bluuebunny/crossref_metadata_2025 huggingface dataset:
Synbiotics, Prebiotics, Glutamine, or Peptide in Early Enteral Nutrition: A Randomized Study in Trauma Patients
Authors: Spindler‐Vesel Alenka , Bengmark Stig , Vovk Irena , Cerovic Ognjen , Kompan Lidija
Published: May 2008

Background: Since the hepatosplanchnic region plays a central role in development of multiple‐organ failure and infections in critically ill trauma patients, this study focuses on the influence of glutamine, peptide, and synbiotics on intestinal permeability and clinical outcome. Methods: One hundred thirteen multiple injured patients were prospectively randomized into 4 groups: group A, glutamine; B, fermentable fiber; C, peptide diet; and D, standard enteral formula with fibers combined with Synbiotic 2000 (Synbiotic 2000 Forte; Medifarm, Sweden), a formula containing live lactobacilli and specific bioactive fibers. Intestinal permeability was evaluated by measuring lactulose‐mannitol excretion ratio on days 2, 4, and 7. Results: No differences in days of mechanical ventilation, intensive care unit stay, or multiple‐organ failure scores were found between the patient groups. A total of 51 infections, including 38 pneumonia, were observed, with only 5 infections and 4 pneumonias in group D, which was significantly less than combined infections (p = .003) and pneumonias (p = .03) in groups A, B, and C. Intestinal permeability decreased only in group D, from 0.148 (0.056–0.240) on day 4 to 0.061 (0.040–0.099) on day 7; (p < .05). In group A, the lactulose‐mannitol excretion ratio increased significantly (p < .02) from 0.050 (0.013–0.116) on day 2 to 0.159 (0.088–0.311) on day 7. The total gastric retention volume in 7 days was 1150 (785–2395) mL in group D, which was significantly more than the 410 (382–1062) mL in group A (p < .02), and 620 (337–1190) mL in group C (p < .03). Conclusions: Patients supplemented with synbiotics did better than the others, with lower intestinal permeability and fewer infections.
Glutamine Transporter ASCT2 Was Down‐Regulated in Ischemic Injured Human Intestinal Epithelial Cells and Reversed by Epidermal Growth Factor
Authors: Huang Qian , Li Ning , Zhu Weiming , Li Qiurong , Li Jieshou
Published: May 2008

Background: Clinically, nutrition support has been an important component of the care of the hypoperfusion traumatized patient who is unable to accept complete volitional nutrition. However, enterocyte transport function during states of intestinal hypoperfusion remains unclear. Glutamine is essential for the viability and growth of intestine epithelial cells, and the Na+‐dependent neutral amino acid transporter ASCT2 is thought to mainly mediate glutamine transport. This study aims to quantify the change of glutamine transporter ASCT2 expression in ischemic injured Caco‐2 cell lines and the regulatory action of epidermal growth factor (EGF) on glutamine transport and its transporter. Methods: Cells were cultured under ischemic conditions for 2 hours. After ischemia was performed, Caco‐2 cells were incubated with or without EGF (100 μg/mL) for 0–8 hours. Then we studied the cell membrane l‐glutamine transport, the expression of ASCT2 protein, and mRNA. Results: After ischemia was performed, Caco‐2 cell membrane glutamine transport decreased significantly (p< .01), and the expression of ASCT2 proteins decreased significantly compared with control (p < .01). Under ischemic conditions, expression of ASCT2 mRNA was down‐regulated by a real‐time polymerase chain reaction (PCR) method. After EGF incubation for 1–2 hours, the proteins and mRNA of ASCT2 were reversed to normal levels (p > .05). Conclusions: In ischemic injured Caco‐2 cells, ASCT2 protein expression and mRNA transcription were involved in the down‐regulation of Na+‐dependent glutamine transport. The decrease of glutamine transport and its transporter under ischemic conditions could be reversed by EGF action. These findings may help in the choice of the nutrition support manner and clinical therapy of ischemia‐damaged intestinal epithelial cells.
Administration of Glutamine After Hemorrhagic Shock Restores Cellular Energy, Reduces Cell Apoptosis and Damage, and Increases Survival
Authors: Yang Rongjie , Martin‐Hawver Lisa , Woodall Charles , Thomas Ann , Qureshi Nilofer , Morrison David , Van Way Charles
Published: May 2008

Background:Hemorrhagic shock causes a rapid depletion of adenosine triphosphate (ATP) and an increase of the terminal metabolite xanthine. Free radicals generated from xanthine oxidase play a major role in cell injury. Programmed cell death, apoptosis, is a major pathway causing reperfusion injury. During apoptosis, cytosolic cytochrome‐c is released from damaged mitochondria, and it further initiates activation of apoptosis as evidenced by the appearance of caspase‐3. The bcl‐2 protein serves as an antiapoptosis found on the mitochondrial membrane. Glutamine has been known as a conditionally essential nutrient and seems to have beneficial effects in critically ill patients. The hypothesis of the present study is that glutamine administered during resuscitation following hemorrhagic shock would restore the depletion of hepatic ATP, reduce cellular apoptosis, and increase survival.Methods:Male Sprague‐Dawley rats were randomly assigned to 3 groups for resuscitation after the same pattern of hemorrhagic shock: Ringer's lactate (LR 21 ml/kg); Alanine‐glycine (LR with alanine 0.15 gm/kg and glycine 0.18 gm/kg); and glutamine (LR with glutamine 0.3 gm/kg). Hepatic ATP and xanthine was measured at different time periods. Hepatic apoptosis was measured and the levels of cytosolic cytochrome‐c, caspase‐3 and bcl‐2 were analyzed. Another group of rats were used for survival study.Results:Glutamine administered during resuscitation following hemorrhagic shock partially restored the depletion of hepatic ATP, reduced cellular apoptosis, and increased survival.Conclusions:Glutamine administration during resuscitation significantly protected the liver from tissue damage caused by hemorrhagic shock. Glutamine supplementation may offer opportunities for therapeutic intervention during and after shock.
Assessment by a Multidisciplinary Clinical Nutrition Team Before Percutaneous Endoscopic Gastrostomy Placement Reduces Early Postprocedure Mortality
Authors: Tanswell I. , Barrett D. , Emm C. , Lycett W. , Charles C. , Evans K. , Hearing S. D.
Published: May 2008

