bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutrition Requirements in Patients with Toxic Epidermal Necrolysis
Authors: Coss‐Bu Jorge A. , Jefferson Larry S. , Levy Moise L. , Walding David , David Yadin , Klish William J.
Published: May 2008

Patients with toxic epidermal necrolysis, a severe, exfoliative skin disorder, have clinical features similar to those of partial‐thickness burn patients. The literature suggests that they also have similar nutritional requirements. We report two patients diagnosed with toxic epidermal necrolysis on mechanical ventilation, in whom resting energy expenditure and respiratory quotient were measured by indirect calorimetry. The patients were treated using standard burn protocols. Nitrogen balance was calculated by measuring total urinary nitrogen in urine samples obtained over 24 hours. These measurements were done while the patients were on mechanical ventilation and receiving total parenteral nutrition. As in burn patients, early in their course the two patients had resting energy expenditure values twice that predicted. After 12 days of hospitalization, nitrogen balance was negative in patient 1 and positive in patient 2. Energy and protein requirements appear to have been related to the amount of body surface affected.
Lipid Peroxidation of Intravenous Lipid Emulsions and All‐in‐One Admixtures in Total Parenteral Nutrition Bags: The Influence of Trace Elements
Authors: Steger Patrick J. K. , Mühlebach Stefan F.
Published: May 2008

An iodometric titration was used to assess the influence of a daily portion of trace elements on lipid peroxidation of pure lipid emulsions and lipid‐containing all‐in‐one (AIO) admixtures by measuring the peroxide value (PV; mmol peroxides/L). A pure lipid emulsion (Intralipid 20%; Pharmacia & Upjohn, Dübendorf, Switzerland) was stored in ethylvinylacetate bags under light protection (LP) at 40° C with and without trace elements. In absence of trace elements the PV of Intralipid 20% was significantly lower (day 14: 2.77 vs 18.04; p <.001). After the same time period with the same storage conditions the drop in pH was two times higher in presence of trace elements (1.54 vs 0.77). In an AIO admixture with LP stored at 2°C to 8°C, trace elements increased the PV from 0.04 to 0.19 mmol/L (day 29; p <.01). The drop in pH was 0.01 and 0.02 units, respectively. When stored at 20°C to 30°C and exposed to daylight, the PV of the AIO admixture containing trace elements reached 1.92 compared with 0.52 in their absence (day 19; p <.001) with a pH drop of 0.03 and 0.11, respectively (day 29). Although trace elements led to a much higher drop in pH in pure lipid emulsions, no obvious influence on the pH of AIO admixtures was demonstrated. To minimize lipid peroxidation, AIO admixtures should be stored light‐protected and refrigerated without trace elements. The latter should be added immediately before administration or should be given separately. (Journal of Parenteral and Enteral Nutrition 24:37–41, 2000)
Time‐Dependent Variation in Weight and Body Composition in Healthy Adults
Authors: Rosenbaum Karen , Wang Jack , Pierson Richard N. , Kotler Donald P.
Published: May 2008

Objectives: To define the limits of change in body weight and body composition after different time intervals in healthy, normal adults. Methods: Prospective and retrospective analyses of paired body composition studies in a total of 326 healthy adults, ages 18 to 97. Measurements included body weight, fat and fat‐free mass (FFM) by dual x‐ray absorptiometry (DXA) and bioimpedance analysis (BIA), plus body cell mass (BCM) by whole‐body counting of 40K and BIA. Results: Time interval between studies was a significant predictor of the differences in paired studies. The 95% confidence intervals for percent difference were lowest for body weight, intermediate for BCM and FFM, and highest for fat, in part because of the differences in sizes of these body compartments. There were significant associations among the changes in body composition by BIA and by criterion methods, suggesting that the observed changes are real. Conclusions: The normal variation in body weight and body composition increases over time. Time‐dependent criteria may increase the sensitivity in diagnosing malnutrition. Interpreting changes in body compartments requires consideration of the size of each compartment. (Journal of Parenteral and Enteral Nutrition 24:52–55, 2000)
Arginine‐Supplemented Diet Decreases Expression of Inflammatory Cytokines and Improves Survival in Burned Rats
Authors: Cui Xue‐Lin , Iwasa Masato , Iwasa Yoshie , Ogoshi Shohei
Published: May 2008

Background: We examined whether the expression of inflammatory cytokines in organs was influenced by the enteral diet supplemented with arginine in burned rats. Methods: Male Wistar rats weighing about 200 g underwent catheter jejunostomy and received scald burns covering 30% of the whole‐body surface area. Animals were divided into two groups: a control group (no supplemental arginine, n = 12) and an arginine group (supplemental arginine: 7.7 g/L, n = 10), which continuously received total enteral nutrition for 7 days (250 kcal/kg/d, 1.72 gN/kg/d). The following were measured after the experiment: (1) messenger RNA (mRNA) expression of tumor necrosis factor‐alpha (TNF‐α), interferon‐gamma (IFN‐γ), interleukin‐1beta (IL‐1β), and IL‐6 in the spleen, thymus, lung, and liver by a semiquantitative reverse transcription‐polymerase chain reaction method, (2) inflammatory cytokines in the plasma and supernatant of cultured splenic lymphocytes by enzyme‐linked immunosorbant assay, (3) nitric oxide (NO) product, NO2 −/NO3 −, in the plasma and supernatant of cultured splenic lymphocytes by the Griess method, and (4) survival rate by the Kaplan‐Meier method. Results: The mRNA expression of TNF‐α was significantly decreased in the spleen and lung (p <.01, p <.05), IFN‐γ in the lung (p <.05), IL‐1β in the spleen (p <.05), and IL‐6 in the thymus and liver (p <.05, p <.05) in the arginine group when compared with the control group. The production of TNF‐α by splenic lymphocytes was suppressed in the arginine group in both concanavalin A (Con A)‐treated and ‐untreated cultures (p <.01, p <.05). The production of IFN‐γ by splenic lymphocytes treated with Con A was suppressed in the arginine group (p <.05). The NO product in the supernatant without Con A was increased in the arginine group (p <.05). The mortality rate of the arginine group (0%) was lower than that in the control group (33.3%) on day 7 after the burn injury (p <.05). Conclusions: The data suggest that dietary arginine supplementation decreases the mRNA expression of inflammatory cytokines in organs and improves the survival rate after thermal injury. (Journal of Parenteral and Enteral Nutrition 24:89–96, 2000)
Effectiveness of Feeding Tubes in Nursing Home Residents With Swallowing Disorders
Authors: Rudberg Mark A. , Egleston Brian L. , Grant Mark D. , Brody Jacob A.
Published: May 2008

