± 0.10% per 24 hours in the saline group (p <.02) and by 23% from 1.59 ± 0.10% to 1.22 ± 0.07% per 24 hours in the group receiving TPN (p <.01), showing no significant difference between the two groups. Conclusion: A continuous and ongoing infusion of conventional TPN started immediately after surgery did not counteract the obligatory decline of muscle protein synthesis, observed 24 hours postoperatively. (journal of Parenteral and Enteral Nutrition 20:135–138, 1996)
Overview of Randomized Clinical Trials of Oral Branched‐Chain Amino Acid Treatment in Chronic Hepatic Encephalopathy
Authors: Fabbri Andrea , Magrini Nicola , Bianchi Giampaolo , Zoli Marco , Marchesini Giulio
Published: May 2008

Background: The role of oral branched‐chain amino acid supplements in the prevention and treatment of chronic hepatic encephalopathy is not yet established, and conflicting opinions are expressed in authoritative textbooks. We aimed to review and pool the published controlled studies by means of meta‐analytical techniques. Methods: A computerized search of published papers identified nine studies, controlled against placebo, energy, alimentary proteins, or casein. Their quality score was calculated according to the protocol of Chalmers. The value of the portal‐systemic encephalopathy index was chosen as main outcome, because of lack of more significant clinical outcomes. To cope with differences in trial design and data presentation, individual data were requested to authors. Results: After 18 months, we received the individual data of only two studies, thus precluding any meta‐analysis. Two studies, accounting for over 60% of total enrolled patients, were in favor of branched‐chain amino acids. Their quality score was much better than that of the remaining seven negative small studies, carrying a significant risk of type II error. Conclusions: Based on the results of the two largest, long‐term studies, the use of oral branched‐chain amino acids in the prevention and treatment of chronic encephalopathy may only be proposed for patients with advanced cirrhosis, intolerant to alimentary proteins. Large, multicenter, long‐term studies, considering more important clinical outcomes, are needed to provide definite answers to an aged question. (journal of Parenteral and Enteral Nutrition 20:159–164, 1996)
High Osmolality Feedings Do Not Increase the Incidence of Thrombophlebitis During Peripheral IV Nutrition
Authors: Kane K.F. , Cologiovanni L. , Mckiernan J. , Panos M.Z. , Ayres R.C.S. , Langman M.J.S. , Lowes J.R.
Published: May 2008

Background: Peripheral IV nutrition has been advocated for patients who require short‐term IV nutrition support to avoid the complications and expense of central venous catheterization. Feeding formulas for peripheral administration have usually been modified by increasing the proportion of lipid, because increasing osmolality is reported to cause thrombophlebitis. The aim of this study was to determine whether standard feeding formulas can be given via the peripheral route and also to establish whether increasing osmolality does increase the incidence of thrombophlebitis under these conditions. Methods: Thirty‐six patients requiring parenteral nutrition were randomized to receive either a “high” (1700 mOsmol/L) or “standard” (1200 mOsmol/L) osmolality feeding containing 2000 kcal and 12 g nitrogen via a peripheral line. Results: Twenty patients (mean age 55.6 years, range 16 to 78) received standard osmolality feedings using 20 peripheral feeding lines for a mean duration of 6.8 days (range 2 to 16) with 10 line failures (8 thrombophlebitis, 2 occlusion). Nineteen patients (mean age 56.1 years, range 27 to 83) received high osmolality feedings via 20 lines for a mean of 6.3 days (range 0 to 18) with five line failures (4 thrombophlebitis, 1 occlusion), one failed insertion, one line removed at the patient's request, and four lines that fell out. Forty lines were inserted overall of which 19 (47.5%) were removed electively, 12 (30%) developed thrombophlebitis, 3 (7.5%) occluded, 4 (10%) fell out, 1 (2.5%) was a failed insertion, and 1 (2.5%) was removed for nonmedical reasons. Conclusions: Increasing osmolality of total parenteral nutrition did not increase episodes of thrombophlebitis in this trial and did not affect the success rate of the lines. We conclude that standard total parenteral nutrition formulas of higher osmolality than previously thought can be safely given via the peripheral route for short‐term feeding and do not increase the risk of thrombophlebitis. (Journal of Parenteral and Enteral Nutrition 20:194–197, 1996)
Impact of Portacaval Anastomosis on Plasma Fatty Acid Profile in Cirrhosis: A Randomized 24‐Month Follow‐up Study
Authors: Cabré Eduard , Navarro Elisabet , De Ramon Marta , Klaassen Julieta , Planas Ramon , Mingorance Ma Dolores , Pastor Ma Cruz , Lachica Manuel , Boix Jaume , Gassull Miquel A.
Published: May 2008