Background: The purpose of this study was to determine whether preassessment by a multidisciplinary nutrition team before percutaneous endoscopic gastrostomy (PEG) placement can reduce postprocedure mortality. This was a prospective single‐center audit. Methods: Patients who had been referred to the Gastroenterology Department for consideration of PEG placement between 1995 and 2004 were included. In the index year, 2003–2004, where a formal nutrition team assessment was commenced, 79 patients were enrolled into our study group on a consecutive basis. These patients were subdivided into 3 groups; group A, PEG placed (51 patients); group B, PEG not placed due to severe comorbidity (19 patients); and group C, PEG not placed as deemed unnecessary (9 patients). Comparison was made with previous years where no formal preassessment had occurred. At Staffordshire General Hospital, a comparison of mortality post‐PEG placement was made between the index group and previous years. Secondary measures included complication rates and frequency of biochemical monitoring. Results: One week post‐PEG mortality fell from 10%–20% in previous years to 0% in the index year (p < .02). This improved survival extended to 3 months postprocedure (p < .016). Three patients (6%) had biochemical evidence of refeeding syndrome postplacement. Biochemical monitoring was inadequate, with only 27/51 (53%) patients being completely monitored. No complications pertaining to the endoscopy were reported. Conclusions: This study demonstrates that early post‐PEG mortality can be reduced by preassessment of patients by a multidisciplinary nutrition team and is evidence supporting the recommendations of the National Confidential Enquiry into Patient Outcome and Death report.
Predicting Energy Expenditure in Extremely Obese Women
Authors: Dobratz Jennifer R. , Sibley Shalamar D. , Beckman Tiffany R. , Valentine Bret J. , Kellogg Todd A. , Ikramuddin Sayeed , Earthman Carrie P.
Published: May 2008

Background: The most common clinical method for resting energy expenditure (REE) assessment is prediction equations. The purpose of this study was to elucidate which prediction equation is most accurate for REE assessment in extremely obese women. Methods: Fourteen extremely obese women (mean ± SD body mass index: 49.8 ± 6.2 kg/m2; age: 49 ± 10 years) were measured for height and weight and REE via indirect calorimetry (IC) by a metabolic cart system. Predicted REE was evaluated by several equations, including Harris‐Benedict with actual body weight, Harris‐Benedict with several adjustments to body weight, Cunningham, Mifflin‐St Jeor, Owen, World Health Organization (WHO), and Bernstein equations. Accuracy was determined by mean difference data (IC REE – equation REE; Student's paired t‐test), correlation coefficients, and agreement between methods by Bland‐Altman plots. Accuracy was also evaluated on an individual basis, defined by the percentage of individuals within ±10% of IC REE. Results: The Mifflin‐St Jeor, Harris‐Benedict with actual body weight, and the WHO equations were the most accurate in terms of mean predicted REE. The mean predicted REE values by all other equations were different from the IC REE values (p < .1). According to the individual data, the Mifflin‐St Jeor was most accurate (14% outside± 10% IC REE). The Harris‐Benedict with actual body weight and WHO equations were less accurate on individual terms, with 29% and 42% of the predicted REE values, respectively, falling outside ±10% of IC REE. Conclusions: The Mifflin‐St Jeor equation was most accurate method for REE assessment in extremely obese women.
Telehealth Videoconferencing: Improving Home Parenteral Nutrition Patient Care to Rural Areas of Ontario, Canada
Authors: Saqui Olivia , Chang Albert , McGonigle Sharon , Purdy Brendan , Fairholm Lydia , Baun Mary , Yeung Millie , Rossos Peter , Allard Johane
Published: May 2008

Background: Telehealth videoconferencing is a medium for health care professionals to communicate and care for patients living in remote areas. The aim of this study was to provide a survey to examine management outcome of home parenteral nutrition (HPN) patients when followed by telehealth as an alternative modality of care. Methods: Twenty‐six individuals who were identified to benefit from tele‐health were invited to participate in a satisfaction survey. The survey was sent to patients by postal mail. The survey also documented the incidence of line sepsis and other medical HPN complications. A cost analysis was also performed according to technology, human resources, and infrastructure. Results: Eighty‐one telehealth videoconference sessions have been held since the inception of telehealth in 2002. Of the current telehealth patients, 13 were eligible for the survey. The satisfaction survey response rate was 11/13 (84.6%). The average line sepsis rate for the 13 patients was 0.89/1000 catheter‐days. All patients were generally satisfied with videoconferencing as an alternative method of communication and care for new consultation, patient and family education, and follow‐up. Travel time and costs to the patients, their families, and the health care system were significantly less. For example, a patient who resides 611 km from Toronto would cost CDN (Canadian) $724.00 for flight and accommodation to meet with the team at the HPN clinic in Toronto. Conclusion: Telehealth incorporated the cost‐saving ability for HPN patients to maintain proper medical care, support, and collaboration of specialists inaccessible to their local community. Thus, its strongly positive role in HPN care deserves further consideration for a national application.
Noninvasive Measurement of Transit Time in Short Bowel Syndrome
Authors: Compher Charlene , Rubesin Stephen , Kinosian Bruce , Madaras Julie , Metz David
Published: May 2008