Background: Among nursing home residents who stop eating, a common decision for residents, caregivers, and families is the decision to begin tube feeding. This study examines the effectiveness of feeding tubes at reducing mortality among nursing home residents with swallowing disorders and feeding disabilities. Methods: Data from a version of the Minimum Data Set+ (MDS+) encompassing three different states from calendar years 1993 and 1994 were analyzed. Residents were included in the study if they were not totally dependent on staff for eating upon their first assessment but became totally dependent on staff for eating and had a swallowing disorder at some point during their nursing home stay. We used a proportional hazard regression to examine the relationship of feeding tubes with mortality after total eating dependence occurred. Results: Unadjusted Kaplan‐Meier curves found that those with feeding tubes were less likely to die than comparable residents without feeding tubes (p <.001). Estimated survival at 1 year was 39% for those without feeding tubes and 50% for those with feeding tubes. The multivariate results indicated that feeding tubes were associated with a reduced risk of death (risk ratio, 0.71; 95% confidence interval, 0.59, 0.86). Conclusions: This study provides evidence that tube feeding can be life‐prolonging, even if the gain in life is not substantial. Such information can be useful to nursing home staff, residents, and families when trying to decide whether to place a feeding tube in a resident with swallowing disorders and eating disabilities. (Journal of Parenteral and Enteral Nutrition 24:97–102, 2000)
Early Versus Delayed Feeding with an Immune‐Enhancing Diet in Patients with Severe Head Injuries
Authors: Minard Gayle , Kudsk Kenneth A. , Melton Sherry , Patton Joseph H. , Tolley Elizabeth A.
Published: May 2008

Background: Although early enteral feeding clearly reduces septic morbidity after blunt and penetrating trauma, data for head‐injured patients are conflicting. This study examines the effects of early us delayed enteral feedings on outcome in patients with severe closed‐head injuries with a Glasgow Coma Scale (GCS) score greater than 3 and less than 11. Methods: Thirty patients were prospectively randomized to receive an immune‐enhancing diet (Impact with fiber) early (initiated < 72 hours after trauma) delivered via an endoscopically placed nasoenteric tube (Stay‐Put) or late (administered after gastric ileus resolved). This formula was continued for 14 days or until the patient tolerated oral feeding. Goal rate of nutrition was 21 nonprotein cal/kg/d and 0.3 g N/kg/d. Results: Two patients in the early group were excluded due to inability to place the tube, and one patient in the late group died before 72 hours. Five of the remaining 27 died, 1 in the early group and 4 in the late group. There were no significant differences between the groups in length of stay, intensive care unit (ICU) days, significant infection, or GCS score. However, major infection correlated inversely with admission GCS score (R = ‐0.6, p <.003). Time to reach a GCS score of 14 was significantly longer in patients with significant infections compared with those without (p <.02). Conclusions: No difference in length of stay or infectious complications is shown in patients with severe closed‐head injury when they are given early us delayed feeding using an immune‐enhancing formula. Severity of the head injury is closely associated with significant infection. (Journal of Parenteral and Enteral Nutrition 24:145–149, 2000)
Fish Oil Modulates Macrophage P44/P42 Mitogen‐Activated Protein Kinase Activity Induced By Lipopolysaccharide
Authors: Lo Chong‐Jeh , Chiu Ken C. , Fu Minjuan , Chu Audrey , Helton Scott
Published: May 2008

Background: Mitogen‐activated protein kinase (MAPK) cascades represent a major signal system to transduce extracellular signals into cellular responses. Overactivity of MAPK has been implicated in the development of many diseases, including cancer and sepsis. This study investigated the hypothesis that fish oil altered the membrane phospholipid composition and modulated MAPK activity. Methods: RAW 264.7 cells, a mouse macrophage (M(ϕ) cell line, were grown in eicosapentaenoic acid (EPA)‐rich media (114 μmol/L) for 48 hours. Mϕ were washed and exposed to Escherichia coli lipopolysaccharide (LPS; 1 μg/mL) for 10 minutes. Both total and activated (phosphorylated) portions of MAPK (P44 and P42) were determined by Western blot assays. AP‐1 transcription factor activity was determined by electrophoretic mobility gel shift assays (EMSA). Mϕ tumor necrosis factor (TNF) mRNA expression was measured by Northern blot assays. Results: LPS stimulation induced RAW cell phosphorylation of P44/P42. In contrast, RAW cells grown in EPA‐rich media had less P44/P42 activation in the presence of LPS. Total P44/P42 were not affected by EPA or LPS. Similarly, EPA also inhibited AP‐1 activity. Inhibition of P44/P42 activity with PD98059 reduced both AP‐1 activity and TNF mRNA expression of LPS‐stimulated Mϕ. Conclusions: Our data suggest that fish oil regulates macrophage proinflammatory gene activation, at least in part, by modulating the MAPK activity. (Journal of Parenteral and Enteral Nutrition 24:159–163, 2000)
Sleeve Thrombus Fibrosis Causing Neck Pain
Authors: Ghosh Arundhati , Griffiths D. Mervyn
Published: May 2008

