bluuebunny/crossref_metadata_2025 huggingface dataset:
Vancomycin Stability in Heparin and Total Parenteral Nutrition Solutions: Novel Approach to Therapy of Central Venous Catheter‐Related Infections
Authors: Yao Joseph D.C. , Arkin Charles F. , Karchmer Adolf W.
Published: May 2008

To facilitate therapy of central venous catheter‐related Gram‐positive bacterial infection in patients who require total parenteral nutrition (TPN) therapy, we studied the stability of vancomycin in a commonly used TPN solution (V‐TPN) at final concentrations of 0.5 mg/mL and 1.0 mg/mL and in heparin (100 U/mL in 0.9% NaCl) at 25 μg/mL (V‐H). Vancomycin concentrations in V‐TPN and V‐H after storage at 4°C over 35 and 14 days, respectively, were stable (within 10% of the prestorage vancomycin concentration). After 14 days at 4°C heparin activity in V‐H solution was 100 ± 4% of that noted initially. Vancomycin remained stable (100 ± 6% of the original vancomycin concentration) when the previously refrigerated V‐TPN was held for an additional 24 hours at 22°C. When the previously refrigerated V‐H was held for an additional 24 hours at 37°C, vancomycin concentrations decreased to 78 ± 9% of the baseline concentrations (p <.001). The stability of vancomycin in this TPN solution allows the daily dose of vancomycin to be mixed with the solution and then infused over 10 hours. As shown with pharmacokinetic modeling, this form of therapy will achieve serum vancomycin concentrations within the therapeutic range throughout a 24‐hour period. The relative stability of vancomycin in a heparin line‐flush solution allows vancomycin concentration in the lumen of the catheter to be maintained at ≥15 μg/mL during the interval between catheter flushing and the subsequent TPN infusion. A simplified method of administering vancomycin to patients receiving concurrent TPN is possible. (Journal of Parenteral and Enteral Nutrition 16:268–274, 1992)
Inadvertent Arterial Administration of Parenteral Hyperalimentation Solution Resulting in Generalized Seizure Activity
Authors: Sherman Bruce W. , Mcnamara Michael P. , Shen Shu‐Jane
Published: May 2008

Serious complications may arise from improper central venous catheter placement. In this case report, seizures occurred as a result of inadvertent arterial administration of parenteral hyperalimentation. There is a need for radiographic confirmation of central venous catheter position by qualified personnel before catheter use. (Journal of Parenteral and Enteral Nutrition 16:284–285, 1992)
Effect of Different Dietary Triglycerides on Liver Fatty Acids and Prostaglandin Synthesis by Mouse Peritoneal Cells
Authors: Lokesh Belur , Licari Jerome , Kinsella John E.
Published: May 2008

The effect of dietary triglycerides varying in fatty acid composition on the tissue fatty acids and prostaglandin synthesis was studied in mice. The dietary fats were medium‐chain triglycerides (rich in C8:0 and C10:0), structured lipids (rich in 12:0), high oleic sunflower oil (rich in 18:1), corn oil (rich in n‐6 polyunsaturated fatty acids), and menhaden oil (rich in n‐3 polyunsaturated fatty acids) fed at 5% by weight in refined diets. The medium chain fatty acids C8 to C12 from medium‐chain triglycerides and structured lipids did not accumulate in liver phospholipids. However, long‐chain fatty acids from the dietary fats were incorporated into liver lipids, with n‐3 polyunsaturated fatty acids replacing arachidonic acid. The synthesis of 6‐keto‐prostaglandin F1α and prostaglandin E2 by peritoneal cells in response to intraperitoneal injection of zymosan decreased as the arachidonic acid levels were decreased. When the same dietary fats were added to the refined, fat‐free diets, at 7.5 wt% levels, together with 2.5 wt% of safflower oil to provide essential fatty acids, only the long‐chain fatty acids from the dietary fats were incorporated into the liver lipids. The arachidonic acid in liver lipids was enhanced after supplementation of diets with safflower oil. However, the reduction in prostaglandin synthesis by peritoneal cells in response to intraperitoneal injection of zymosan was similar to that observed when 5% fat was fed. The data suggest that dietary fats of defined composition, with or without added essential fatty acids, may be useful as alternate fat sources in parenteral nutrition in reducing inflammatory responses mediated via prostaglandins. (Journal of Parenteral and Enteral Nutrition 16:316–321, 1992)
Influences of Postnatal Age and Dietary Nucleotides on Plasma Fatty Acids in the Weanling Rat
Authors: Boza Julio , Jimenez Jesus , Faus Maria Jose , Gil Angel
Published: May 2008

