bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary Protein Absorption of the Small Intestine in Human Neonates
Authors: Schaart Maaike W. , de Bruijn Adrianus C. J. M. , Tibboel Dick , Renes Ingrid B. , van Goudoever Johannes B.
Published: May 2008

Background: The intestine plays a key role in the absorption of dietary proteins, which determines growth of human neonates. Bowel resection in the neonatal period brings loss of absorptive and protective surface and may consequently lead to malabsorption of dietary nutrients. However, there are no data on net dietary protein absorption of the small intestine in the period after intestinal surgery in human neonates. We therefore evaluated dietary feeding tolerance and quantified net dietary protein absorption capacity of the small intestine in human neonates in whom a temporary jejunostomy or ileostomy was created. Methods: Seventeen patients were included in the study. We collected small intestinal outflow fluid at the level of the enterostomy weekly for 24–48 hours during weeks 3 through 6 postoperatively. Protein levels in the intestinal outflow fluid were determined by bicinchoninic acid (BCA) assay. Results: In 14 patients, an enteral intake of >100 mL/kg/d was reached at a median of 17 days (range, 8–32 days) postoperatively. Three patients did not reach this level within the study period. Overall, the net dietary protein absorption capacity was 70%–90% of the total enteral protein intake. Conclusions: This study demonstrates that the dietary protein absorption capacity of the small intestine is intact in most human neonates after intestinal surgery in a very critical period of their lives. Furthermore, our results do not support the use of hydrolyzed or elemental formula in newborns with an enterostomy to improve amino acid uptake.
Effects of Protein/Nonprotein Caloric Intake on Parenteral Nutrition–Associated Cholestasis in Premature Infants Weighing 600–1000 Grams
Authors: Blau Jonathan , Sridhar Shanthy , Mathieson Susan , Chawla Anupama
Published: May 2008

Background:Parenteral nutrition‐associated cholestasis (PNAC) has historically been a significant cause of morbidity and mortality in neonates undergoing parenteral feeding. Studies examining the causes of cholestasis in the PN‐dependent neonate have produced a wide range of data, with some conflicting results. Increased protein/nonprotein calorie ratios, increased glucose concentrations, and increased lipid concentrations have all been implicated as possible causes of PNAC. However, these studies were done in the pre‐TrophAmine (neonatal‐specific amino acid parenteral nutrition [PN] formulation) era. With the introduction of TrophAmine, infants are now receiving higher concentrations of protein, often being advanced rapidly even when nonprotein calories may not be sufficiently advanced to meet the infants' caloric needs. To the best of our knowledge, no studies have been conducted to evaluate the protein/nonprotein calorie ratio as a cause of PNAC in the TrophAmine era.Methods:A retrospective chart review of 25 cholestatic and 25 noncholestatic PN‐dependent premature neonates was conducted. All neonates weighed between 600 and 1000 g. Cholestasis was defined as a serum total bilirubin (TB) ≥2.0 mg/dL, with a serum direct bilirubin (DB) ≥20% of the TB. Neonates with major congenital anomalies or who underwent major surgery were excluded. PN macronutrient compositions were analyzed to examine if the different amounts of protein concentrations and protein/nonprotein calorie ratios played a role in the development of PNAC. Statistical analysis was performed using Student'st‐tests.pValues < .05 were considered statistically significant.Results:All measured nutrition parameters did not differ significantly between the cholestatic and noncholestatic groups. Protein intake, the protein/nonprotein calorie ratio, and renal function as evaluated by blood urea nitrogen (BUN) and creatinine did not differ between the 2 study groups. The only parameters that differed significantly between the groups were the duration of PN therapy and length of hospital stay.Conclusions:Protein to nonprotein calorie ratio was not an etiology in the development of cholestasis in infants (600–1000 g) receiving PN. Renal function elicited not to have an impact on cholestasis status of these infants. Therefore, providing adequate protein calories should not be limited in this patient population, as suggested by previous studies in the pre‐TrophAmine era. We found that increased duration of PN therapy and increased length of hospital stay were associated with PNAC.
Effects of Parenteral Nutrition Without and With Growth Hormone on Growth Hormone/Insulin‐Like Growth Factor‐1 Axis After Hepatectomy in Hepatocellular Carcinoma With Liver Cirrhosis
Authors: Cao Jie , Luo Shi‐Min , Liang Lijian , Lai Jiaming
Published: May 2008

Background:Complex alterations in the growth hormone (GH)/insulin‐like growth factor‐1 (IGF‐1) axis are thought to play an important role in the protein catabolism that complicates major surgical procedures. The aim of this study was to evaluate the potential roles of recombinant human growth hormone (rhGH) therapy after hepatectomy in hepatocellular carcinoma (HCC) with liver cirrhosis, and to investigate whether postoperative administration of rhGH increases the risk of tumor recurrences.Methods:Twenty‐four patients with HCC in the setting of cirrhosis who underwent hepatectomy were randomly divided into 2 groups: parenteral nutrition (PN) group (n = 12) and rhGH + parenteral nutrition group (n = 12). Liver function, serum GH, IGF‐1, and IGF binding protein‐3 (IGFBP‐3) were measured before operation, at postoperative days (POD) 1 and 6. IGF‐1 and IGFBP‐3 mRNA in liver tissue was measured by reverse transcriptase polymerase chain reaction. Liver Ki67 immunohistochemistry staining was studied. At the same time, 12 patients with cholelithiasis or liver hemangioma who underwent operation were segregated as a normal control.Results:On POD 6, compared with the PN group, serum prealbumin, GH, IGF‐1, IGFBP‐3, hepatic IGF‐1 mRNA, IGFBP‐3 mRNA, and liver Ki67 LI were higher in rhGH + PN group. The 6‐ and 12‐month tumor‐free survival rates, a median tumor‐free survival time, were not different between the PN and rhGH + PN group.Conclusions:rhGH + PN can ameliorate changes in the GH/IGF‐1 axis after hepatectomy for HCC in the setting of cirrhosis.
Assessing Energy Expenditure in Cancer Patients: A Pilot Validation of a New Wearable Device
Authors: Cereda Emanuele , Turrini Mauro , Ciapanna Denis , Marbello Laura , Pietrobelli Angelo , Corradi Ettore
Published: May 2008