Background: Central venous catheter occlusion due to thrombus formation is the most common cause for malfunction of long‐term indwelling catheters. The exact pathology and pathogenesis of this common complication is misunderstood because of an array of terms being used interchangeably in the literature. This article identifies the pathogenesis and symptoms and gives suggestions for the treatment of central venous catheter‐related thrombosis. Methods: Our case report is of a girl who had a percutaneously placed left subclavian central venous line attached to her vascuport. After 9 months she developed severe pain over the catheter tubing on injection into the port. Surgical exploration of the catheter tubing in the infraclavicular region demonstrated that the pain was due to retrograde flow around the catheter within a sleeve thrombus. Conclusions: In this type of patient, all precautions should be taken to minimize the risk of thrombus formation, including considering the prophylactic use of anticoagulants. (Journal of Parenteral and Enteral Nutrition 24:180–182, 2000)
Microbiological Quality Control Study of “All‐In‐One” Total Parenteral Nutrition Admixtures
Authors: Montejo Oscar , Cardona Daniel , Sánchez Ferran , Rigueira Ana Isabel , Coll Pere , Bonal Joaquim
Published: May 2008

A microbiological quality control study of parenteral nutrition (PN) is presented. The study was carried out in the Pharmacy and Microbiology Services of the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain) from April 1991 to May 1998 and represents more than 25,000 lipid‐containing PN admixtures prepared during that 7‐year period. A randomized sampling procedure according to the cumulative sum control charts was performed and a 0.45‐μm membrane filtration method was used as the microbiological test. Validation showed that the method is sensitive for sterility tests. Bacterial growth was observed on 59 filters (4.58% of the samples). A second control was made for these positive outcomes, and bacterial growth was found in only two cases. The patients' clinical history was reviewed and no relation between the microorganisms of the nutrition and the results obtained from blood cultures was observed. The quality control study revealed a low incidence of contamination in our PN preparation process. (Journal of Parenteral and Enteral Nutrition 24:183–186, 2000)
Effect of Alanyl‐Glutamine on Leucine and Protein Metabolism in Endotoxemic Rats
Authors: Holeček Milan , Skopec František , Skalská Hana , Šprongl Luděk
Published: May 2008

Background: Branched‐chain amino acids (BCAA; valine, leucine, and isoleucine) have a regulatory effect on protein metabolism and are the main donor for synthesis of alanine and glutamine in the skeletal muscle. This study was performed to investigate whether exogenous alanine or glutamine would affect leucine and protein metabolism in intact and endotoxemic rats. Methods : Rats were injected with endotoxin of Salmonella enteritidis or saline. Thirty minutes later, the effects of endotoxemia and L‐alanyl‐L‐glutamine (AG) on leucine and protein metabolism were evaluated using a primed constant infusion of [1‐14C]leucine, endotoxin, and AG (200 mg/mL) solution or an infusion of [1‐14C]leucine without endotoxin or AG. The specificity of the effect of exogenous alanine and glutamine was evaluated by a single infusion of alanine, glutamine, and glycine in a separate study. Results: Endotoxin treatment induced more negative net protein balance caused mainly by an increase in whole‐body proteolysis. Protein synthesis increased in kidneys, colon, and spleen, while a decrease was observed in skeletal muscle. The impressive effects of AG were the decrease in plasma branched‐chain amino acid (BCAA) levels, decrease in leucine oxidized fraction, and improvement of protein balance associated with a decrease in whole‐body proteolysis. Similar changes in leucine and protein metabolism were induced by infusion of alanine or glutamine but not by infusion of glycine. Conclusions: IV administration of alanine or glutamine improves protein balance and decreases leucine oxidized fraction in postabsorptive state and in endotoxemia. Decreased proteolysis is the main cause of decreased plasma BCAA levels after AG treatment. (Journal of Parenteral and Enteral Nutrition 24:215–222, 2000)
Brain Manganese Deposition and Blood Levels in Patients Undergoing Home Parenteral Nutrition
Authors: Boggio Bertinet Daniela , Tinivella Marco , Alessandro Balzola Federico , de Francesco Antonella , Davini Ottavio , Rizzo Laura , Massarenti Paola , Antonietta Leonardi Maria , Balzola Franco
Published: May 2008

Background : Extrapyramidal syndrome and alterations in brain magnetic resonance images are described in patients undergoing long‐term home parenteral nutrition (HPN) and in cholestatic patients. These abnormalities have been correlated to basal ganglia manganese (Mn) accumulation. Methods: A longitudinal 1‐year study was conducted on 15 patients undergoing HPN (median duration, 3.8 years; range, 1.7–10; median Mn parenteral supplementation, 0.1 mg/d). Whole‐blood, plasma, intra‐erythrocytes, and urinary Mn concentrations were measured and brain magnetic resonance was performed at the beginning (time 0) and after 1 year of Mn intravenous supplementation withdrawal (time 1). No patients showed psychosis, extrapyramidal syndrome, or cholestasis. Results: At time zero, 10 of 15 patients (67%) showed paramagnetic accumulation on cerebral magnetic resonance images; at time 1 there was a reduction of cerebral Mn accumulation. In all patients, blood‐Mn levels were significantly reduced after 1 year of Mn intravenous supplementation withdrawal. Conclusions: Patients receiving long‐term HPN showed an elevated incidence of alterations in brain magnetic resonance images with a median Mn intravenous supplementation of 0.1 mg/d. Mn supplementation withdrawal significantly decreased metal levels in blood and brain storage. We noticed that the intra‐erythrocyte Mn level was a good index of Mn status. (Journal of Parenteral and Enteral Nutrition 24:223–227, 2000)
Disposition of a Mixed Meal by Conscious Dogs after Seven Days of Treatment with Cyclosporine A and Prednisone
Authors: Courtney Moore Mary , Cherrington Alan D. , Palmer Brett , Brooks Lacy D. , Goldstein Richard E.
Published: May 2008