Background: Patients with short bowel syndrome (SBS) have limited absorption of nutrients, in part because of the rapidity with which chyme passes through the bowel. We sought to evaluate noninvasive measurements of intestinal transit time to aid in research questions where transit is measured repeatedly. Methods: Three methods were compared in 8 patients with SBS: the time for blue food color to appear in ostomy effluent or stool, lactulose breath hydrogen testing, and the first radiopaque ring from a capsule in timed stool samples. Results: Median blue dye fasted transit was 96.3 minutes, with breakfast was 117.3 minutes, and with lactulose was 72 minutes. By breath hydrogen testing, transit time was 52.5 minutes but detectible in only 5 of 13 tests. Transit time by radiopaque marker was 967 minutes, but no markers passed in 7 of 14 tests. Conclusions: Visualization of blue food color in ostomy effluent is a simple, inexpensive approach that can be applied to fasted subjects or after specific meals. Breath hydrogen testing should only be applied in the rare patient with SBS who has an intact ileocecal valve. Radiopaque markers are less useful, most likely because they become trapped due to anatomic changes.
Is There Evidence That the Gut Contributes to Mucosal Immunity in Humans?
Authors: Kang Woodae , Kudsk Kenneth A.
Published: May 2008

Background: Our understanding of the common mucosal immune system derives from animal studies. Antigen‐sensitized lymphocytes in the gut‐associated lymphoid tissue (GALT) migrate via the blood to mucosal tissues to generate the mucosal‐associated lymphoid tissue (MALT). In these sites, B cells differentiate into plasma cells and produce antigen‐specific secretory IgA, the principal specific immune antiviral and antibacterial defense of moist mucosal surfaces. Responses to oral intake seem necessary to actively maintain this system in health. Experimentally, lack of enteral stimulation with parenteral feeding alters GALT and MALT size and function. These alterations disturb intestinal and extraintestinal mucosal immunity. Methods: This review is an overview of current and classical studies demonstrating the human mucosal immune system and interactions with nutrition. Results: Human evidence of the mucosal immune system exists, although most data are indirect. Gut stimulation after oral intake induces a generalized immune response in the human MALT through a mucosal‐immune network. Examples include neonatal development of GALT influenced by enteral feeding, the presence of antigen‐specific IgA and antigen‐specific IgA‐secreting plasma cells in distant mucosal effector sites such as the breast after gut luminal antigen exposure, and isolation of IgA‐producing cells from circulating blood. Conclusions: It is unlikely that clinical studies will ever completely define the effect of route of feeding in all patient populations. This may be possible, however, if investigators understand, define and characterize nutrition‐dependent immunologic mechanisms, allowing clinicians to examine clinical responses to nutrition in specific patient populations. This might allow generation of new approaches to protect mucosal immunity.
Defects in Postabsorptive Plasma Homeostasis of Fatty Acids in Sickle Cell Disease
Authors: Buchowski Maciej S. , Swift Larry L. , Akohoue Sylvie A. , Shankar Sadhna M. , Flakoll Paul J. , Abumrad Naji
Published: May 2008

Background: The chronic hemolytic anemia experienced by sickle cell disease (SCD) patients leads to adverse effects on oxygen transport by the blood and to a decrease in oxygen availability for peripheral tissues. Limited tissue oxygen availability has the potential to modify events of intracellular metabolism and, thus, alter lipid homeostasis. Methods: The impact of SCD on plasma fatty acid homeostasis was determined in 8 African American SCD patients and in 6 healthy African American control subjects under postabsorptive conditions and during a 3‐hour IV infusion of a nutrient solution containing lipid, glucose, and amino acids. Results: SCD patients had higher fasting levels of plasma nonesterified fatty acids (NEFA), triglycerides, and phospholipids than healthy controls. Similarly, SCD patients had higher fasting levels of fatty acids in plasma triglycerides and phospholipids than healthy controls. Infusion of nutrients resulted in equivalent plasma NEFA profiles, total NEFA, and triglycerides in SCD patients and controls. However, the plasma phospholipid concentrations and fatty acid composition of plasma triglycerides and phospholipids were significantly higher in SCD patients; in particular, plasma pools of oleic acid were consistently increased in SCD. Plasma free oleic acid levels were elevated basally, leading to increased oleic acid content in triglycerides and phospholipids both postabsorptively and during nutrient infusion. Conclusions: There is an underlying defect in lipid metabolism associated with SCD best manifested during the fasting state. This abnormality in lipid homeostasis has the potential to alter red blood cell (RBC) membrane fluidity and function in SCD patients.
Parenteral Amino Acid and Metabolic Acidosis in Premature Infants
Authors: Jadhav Pushkaraj , Parimi Prabhu S. , Kalhan Satish C.
Published: May 2008