Background: Nutrition problems are common in cancer patients and are frequently due to metabolic derangements. Thus, accurately assessing energy expenditure (EE) is important in planning adequate nutrition support. Indirect calorimetry (IC) represents the gold standard method but is not always available or applicable to all settings. The purpose of this study was to preliminary compare a new wearable device, the SenseWear armband (SWA), to IC in cancer patients. Methods: Ten (6 M, 4 F) subjects (mean± SD: 56.6 ± 13.3 years) affected by newly diagnosed acute myelogenous leukemia, undergoing induction chemotherapy, were prospectively enrolled. Resting EE (REE) was measured simultaneously by SWA and IC on admission (day 0) and at discharge (end). Total daily EE (TDEE) was determined by SWA 4 times during the stay (days 0, 7, 14, and end) and predicted values were calculated according to IC REE estimates (TDEE = IC × correction factor 1.2). Results: Mean length of stay was 27.1 ± 6.2 days. Bland‐Altman plots revealed no significant differences between overall REE estimates (day 0 + end) performed by IC and SWA (mean ± SD; 1645± 282 vs 1705 ± 278 kcal/d) and the correlation was high (r = 0.84; p < .0001). SWA TDEE showed a progressive reduction during the stay. No bias was detected between overall SWA TDEE (1799± 153 kcal/d) and IC predicted TDEE (1974 ± 176 kcal/d), but there was a wide 95% confidence interval (–672; +321 kcal/d). Moreover, the correlation between these values was significant (r = 0.68; p = .001). Conclusions: SWA seems to provide accurate and reliable estimation of REE and useful information on TDEE also in cancer patients. Its use appears promising. Validation studies on larger samples and different cancer types should be considered.
Percutaneous Endoscopic Gastrostomy in the Neurosurgical Intensive Care Unit: Complications and Outcome
Authors: Koc Demet , Gercek Arzu , Gencosmanoglu Rasim , Tozun Nurdan
Published: May 2008

Background: Even with a functioning gastrointestinal tract, it is not always easy to initiate oral feeding in some neurosurgical patients because of their persistently depressed neurologic status or severe lower cranial nerve palsies. Percutaneous endoscopic gastrostomy (PEG) may be required for long‐term feeding in these patients. The purpose of the present study is to report our experience with PEG chosen for establishing an enteral route in patients of neurosurgical intensive care unit (ICU). Methods: The outcome and complications of PEG in neurosurgical ICU patients of Marmara University Institute of Neurological Science between January 2001 and November 2006 were retrospectively evaluated. Results: Thirty‐one patients, with the median age of 51 years (range, 14–78 years) underwent PEG placement. PEG was placed before the craniotomy in 2 patients and after in 29. Indications for PEG were absent gag reflex in 10 patients and low Glasgow Coma Scale score in 21. Before the PEG tube insertion, 18 patients had enteral nutrition by a nasogastric tube and 10 had parenteral nutrition (PN), with a median duration of 14.5 (range, 4–60) and 12 (range, 7–25) days, respectively. Two patients accidentally pulled out the gastrostomy tubes 10 and 11 days after insertion. Buried bumper syndrome developed in 1 patient. Two patients died 8 and 34 days after the procedure in the neurosurgical ICU. Twenty‐nine patients were discharged from the hospital while being fed via the PEG tubes. In 11 patients who were able to resume oral feeding, the tube was removed, with a median interval of 62 (range, 25–150) days. Procedure‐related mortality, 30‐day mortality, and overall mortality of the patients were 0%, 6.4%, and 45%, respectively. Conclusion: PEG is a safe and well‐tolerated gastrostomy method for neurosurgical ICU patients with depressed neurologic state or severe lower cranial nerve palsies.
Effect of Calorically Dense Enteral Nutrition Formulas on Outcome in Critically Ill Trauma and Surgical Patients
Authors: Bryk Jodie , Zenati Mazen , Forsythe Raquel , Peitzman Andrew , Ochoa Juan B.
Published: May 2008

Background: Surgical and trauma patients are traditionally provided with calorically dense dietary formulas to deliver high amounts of nutrients. The benefits of these formulas remain unproven and may be associated with significant side effects and even increased mortality. We studied outcomes on surgical and trauma patients receiving either a calorically dense dietary formula or a normocaloric dietary formula. Methods: A retrospective analysis comparing outcomes in intensive care unit (ICU) surgical and trauma patients receiving either a calorically dense dietary formula or a normocaloric dietary formula was performed at the University of Pittsburgh Medical Center. Results: One hundred seventeen patients met study criteria. Surgical and trauma patients were analyzed separately. Despite receiving different calorically dense diets, caloric intake was not significantly different in surgical patients receiving either diet. However, surgical patients receiving a normocaloric formula exhibited decreased length of stay (14.7 ± 10.1 vs 25.0± 11.3 days; p = .01), ventilator days (14.3 ± 12.9 vs 21.3 ± 10.5 days; p = .04), and average daily glucose levels (129.8 ± 4.1 vs 157.9 ± 13.6 mg/dL; p =.01), and were more likely to be directly discharged home compared with those receiving a calorically dense dietary formula. Trauma patients receiving a calorically dense dietary formula were on average 17 years younger (p = .01). However, trauma patients receiving a normocaloric formula exhibited decreased length of stay (15.3 ± 1.6 vs 18.7± 1.6 days; p = .02) and a greater likelihood of direct discharge home. Conclusions: The data generated suggest that what a patient is fed affects both short‐ and long‐term outcomes. A prospective study should be designed to determine the ideal calories needed in surgical and trauma patients.
Dietary ω‐3 Polyunsaturated Fatty Acids Can Inhibit Expression of Granzyme B, Perforin, and Cation‐Independent Mannose 6‐Phosphate/Insulin‐Like Growth Factor Receptor in Rat Model of Small Bowel Transplant Chronic Rejection
Authors: Kun Zhao , Haiyun Zhang , Meng Wang , Li Ning  , Li Yousheng  , Li Jieshou
Published: May 2008