Background: Combination immunosuppressive therapy, that often includes prednisone and cyclosporine A (CyA), is commonly used in the treatment of organ transplant patients. We hypothesized that CyA and prednisone treatment would alter the roles of the liver and peripheral tissues in the disposal of carbohydrates from a meal. Methods: Using the arteriovenous difference technique, we examined the disposition of an intragastrically delivered mixed meal in eight 24‐hour fasted conscious dogs that had received CyA 15 mg· kg−1 daily and prednisone 5 mg twice daily for 7 consecutive days before study (CyA‐prednisone group). The results were compared with those from a group of 13 dogs (control group) receiving the same meal but no drugs. Results: Neither arterial blood glucose concentrations nor arterial plasma insulin or glucagon concentrations differed significantly between the groups at any time. Cumulative net gut glucose output was equivalent to 43 ± 9 us 57% ± 7% of the glucose in the meal in CyA‐prednisone us control (p =.12). The CyA‐prednisone group exhibited greater (p <.05) mean net hepatic glucose uptakes (15.4 ± 4.6 us 4.3 ± 2.2 μmol · kg−1 · min−1) and net hepatic fractional extractions of glucose (7.8 ± 1.6 and 1.5% ± 1.0%) than the control group. Arterial blood lactate concentrations and net hepatic lactate output were greater in the CyA‐prednisone group than the control group (p <.05). Hepatic glycogen content at the end of the study was 2.5‐fold greater in the CyA‐prednisone group than in the control group (p <.05). The nonhepatic tissues disposed of approximately 91% of the absorbed glucose in the control group but only approximately 26% in the CyA‐prednisone group (p <.05). Conclusions: CyA‐prednisone treatment caused a marked shift in the carbohydrate disposal from a meal, enhancing the hepatic glucose uptake and decreasing peripheral glucose disposal. (Journal of Parenteral and Enteral Nutrition 24:244— 250, 2000)
Indwelling Catheter Retraction Because of Pendulous Breast
Authors: Inoue Yoshifumi , Miyazaki Naoko , Shimizu Yuka , Soh Hideki , Fujita Shigeo , Takao Tetsuto
Published: May 2008

Long‐term home parenteral nutrition (HPN) is an established treatment for chronic intestinal failure. A reliable and safe vascular access is of fundamental importance to HPN patients. We have typically used a right atrial catheter attached to a subcutaneous port. We present a case of right atrial catheter retraction in a large‐breasted woman with short bowel syndrome. The catheter was retracted and coiled around the reservoir in the subcutaneous pocket by motion of the patient with large breasts. Displacement of right atrial catheters is a rare but recognized complication. To avoid this complication in obese patients with large breasts, the positional changes of the breast should be determined, and the reservoir should be implanted in the area of least motion along the sternum. (Journal of Parenteral and Enteral Nutrition 24:251–253, 2000)
Impact of Enteral and Parenteral Nutrition on Hepatic and Muscle Glucose Metabolism
Authors: Song Chen Sheng , Donmoyer Christine , Zhang Yiqun , Hande Scott A. , Lacy D. Brooks , McGuinness Owen P.
Published: May 2008

Liver and muscle metabolism were assessed in dogs adapted to long‐term total parenteral (TPN) and enteral (TEN) nutrition. Studies were done in 13 conscious long‐term catheterized dogs in which sampling (artery, portal and hepatic vein, and iliac vein), infusion catheters (inferior vena cava, duodenum), and transonic flow probes (hepatic artery, portal vein, and iliac artery) were implanted. Fourteen days after surgery dogs were grouped to receive TPN or TEN. After 5 days of TPN/TEN, substrate balances across the liver and limb were assessed. The liver was a marked net consumer of glucose in both groups (23.6 ± 3.3 vs 22.6 ± 2.8 μmol · kg−1 · min−1, TPN vs TEN) despite near normoglycemia (6.5 ± 0.3 vs 6.7 ± 0.2 mmol/L). Arterial insulin levels were higher during TEN (96 ± 6 vs 144 ± 30 pmol/L; p <.05). The majority (79 ± 13 vs 76%±7%) of the glucose taken up by the liver was released as lactate. Despite higher insulin levels during TEN the nonsplanchnic tissues consumed a lessor quantity of glucose (25.9 ± 3.3 vs 16.1 ± 3.9 μmol · kg−1 · min−1). In summary, the liver undergoes a profound adaptation to TPN and TEN making it a major site of glucose uptake and conversion to lactate irrespective of the route of nutrient delivery. However, the insulin requirements are higher with TEN possibly secondary to impaired peripheral glucose removal. (Journal of Parenteral and Enteral Nutrition 24:255–260, 2000)
Enterotrophic Effect of Insulin‐Like Growth Factor‐I but not Growth Hormone and Localized Expression of Insulin‐Like Growth Factor‐I, Insulin‐Like Growth Factor Binding Protein‐3 and ‐5 mRNAs in Jejunum of Parenterally Fed Rats
Authors: Peterson Catherine A. , Gillingham Melanie B. , Mohapatra Niru K. , Dahly Elizabeth M. , Adamo Martin L. , Carey Hannah V. , Lund Pauline Kay , Ney Denise M.
Published: May 2008