Background: Aggressive parenteral nutrition (PN) including amino acids is recommended for low‐birth‐weight infants to prevent energy and protein deficit. Their impact on acid‐base homeostasis has not been examined. Methods: We investigated the impact of dose and duration of parenteral amino acids, with cysteine, on acid‐base parameters in 122 low‐birth‐weight infants. Premature infants ≤32 weeks, ≤1850 g, and receiving parenteral amino acids at 1.5 g/kg/d for an extended period (>24 hours), or 3 g/kg/d for a short (5 hour), extended (24 hour), or prolonged (3–5 days) duration were included in the study. Data were obtained at age 0–3 days (n = 43) or, when clinically stable, age 3–5 days (n = 49). Data from 30 infants, matched for birth weight and gestational age, receiving PN during the first 5 days after birth were also obtained. Acidosis was defined as pH <7.25. Results: Acidosis was evident in all infants between 2 and 5 days after birth. Infants with large patent ductus arteriosus (PDA) exhibited significantly (p < .05) lower pH early, had higher blood urea nitrogen levels (26 ± 9 vs 18 + 8 mg/dL; p < .05), and had greater weight loss (∼17% of birth weight) when compared with infants without PDA. Gestational age, weight loss, and patent ductus arteriosus accounted for 65% of variance in acidosis. Conclusions: Low‐birth‐weight infants develop metabolic acidosis between 2 and 5 days after birth, irrespective of dose and duration of parenteral amino acid administration. Careful management of parenteral fluids and comorbidities may lower the incidence of acidosis and promote protein accretion.
Jonathan E. Rhoads Lecture: Experiences and Observations in the Management of Patients With Short Bowel Syndrome
Authors: Steiger Ezra
Published: May 2008

In an era before parenteral nutrition (PN) was made practical by Stanley Dudrick, MD, and his colleagues, patients with prolonged intestinal dysfunction or short bowel syndrome would often die of malnutrition or its sequelae. Over the past 4 decades, the treatment of patients with short bowel syndrome had progressed from PN in the hospital to small bowel transplantation. Multimodal therapies have evolved in the management of these patients, including specialized diets and enteral supplements, oral rehydration fluids, antisecretory medication, and the use of growth factors. Home PN is lifesaving when these modalities are ineffective and a surgical procedure to restore or enhance gastrointestinal tract length or absorptive potential is impossible. Small intestine transplantation had been used to salvage those patients who developed life‐threatening complications of home PN, but as the survival after intestinal transplant has approached that of liver transplantation, it may soon be considered as primary therapy for patients with short bowel syndrome. This article presents the author's experiences and observations after a 4‐decade experience in the management of patients with short bowel syndrome.
Tip Position of Long‐Term Central Venous Access Devices Used for Parenteral Nutrition
Authors: DeChicco Robert , Seidner Douglas L. , Brun Carlos , Steiger Ezra , Stafford Judy , Lopez Rocio
Published: May 2008

Background: Venous thrombosis is a potential postplacement complication of a central venous access device (VAD). Improper catheter tip position is a predisposing factor, especially when the device is used to administer parenteral nutrition (PN). American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) guidelines recommend that a central VAD used for PN be placed with its tip in the superior vena cava (SVC) adjacent to the right atrium (RA). The purpose of this study is to determine the prevalence of improper central VAD tip position and factors associated with malpositioning. Methods: All adult patients with a longterm VAD (ie, tunneled central venous catheter, peripherally inserted central catheter [PICC], or implanted port) placed before the current admission who were scheduled to receive PN also received chest x‐rays to evaluate position of the catheter tip. Position was determined by a staff radiologist. A catheter with its tip ranging from the middle third of the SVC to the RA was considered acceptable; a catheter with its tip in any other position was considered malpositioned. Subjects with multiple VADs or multiple evaluations for the same catheter had the first placement and last evaluation considered. A logistic regression analysis was used to study the univariable and multivariable associations of these factors with tip malposition. Results: Data were collected for catheters in 124 patients, including 74 tunneled catheters (71 Hickman, 2 Broviac, 1 Groshong), 38 PICCs, and implanted ports. Most of the catheters were placed for (81.9%) or chemotherapy (14.5%). Median catheter duration was 1.6 months at time of evaluation. Of 138 catheters ied, 15.9% (95% confidence interval, 10.2–23.1) were sitioned at time of evaluation. According to univariable ysis, factors associated with malpositioned catheters included shorter catheter duration (p = .001), greater ber of lumens (p = .029), venous entry site on the arm (p .001) and catheters placed at institutions other than Cleveland Clinic (p = .007). Additionally, PICCs were likely to be malpositioned at time of evaluation compared with other long‐term VADs combined (34.2% vs 9.0%; p .001). Conclusions: A high percentage of long‐term VADs improperly positioned for PN in the present study. were more likely to be malpositioned at time of evaluation compared with tunneled catheters and implanted These findings suggest the tip position of long‐term should be confirmed before infusing PN.
Autopsy Tissue Trace Elements in 8 Long‐Term Parenteral Nutrition Patients Who Received the Current U.S. Food and Drug Administration Formulation
Authors: Howard Lyn , Ashley Christopher , Lyon David , Shenkin Alan
Published: May 2008

Iron, zinc, copper, manganese, chromium, and selenium levels were measured in autopsy tissues of 8 people with short bowel syndrome who received home parenteral nutrition (HPN) and the U.S. Food and Drug Administration (FDA)– approved trace element formulation for an average duration of 14 years (range, 2–21). Iron, zinc, copper, manganese and selenium were measured by inductively coupled plasma methods; chromium, by graphite furnace atomic absorption spectrometry. The levels in the 4 tissues studied, heart, skeletal muscle, liver, and kidney, were compared with levels in 45 controls who died without chronic gastrointestinal disorders. Results showed normal HPN patient values for iron and selenium, mild elevation of zinc, and major elevations of copper, manganese, and chromium. The implications of these results for trace‐element supplements in long‐term PN adult patients are discussed, and the need for reformulation of commercially available multi–trace element products in the United States is stressed.
A.S.P.E.N. Statement on Parenteral Nutrition Standardization
Authors:   A.S.P.E.N. Board of Directors and Task Force on Parenteral Nutrition Standardization, Kochevar Marty , Guenter Peggi , Holcombe Beverly , Malone Ainsley , Mirtallo Jay
Published: May 2008