Background: The aim of our work was to investigate the effects ofω ‐3 polyunsaturated fatty acids on apoptosis and granzyme B, perforin, and cation‐independent mannose 6‐phosphate/insulin‐like growth factor receptor (CI‐MPR) expression of intestinal epithelial cells of chronic rejection after small intestinal transplantation. Methods: Small bowel transplantation was performed in a rat combination of 3 groups: group 1, Lewis‐to‐Lewis; group 2, F344‐to‐Lewis, dietary corn oil; group 3, F344‐to‐Lewis, dietary fish oil. All recipients were killed at 16 weeks posttransplantation. The apoptosis rate of mucosal cells was evaluated by flow cytometry. The expression of granzyme B, perforin, and CI‐MPR was analyzed by reverse transcriptase PCR. Results: A high apoptotic rate was observed when the allografts demonstrated 1 or more histologic features of chronic rejection. ω‐3 Polyunsaturated fatty acids decreased in rate of the apoptosis, and it can inhibit the expression of granzyme B, perforin, and CI‐MPR. Conclusions: ω‐3 Polyunsaturated fatty acids can suppress the rejection to mucosal cells of allograft at the time of chronic rejection in small intestinal transplantation, which may be significant in increasing the surviving rate of allograft, delaying the chronic dysfunction, and prolonging the lifetime of both allograft and acceptor.
A Computerized Insulin Infusion Titration Protocol Improves Glucose Control With Less Hypoglycemia Compared to a Manual Titration Protocol in a Trauma Intensive Care Unit
Authors: Dortch Marcus J. , Mowery Nathan T. , Ozdas Asli , Dossett Lesly , Cao Hanqing , Collier Bryan , Holder Gwen , Miller Randolph A. , May Addison K.
Published: May 2008

Background: Previous studies reflect reduced morbidity and mortality with intensive blood glucose control in critically ill patients. Unfortunately, implementation of such protocols has proved challenging. This study evaluated the degree of glucose control using manual paper‐based vs computer‐based insulin protocols in a trauma intensive care unit. Methods: Of 1455 trauma admissions from May 31 to December 31, 2005, a cohort of 552 critically ill patients met study entry criteria. The patients received intensive blood glucose management with IV insulin infusions. Using Fisher's exact test, the authors compared patients managed with a computerized protocol vs a paper‐based insulin protocol with respect to the portion of glucose values in a target range of 80–110 mg/dL, the incidence of hyperglycemia (≥150 mg/dL), and the incidence of hypoglycemia (≤40 mg/dL). Results: Three hundred nine patients were managed with a manual paper‐based protocol and 243 were managed with a computerized protocol. The total number of blood glucose values across both groups was 21,178. Mean admission glucose was higher in the computer‐based protocol group (170 vs 152 mg/dL; p < .001, t‐test). Despite this finding by Fisher's exact test, glucose control was superior in the computerized group; a higher portion of glucose values was in range 80–110 mg/dL (41.8% vs 34.0%; p < .001), less hyperglycemia occurred (12.8% vs 15.1%; p < .001), and less hypoglycemia occurred (0.2% vs 0.5%; p < .001). Conclusions: A computerized insulin titration protocol improves glucose control by (1) increasing the percentage of glucose values in range, (2) reducing hyperglycemia, and (3) reducing severe hypoglycemia.
Emergency High‐Loop Jejunostomy as Enteral Nutrition Access: A Simple and Safe Method
Authors: Pacelli Fabio , Rotondi Fabio , Rosa Fausto , Bossola Maurizio , Papa Valerio , Tortorelli Antonio Pio , Sollazzi Liliana , Doglietto Giovanni Battista
Published: May 2008

Background: Emergency high‐loop jejunostomies are seldom used for nutrition access in the clinical practice. Methods: This paper describes the results of a simple and safe technique that uses emergency high‐loop jejunostomy as an enteral feeding access. A feeding tube is inserted into the efferent loop of the jejunostomy and then subcutaneously tunneled. In this way, whenever it becomes necessary, the bag collecting fluids from the afferent loop can be changed without removing the tube, which remains permanently inserted into the efferent loop and secured to the skin in order to avoid displacements. Results: Twenty‐nine patients with high‐loop jejunostomy were consecutively treated with the described technique during the period 2000–2006. The mean distance between the ligament of Treitz and tube was 38.3 ± 16.2 cm. After an induction period, all patients received full‐strength enteral nutrition and were discharged after a mean of 25.1 ± 19.5 days of treatment. All patients were subsequently readmitted to our unit, and their ostomies were successfully closed. No major early and late complications were observed; particularly, no patient experienced local or systemic septic complications. Conclusion: From the analysis of our results, the described method for delivering enteral nutrition through an emergency high‐loop ostomy proves easy to apply and clinically effective. Enteral nutrition can be started as soon as possible after operation through the efferent loop of the ostomy; the management of the jejunostomy is simple and safe, with no additional discomfort for the patients.
Effect of Liquid Pancreatic Enzymes on the Assimilation of Fat in Different Liquid Formula Diets
Authors: Hauenschild Annette , Ewald Nils , Klauke Thorsten , Liebchen Ariane , Bretzel Reinhard Georg , Kloer Hans‐Ulrich , Hardt Philip Daniel
Published: May 2008