Dietary nucleotides seem to play a number of physiologic roles during early life. They are improved in the maintenance of the immune system, intestinal maturation, and lipid metabolism. Nucleotides affect the conversion of essential fatty acids into their long‐chain polyunsaturated (PUFA) derivatives in both preterm and at‐term newborn infants. This work examines the effect of postnatal age and dietary nucleotides on the fatty acid composition of total plasma lipids and lipid fractions in the rat. Weanling rats (21 days old) were divided into three groups. The first group was killed, and the other two groups were fed a standard semipurified diet, and the same diet supplemented with 250 mg each of CMP, UMP, AMP, GMP, and IMP per 100 g of diet for 4 weeks. Advancing postnatal age led to an increase of total plasma fatty acids, especially saturated, and PUFA of the n‐6 series, whereas PUFA of the n‐3 series decreased. The fatty acid profile of plasma phospholipids (PL) exhibited minor changes, although there was a tendency to show lower levels of saturates and PUFA of the n‐3 series and increased levels of PUFA of the n‐6 series. Cholesteryl esters showed a response similar to that of PL, although the increase in arachidonic acid (20:4n‐6) was significant. For triglycerides, linoleic acid (18:2n‐6) and mono‐unsaturates increased their levels, whereas saturates decreased. Dietary nucleotides mediated a significant increase in total plasma fatty acids, namely monounsaturated fatty acids and PUFA of both n‐6 and n‐3 series as compared with the control group. The relative fatty acid composition of PL and cholesteryl esters was mostly unaffected. Only increased levels of MUFA were found for PL. For triglycerides, a relative increase of palmitic acid (16:0) and oleic acid (18:1) was observed in the group fed the supplemented diet, whereas 20:4n‐6 decreased. These data suggest that dietary nucleotides are important modulators of PUFA synthesis and that the weanling rat may be a relatively valid experimental model to ascertain the biochemical mechanisms by which nucleotides affect the lipid metabolism in early life. (Journal of Parenteral and Enteral Nutrition 16: 322–326, 1992)
Home Parenteral Nutrition—A 3‐Year Analysis of Clinical and Laboratory Monitoring
Authors: Burnes Jan U. , O'Keefe Stephen J.D. , Fleming C. Richard , Devine Richard M. , Berkner Sharon , Herrick Linda
Published: May 2008

We report a 3‐year analysis (1986 to 1989) of the management of 63 home parenteral nutrition patients, 40 with short‐bowel syndrome and 23 with chronic intestinal obstruction with or without intestinal resection. Intravenous fluid requirements varied from 0.9 to 6 L/day, and the content of glucose varied between 46 and 531 g/day, protein varied from.0 to 85 g/day, fat from.0 to 100 g/day, sodium from 37 to 695 mEq/day, potassium from 30 to 220 mEq/day, chloride from 60 to 760 mEq/day, and acetate from 0 to 200 mEq/day. Body weight was normalized and well maintained in the majority of patients, but using the strict definition of deficiency as the presence of one abnormal value during 3 years, more than half had abnormal plasma chloride, glucose, alkaline phosphatase, serum glutamic oxaloacetic transaminase, total protein, albumin, selenium, and iron concentrations, and more than a third had low calcium, magnesium, vitamin D, and vitamin C levels. Normochromic anemia was seen in 73% and high blood creatinine associated with low urine volumes in 42%. Most (78%) returned to relatively normal lifestyles, but employability was occasionally impaired by loss of third‐party insurance coverage resulting from a therapy that may cost $100,000 per year. Overall mortality was low (5% per year), but 73% needed readmission to hospital, mainly for suspected catheter sepsis. The results indicate that home parenteral nutrition has allowed many patients to survive gut failure and return to work but problems with chronic fluid, electrolyte and micronutrient deficiencies, catheter sepsis, and insurance coverage often restrict optimal rehabilitation. (Journal of Parenteral and Enteral Nutrition 16:327–332, 1992)
Differentiating Subtypes (Hypoalbuminemic vs Marasmic) of Protein‐Calorie Malnutrition: Incidence and Clinical Significance in a University Hospital Setting
Authors: Mcclave Stephen A. , Mitoraj Thomas E. , Thielmeier Kenneth A. , Greenburg Richard A.
Published: May 2008