In response to questions regarding use of standardized parenteral nutrition (PN) formulations, the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) developed a Task Force to address some of these issues. A.S.P.E.N. envisions standardized PN as a broader issue rather than simply using a standardized, commercially available PN product. A standardized process for PN must be explored in order to improve patient safety and clinical appropriateness, and to maximize resource efficiency. A standardized process may include use of standardized PN formulations (including standardized, commercial PN products) but also includes aspects of ordering, labeling, screening, compounding, and administration of PN. A safe PN system must exist which minimizes procedural incidents and maximizes the ability to meet individual patient requirements. Using clinicians with nutrition support therapy expertise will contribute to that safe PN system. The purpose of this statement is to present the published literature associated with standardized PN formulations, to provide recommendations, and to identify areas in need of future research.
Pretreatment With the Protegrin IB‐367 Affects Gram‐Positive Biofilm and Enhances the Therapeutic Efficacy of Linezolid in Animal Models of Central Venous Catheter Infection
Authors: Ghiselli Roberto , Giacometti Andrea , Cirioni Oscar , Mocchegiani Federico , Silvestri Carmela , Orlando Fiorenza , Kamysz Wojciech , Licci Alberto , Nadolski Piotr , Della Vittoria Agnese , Łukasiak Jerzy , Scalise Giorgio , Saba Vittorio
Published: May 2008

Background: Biofilms play an important role in the pathogenesis of several chronic infections and nosocomial infections related to indwelling medical devices. Methods: To assess the efficacy of IB‐367 and linezolid (LZD) in the treatment of central venous catheter (CVC) infections using the antibiotic‐lock technique, in vitro and in vivo studies were performed. The in vitro antibiotic susceptibility assay for Staphylococcus aureus and Enterococcus faecalis biofilms developed on 96‐well polystyrene tissue culture plates was performed to determine the activity of the compounds. Efficacy studies were performed in rat models of Gram‐positive CVC infection. Silastic catheters were implanted into the superior cava of adult male Wistar rats. Twenty‐four hours after implantation, the catheters were pretreated by filling with IB‐367. Thirty minutes later, rats were challenged via the CVC with 1.0 × 106 CFU (colony forming units) of S aureus strain diffuse Smith and clinical isolate of slime‐producing E faecalis. Administration of LZD into the CVC at a concentration equal to the minimum bacteriocidal concentration observed using adherent cells or at a much higher concentration (1024 μg/mL) began 24 hours later. Results: Both for S aureus and E faecalis, the killing activities of LZD against adherent bacteria were at least 4‐fold to 8‐fold lower than that against freely growing cells. For both strains, in IB‐367‐pretreated wells, LZD strongly increases its activity. The in vivo studies showed that when CVCs were pretreated with IB‐367, Gram‐positive biofilm bacterial load was further decreased to 101 CFU/mL and bacteremia was not detected. Conclusions: IB‐367 has potential as an adjunctive agent to LZD in the treatment of Gram‐positive biofilm infections such as CVC infections.
Effects of the In Vivo Supply of Butyrate on Histone Acetylation of Cecum in Piglets
Authors: Kien C. Lawrence , Peltier Cheryl P. , Mandal Soma , Davie James R. , Blauwiekel Ruth
Published: May 2008

Background: In vitro, butyrate inhibits histone deacetylase and down‐regulates expression of cyclin D1. We hypothesized that an increased entry rate of butyrate into the cecal lumen would have similar effects in vivo. Methods: We used frozen cecal tissue and data from previous studies, one showing that lactulose supplementation caused an increased rate of cecal synthesis of butyrate and decreased cecal cell proliferation and density of clostridia and the other showing that cecal cell proliferation was increased by an exogenous cecal butyrate infusion at a comparable rate. The ratio of acetylated to total histones (AH ratio) and cyclin D1 mRNA expression were measured in cecal tissue. Results: Lactulose supplementation caused a 189% increase in the AH ratio (p = .004), which inversely correlated with cecal cell proliferation (r = –0.782; p = .008). With cecal butyrate infusion, we observed a significant decrease in histone acetylation (p = .02), which also inversely correlated with cecal cell proliferation (r = –0.797; p = .002). Cyclin D1 expression was increased 6.5‐fold by lactulose feeding (p = .02) but decreased 50% with cecal butyrate infusion (p = .004). Conclusions: The effects on histone acetylation of increased“ endogenous” butyrate production produced by lactulose feeding, but not exogenous cecal infusion of butyrate, mirror those in vitro. Thus, bacterial production and exogenous infusion of butyrate have opposite effects on histone acetylation and cyclin D1 expression, suggesting that the composition of bacterial flora may play a role in butyrate's in vivo effects on the cell cycle.
Effects of Parenteral Nutrition on the Exocrine Pancreas in Response to Cholecystokinin
Authors: Fan Bo‐Guang
Published: May 2008