Background: In some diseases, patients require high‐calorie tube feeding with standard enteral formulas usually administered via temporal feeding tubes. One frequent pathophysiological condition in a relevant number of these patients is exocrine pancreatic insufficiency. Patients unable to swallow capsules might benefit from a liquid pancreatic enzyme (LPE) preparation. Methods: LPEs were prepared and mixed with different commercially available formula diets produced for enteral feeding. Lipolysis was then measured by fatty acid titration. Results: Complete lipolysis by liquid enzyme preparations was observed in diverse formula diets. Fat assimilation was even complete when LPE had been prepared 3.5 hours before the experiments, showing that the enzymes had been stable up to that time. Conclusions: The use of LPEs seems to be a good therapeutic option in patients with exocrine pancreatic insufficiency and the need for permanent high‐calorie enteral feeding. Pharmaceutical companies should therefore be further encouraged to develop and distribute liquid enzyme preparations.
Feasibility Evaluation of Emodin (Rhubarb Extract) as an Inhibitor of Pancreatic Cancer Cell Proliferation In Vitro
Authors: Cai Jun , Razzak Anthony , Hering Justin , Saed Abdul , Babcock Tricia A. , Helton Scott , Espat N. Joseph
Published: May 2008

Emodin is a commonly used traditional herbal treatment in China, including use for pancreatic malignancy. In this study, the potential for emodin to inhibit pancreatic cancer cell proliferation was examined using 4 human pancreatic adenocarcinoma cell lines: Mia Paca‐2, BxPC‐3, Panc‐1, and L3.6pl. WST‐1 proliferation, propidium iodide flow cytometry cell cycle analysis, and poly‐ADP‐ribose polymerase (PARP) Western blot analysis were performed. Forty‐eight‐hour treatment with 50 μM emodin inhibited proliferation in Mia Paca‐2 cells by 42%, BxPc‐3 by 38%, L3.6pl by 56%, and Panc‐1 by 18% (all P < .01). In three‐fourths of the cell lines, emodin treatment resulted in an increase (from 4.7% to 22%) in the cell population number in apoptosis when measured by flow cytometric analysis. Mia Paca‐2 revealed a significant PARP cleavage product when compared with control. These feasibility experiments provide initial evidence that emodin exerts an antiproliferative effect, likely through apoptosis induction‐related mechanism(s), that is reproducible in various human pancreatic cancer cell lines.
Iatrogenic Malnutrition in Neonatal Intensive Care Units: Urgent Need to Modify Practice
Authors: Grover Anuj , Khashu Minesh , Mukherjee Anindyalal , Kairamkonda Venkatesh
Published: May 2008

Background: Extrauterine growth retardation is a major clinical problem in very‐low‐birth‐weight infants. Parenteral nutrition (PN) serves to achieve rapid maximal nutrition in early postnatal life. There is a lack of uniformity with regard to neonatal PN practice. The objective of this study is to ascertain current practice regarding neonatal PN prescription in the early postnatal period in the United Kingdom. Methods: A study questionnaire was e‐mailed to neonatal pharmacists serving level 3 and major level 2 units in the United Kingdom between October 2005 and March 2006. Static numerical information regarding glucose, amino acids, and lipid prescription during the first 10 days of life was collected and compared with current recommendations. Results: Fifty‐two (81%) units responded to the questionnaire; 4 units were excluded for incomplete data. Twenty‐six units (54%) initiated PN on day 1. Full PN was achieved by the median age of 6 days. Twelve units (25%) achieved full PN only by day 7 or later. Maximum median amino acids were 2.9 g/kg/d. Only 13 units (27%) prescribed ≥3 g/kg/d, and 2 prescribed more than 3.5 g/kg/d. Nineteen units (39%) initiated lipids on day 1. Eleven units (23%) delayed lipids until day 3, and 2 units delayed lipids until day 4. In comparison to the recommended intake of calories and amino acids, the current median prescription would result in a cumulative deficit over the first 10 days of 420 kcal/kg and 11.9 g/kg, respectively. Conclusions: Our study suggests diverse practice with regard to neonatal PN prescription in the United Kingdom. Current neonatal PN practice entails a significant calorie and protein deficit during early postnatal life and warrants further review.
Effects of Medium‐Chain Triglycerides, Long‐Chain Triglycerides, or 2‐Monododecanoin on Fatty Acid Composition in the Portal Vein, Intestinal Lymph, and Systemic Circulation in Rats
Authors: You Yi‐Qian Nancy , Ling Pei‐Ra , Qu Jason Zhensheng , Bistrian Bruce R.
Published: May 2008