Background: Administration of insulin‐like growth factor (IGF)‐I, but not growth hormone (GH), stimulates mucosal hyperplasia in surgically stressed rats with intestinal atrophy induced by hypocaloric total parenteral nutrition (TPN). Our aim was to characterize the basis for this disparity in enterotrophic action by assessing the relationships between stimulation of intestinal growth, nutritional adequacy, and localization of expression of IGF‐I, insulin‐like growth factor binding protein (IGFBP)‐3 and IGFBP‐5 mRNAs in jejunum. Methods: Rats were maintained with TPN for 8 days and treated with IGF‐I or GH and adequate nutrition for 5 days after recovery from surgery. Jejunal mass, morphology, and sucrase activity were assessed. Localization of expression of IGF‐I, IGFBP‐3, and IGFBP‐5 mRNAs in jejunum was accomplished by in situ hybridization. Results: Serum IGF‐I and body weight gain were significantly increased by IGF‐I or GH. Jejunal mucosal dry mass, morphology, and sucrase activity were improved with IGF‐I but not GH. There were no differences in IGF‐I mRNA. IGFBP‐3 mRNA was localized in the lamina propria of the villi. IGF‐I or GH stimulated IGFBP‐3 expression. IGF‐I strongly stimulated IGFBP‐5 expression in the lamina propria and the muscularis and induced a twofold increase in IGFBP‐5 mRNA based on RNase protection assay of intact jejunum total RNA. GH induced a modest increase in IGFBP‐5 expression in the muscularis with no effect on intact jejunum total RNA. Conclusions: The GH resistance observed in the jejunal mucosa of TPN rats cannot be fully explained by inadequate nutrition. The expression of IGFBP‐5 in the lamina propria suggests it may modulate the enterotrophic action of exogeneous IGF‐I. (Journal of Parenteral and Enteral Nutrition 24:288–295, 2000)
Hazard Analysis and Critical Control Point System Approach in the Evaluation of Environmental and Procedural Sources of Contamination of Enteral Feedings in Three Hospitals
Authors: Rocha Carvalho Mirian Lucia , Beninga Morais Tania , Ferraz Amaral Daniela , Sigulem Dirce Maria
Published: May 2008

Background: The administration of contaminated diets may contribute to severe infections, mainly in immunosuppressed patients. To determine the microbiologic quality of enteral feedings and the critical control points involved in the processing of the formulas, a study was carried out in three hospitals in São Paulo, Brazil. Methods: One hundred sixteen diets were evaluated according to the system known as hazard analysis and critical control points (HACCP). The techniques included the monitoring of the cleaning and disinfection of utensils, surfaces, and equipment; time and temperature controls; and microbiologic analyses that comprised the enumeration of facultative aerobic mesophilic bacteria, yeasts and molds, coliforms, and Escherichia coli. The diets were assessed based on the British Dietetic Association and the Food and Drug Administration standards. Results: The hospital‐formulated diets and the commercially made powdered feeds presented statistically significant higher counts of mesophilic bacteria and percentages of no compliance with the standards for coliforms when compared with the commercially prepared, ready‐to‐feed enteral formula supplied in cans. According to the British standards, 77% and 38% of the diets were inadequate for mesophilic and coliform bacteria, respectively, just after preparation. After 24‐hour storage in refrigerators, the percentages rose to 83% and 45%, respectively; the mesophilic and coliforms counts were also significantly higher. The following critical control points (CCP) were identified: cleaning and disinfecting of surfaces, utensils, and equipment; the time spent in preparation; the water used for reconstitution; the final temperature of the diet; the exposure to room temperatures; the lack of a chilling step; the refrigeration temperature; the inadequate disinfecting of the handlers' hands; and the lack of external cleaning and disinfecting of the cans before opening. Conclusions: The results of this study are worrisome and show the need for implementation of good practices of hygiene and handling of the diets, and the regular monitoring of their preparation. The microbiologic quality of the enteral diets was compromised according to international standards, representing a potential risk of infection to the patients who require enteral nutrition. (Journal of Parenteral and Enteral Nutrition 24:296–303, 2000)
A Multicenter, Prospective Study of the Placement of Transpyloric Feeding Tubes with Assistance of a Magnetic Device
Authors: Boivin Michel , Levy Howard , Hayes James ,   The Magnet‐Guided Enteral Feeding Tube Study Group
Published: May 2008

Background: Placement of feeding tubes in the transpyloric position can be helpful in the management of enterally fed patients with pancreatitis, gastric atony, enterocutaneous fistulae, or pulmonary aspiration risk. The attainment of transpyloric position is difficult, and numerous techniques have been proposed to help in achieving this location. Recently, the use of a magnet‐tipped feeding tube, dragged into proper position with an external magnet, has been described with an excellent success rate. Methods: At 10 participating institutions, practitioners were trained in the use of the device. Successful tube placement was determined by abdominal radiograph. Results: One hundred fifty‐six tube placements were attempted. Transpyloric position was obtained in 60%. Placement into the third portion of the duodenum or distal was obtained in only 32%. Analysis of the data did not reveal a learning curve at the institutions, and 7 of 10 had a 50% or lower success rate. Conclusions: Placement of feeding tubes with the assistance of a magnetic device was infrequently successful at the majority of institutions where it was attempted. We report a lower success rate than the original article, which described an 88% success rate of transpyloric intubation. Although this technique has a high failure rate, some individuals seem to be very successful using it, which could reduce the need for endoscopy or transport for the placement of feeding tubes. (Journal of Parenteral and Enteral Nutrition 24:304–307, 2000)
A Novel Efficient Method to Identify β‐Glucuronidase Activity in Rat Small Intestine
Authors: Andlauer Wilfried , Kolb Jochen , Fürst Peter
Published: May 2008