Clinical nutrition assessment has identified two types of protein‐calorie malnutrition (PCM), a stress‐induced hypoalbuminemic form (HAF‐PCM) and a marasmic form (MF‐PCM) generated by adaptation to starvation. This study evaluated the differences between these two patterns of PCM with regard to precipitating factors and the clinical sequelae of mortality, cost of total parenteral nutrition, length of hospitalization, and rate of sepsis and nosocomial infection. Of 220 patients receiving total parenteral nutrition over a 12‐month period (0.7% of 30, 127 admissions), 180 were included in this study. HAF‐PCM was diagnosed in 45% and MF‐PCM in 25% of study patients. HAF‐PCM was more common in older age groups. Women had PCM less often than did men (57% vs 83%), but whereas men developed both forms of PCM equally, women were more likely to develop HAF‐PCM. Prolonged mechanical ventilation increased the likelihood of both patterns, whereas the presence of malignancy, concomitant organ failure, trauma, burns, or surgery did not increase the likelihood of developing either pattern of PCM. HAF‐PCM increased the length of hospitalization by 29% and the cost of total parenteral nutrition by 42%. The presence of HAF‐PCM increased fourfold the odds of dying, and the odds of developing nosocomial infection and sepsis almost 2.5 times above that seen in its absence. MF‐PCM had no clinical effect of its own on any of the outcome parameters, but instead exerted only an interactive synergistic effect with HAF‐PCM on length of hospitalization and cost of total parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 16:337–342, 1992)
Measurement of Resting Energy Expenditure in Patients With Chronic Obstructive Pulmonary Disease in a Clinical Setting
Authors: Schols A.M.W.J. , Schoffelen P.F.M. , Ceulemans H. , Wouters E.F.M. , Saris W.H.M.
Published: May 2008

There is a growing tendency to estimate energy requirements by means of the assessment of resting energy expenditure (REE) by indirect calorimetry. In this study a computerized open‐circuit ventilated hood system is described that was constructed for assessing REE in a clinical setting. Measurement error of the device, tested by ethanol combustion was +2% for VO2 and VCO2 and <1% for respiratory quotient. To assess the within‐patient variability of REE measurements performed in a daily clinical routine, we studied the following aspects of the measurements in several groups of patients with chronic obstructive pulmonary disease: (1) reproducibility, (2) the influence of routine physical activities before the measurement, (3) measurement duration, and (4) difference between measurements using a ventilated hood or a mouthpiece. Reproducibility of measurements with a 2‐month interval in 12 weight‐stable patients was good (1415 ± 128 and 1398 ± 138 kcal/day). Variations due to limited activities and different measurement durations (between 10 and 30 minutes) were not significant. Variations between measurements with a mouthpiece and ventilated hood were larger in patients than in healthy control subjects, but for both groups no systematic difference was established. REE can be assessed reliably by short‐term measurements with a ventilated hood in stable chronic obstructive pulmonary disease patients on an outpatient basis, provided a short rest is taken before the measurement. (Journal of Parenteral and Enteral Nutrition 16:364–368, 1992)
Retrograde (Ascending) Bacterial Contamination of Enteral Diet Administration Systems
Authors: Payne‐James J. Jason , Rana S.K. , Bray M.J. , Mcswiggan David A. , Silk David B.A.
Published: May 2008

A prospective clinical study in three phases was performed to determine whether it was possible that enteral diet containers could become contaminated as a result of endogenous organisms ascending retrogradely from the enteral feeding tube via the giving set, and if this did occur whether the incidence could be altered by modifying enteral delivery systems. Each phase observed patients on enteral feeding over a 48‐hour study period (phase I, n = 18; phase II, n = 17; phase III, n = 18). Each patient was prescribed an enteral diet of 2 L/24 h administered by continuous pump infusion from a closed 1‐L sterile diet container. Four containers were used for each patient, and one giving set was used in the 48‐hour period. Diet samples were taken at 12‐hour intervals: two from the giving set before and after flushing with residual diet, and one from the diet container. Phases differed only in the design of the giving set: phase I had no drip chamber, phase II had a drip chamber, phase III had a drip chamber and an anti‐reflux ball valve at the distal end. Both phase I and III had greater numbers of giving set samples colonized at 24, 36, and 48 hours. In phase I, 3 of 14 sterile diet containers were colonized with >104 colony‐forming organisms/mL of diet at 48 hours. Only phase II had no organisms contaminating the containers at 48 hours. We conclude that the retrograde spread of organisms from patient to sterile diet container does occur in clinical practice, and that a drip chamber in the giving set may prevent the problem. However, including a ball valve at the distal end of a giving set with a drip chamber negates this beneficial effect. These results have important implications when administering enteral nutrition to high‐risk patient groups.(Journal of Parenteral and Enteral Nutrition 16:369–373, 1992)
Cuff Cath: An Initial Experience of Cuffed Polyurethane Central Venous Catheters in Children
Authors: Wheeler Robert A. , Griffiths D. Mervyn
Published: May 2008

The tendency of medium‐ and long‐term silicone central venous catheters (CVCs) to block, fracture, and become displaced has led to the evaluation of a polyurethane CVC, Cuff Cath (Viggo Spectramed, Swindon, Wilts, United Kingdom) as a possible alternative because polyurethane is smoother and stronger. We report the first prospective study of polyurethane cuffed CVCs in children. Sixty Cuff Caths were placed in 53 children, mean age 4.7 years (range, 4 days to 16.3 years), mean weight 15.6 kg (range, 3.1 to 58 kg). All CVCs were tunnelled (mean tunnel length, 12 cm; range, 5 to 20 cm) and inserted either into the subclavian vein (n = 28) or internal jugular vein (n = 32). In a total of 6363 catheter days (mean, 111 days per patient; range, 15 to 364 days), three (5%) CVCs had to be removed because of sepsis and one (2%) because of blockage. All other Cuff Caths remained patent to infusion and blood sampling. No Cuff Caths were pulled or fell out, fractured, or migrated. This study demonstrates significant advantages of polyurethane compared with previous series using silicone CVCs with respect to blockage, fragmentation, and dislodgement. A prospective, randomized, controlled trial of Cuff Cath compared with a silicone CVCs in children is required. (Journal of Parenteral and Enteral Nutrition 16:384–385, 1992)
Review: Parenteral Nutrition‐Related Bone Disease
Authors: Koo Winston W.K.
Published: May 2008