Background: Fatty acid absorption patterns can have a major impact on the fatty acid composition in the portal, intestinal lymph, and systemic circulation. This study sought to determine the effects of long‐chain triglycerides (LCT), medium‐chain triglycerides (MCT), and 2‐monododecanoin (2mono) on intestinal fatty acid composition during continuous feeding over a brief period. Methods: The lipid sources were 100% LCT, 100% MCT, a 50:50 mixture of LCT and MCT (LCT/MCT), and a 50:50 mixture of LCT and 2mono (LCT/2mono). A total of 27 rats were randomly given 1 of the 4 diets at 200 kcal/kg/d, with 30% of total calories from lipids over 3 hours. Results: MCT significantly increased each of the medium‐chain fatty acids (C6:0, C8:0, and C10:0) as free fatty acids in the portal vein and about 10%/mol of C10:0 as triglycerides in the lymph compared with the other groups. There was significantly less C10:0 in lymphatic triglycerides with LCT/MCT than with MCT, but more than in the LCT and LCT/2mono diets. MCT also significantly increased the contents of C16:0, C18:0, C18:1, and C20:4 in the lymphatic triglycerides compared with all other groups including LCT/MCT. The amount of linoleic acid (C18:2) in lymphatic triglycerides followed the relative amounts of this fatty acid in the diet, with the greatest in LCT followed by LCT/MCT and LCT/2mono and least in MCT. A so‐called structured lipid composed of the medium‐chain fatty acid dodecanoic acid on the 2 position and long‐chain fatty acids on the 1 and 3 positions appeared to be endogenously synthesized in response to the LCT/2mono diet. Conclusions: The original differences in MCT and LCT content in the diets were preserved in the fatty acid composition in the intestinal free fatty acids and triglycerides during feeding. In addition, the duration of lipid administration can play a role in altering fatty acid composition in the intestine.
Trace Element Loss in Urine and Effluent Following Traumatic Injury
Authors: Klein Catherine J. , Nielsen Forrest H. , Moser‐Veillon Phylis B.
Published: May 2008

Background: Few data are available to establish recommendations for trace element supplementation during critical illness. This study quantified the loss of several elements and assessed the adequacy of manganese and selenium in parenteral nutrition (PN). Methods: Men with traumatic injuries were grouped by renal status: adequate (POLY; n = 6), acute failure with continuous venovenous hemofiltration (CVVH; n = 2), or continuous venovenous hemodiafiltration (CVVHD; n = 4). PN supplied 300 μg/d manganese and 60 μg/d selenium. Urine and effluent (from artificial kidneys) were collected for 3 days and analyzed for boron, manganese, nickel, and silicon using inductively coupled plasma atomic emission spectrometry, and for selenium using atomic absorption spectrometry. Results: POLY manganese and selenium excretion averaged (standard deviation [SD]) 7.9 (3.3)μ g/d and 103.5 (22.4) μg/d, respectively. All elements except selenium were detected in dialysate (prior to use). CVVHD effluent contained 3.5 and 7.3 times more manganese and nickel than CVVH ultrafiltrate, respectively. Loss of manganese averaged 2.6%, 21%, and 73% of PN amounts for POLY, CVVH, and CVVHD groups, respectively. Discussion: Minimal loss of manganese compared with the amount in PN suggests that excessive amounts are retained. POLY patients excreted more selenium than was in PN, indicating negative balance. POLY losses of boron and silicon were less than that published for healthy adults, reflecting less than typical intake, whereas loss during CVVH was in the normal reference range, possibly because of added intake from boron contamination of replacement fluids. All patients lost more nickel than amounts published for healthy adults. Conclusions: Current guidelines of 60‐100 μg/d of parenteral manganese may be excessive for trauma patients. The uptake of manganese and nickel from contaminants in CVVHD dialysate should be investigated.
Sesame Oil Attenuates Hepatic Lipid Peroxidation by Inhibiting Nitric Oxide and Superoxide Anion Generation in Septic Rats
Authors: Hsu Dur‐Zong , Chien Se‐Ping , Li Ya‐Hui , Chuang Yin‐Ching , Chang Yu‐Chung , Liu Ming‐Yie
Published: May 2008

Background: Sepsis is a major cause of mortality in the intensive care unit. Oxidative stress plays an important role in the pathogenesis of organ failure during sepsis. Sesame oil decreases circulating oxygen free radicals in septic rats; however, its effect on hepatic oxidative status is unknown. The authors examined the effect of sesame oil on hepatic lipid peroxidation in septic rats. Methods: Hepatic injury was induced using cecal ligation and puncture (CLP). Rats were divided into 4 groups: sham, rats given a sham operation without CLP; SO, rats given sesame oil alone; CLP, rats given saline and then CLP; and CS, rats given sesame oil and then CLP. All rats were first given a 1‐week daily oral supplement of sesame oil or saline (4 mL/kg/d) and then CLP or a sham operation. The authors assessed hepatic oxidative stress by determining hepatic lipid peroxidation, hydroxyl radical, superoxide anion, and nitric oxide levels 12 hours after CLP. They also assessed xanthine oxidase activity and nitric oxide synthase expression. Results: Hepatic lipid peroxidation (P < .0001), hydroxyl radical (P < .05), superoxide anion (P< .05), and nitrite (P < .05) levels were significantly lower in sesame oil–treated septic rats. Furthermore, sesame oil significantly reduced xanthine oxidase activity (P < .01) and inducible nitric oxide synthase expression (P < .005) in septic rats. Conclusions: Sesame oil might attenuate hepatic lipid peroxidation by inhibiting superoxide anion and nitric oxide, at least partially, in experimental septic rats.
Covert Assessment of Concurrent and Construct Validity of a Chart to Characterize Fecal Output and Diarrhea in Patients Receiving Enteral Nutrition
Authors: Whelan Kevin , Judd Patricia A. , Preedy Victor R. , Taylor Moira A.
Published: May 2008