Background: Clinical and experimental data have revealed that parenteral nutrition (PN) can lead to hypotrophy and dysfunction in the morphology and physiology of the pancreas. These adverse alterations appear to be related to many different factors. One important factor is the absence of a gastrointestinal hormone, such as cholecystokinin, which is the most important stimulator for the integrity of the pancreas. The level of cholecystokinin is decreased during absent enteral feeding, and the stimulatory effect of cholecystokinin is significantly reduced during PN. Methods: Original and review articles, editorials, and case reports published primarily in English and listed in MEDLINE/ISI up to September 2006 or identified by a manual search have been reviewed in an attempt to provide a comprehensive overview of the effects of PN on the exocrine pancreas in response to cholecystokinin. Results: When hypercholecystokininemia, produced by endogenous and exogenous procedures, is present during PN, the morphology and functions of the pancreas are still unable to be fully reversed. Conclusions: Other growth factors besides cholecystokinin are probably involved in the pancreatic regulation, and enteral feeding seems to be important for the full expression of the trophic effects of cholecystokinin on the pancreas.
The Effects of a Short‐Term Long‐Chain‐Triglyceride Infusion on the Postoperative Immune Function of Pediatric Patients Receiving a Gastrointestinal Surgical Procedure
Authors: Li Xiaogang , Ying Jiaoqian , Zeng Shan , Li Yixiong , Yang Huixiang , Shen Liangfang , Han Jie , Chen Jia , Shen Hong
Published: May 2008

Objective: This clinical trial investigates whether short‐term administration of long chain triglycerides (LCT) has any influence on the immune function in children following gastrointestinal surgery. Methods: Sixty pediatric patients receiving a gastrointestinal operation were randomly divided into the experimental group (n = 36) and the control group (n = 24). After abdominal operation, the subjects received parenteral nutrition (PN) support with or without LCT for 5 days. The patients' fasting blood samples were respectively collected at 24 hours preoperative, then 24 hours and 120 hours postoperative. Blood parameters related to the patients' immune function were measured. Results: Before surgery and LCT treatment, the experimental group and control group did not differ significantly in overall state of health. Except for a small increase of serum IgM at 24 hours postsurgery (p < .05), all parameters representing the patients' immune function showed no significant difference between the LCT group and the control group with respect to peripheral blood mononuclear cell (PBMC), T lymphocyte, CD4, CD8, CD4/CD8, serum immunoglobulin A (IgA), IgG, IgM, complement C3, C4, interleukin (IL)‐2, IL‐4, IL‐10, IL‐12, tumor necrosis factor (TNF)‐α and IFN‐γ (p > .05, respectively) before the operation, 24 hours and 120 hours after the operation. Conclusions: A short‐term LCT administration at an appropriate dosage and infusion speed does not alter the pediatric patients' immune function after gastrointestinal surgery. The etiology and clinical significance of the slightly increased IgM 24 hours postsurgery need to be further investigated.
Effect of Olive Oil–Based Emulsion on Human Lymphocyte and Neutrophil Death
Authors: Cury‐Boaventura Maria Fernanda , Gorjão Renata , de Lima Thaís Martins , Fiamoncini Jarlei , Torres Rosângela Pavan , Mancini‐Filho Jorge , Soriano Francisco Garcia , Curi Rui
Published: May 2008

Background: The incorporation of lipid emulsions in parenteral diets is a requirement for energy and essential fatty acid supply to critically ill patients. The most frequently used IV lipid emulsions (LE) are composed with long‐chain triacylglycerols rich in ω‐6 polyunsaturated fatty acids (PUFA) from soybean oil, but these LE promote lymphocyte and neutrophil death. A new emulsion containing 20% soybean oil and 80% olive oil rich in ω‐9 monounsaturated fatty acids (MUFA) has been hypothesized not to cause impairment of immune function. In this study, the toxicity of an olive oil‐based emulsion (OOE) on lymphocytes and neutrophils from healthy volunteers was investigated. Methods: Twenty volunteers were recruited and blood was collected before a 6‐hour infusion of an OOE, immediately after infusion, and again 18 hours postinfusion. Lymphocytes and neutrophils were isolated by gradient density. The cells were studied immediately after isolation and after 24 hours or 48 hours in culture. The following determinations were carried out: triacylglycerol levels and fatty acid composition and levels in plasma, lymphocyte proliferation, production of reactive oxygen species, and parameters of lymphocyte and neutrophil death (viability, DNA fragmentation, phosphatidylserine externalization, mitochondrial depolarization, and neutral lipid accumulation). Results: OOE decreased lymphocyte proliferation, provoked lymphocyte necrosis, and had no effect on the proportion of viable neutrophils. The mechanism of cell death induced by OOE involved neutral lipid accumulation but had no effect on mitochondrial membrane depolarization. Conclusions: The OOE given as a single dose of 500 mL induced low toxicity to lymphocytes from healthy volunteers, probably by necrosis.
Field Testing of the 2006 World Health Organization Growth Charts From Birth to 2 Years: Assessment of Hospital Undernutrition and Overnutrition Rates and the Usefulness of BMI
Authors: Nash Andrea , Secker Donna , Corey Mary , Dunn Michael , O'Connor Deborah L.
Published: May 2008