Parenteral nutrition (PN)‐related bone disease remains a problem in patients of all ages. Understanding of the pathogenesis of PN‐related bone disease is complicated by the effect of underlying illnesses, therapeutic interventions, and pre‐existing nutrition deficiencies before the initiation of PN therapy. Interrelation of various nutrients, for example, calcium, phosphorus, and vitamin D, in their effects on bone mineralization, demands simultaneous assessment of the role of multiple nutrients and increases the difficulty in defining the role of a single nutrient in the development of bone disease. However, recent reports indicate that there exist a number of factors important in the development of PN‐related bone disease and some factors such as increased mineral requirement are unique to growing infants whereas other factors such as aluminum toxicity may be common to both adult and pediatric populations. Nonnutritional factors, including chronic use of potent loop diuretics and altered acid‐base status, can affect urine mineral loss, cell metabolism, and bone mineralization, particularly in small, preterm infants. Current evidence indicates that the cause of PN‐related bone disease is multifactorial, and the prevention of PN‐related bone disease awaits better delineation of the exact sequence of pathogenic events. (Journal of Parenteral and Enteral Nutrition16:386–394)
Depressed Gut Absorptive Capacity Early After Trauma‐Hemorrhagic Shock G. SINGH, K. I. CHAUDRY, L. C. CHUDLER, AND I. H. CHAUDRY Annals of Surgery 214:712–718, 1991
Authors: Nussbaum Michael S.
Published: May 2008

The authors investigated the effect of the calcium channel antagonist diltiazem on gut absorptive capacity after hemorrhage in rats. Carotid and femoral arterial catheters, portal and jugular venous catheters, and nasogastric tubes were placed in 12 anesthetized animals. After recovery from the anesthetic, eight animals (groups 2 and 3) were bled via the femoral catheter to a mean arterial pressure (MAP) of 40 mm Hg. This level of hypotension was maintained by continued bleeding to the maximal bleedout volume (approximately 60% of the animal's circulating blood volume), followed by infusion of lactated Ringer's solution until 40% of the maximal bleedout volume had been returned. The animals were then resuscitated with lactated Ringer's solution. Four rats (group 1) were not hemorrhaged and served as sham controls. During resuscitation the animals in group 2 received an additional 1 mL of saline, whereas those in group 3 were treated with diltiazem 400 μg/kg body weight in 1 mL of saline. MAP was measured throughout the experiment. Portal and central venous pressures were measured at the onset of hemorrhage, maximal bleedout, end of hemorrhage, end of resuscitation, and just before the D‐xylose absorption tests. Gut absorptive, capacity was determined using the 1‐hour D‐xylose absorption test at 2 hours and 4 hours after the end of hemorrhage. The D‐xylose was administered via the nasogastric tubes; portal blood was sampled 1 hour later and assayed for D‐xylose.

The animals treated with diltiazem had a significantly lower MAP 2 hours after the end of hemorrhage, whereas at 4 hours, both hemorrhaged groups were significantly lower than controls. Central venous and portal pressures were significantly lower in the hemorrhaged groups at maximal bleedout and end of hemorrhage compared with the sham‐operated animals. However, these values returned to normal by 2 hours after the end of hemorrhage. There were no differences in the venous pressures between the animals receiving saline or diltiazem. The saline‐treated animals' gut absorptive capacity as measured by D‐xylose absorption was significantly reduced at 2 and 4 hours after the end of hemorrhage. Diltiazem administration restored gut absorptive capacity to normal at both time points after the end of hemorrhage.
Parenteral Arginine Infusion in Humans: Nutrient Substrate or Pharmacologic Agent?
Authors: Sigal Robert K. , Jian Shou  , Daly John M.
Published: May 2008