Background: An accurate and convenient method for characterizing fecal output and a consistent threshold for classifying diarrhea in patients receiving enteral nutrition are required. The aim of this study is to covertly assess the construct and concurrent validity of a chart for characterizing fecal output and classifying diarrhea in patients receiving enteral nutrition. Methods: The chart was used to monitor fecal output in patients receiving enteral nutrition for a total of 280 patient days. Nurses characterized 291 fecal samples, of which 84 underwent measurement of fecal water using lyophilization and 60 underwent Clostridium difficile enterotoxin analysis using enzyme‐linked immunosorbent assay. Construct and concurrent validity was assessed covertly to measure the true performance of the chart in a real‐life clinical and research context. Results: Use of the chart demonstrated higher fecal frequency (P ≤ .04), heavier stools (P ≤ .167), more unformed stools (P ≤ .001), higher daily fecal scores (P ≤ .001), and higher incidence of diarrhea (P ≤ .002) on days when patients had severe hypoalbuminemia, were receiving antibiotics, or had a recent positive C difficile assay, demonstrating construct validity. The water content of samples assigned to hard and formed (62.0%), soft and formed (72.1%), loose and unformed (79.3%), and liquid (87.9%) categories was significantly different (P < .001), demonstrating concurrent validity. Conclusions: Under covert assessment, the chart demonstrated construct validity for characterizing fecal output, daily fecal score, and diarrhea, together with concurrent validity for characterizing fecal consistency. Use of the chart in clinical practice and research will standardize the characterization of fecal output and classification of diarrhea in patients receiving enteral nutrition.
Aluminum Exposure From Pediatric Parenteral Nutrition: Meeting the New FDA Regulation
Authors: Poole Robert L. , Hintz Susan R. , Mackenzie Nicol I. , Kerner John A.
Published: May 2008

Background: Aluminum toxicity can cause serious central nervous system and bone toxicities. Aluminum is a contaminant of parenteral nutrition (PN) solution components. Premature neonates requiring high doses of calcium and phosphate to mineralize their bones, children with impaired renal function, and children on PN therapy for prolonged duration are at the highest risk. Effective in July 2004, the U.S. Food and Drug Administration (FDA) mandated labeling requirements for aluminum content in all PN solution components. To assess the aluminum exposure in neonatal and pediatric populations, this study aims to determine patients' daily aluminum load (μg/kg/d) delivered from PN solutions. Methods: The study included all inpatients who received PN during calendar year 2006 (13,384 PN patient days). The calculated parameters of μg/kg/d and μg/L of parentally administered aluminum were stratified according to patient age and weight. Aluminum content by product and manufacturer were tabulated. Results: Forty‐nine percent of the PN patient days were in patients weighing < 3 kg. These patients also received the largest amounts of aluminum (range, 30‐60μ g/kg/d). Meeting the FDA regulation was possible only in patients weighing> 50 kg. Conclusions: Currently available parenteral products used to make PN solutions contain amounts of aluminum that make it impossible to meet the new FDA rule of <5 μg/kg/d of aluminum exposure. Manufacturers must identify, develop, and adopt new methods to reduce the aluminum contamination in their products. Health care professionals should calculate aluminum loads in patients and make informed decisions when choosing PN products.
Carbohydrate Supplementation Before Operation Retains Intestinal Barrier Function and Lowers Bacterial Translocation in a Rat Model of Major Abdominal Surgery
Authors: Bouritius Hetty , van Hoorn Danny C. , Oosting Annemarie , van Middelaar‐Voskuilen Mariska C. , van Limpt Cees J. P. , Lamb Kelly J. , van Leeuwen Paul A. M. , Vriesema Aldwin J. M. , van Norren Klaske
Published: May 2008

Background: Overnight fasting of rats augments the susceptibility of the small intestine to ischemia–reperfusion damage. Feeding before surgery may improve injuries to distant organs that were induced by ischemia–reperfusion. The present study tested the hypothesis that one of the food constituents, namely carbohydrates, may be responsible for the protective effect of preoperative feeding on postoperative organ dysfunction. Methods: Male Wistar rats were fed ad libitum for 5 d and had either free access to water or free access to a carbohydrate drink and water. Then they were fasted for 16 h and access remained to either water or a carbohydrate drink and water. Following this, the arteria mesenterica superior was clamped for 60 min followed by 180 min of reperfusion. Subsequently, the intestinal permeability of stripped ileum was determined by measuring the mucosal to serosal flux in Ussing chambers. For assessment of bacterial content, organs were aseptically removed and assessed for bacterial content by culture under anaerobic conditions. Results: Preoperative supplementation with carbohydrates resulted in a better maintenance of intestinal barrier function when compared with water supplemented animals. Moreover, carbohydrate supplementation resulted in a reduction in the ischemiareperfusion–induced increase in bacterial content of the liver, kidney, and mesenteric lymph nodes. Conclusions: Preoperative intake of carbohydrates by rats retains both the intestinal barrier function and prevents translocation of bacteria to distant organs.
Sesame Oil Does Not Show Accumulatively Enhanced Protection Against Oxidative Stress–Associated Hepatic Injury in Septic Rats
Authors: Hsu Dur‐Zong , Chien Se‐Ping , Li Ya‐Hui , Liu Ming‐Yie
Published: May 2008