Background: Recent epidemiologic studies promote the notion that high intake of food rich in phytochemicals protects against degenerative diseases such as coronary heart diseases and cancer. Phytochemicals are detoxified in mammalian tissues by conjugation with glucuronic acid yielding less active glucuronide conjugates. However, in several tissues glucuronide conjugates are reactivated by the cleaving enzyme β‐glucuronidase. The aim of the present study was to develop a routinely manageable, rapid technique to localize the β‐glucuronidase activity in the small intestinal tissue. Methods: Histologic slices of rat duodenum, jejunum, and ileum were incubated with a specific chromogenic β‐glucuronidase substrate, 5‐bromo‐4‐chloro‐3‐indolyl‐β‐D‐glucuronide (X‐GlcU). After enzymatic cleavage, X‐GlcU yields 5‐bromo‐4‐chloro‐3‐indol, a dark blue crystalline precipitate easily monitored by light microscopic technique. Results: The number and intensity of the crystals were highest in the jejunum and lowest in the ileum. In all three sections of the small intestine, the highest activity was observed at the villar tip and in the tela submucosa and only moderate activity in other layers of the intestinal tissue. Conclusions: By using the X‐GlcU‐technique, it could be demonstrated convincingly that β‐glucuronidase exists in all three segments of the rat small intestine. The proposed method is an efficient, simple, and convenient method to visualize β‐glucuronidase activity.(Journalof Parenteral and Enteral Nutrition 24:308–310, 2000)
Survival of Malnourished Head and Neck Cancer Patients Can Be Predicted by Human Leukocyte Antigen‐DR Expression and Interleukin‐6/Tumor Necrosis Factor‐α Response of the Monocyte
Authors: van Bokhorst‐de van der Schueren Marian A. E. , von Blomberg‐van der Flier B. Mary E. , Kuik Dirk J. , Scholten Petra E. T. , Siroen Michiel P. C. , Snow Gordon B. , Quak Jasper J. , van Leeuwen Paul A. M.
Published: May 2008

Background: Patients with advanced stages of head and neck cancer are often characterized by malnutrition and by an impaired immune system. Because some of the suppressed immune parameters were shown to be of prognostic importance in trauma and sepsis, we investigated whether these would also correlate with survival in head and neck cancer. Methods: Severely malnourished head and neck cancer patients undergoing ablative and reconstructive surgery were followed prospectively and their perioperative immune parameters were related to long‐term survival. Results: Forty‐nine patients with a preoperative weight loss of more than 10% were followed up for a period of at least 16 months after surgery. Analyses of variance revealed that preoperative human leukocyte antigen‐DR (HLA‐DR) expression on monocytes and endotoxin‐induced production of tumor necrosis factor‐α (TNF‐α) and interleukin‐6 (IL‐6) were different between patients who survived and patients who died. Proportional hazards identified a weight loss of more than 12%, the presence of coexistent disease, and an HLA‐DR expression on monocytes below the cutoff points (mean fluorescence index < 15, peak channel index < 9) to be of significant influence on survival. Conclusions: In addition to known prognostic parameters such as tumor stage, coexistent disease, and weight loss, the immune parameters HLA‐DR expression on monocytes and endotoxin‐induced cytokine production may carry prognostic value in cancer patients. Immunomodulating therapies leading to improvement of these parameters might in the future lead to increased options for treatment. (Journal of Parenteral and Enteral Nutrition 24:329–336, 2000)
Hyperhomocysteinemia Is Associated with Venous Thrombosis in Patients with Short Bowel Syndrome
Authors: Compher Charlene W. , Kinosian Bruce P. , Evans‐Stoner Nancy , Huzinec Jill , Buzby Gordon P.
Published: May 2008

Background: Hyperhomocysteinemia is associated with venous thrombosis and vitamin deficiency. Patients with short bowel syndrome have increased risk of venous thrombosis due to central catheters, and of vitamin deficiency due to malabsorption. The current investigation was designed to evaluate the relationship between history of venous thrombosis and current hyperhomocystinemia and vitamin deficiency in patients with short bowel syndrome. Methods: Plasma total homocysteine (tHcy), serum vitamin B12, folate, B6, and methylmalonic acid (MMA) were measured. Venous thrombosis was documented by venogram or ultrasound. Results: Ten of 17 patients had venous thromboses, including 17 of 38 observed superior and 12 of 26 inferior veins. Total homocysteine was correlated with number of thromboses. The relative risk of multiple thromboses in the highest tHcy tertile was 3.6‐fold that of the lowest tertile. Vitamin B12 and folate levels were within normal limits, but B12 deficiency by MMA or tHcy level was apparent in 7 patients. Vitamin‐deficient patients had higher tHcy and MMA than those without deficiency. Conclusions: Venous thrombosis in patients with short bowel syndrome is related to hyperhomocystinemia, which is also related to vitamin B12 deficiency, not detected by serum vitamin B12 concentration. Whether treatment of vitamin deficiencies and associated reduction in tHcy will reduce recurrent venous thrombosis in these patients is not known. (Journal of Parenteral and Enteral Nutrition 25:1–8, 2001)
Assessment of Distal Tip Position of Long‐Term Central Venous Feeding Catheters Using Transesophageal Echocardiology
Authors: Reynolds Nigel , McCulloch Alan S. , Pennington Christopher R. , MacFadyen Robert J.
Published: May 2008