When given as a dietary supplement, arginine enhances lymphocyte mitogenesis and improves nitrogen balance. The purpose of this study was to evaluate arginine's ability to mediate these same effects when given as the sole nitrogen source with minimum additional calories. Thirty patients were randomized to receive 20 g/day arginine hydrochloride or a mixed amino acid solution (Travasol) by intravenous infusion for 7 days after abdominal operations. Mean patient age, body weight, gender ratios, and preoperative degree of weight loss were similar between groups. Mean plasma arginine and ornithine levels rose to 228 ± 50 μmol/L and 191 ± 76 μmol/L in the arginine group during infusion. Mean nitrogen balance was ‐8.8 g/day and ‐9.2 g/day in the arginine and Travasol groups, respectively. Mean lymphocyte stimulation indices to concanavalin A and phytohemagglutinin fell on postoperative day 1 in both groups. No significant differences in patterns of lymphocyte mitogenesis changes were noted between groups. The mean total number of circulating T cells increased in the arginine group at postoperative day 7. Thus, parenteral arginine infusion in postoperative patients provided comparable nitrogen balance to a balanced amino acid solution but did not increase peripheral blood lymphocyte mitogenesis. When arginine is given parenterally as the sole nitrogen source with minimal additional calories to postoperative patients, no enhancement of mitogen‐stimulated lymphocyte proliferation could be demonstrated. (Journal of Parenteral and Enteral Nutrition 16:423–428, 1992)
Prefilter and Postfilter Cysteine/Cystine and Copper Concentrations in Pediatric Parenteral Nutrition Solutions
Authors: Cochran Emily B. , Boehm Kristi A.
Published: May 2008

Pediatric amino acid products contain lower concentrations of methionine and require the addition of L‐cysteine HCl just before infusion. Reports of a potential interaction between cysteine and copper, a routine addition to parenteral nutrition solutions, have appeared in the literature. This study serially evaluated cysteine/cystine and copper concentrations pre‐ and postfilter (0.22 μm) in two parenteral nutrition formulations prescribed for normal fluid (NF) or fluid‐restricted (FR) pediatric patients. Solutions were infused via a peristaltic pump in vitro for 24 hours. Pre‐ and postfilter samples were obtained immediately after the infusion began (time 0) and at 1, 2, 3, 4, 8, 12, 16, 20, and 24 hours during the infusion. At 24 hours pre‐ and postfilter, cysteine/cystine were quantitated at 87.3% and 85% of the initial concentrations, respectively, for the NF solution and 92% and 91.5% for the FR solution. Pre‐ and postfilter copper was quantitated at 87.5% and 92.5% of the initial concentrations, respectively, for the NF solution and 88.2% and 95.2% for the FR solution. The 24 hour area under the curve for cysteine/cystine was 88.4% for the NF solution and 96.4% for the FR solution. For copper, the area under the curve for the NF solution was 99% and 96.7% for the FR solution. There was no visual evidence of incompatibility or precipitation. We conclude that copper‐containing parenteral nutrition solutions with L‐cysteine HCl added immediately before infusion are relatively stable after compounding and infusion over 24 hours. (Journal of Parenteral and Enteral Nutrition 16:460–463, 1992)
Gastrointestinal Effects of Modified Guar Gum and Soy Polysaccharide as Part of an Enteral Formula Diet
Authors: Lampe Johanna W. , Effertz Michelle E. , Larson Janice L. , Slavin Joanne L.
Published: May 2008

Dietary fiber supplementation may improve gastrointestinal tolerance and decrease diarrhea in patients receiving enteral formula diets. To compare the effects of two dietary fibers on bowel function parameters and short‐chain fatty acid excretion we fed 11 healthy men three defined enteral formula diets in random order for 18 days each. The test diets consisted of a fiber‐free formula and daily intakes of maltodextrin (0 g of fiber), 15 g of total dietary fiber as an enzymatically modified guar gum, and 15 g of total dietary fiber as soy polysaccharide. Data were also collected while subjects consumed self‐selected diets for 5 days. Mean transit time was longer and fecal moisture content was lower on 0 g of fiber and modified guar than on the self‐selected and soy diets. Furthermore, mean transit time was slightly longer and fecal nitrogen excretion greater on modified guar compared with 0 g of fiber. Daily fecal output and frequency of defecation were greater, fecal pH was lower, and fecal butyrate concentrations were higher on the self‐selected diet compared with the enteral formula diets. However, there was no difference in these parameters among the three liquid diets. Thus, despite significant differences in mean transit time, few differences in other parameters of bowel function were observed when healthy subjects consumed enteral formula diets containing 0 g of fiber and 15 g of total dietary fiber as modified guar and soy. (Journal of Parenteral and Enteral Nutrition 16:538–544, 1992)
Clinical and Metabolic Efficacy of Glutamine‐ Supplemented Parenteral Nutrition After Bone Marrow Transplantation. A Randomized, Double‐Blind, Controlled Study T. R. ZIEGLER, L. S. YOUNG, K. BENFELL, ET AL Annals of Internal Medicine 116:821–828, 1992
Authors: Sax Harry C.
Published: May 2008

Glutamine (GLN), long considered to be a nonessential amino acid, may be conditionally essential during periods of metabolic stress.1 It has been suggested that the improved results seen in patients given enteral, as opposed to parenteral, nutrition may in part be due to the provision of GLN. Commercial amino acid solutions do not contain GLN because of its inherent instability. Glutamine‐supplemented solutions are currently under investigation and may be of benefit to patients who cannot tolerate enteral feedings. Bone marrow transplantation is one such setting, where the combination of radiation and chemotherapy make enteral support untenable.