Background: Sepsis is one of the major causes of death reported in intensive care units. A daily supplement of sesame oil for 1 week significantly attenuates oxidative stress–associated hepatic injury in septic rats. However, the excess intake of sesame oil may be associated with a health risk. This study investigates the effect of accumulative sesame oil on oxidative stress–associated hepatic injury after cecal ligation and puncture in rats. Methods: Sesame oil was administered daily (4 mL/kg/d, orally) to rats, and the total intake of sesame oil ranged from 0 (control) to 140 mL/kg before cecal ligation and puncture in 9 groups of rats. Oxidative stress was examined by determining the levels of lipid peroxidation and glutathione. Hepatic injury was evaluated by measuring serum levels of aspartate aminotransferase and alkaline phosphatase. Results: Rats that received sesame oil for 4 and 5 weeks had a lower body weight gain compared with those that received saline. Lipid peroxidation was decreased in the 20‐mL/kg and 28‐mL/kg groups, but it was increased in the 140‐mL/kg group compared with the control group. Glutathione levels were increased in the≤ 28‐mL/kg groups compared with the control group. Serum levels of aspartate aminotransferase and alkaline phosphatase were reduced in the ≤28‐mL/kg groups compared with the control group. Conclusion: Sesame oil does not demonstrate accumulatively enhanced protection against oxidative stress–associated hepatic injury after cecal ligation and puncture in rats.
Severe Weight Loss and Hypermetabolic Paroxysmal Dysautonomia Following Hypoxic Ischemic Brain Injury: The Role of Indirect Calorimetry in the Intensive Care Unit
Authors: Mehta Nilesh M. , Bechard Lori J. , Leavitt Kristen , Duggan Christopher
Published: May 2008

A 14‐year‐old girl with hypoxic ischemic brain injury developed multiple paroxysms (storms) of dysautonomia. She had a dramatic weight loss of 20 kg over 8 weeks. Resting energy expenditure measured by indirect calorimetry during an autonomic storm was 309% of predicted resting energy expenditure, indicating extreme hypermetabolism. Energy intake and expenditure calculations showed cumulative energy deficits during the period of weight loss. The frequency of her hypermetabolic events increased daily energy needs that were unmatched by her intake, which was calculated from standard equations. Weight stabilized soon after nutrient intake was titrated to account for her heightened energy expenditure. This case illustrates an important nutrition complication of dysautonomic storms in children with brain injury. Regular weight checks during the intensive care course allow detection of weight loss from underfeeding. Measurement of energy needs is prudent when weight loss is unexplained or increased energy expenditure is suspected. In hospitalized patients with metabolic fluctuations, accurate measurement of energy requirements by indirect calorimetry allows serial monitoring of energy balance and may guide nutrition intake to prevent cumulative energy deficits.
Colostrum Supplementation Restores Insulin‐like Growth Factor ‐1 Levels and Alters Muscle Morphology Following Massive Small Bowel Resection
Authors: Pereira‐Fantini Prue M. , Thomas Sarah L. , Taylor Russell G. , Nagy Eva , Sourial Magdy , Fuller Peter J. , Bines Julie E.
Published: May 2008

Background: Colostrum protein concentrate (CPC) contains a high level of insulin‐like growth factor‐1 (IGF‐1). IGF‐1 and IGF binding protein (IGFBPs) may play an important role during the postresection adaptation response. As smooth muscle is an important site for IGF‐1 action in the intestine, this study aims to (1) investigate the effect of CPC supplementation on circulating levels and tissue expression of IGF‐1, IGF‐1 receptor, and IGFBPs following massive small bowel resection (MSBR), and (2) characterize the effect of CPC on the muscular adaptation response following MSBR. Methods: Four‐week‐old piglets underwent either a 75% MSBR or sham operation. Piglets received either a polymeric infant formula (PIF) diet or PIF supplemented with CPC for 8 weeks. Serum was analyzed by enzyme‐linked immunosorbent assay, and ileal tissue assessed by molecular and histological analysis. Results: There was no difference in IGF‐1 or IGFBPs mRNA among groups. CPC treatment resulted in significant increases in circulating levels of IGF‐1 and IGFBPs and a concurrent increase in muscle width and the number of muscle cells, but did not alter muscle cell size. Conclusions: Strategies aimed at increasing muscular adaptation may decrease Gl transit and allow greater mucosal contact time for absorption. We have shown that CPC supplementation following resection results in increased levels of circulating IGF‐1, IGFBP‐2, and IGFBP‐3 and muscular hypertrophy. Our results suggest that IGF‐1 and its mediators may play a role in the muscular adaptation response and warrant further exploration as a treatment option for short bowel syndrome.
Maintenance of GI Function after Bowel Surgery and Immediate Enteral Full Nutrition. I. Doubling of Canine Colorectal Anastomotic Bursting Pressure and Intestinal Wound Mature Collagen Content
Authors: Moss Gerald , Greenstein Alan , Levy Steven , Bierenbaum Arnold
Published: May 2008

Following either standardized stapled resection of an ileal blind loop terminus (17 beagles) or construction of a colorectal anastomosis (10 beagles), half the subjects immediately were fed an elemental diet (Vivonex HN). Gastrointestinal (GI) motility and absorption were maintained by exclusion of swallowed air. Controls received the same rate of feeding solution containing only the electrolyte components. Four days postoperatively, the fed beagle's colorectal anastomosis had over double the bursting pressure of the control, 303 ± 36 versus 138 ± 46 mm Hg (p > 0.001). At this time, the mature collagen content of the fed subjects' ileal wound was undiminished from that of normal ileum, 2,223 ± 336 verus 2,250 ± 577, contrasting with the 45% decrease of this structural component (OHP) in the wounds of the unfed controls, 1,237 ± 820 μg/g of tissue (p > 0.001). Similarly, the wounds of fed but not unfed subjects had a doubling (p > 0.001) in concentration of collagen precursors and “new” collagen. The “catabolic” and “lag” phases, as noted in unfed experimental animals, appeared to be reflections of the relative starvation that accompanied the intestinal wounding. With maintenance of GI function and immediate full enteral nutrition, “accelerated healing” was noted relative to the previously considered “norm.”
Psychological Aspects of Long‐Term Home Hyperalimentation
Authors: Perl Mark , Hall Richard C. W. , Dudrick Stanley J. , Englert Deann M. , Stickney Sondra K. , Gardner Earl R.
Published: May 2008