Background: Central vein catheter position is a vital element in promoting longevity and minimizing adverse events associated with long‐term parenteral nutrition. Traditionally, position has been verified using a chest radiograph. However, this mode of assessment has limitations as the catheter is placed in a dynamic system subject to forces from changes in posture and diaphragmatic movement. Methods: We compared the reported position using a chest x‐ray compared with assessment using transesophageal echocardiology (TOE) in 9 patients receiving home parenteral nutrition. The x‐ray was reported by a radiologist unaware of the study. Results: There were discordant results in 7 of the 9 cases with catheter tip placed in the right atrium or impinging in the tricuspid valve which was not evident from the chest x‐ray. TOE offered greater information of catheter tip position and relationship to adjacent anatomy. Conclusions: Further work is required but this observational study suggests guidelines suggesting the use of a chest radiograph to confirm catheter position may need to be re‐assessed. (Journal of Parenteral and Enteral Nutrition 25:39–41, 2001)
Total Parenteral Nutrition Decreases Liver Oxidative Metabolism and Antioxidant Defenses in Healthy Rats: Comparative Effect of Dietary Olive and Soybean Oil
Authors: Lespine Anne , Fernandez Yvette , Periquet Brigitte , Galinier Anne , Garcia Jesus , Anglade Francine , Ghisolfi Jacques , Thouvenot Jean‐Paul
Published: May 2008

Background : Total parenteral nutrition (TPN) is used for critically ill patients undergoing surgery, after trauma, or during disease conditions that favor oxidative stress. We studied the effect of TPN on liver oxidative metabolism and antioxidant defenses in rats, and we compared the effect of soybean oil‐ and olive oil‐based diets. Methods: Seven‐week‐old rats (n = 28) were divided into four groups. Two experimental groups received a TPN solution containing soybean oil (TPN‐S) or a mixture of olive/soybean oil, 80/20 (TPN‐O), IV for 6 days. Orally fed animals received a solid diet including soybean oil (Oral‐S) or olive/soybean oil, 80/20 (Oral‐O). The following parameters were measured: DL‐α‐tocopherol, vitamin A, malondialdehyde and thiobarbituric acid reactive substances (MDA‐TBARS), and total radical‐trapping antioxidant parameter (TRAP) in serum; DL‐α‐tocopherol, vitamin A, glutathione (GSH), and catalase (Cat) activity in liver homogenate; fatty acids from phospholipid, cytochrome P‐450 content, NADPH‐cytochrome c 2 reductase activity in liver microsomes; superoxide dismutase (SOD), glutathione peroxidase (Gpx), glutathione reductase (GR), glutathione transferase (GST), and glucose‐6‐phosphate dehydrogenase (G6PD) in liver cytosol. Results: The soybean or olive oil diets modified the liver microsomal fatty acid phospholipid composition, but the unsaturation index remained unchanged. TPN specifically increased the saturation of the membrane. The cytochrome P‐450 level and the NADPH‐cytochrome c 2 reductase, SOD, Gpx, Cat, and GST activities were unchanged by soybean oil or olive oil diet but decreased receiving TPN. Conclusions: In rats, TPN decreased the liver oxidative metabolism and enzymatic antioxidant defenses. This may be related to saturation of the liver microsomal fatty acids. (Journal of Parenteral and Enteral Nutrition 25:52–59, 2001)
Growth Factors Regulation of Rabbit Sodium‐Dependent Neutral Amino Acid Transporter ATB0 and Oligopeptide Transporter 1 mRNAs Expression after Enterectomy
Authors: Avissar Nelly E. , Ziegler Thomas R. , Wang Howard T. , Gu Li H. , Miller Jen‐nie H. , Iannoli Pasquale , Leibach Frederick H. , Ganapathy Vadivel , Sax Harry C.
Published: May 2008

Background:Sucessful intestinal adaptation after massive enterectomy is dependent on increased efficiency of nutrient transport. However, midgut resection (MGR) in rabbits induces an initial decrease in sodium‐dependent brush border neutral amino acid transport, whereas parenteral epidermal growth factor (EGF) and growth hormone (GH) reverse this downregulation. We investigated intestinal amino acid transporter B° (ATB°) and oligopeptide transporter 1 (PEPT 1) mRNA expression after resection and in response to EGF and/or GH.Methods:Rabbits underwent anesthesia alone (control) or proximal, midgut, and distal resections. Full‐thickness intestine was harvested from all groups on postoperative day (POD) 7, and on POD 14 from control and MGR rabbits. A second group of MGR rabbits received EGF and/or GH for 7 days, beginning 7 days after resection. ATB° and PEPT 1 mRNA levels were determined by Northern blot analysis.Results:In control animals, ileal ATB° mRNA abundance was three times higher than jejunal mRNA, whereas PEPT 1 mRNA expression was similar. By 7 and 14 days after MGR, jejunal ATB° mRNA abundance was decreased by 50%uscontrol jejunum. A 50% decrease in jejunal PEPT 1 message was delayed until 14 days after MGR. Treatment with EGF plus GH did not alter ATB° mRNA expression but doubled PEPT 1 mRNA in the jejunum.Conclusion:The site of resection, time postresection, and growth factors treatment differentially influence ATB° and PEPT 1 mRNA expression. Enhanced sodium‐dependent brush border neutral amino acid transport with GH plus EGF administration is independent of increased ATB° mRNA expression in rabbit small intestine after enterectomy.(journal of Parenteral and Enteral Nutrition25:65–72,2001)
A Comparison of Renal Phosphorus Regulation in Thermally Injured and Multiple Trauma Patients Receiving Specialized Nutrition Support
Authors: Dickerson Roland N. , Gervasio Jane M. , Sherman Justin J. , Kudsk Kenneth A. , Hickerson William L. , Brown Rex O.
Published: May 2008