Background:The World Health Organization (WHO) recently released a growth standard, a first attempt at describing how children should grow in an ideal environment. These charts introduce body mass index (BMI)–for‐age percentiles for children younger than 2 years. Adopting the WHO standard may affect the number of children screened to require follow‐up; hence, field testing needs to be completed in a tertiary care center where the incidence of suboptimal nutrition is high. The objectives of this study were to quantify differences between the new WHO and 2000 Centers for Disease Control and Prevention (CDC) growth charts for children younger than 2 years. The interchangeability of the WHO weight‐for‐length and WHO BMI percentiles was also assessed.Methods:Percentile scores were computed for children younger than 2 years (n = 547) admitted to a pediatric tertiary health care center in Toronto, Canada.Results:The WHO standard identified more children younger than 2 years as at risk of overweight/obesity compared with the CDC reference (21.0% vs 16.6%, ≥85th weight‐for‐length percentile) and fewer children as wasted (18.6% vs 23.0%,<5th weight‐for‐length percentile). The WHO BMI‐for‐age and WHO weight‐for‐length percentiles were highly correlated (r2= 0.83) but not interchangeable. For ∼9% of all children, and ∼16% of those aged ≤6 months, BMI‐for‐age and weight‐for‐length percentiles differed by >25 percentile points.Conclusions:These data describe for the first time the magnitude of differences in the number of children screened as undernourished (4.4% decrease) or overnourished (4.4% increase) with adoption of the WHO standard in a tertiary care setting. Furthermore, the WHO's BMI‐for‐age and weight‐for‐length percentiles for children younger than 2 years are correlated but are not interchangeable.
Effects of Oral Nutritional Supplements in Normally Nourished or Mildly Undernourished Geriatric Patients After Surgery for Hip Fracture: A Randomized Clinical Trial
Authors: Botella‐Carretero José I. , Iglesias Borja , Balsa José A. , Zamarrón Isabel , Arrieta Francisco , Vázquez Clotilde
Published: May 2008

Background: Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients to reduce postoperative complications. However, tolerability of supplements could be a limitation, and their universal use is not supported by the heterogeneity of previous studies, especially in patients without malnutrition. Methods: This study is a randomized, controlled, open, parallel, 3‐arm clinical trial comparing supplementation with protein powder dissolved in liquids to aim at 36 g of protein per day, energy and protein supplements to aim at 37.6 g of protein and 500 kcal per day, or no intervention in normally nourished or mildly undernourished patients. Outcomes were serum albumin, prealbumin, retinol‐binding globulin, and body mass index, among others. Postoperative complications were also recorded. Results: Ninety patients aged 83.8± 6.6 years were included. The mean ingested amount of supplements was 41.1% ± 20.6% in the protein powder supplement group and 51.4% ± 13.2% in the energy protein supplement group (t = 2.278, P = .027). Postoperative supplements had no effect on the nutrition status during in‐hospital follow‐up, as assessed by serum albumin (P = .251), prealbumin (P = .530), retinol‐binding globulin (P = .552), or body mass index (P = .582). Multivariate analysis showed that length of hospital stay with an established complication until its resolution (β = .230, P = .031), total hospital stay (β = .450, P < .001), baseline body mass index (β = .204, P = .045), and total daily ingested proteins per body weight (β = .252, P = .018) were predictive variables on the change in serum albumin (R 2 = 0.409, F = 11.246, P < .001). Conclusions: Oral nutritional supplements in normally nourished or only mildly undernourished geriatric patients with hip fracture submitted to surgery may be of interest for patients with postoperative complications and long hospital stays.
Physicochemical Stability of Parenteral Nutrition Supplied as All‐in‐One for Neonates
Authors: Skouroliakou Maria , Matthaiou Chrysoula , Chiou Antonia , Panagiotakos Demosthenes , Gounaris Antonis , Nunn Tony , Andrikopoulos Nikolaos
Published: May 2008

Background: Common clinical practice for the provision of parenteral nutrition of neonates is to administer the nutrients in separate solutions. The aim of this study was to introduce and examine an alternative way of parenteral feeding for neonates, providing all‐in‐one parenteral regimes. Methods: Stability studies were carried out on 2 all‐in‐one admixtures. Stability assays consisted of the assessment of the admixture's (1) macroscopic aspect, (2) drop size measurement, (3) pH measurement, (4) peroxide value, and (5) α‐tocopherol concentration. For the measurements, the admixtures were stored at 2 different temperatures, 4°C (storage) and 25°C (compounding), and then analyzed at a starting time, 24 hours, 48 hours, and 7 days after compounding. Results: The 2 all‐in‐one parenteral admixtures for neonates were shown to be physically stable under analysis conditions, and there were no particles larger than 1μ m. The maximum loss of α‐tocopherol was approximately 24%. In all‐in‐one admixtures, lipid peroxide occurred within 24 hours after the addition of the lipid emulsion. Conclusions: The addition of fat emulsion and fat‐soluble vitamins did not alter the physical stability of parenteral admixtures for neonates. Moreover, the admixtures examined were relatively chemically stable for 24 hours, as far as vitamin E is concerned. Lipid peroxidation was the limiting factor for application stability of an all‐in‐one neonatal parenteral regimen.
Quantifying Amount of Adsorption of Levothyroxine by Percutaneous Endoscopic Gastrostomy Tubes
Authors: Manessis Anastasios , Lascher Steven , Bukberg Phillip , Darmody Todd , Yen Vincent , Sadek Samy , Young Iven
Published: May 2008