Background: Portacaval anastomosis has an hypolipemic effect in familial hypercholesterolemia and in healthy animals. In cirrhosis, it raises serum cholesterol, but there is no information on its effect upon plasma fatty acids. However, indirect data suggest that portacaval shunting might contribute to the polyunsaturated fatty acid deficit of these patients. We assessed the effect of portacaval anastomosis on plasma fatty acid profile in cirrhosis. Methods: Forty‐four Child‐Pugh class A/B bleeding cirrhotics were randomized to be treated with portacaval anastomosis (n = 20) or nonsurgical therapy (n = 24). Fatty acid profile in plasma total lipids, alcohol intake, anthropometry, Child‐Pugh score, serum cholesterol, triglycerides, and antioxidant micronutrients were assessed before and 3, 6, 12, 18, and 24 months after surgery or the start of nonsurgical therapy. Time course of plasma fatty acids was assessed using unbalanced repeated measures models with the abovementioned variables acting as covariates. Results: No changes in the time course of percent plasma saturated, monounsaturated, and essential fatty acids were found between groups. Percent long‐chain ω‐6 and ω‐3 polyunsaturated fatty acids decreased during follow‐up in shunted patients compared with controls (p =.007 and p <.0005). However, this was not due to a true decrease in polyunsaturated fatty acid levels but to greater increases in saturated and monounsaturated fatty acid concentrations in shunted patients compared with control patients (p =.047 and p =.006). Conclusions: Portacaval anastomosis does not worsen plasma polyunsaturated fatty acid deficiency in cirrhosis. However, by increasing saturated and monounsaturated fatty acids, it further decreases plasma lipid unsaturation. (Journal of Parenteral and Enteral Nutrition 20:198–205, 1996)
Stability of Heparin Anticoagulant Activity Over TIme in Parenteral Nutrition Solutions
Authors: Hensrud Donald D. , Burritt Mary F. , Hall Larry G.
Published: May 2008

Background: Heparin added to parenteral nutrition solutions may decrease the incidence of central venous thrombosis in patients receiving home parenteral nutrition. However, there are little data regarding the stability of heparin over time under conditions similar to those associated with home parenteral nutrition: low concentrations of heparin stored in solutions containing amino acids and high concentrations of dextrose for more than 24 hours. Methods: The activity of porcine mucosal heparin was measured over time using an antifactor Xa assay in six IV solutions: four parenteral nutrition solutions containing 25% dextrose; 5% amino acids; trace elements; electrolytes; and 3000, 5000, 10,000, or 20,000 units/L of heparin; one solution of 25% dextrose and 5000 units/L heparin; and one solution of 0.9% saline and 5000 units/L heparin. Results: In all solutions except 25% dextrose (without amino acids and additives), heparin activity remained stable within 4% of baseline up to 28 days. In the 25% dextrose solution, heparin activity declined by 3%, 6%, and 11% at 14, 21, and 28 days, respectively. Conclusion: Heparin activity was stable over time in the normal saline and parenteral nutrition solutions and decreased slightly from 2 to 4 weeks in the dextrose‐containing solution. Based on these data, when is administered home parenteral nutrition containing components similar to the solutions used in this study, heparin may be added at the time of preparation of the home parenteral nutrition solution rather than just before administration, with no resultant loss of heparin activity over time. (Journal of Parenteral and Enteral Nutrition 20:219–221, 1996)
Management of Total Parenteral Nutrition‐Related Superior Vena Cava Obstruction With Expandable Metal Stents
Authors: Hemphill D.J. , Sniderman K.W. , Allard J.P.
Published: May 2008