Forty‐five patients underwent allogeneic bone marrow transplantation for hematologic malignancies. They were randomly assigned to receive either a standard glutamine‐free total parenteral nutrition solution or one supplemented with L‐glutamine to provide 0.57 g of GLN/ kg per day in a blinded fashion. Overall protein intake was 1.5 g/kg per day. Patients were allowed to eat ad libitum, but they consumed fewer than 300 calories daily. Total parenteral nutrition was discontinued when patients were able to consume 50% of their needs orally daily for 3 consecutive days.

All patients survived their acute hospitalization. One hundred‐day survival was not different between the two groups. The GLN group had significantly fewer clinical infections than did the control group. Ten of 24 GLN patients completed their hospitalization with no positive cultures as opposed to 1 of 21 control patients (p <.01). The majority of positive cultures in the control group were for Candida albicans.

Daily nitrogen balance data were available in those patients not being treated with corticosteroids for graftvs‐host disease. During the early phase of transplantation (days 4 to 11), average daily nitrogen balance remained more negative in the control group (—4.2 ± 1.2 vs ‐1.4 ± 0.5 g; p <.002). There was no statistically significant difference between the two groups from days 18 to 25.

Total days of parenteral support were equal in both groups. However, total hospital days were significantly fewer in the GLN group, most likely because of the decreased incidence of septic complications.
Prevalence of Malnutrition in Alcoholic and Nonalcoholic Medical Inpatients: A Comparative Anthropometric Study
Authors: Koehn Véronique , Burnand Bernard , Niquille Marc , Paccaud Fred , Magnenat Pierre , Yersin Bertrand
Published: May 2008

Available data on the nutritional status of alcoholics is controversial. The present study was conducted to assess the frequency of malnutrition in alcoholic inpatients. The objectives were to (1) compare anthropometric data of hospitalized alcoholic and nonalcoholic patients and (2) evaluate the association between alcoholism and protein‐energy malnutrition. It was a cross‐sectional comparative study including a stratified analysis to control for potential confounding factors. Alcoholics were identified as patients with a score from the Michigan Alcoholism Screening Test ≥8 among patients admitted consecutively to the general wards of a department of internal medicine; they were matched for sex, age, and time of admission with nonalcoholic patients (Michigan Alcoholism Screening Test score ≤4). Nutritional status was assessed using weight, height, midarm circumference, and tricipital skinfold thickness values, which were then used to determine the Quetelet body mass index and the mid‐arm muscle circumference. The study took place in general wards of internal medicine in a 1000‐bed city and teaching hospital in Lausanne, Switzerland. The participants were 93 alcoholic patients and 93 controls aged 20 to 75 years, admitted from September 1, 1988, to March 18, 1989. Alcoholics were characterized by a low rate of severe protein‐energy malnutrition (<5%); their average body weight was normal, similar to the weight of nonalcoholic inpatients, and not greatly influenced by the presence or severity of concomitant liver disease. However, tricipital skinfold thickness was lower in alcoholics than in nonalcoholics (8 mm vs 10 mm, p <.05, and 13 mm vs 20 mm, p <.01, in men and women, respectively). The association between alcoholism and protein‐energy malnutrition (odds ratio 3.0, 95% confidence interval 1.6–5.7) remained positive when adjusted for smoking, liver disease, or occupational status. In conclusion, alcoholism was associated with poor nutritional status in hospitalized patients, although severe protein‐energy malnutrition was infrequent. The results suggest that alcoholism‐related malnutrition exists irrespective of the social and medical situation of the patient and is mostly related to caloric undernutrition. (Journal of Parenteral and Enteral Nutrition 17:35–40, 1993)
Dynamic Change of Reticuloendothelial System Function After Surgical Stress
Authors: Tsujinaka Toshimasa , Ishida Hideyuki , Kido Yoshihiro , Kan Kazuomi , Shiozaki Hitoshi , Jima Shohei , Homma Taro , Mori Takesada
Published: May 2008