Background: It has been the authors' clinical experience that hypothyroid patients who achieve a euthyroid state on a steady dose of oral levothyroxine often become hypothyroid over time if the medication is given via a feeding tube. The authors hypothesize that the tubing and enteral feeds may adsorb a significant percentage of the levothyroxine and thereby reduce its bioavailability. To the authors' knowledge, no previous research has been reported on this subject. They therefore performed an in vitro assessment of the degree of levothyroxine adsorption to quantify the amount of drug adsorbed to the percutaneous endoscopic gastrostomy (PEG) tube and how enteral tube feeds mitigate or exacerbate this adsorption. Methods: Using levothyroxine radiolabeled with an I125 tracer, a known dose of levothyroxine was passed through 60 new PEG tubes. One‐half of the tubes were pretreated with Jevity feeds, and the other half were not. The authors measured the activity of the radiolabeled levothyroxine before and after it had passed through the tubes and, using a subtraction analysis, inferred the amount of thyroxine left within the tube. Results: Tubes presoaked with feeds had a greater uptake in radioactivity by 326.4 cpm (95% confidence interval, 226.7‐426.1), corresponding to a 45.08% relative increase in uptake compared with virgin PEG tubes without feeds. Conclusions: Although the authors found statistically significant differences in mean drug concentrations, they conclude that the amount of uptake of levothyroxine by PEG tubes and adsorption of levothyroxine by PEG tubes is probably clinically insignificant. The differences found may be attributed to the amount of drug lost during crushing and transfer.
Exogenous Glucagon‐Like Peptide‐2 (GLP‐2) Augments GLP‐2 Receptor mRNA and Maintains Proglucagon mRNA Levels in Resected Rats
Authors: Koopmann Matthew C. , Nelson David W. , Murali Sangita G. , Liu Xiaowen , Brownfield Mark S. , Holst Jens J. , Ney Denise M.
Published: May 2008

Background: Glucagon‐like peptide‐2 (GLP‐2) is a nutrient‐dependent proglucagon‐derived hormone that stimulates intestinal adaptive growth. Our aim was to determine whether exogenous GLP‐2 increases resection‐induced adaptation without diminishing endogenous proglucagon and GLP‐2 receptor expression. Methods: Rats underwent transection or 70% jejunoileal resection ± GLP‐2 infusion (100 μg/kg body weight/d) and were fed a semipurified diet with continuous infusion of GLP‐2 or saline by means of jugular catheter. After 7 days, body weight, mucosal cellularity (dry mass, protein and DNA), crypt–villus height, and crypt cell proliferation (by bromodeoxyuridine staining) were determined. Plasma bioactive GLP‐2 (by radioimmunoassay), proglucagon and GLP‐2 receptor mRNA expression (by Northern blot and real‐time reverse transcriptase quantitative polymerase chain reaction) were measured. GLP‐2 receptor was colocalized to neuroendocrine markers by immunohistochemistry. Results: Low‐dose exogenous GLP‐2 increased mucosal cellularity and crypt–villus height in the duodenum, jejunum, and ileum; enterocyte proliferation in the jejunal crypt; and duodenal and jejunal sucrase segmental activity. Plasma bioactive GLP‐2 concentration increased 70% upon resection, with an additional 54% increase upon GLP‐2 infusion in resected rats (P < .05). Ileal proglucagon mRNA expression increased with resection, and exogenous ileum GLP‐2 failed to blunt this response. Exogenous GLP‐2 increased ileum GLP‐2 receptor expression 3‐fold in resected animals and was colocalized to vasoactive intestinal peptide‐positive and endothelial nitric oxide synthase‐expressing enteric neurons and serotonin‐containing enteroendocrine cells in the jejunum and ileum of resected rats. Conclusions: Exogenous GLP‐2 augments adaptive growth and digestive capacity of the residual small intestine in a rat model of mid–small bowel resection by increasing plasma GLP‐2 concentrations and GLP‐2 receptor expression without diminishing endogenous proglucagon expression.
The Effect of Intravenous Fat Emulsions in Patients with Pancreatic Fistula
Authors: GRUNDFEST S. , STEIGER E. , SELINKOFF P. , FLETCHER J.
Published: May 2008

Three patients with pancreatic fistulae were given parenteral 10% fat emulsion (Intralipid) to study the effect of intravenous fat on pancreatic fistula output. Each patient received nutritional support with isovolumetric, isoni‐trogenous, and isocaloric solutions containing either hypertonic dextrose and amino acids, or hypertonic dextrose, amino acids, and a fat emulsion. Measurements of fistula volume, fistula amylase, lipase, and chloride concentrations, and fistula trypsin activity were performed. The patients were studied for periods of 10 to 26 days. No significant increases in any of the above parameters were noted during the periods when the fat emulsions were infused. In one patient the fistula closed spontaneously. We conclude that intravenous fat emulsions may be used to provide nutritional support for patients with pancreatic fistula without increasing pancreatic juice volume or enzyme content.
Nutritional Effects of Intravenous Infusion Solutions on Normal Rats: Effects of Increased Energy Level and Deletion of Acidic Amino Acids
Authors: Kishi Tetsuya , Iwasawa Yasuo , Itoh Hiroshi , Chibata Ichiro
Published: May 2008

Nutritional effects of intravenous infusion of an amino acid (AA) mixture enriched with the branched chain AA were previously evaluated at a daily level of 45 kcal and 200 mg N using male rats weighing approximately 200 g. The present study was conducted with male rats weighing approximately 200 g to evaluate the nutritional effects of 1) an AA infusion solution at further increased energy level, and 2) an AA solution devoid of aspartic and glutamic acids. By increasing daily energy input from 45 to 55 kcal/rat, the body weight gain of rats was markedly increased and more positive nitrogen balance was observed. Glucose, albumin, and free AA levels were unchanged in plasma of rats after the infusion period, while plasma urea level was somewhat lowered. Organ weights and liver lipid content were also unchanged. The administration of an infusion solution devoid of aspartic and glutamic acids resulted in little alteration in the amounts of urinary excretion and plasma levels of these acidic AA. Furthermore, other parameters measured showed no significant effect of the deletion of the AA. These results indicate that no advantage is expected in the use of acidic AA for parenteral nutrition.