Catheter‐related thrombotic and stenotic obstructions are the second most common serious complication of long‐term total parenteral nutrition. Subsequent venous access problems have profound implications because of immediate and long‐term requirements of nutrition support. Although improved understanding of pathogenesis has led to improved prophylaxis and treatment of thrombosis, some patients will have refractory obstructions that threaten venous access and lead to severe clinical sequelae, including superior vena cava (SVC) syndrome. We describe two cases of patients with SVC syndrome refractory to anticoagulant, thrombolytic, and balloon angioplasty therapy, managed successfully with percutaneous placement of expandable metal stents. A discussion of the current understanding of prophylaxis and treatment of catheter‐related thrombosis and the role for interventional measures to restore venous patency and avoid permanent venous access problems accompanies the case descriptions. (Journal of Parenteral and Enteral Nutrition 20:222–227, 1996)
Review: The Use of Modular Nutrients in Pediatrics
Authors: Davis Anne , Baker Susan
Published: May 2008

Background: Nutrient modules are commonly used by pediatricians and dietitians. There is no readily available current literature to which those using nutrient modules can refer. Therefore, we review nutrient module composition, module use in pediatrics, and complications associated with the use of nutrient modules. Methods: Using an online database, Meduline, we searched the literature from 1966 through 1995. Results: Nutrient modules are single or multiple nutrients that can be combined with a diet to add nutrients or to change the composition of the diet. These nutrients exist as a food or as medically compounded elements of a diet but alone are not complete foods. Discussion The addition of modules to a diet can alter the composition of diet so that a single nutrient may become deficient and the die cannot support normal growth and development. With use of nu trient modules, diets can be prepared to meet the specific needs of children with common or rare nutritional problems. Conclu sion: Health care providers who use nutrient modules must un derstand the importance of diet composition and the carefu monitoring of pediatric patients. (Journal of Parenteral and En teral Nutrition 20:228–236, 1996)
The Role of Anatomic Factors in Nutritional Autonomy After Extensive Small Bowel Resection
Authors: Carbonnel Franck , Cosnes Jacques , Chevret Sylvie , Beaugerie Laurent , Ngô Yann , Malafosse Michel , Parc Rolland , Le Quintrec Yves , Gendre Jean Pierre
Published: May 2008

Background: It is difficult to predict which patients with a postsurgical short bowel will require long‐term parenteral nutrition. Methods: We performed a retrospective prognostic study for the time to home parenteral nutrition or death from malnutrition (nonautonomy), on the basis of 103 patients with a residual short bowel of 17 to 150 cm. The influence of anatomic variables was summarized through the use of Cox regression model.Results:Of the 103 patients included, 24 lost nutritional autonomy. Three anatomic variables were identified as having independent predictive information; remaining small bowel length (measured on small bowel x‐rays;p=.0001), and jejunoileal anastomosis (p =.01) promoted autonomy, whereas end jejunostomy (p =.002) increased the risk of losing nutritional autonomy.Conclusions:On the basis of these results and on the relative weight of these variables, high‐risk patients for loss of nutritional autonomy were defined as those with jejunoileal anastomosis and a remaining small bowel length < 35 cm, patients with jejunocolic anastomosis and remaining small bowel length < 60 cm, and patients with an end jejunostomy and remaining small bowel length < 115 cm. This classification was thereafter validated on a prospective series of 32 patients.(Journal of Parenteral and Enteral Nutrition20:275–280, 1996)
Selenoprotein P in Patients on Home Parenteral Nutrition
Authors: Rannem Terje , Persson‐Moschos Marie , Wenhu Huang  , Staun Michael , Åkesson Björn
Published: May 2008