Ten patients (24–66 yr), maintained on ambulatory home intravenous hyperalimentation (HIVH) for 3 years, have undergone psychological evaluation. Acceptance of oral deprivation and the inconveniences, restraints, and risks of long‐term or life‐long HIVH, and the mechanisms for coping with these stresses, varied among this group. At times, the fear related to the HIVH apparatus and its function assumed almost delusional proportions; at other times, the patients acted indifferently or even irresponsibly toward the management of their life‐sustaining system. These patients had to cope with public inquisitiveness as well as their own self‐consciousness in public. Stress seemed to be related to the patient's prognosis, not only regarding recovery from the primary pathologic process, but also his/her prospects for return of normal gastrointestinal function. Stress reactions also varied among the spouses and families of the patients, and the quality of their psychological, support appeared to affect the patient's mental, physical, and social wellbeing significantly. An entirely new spectrum of psychologic and social problems have emerged to challenge the IVH team who successfully manage patients unable to sustain themselves nutritionally. It is imperative that we recognize, prevent, ameliorate, and treat these problems with the same degree of enthusiasm and competence with which we nourish the patients.
Zinc, Copper, and Parenteral Nutrition in Cancer. A Review
Authors: Askari Augusta , Long Calvin L. , Blakemore William S.
Published: May 2008

Literature concerning zinc and/or copper investigations pertaining to cancer is surveyed; the interrelationships of zinc, copper, and parenteral nutrition (PN) in cancer are examined; and the advantages of adequate nutritional support for patients with malignancies are discussed. Zinc and copper are both essential trace elements and, therefore, are necessary nutrients for cancer patients. Zinc supports growth, including that of neoplasia; copper is a zinc competitor and antagonist; and cancer patients on PN are in danger of becoming both zinc‐and copper‐deficient. The addition of these trace elements as supplements to PN formulae is undertaken with knowledge of only the approximate concentrations of zinc and copper in total intake, but without knowledge of specific requirements for cancer patients for these trace elements, of all the possible interactions of zinc and copper with each other or different trace elements, or even of zinc and copper lower levels of toxicity in cancer patients; balance studies are needed to determine zinc and copper requirements in them. In the future, it is conceivable that manipulations of the host nutrients might be used to control tumors. This might be accomplished by adjusting total PN formulae so that required nutrients will be presented to a cancer patient in such amounts and in such ratios that a desired alteration may be effected in that patient's metabolism.
Plasma Free Fatty Acid Turnover and Oxidation during Fat‐Free and Intralipid TPN
Authors: Skutches Charles L. , Myers Richard N. , Paul Pavle , Smink Robert D. , Reichard George A.
Published: May 2008

Plasma free fatty acid (FFA) turnover and oxidation were determined by the primed continuous infusion of albumin bound (1‐14C) palmitic acid in 2 patients after an overnight fast and during fat‐free total parenteral nutrition (TPN), in 1 during fat‐free TPN, and in another in whom one‐third of calories were administered by the continuous infusion of Intralipid via a central venous catheter in conjunction with a standard glucose‐amino acid solution. During TPN, plasma FFA concentrations in 2 patients were reduced from 0.7 to 0.11 and 0.08 mM, respectively, and their plasma FFA turnover during TPN was only 26% (3.86 and 2.68 μmol/min/kg) of that prior to TPN. In these subjects prior to TPN, 33 and 47% of the plasma FFA turnover was immediately oxidized, accounting for 58% of the CO2 output; however, during TPN only 16% of the plasma FFA turnover was oxidized, accounting for 10% of the caloric expenditure. The plasma FFA kinetics in the third patient were similar to those described for the first two. In contrast, the plasma FFA concentration of the fourth patient during Intralipid TPN was 0.4 mM. His plasma FFA production was 11.3 μmol/min/kg, of which 18.4% was immediately oxidized, contributing 28% to the total CO2 output. These studies indicated that during fat‐free TPN plasma FFA turnover is reduced and plasma FFA oxidation is a minor contributor to energy homeostasis; however, when one‐third of the calories are supplied by fat emulsion, plasma FFA turnover is appreciable and the oxidation of plasma FFA is an important source of energy.
Trace Element Balance in Adults Receiving Parenteral Nutrition: Preliminary Data
Authors: Phillips Garry D. , Garnys Vyt P.
Published: May 2008

There have been many recommendations regarding trace element needs of adults receiving total parenteral nutrition. Balance studies for zinc, copper, manganese, chromium, selenium, and molybdenum were carried out in 3 critically ill patients in an intensive care unit. Results indicate that the need for zinc was great in them, but that for copper and manganese was lower. Small negative chromium and selenium balances were observed. Molybdenum, iron, cobalt, and iodine balances were attempted but proved difficult to interpret. The requirement of each trace element varied from patient to patient, and was influenced by the presence of gastrointestinal fluid loss and renal function.
Calorie and Protein Requirements of Pediatric Patients with Acute Nonlymphocytic Leukemia
Authors: Merritt Russell J. , Ashley Judith M. , Siegel Stuart E. , Sinatra Frank R. , Thomas Daniel W. , Hays Daniel M.
Published: May 2008

The calorie and protein requirements were studied in 6 pediatric patients with acute nonlymphocytic leukemia treated in a laminar air flow unit. Calorie and protein requirements were estimated from anthropometric data. Mean total caloric requirement for weight maintenance was 136% of estimated basal metabolic rate, which is much lower than the RDA for healthy children. The mean protein requirement was 108% RDA. Provision of intravenous nutrients depressed oral intake. Infection had a deleterious effect on visceral protein status as determined by serum albumin.