The influence of surgical stress on the function of the reticuloendothelial system (RES) is not well elucidated. Because we established an in vivo functional test for the RES by using chondroitin sulfate iron colloid in rabbits, the normal range of RES function in healthy volunteers (n = 12) and the dynamic change of RES function in surgical patients after distal gastrectomy (n = 14) were examined by this method. In healthy volunteers, the maximum phagocytic velocity and membrane‐particle constant were 0.0310 ± 0.0052 mg/kg per minute and 0.575 ± 0.205 mg/kg, respectively. In surgical patients, maximum phagocytic velocity (postoperative day 1, 0.0408 ± 0.0088; postoperative day 3, 0.0486 ± 0.0115; and postoperative day 7, 0.0430 ± 0.0115 mg/kg per minute) and membrane‐particle constant (postoperative day 3, 0.717 ± 0.169 mg/kg) significantly increased postoperatively in comparison with preoperative values. These results indicate that the total capacity of the RES is augmented but that its functional phagocytic efficiency is diminished after abdominal surgery. This phenomenon is considered to be one of the immunological alterations caused by surgical stress. The chondroitin sulfate iron colloid test can be applied to monitor the dynamic change of the RES function under various conditions. (Journal of Parenteral and Enteral Nutrition 17:73–76, 1993)
Upregulation of Nutrient Transport in Fetal Rabbit Intestine by Transamniotic Substrate Administration
Authors: Sax Harry C.
Published: May 2008

Intrauterine growth retardation complicates 3% to 7% of full‐term pregnancies. The developing fetal gastrointestinal tract has the ability to absorb nutrients delivered via the amniotic sac. It is not clear, however, if this nutrient delivery does in fact aid in promoting additional maturation and development of the fetal gut. Sixteen pregnant New Zealand White rabbits underwent celiotomy on gestational day 24. The bicornuate uterus was exposed, and the ovarian‐end fetuses were randomly assigned to either a control or a study group. A catheter was placed in the amniotic cavity in each side of the uterus for nutrient infusion and was secured in place. Both catheters were exteriorized; animals were partially restrained but were allowed free access to food and water. Immediately postoperatively, infusion of either a metabolizable carbohydrate (d‐galactose; experimental group) or a nonmetabolized, nontransported carbohydrate (mannitol; control group) was carried out. Six days later, each fetus was harvested. A segment of intestinal sleeve was inverted, and uptakes of radiolabeled glucose and galactose were determined in proximal, middle, and distal segments of the small intestine.

No significant differences were noted in fetal body weight or fetal small intestinal length between control and experimental groups. Mucosal weight, expressed as percent of total small intestinal weight, was significantly greater only in the proximal intestinal segment in the experimental group when compared with the control group.

Mucosal galactose uptake (nmol/mg of protein per minute) for each intestinal segment was determined and significant increases were noted in the experimental group, in the middle and distal segments, when compared with the control group. However, no significant differences between the two groups were noted when galactose uptake was expressed in nmol/cm per minute. Mucosal glucose uptake (nmol/mg per minute) was significantly increased in the proximal and distal segments, but not in the middle segment, of the small intestine. Again, the differences in glucose uptake between the two groups were not statistically significant when expressed as nmol/cm per minute. Nutrient uptake, calculated for the entire small intestine, was significantly greater (p <.05) in the experimental group compared with the control group.

The authors concluded that the developing fetal rabbit is capable of upregulating its intestinal mucosal brush border transport in response to administration of galactose in the amniotic fluid.
Response of Muscle Protein Synthesis to Parenteral Administration of Amino Acid Mixtures in Growing Rats
Authors: Preedy Victor R. , Garlick Peter J.
Published: May 2008

Previous studies have shown that 1‐hour infusions of neither glucose nor an amino acid mixture alone stimulates muscle protein synthesis in postabsorptive rats (Biosci Rep 1986;6:177–183). We have therefore investigated whether longer periods of infusion are required to initiate responses. The effects of intravenous infusions of various substrates for 6 hours on rates of skeletal muscle protein synthesis in fasted rats were studied. Fractional rates of protein synthesis (ks, the percent of muscle protein renewed each day) and the ribonucleic acid activity (KRNA, the amount of protein synthesis per unit of ribonucleic acid [milligrams of protein per day per milligram of ribonucleic acid]) were measured with a flooding dose of L‐[4‐3H]phenylalanine. Infusion of mixed amino acids (15 mg of nitrogen per hour per rat) increased ks and kRNA by approximately 50% in comparison with saline‐infused rats, but rates of muscle protein synthesis remained below those observed in fed animals. Doubling the infusion rate of amino acids to 30 mg of nitrogen per hour per rat had no additional effect on ks and kRNA, and addition of glucose (0.3 g/h per rat) or glucose plus lipid also had no significant additive effect. However, infusion of glucose alone (0.3 g/h per rat) increased ks and kRNA by 25% when compared with saline‐infused controls. Infusion of the branched‐chain amino acids in the same amounts as present in the amino acid mixture increased ks and kRNA by 20% compared with saline‐infused controls, but the rate remained significantly lower than that obtained by infusion of mixed amino acids. (Journal of Parenteral and Enteral Nutrition 17:113–118, 1993)
Gastrin, Motilin, Insulin, and Insulin‐Like Growth Factor‐I Concentrations in Very‐Low‐Birth‐Weight Infants Receiving Enteral or Parenteral Nutrition
Authors: Shulman Dorothy I. , Kanarek Keith
Published: May 2008