Background: The purpose of this study was to evaluate the use of selenoprotein P as an indicator of selenium status in patients receiving home parenteral nutrition. Methods: Adult patients (n = 38) who had been on parenteral nutrition with no addition of selenium for 3 to 216 months were included in the study. Plasma samples were analyzed for selenium, selenoprotein P, and extracellular glutathione peroxidase (eGSHPx) using fluorimetry and newly developed radioimmunoassays. Results: The mean plasma (± SD) eGSHPx and selenoprotein P in the patients were 1.9 ± 1.2 mg/L and 0.7 ± 0.4 arbitrary units, respectively, which corresponds to about 50% of the concentration measured in the plasma of the reference subjects (4.0 ± 1.0 mg/L and 1.50 ± 0.17 arbitrary units). The mean plasma selenium concentration was 0.5 ± 0.4 μmol/L, which was approximately half of the concentration measured in the healthy subjects (1.1 ± 0.2 μmol/ L). Thirty‐four (89%) and 20 (53%) patients, respectively, had selenoprotein P and eGSHPx values lower than mean ‐ 2 SD of the reference material. The lowest values observed for selenoprotein P and eGSHPx were 3% and 2% of the reference mean. Selenoprotein P levels correlated significantly to eGSHPx (p = 0.88, p <.0001) and plasma selenium (p = 0.91, p <.0001). Conclusions: The positive correlations between selenoprotein P and eGSHPX and plasma selenium indicates that selenoprotein P may be used as a marker of selenium status in selenium‐depleted patients. (Journal of Parenteral and Enteral Nutrition 20:287–291, 1996)
The Difficult‐to‐Place Feeding Tube: Successful Endoscopic Placement Using a Mucosal Clip
Authors: Faigel Douglas O. , Kadish Steven L. , Ginsberg Gregory G.
Published: May 2008

Background: Delivery of enteral feeding beyond the ligament of Treitz is often desirable, as it diminishes enterogastric reflux and potential for pulmonary aspiration of enteral feeding solution. However, standard or fluoroscopically guided techniques often fail. We describe three such cases in which enteral feeding tube placement was achieved endoscopically and secured using an endoscopic clip‐fixing device. Methods: A standard feeding tube attached to a mucosal clip by a silk suture was advanced endoscopically into the small intestine. Using a through‐the‐endoscope clip‐fixing device, the tube was attached to the bowel wall. Results: Three patients underwent the above procedure: a postgastrectomy patient with a functionally obstructed jejunal pouch and a previously failed fluoroscopically guided placement had a nasojejunal feeding tube successfully placed beyond the obstruction; a cancer patient with duodenal obstruction due to SMA syndrome, a surgical gastrostomy, and a previously failed fluoroscopic attempt had a dual lumen pergastrostomy feeding tube placed beyond the obstruction; and a patient with a refractory benign esophageal stricture underwent esophageal dilation followed by successful feeding tube placement into the proximal jejunum. In all patients, the tube functioned well without subsequent occlusion or dislodgement. Conclusions: Endoscopic placement of feeding tubes using a clip‐fixing device is a useful technique in patients with normal and abnormal anatomy in whom reliable delivery of enteral feeding beyond the ligament of Treitz is desired. (Journal of Parenteral and Enteral Nutrition 20:306–308, 1996)
Reversible Impairment in Monocyte Major Histocompatibility Complex Class II Expression in Malnourished Surgical Patients
Authors: Welsh Fenella K.S. , Farmery Susan M. , Ramsden Carol , Guillou Pierre J. , Reynolds John V.
Published: May 2008

Background: Upregulation of major histocompatibility complex (MHC) class II antigen in response to the T‐cell lymphokine interferon‐gamma (IFN‐γ) is central to T cell‐macrophage cooperation and immune homeostasis. We evaluated this property in malnourished surgical patients and assessed the impact of nutrition repletion with total parenteral nutrition (TPN). Methods: Sixty‐two patients were studied: 37 malnourished and 25 controls. Whole blood was cultured with or without IFN‐γ (100 U mL−1), dual‐labeled with anti‐CD 14 (monocyte) and anti‐human leukocyte antigen‐DR antibodies and analyzed by flow cytometry. Phagocytosis was measured by flow cytometry. In a second study, 10 severely malnourished patients received 5 days of TPN and MHC class II expression was measured at the end of this period. Results: The magnitude of the increase in monocyte MHC class II expression in response to IFN‐γ was significantly increased in the control group compared with the malnourished group (107% vs 53%; p <.05). This impairment directly correlated with severity of malnutrition, but did not correlate with age or disease type. The number of bacteria phagocytozed per cell was significantly decreased (p <.05) in the malnourished group. In study 2, there was a significant increase in MHC class II induction with IFN‐γ after short‐term TPN (58% before vs 173% after; p <.001). Conclusions: MHC class II induction in response to IFN‐γ is significantly impaired in malnourished patients, correlating with the severity of malnutrition. This defect is reversed by short‐term TPN. These data identify the reversible loss of a key mechanism, fundamental to host defense, that may enhance the risk of infection in malnourished patients. (Journal of Parenteral and Enteral Nutrition 20:344–348, 1996)