To compare phosphorus intake and renal phosphorus regulation between thermally injured patients and multiple trauma patients, 40 consecutive critically ill patients, 20 with thermal injury and 20 with multiple trauma, who required enteral tube feeding were evaluated. Phosphorus intakes were recorded for 14 days from the initiation of tube feeding which was started 1 to 3 days postinjury. Serum for determination of phosphorus concentrations was collected at days 1, 3, 7, and 14 of the study period. A 24‐hour urine collection was obtained during the first and second weeks of nutrition support for urinary phosphorus excretion, fractional excretion of phosphorus, renal threshold phosphate concentration, and phosphorus clearance. Average total daily phosphorus intake during the 14‐day study for thermally injured patients and multiple trauma patients was 0.99 ± 0.26 mmol/kg/d vs 0.58 ± 0.21 mmol/kg/d, respectively, p <.001. Serum phosphorus concentration on the third day of observation was significantly lower in the thermally injured group than those with multiple trauma (1.9 ± 0.8 mg/dL vs 3.0 ± 0.8 mg/dL, p ≤.01). A trend toward hypophosphatemia in the thermally injured group persisted by the seventh day of feeding (2.7 ± 1.2 mg/dL vs 3.3 ± 0.6 mg/dL, p ≤.04). Differences in urinary phosphorus excretion was not statistically significant between the thermally injured and multiple trauma groups (271 ± 213 mg/d vs 171 ± 181 mg/d for week 1, and 320 ± 289 mg/d vs 258 ± 184 mg/d for week 2, respectively). Urinary phosphorus clearance, fractional excretion of phosphorus, or renal threshold phosphate concentrations were also not significantly different between thermally injured and multiple trauma patients. During nutrition support, serum phosphorus concentrations are lower in thermally injured patients compared with multiple trauma patients despite receiving a significantly greater intake of phosphorus. Renal phosphorus regulation does not significantly contribute to the profound hypophosphatemia observed in thermally injured patients when compared with multiple trauma patients during nutrition support. (Journal of Parenteral and Enteral Nutrition 25:152–159, 2001)
Efficacy of Erythromycin for Postpyloric Placement of Feeding Tubes in Critically Ill Children: A Randomized, Double‐Blind, Placebo Controlled Study
Authors: Gharpure Varsha , Meert Kathleen L. , Sarnaik Ashok P.
Published: May 2008

Background:Erythromycin enhances gastric emptying and has been suggested to facilitate nasoenteric feeding tube placement in adults. Our primary objective was to evaluate the effect of erythromycin on the transpyloric passage of feeding tubes in critically ill children, and second, to evaluate the effect of erythromycin on the distal migration of duodenal feeding tubes.Methods:Seventy‐four children were randomly assigned to receive erythromycin lactobionate (10 mg/kg) IV or equal volume of saline placebo 60 minutes before passage of a flexible weighted tip feeding tube. Abdominal radiographs were obtained 4 hours later to assess tube placement. If the tube was proximal to the third part of the duodenum, two additional doses of erythromycin/placebo were administered 6 hours apart. Those receiving additional doses had repeat radiographs 14 to 18 hours after tube placement.Results:The number of postpyloric feeding tubes was similar in the erythromycin and placebo treated groups 4 hours after tube insertion (23/37vs27/37,p=.5). Of those with prepyloric tubes at 4 hours, none in the erythromycin group and 3 in the placebo group had the tube migrate to the postpyloric position by 14 to 18 hours(p<.05). Of those with postpyloric tubes proximal to the third part of the duodenum at 4 hours, additional doses of erythromycin did not cause more tubes to advance further into the intestine than did placebo(p=.6).Conclusions:Erythromycin does not facilitate transpyloric passage of feeding tubes in critically ill children. The distal migration of duodenal tubes further into the small bowel is also not enhanced by erythromycin. (Journal of Parenteral and Enteral Nutrition25:160–165, 2001)
Reviews: Pyruvate in Organ Transplantation
Authors: Cicalese Luca
Published: May 2008

Pyruvate (PY) is a 3‐carbon compound present in human tissues and physiologically used by cells as an energetic substrate in anaerobic conditions. In the last few years, we have successfully used PY to protect small bowel (SB), liver, and kidneys from ischemia/reperfusion injury in several experimental models. Although the mechanism of protection is not fully clarified, we have shown increased tissue levels of adenosine driphosphate (ATP) during ischemia. This suggests that providing supra‐physiologic concentrations of PY during anaerobic glycolysis might enable the cells to remain viable during prolonged hypoxia. Furthermore, mechanisms such as direct inhibition of oxygen free radical formation, abrogation of neutrophilic infiltration and reduced up‐regulation of adhesion molecules have also been documented in these studies. In light of these findings, we evaluated the efficacy of PY in organ preservation and transplantation. We demonstrated a protective effect on intestinal preservation injury and during acute rejection. Oral PY treatment induced immunologic changes in rejecting allograft, inhibiting perforin and granzyme‐b expression and leukocytic infiltration. Protection was also documented on livers after prolonged hypothermic preservation using a PY based preservation solution. Additionally, isolated pancreatic islets were cultured in PY enriched media and maintained viable for up to 120 days followed by in vitro testing and transplantation revealing a well preserved function. All these findings suggest that PY is a potentially beneficial nutrient in patients undergoing organ transplantation and that future clinical application of PY in this field should be encouraged. (Journal of Parenteral and Enteral Nutrition 25:216–218, 2001)