Blood concentrations of gastrin, motilin, insulin, and insulin‐like growth factor‐I were measured sequentially during the first 3 weeks of life in 22 very‐low‐birth‐weight infants (birth weight 1.03 ± 0.24 g; gestational age 28.3 ± 1.9 weeks; mean ± SD) who were in respiratory distress requiring mechanical ventilation and were receiving either total parenteral or enteral feedings. An increase in the blood concentration of motilin beyond the basal measurement was observed in enterally fed infants but not in infants receiving total parenteral nutrition. Motilin and gastrin concentrations were significantly increased in the enterally fed group compared with infants receiving total parenteral nutrition at 2 and 3 weeks and 1 and 3 weeks, respectively. There were no differences in serum insulin or plasma insulin‐like growth factor‐I concentrations between groups after the start of the study. The present data suggest that enteral nutrition in very‐low‐birth‐weight infants is associated with a relative increase in peripheral motilin and gastrin concentrations compared with parenterally fed infants. (Journal of Parenteral and Enteral Nutrition 17:130–133, 1993)
The Vitamin K Content of Intravenous Lipid Emulsions
Authors: Lennon Cathy , Davidson Ken W. , Sadowski James A. , Mason Joel B.
Published: May 2008

Commercially available intravenous lipid emulsions are largely derived from vegetable oils, a natural source of phylloquinone (vitamin K1). We therefore examined the concentration of vitamin K1 in two widely used intravenous lipid emulsions by using a previously validated high performance liquid chromatography technique. The vitamin K1 concentrations of 10% emulsions of Intralipid and Liposyn II were 30.8 and 13.2 μg/dL, respectively. The concentration of vitamin K1 in the 20% emulsions of these products was essentially double that in the 10% emulsions. The coefficients of variation between the vitamin K1 content in three different lots of each product were consistently less than 7.0%. The observed concentrations of the vitamin in these lipid emulsions paralleled the predicted content on the basis of the type of vegetable oil(s) used to make the product. The type of vegetable oil used for production therefore seems to be a major determinant of the final vitamin K1 content. The vitamin K1 contained in these intravenous lipid emulsions is substantial and may have great impact on the vitamin K status of the recipient. (Journal of Parenteral and Enteral Nutrition 17:142–144, 1993)
Peripheral Parenteral Nutrition: A Preliminary Report on Its Efficacy and Safety
Authors: Stokes Maurice A. , Hill Graham L.
Published: May 2008

In this preliminary study of peripheral parenteral nutrition, we compared our first nine patients fed by this method with 21 patients fed by total parenteral nutrition during the same period. We found that peripheral parenteral nutrition was as effective as total parenteral nutrition in improving physiologic function (both skeletal and respiratory muscle function). We also found that by using the protocol described here thrombophlebitis was not a significant problem. Additional study is required to ascertain the exact incidence of this and other complications. We would advocate the greater use of peripheral parenteral nutrition in suitable patients and the use of this protocol for its administration. (Journal of Parenteral and Enteral Nutrition 17:145–147, 1993)
Effect of Glutamine‐Supplemented Total Parenteral Nutrition on Recovery of the Small Intestine After Starvation Atrophy
Authors: Inoue Yoshifumi , Grant John P. , Snyder Phyllis J.
Published: May 2008

Intestinal atrophy was induced in rats by infusion of 5% dextrose for 7 days with only oral water allowed. Compared with control animals fed standard rat chow (Purina Mills, St. Louis), the starved animals lost 30.5% of their initial body weight, 34.7% mucosal wet weight, 68.3% mucosal nitrogen content, 36.7% mucosal thickness, and 38.6% villous height and had variable losses of mucosal disaccharidase activities. Three groups of depleted rats were then refed with different regimens. One group was refed with standard Purina rodent chow (n = 15); a second group with a standard total parenteral nutrition (TPN) solution containing 16% glucose, 2.8% fat, and 4.25% standard amino acids (Travasol 8.5%, Baxter Healthcare Corporation, Deerfield, IL) (n = 15); and the third group with a TPN solution of 16% glucose, 2.8% fat, 2.75% standard amino acids, and 1.5% glutamine (n = 15). After 7 days of refeeding, rats were killed to determine the degree of intestinal recovery. Animals refed with standard TPN solution showed no significant recovery of intestinal mucosal weight, mucosal nitrogen content, villous height, mucosal thickness, or mucosal disaccharidase activities. Animals refed with glutamine‐supplemented TPN solution demonstrated significant recovery of all parameters but not back to normal. Oral rodent chow completely restored intestinal anatomy and function. The addition of glutamine to TPN solutions significantly improved recovery of the intestine from starvation atrophy, and additional efforts to make it commercially available are indicated. This study again confirms the preferable use of a regular oral diet when clinically feasible and safe. (Journal of Parenteral and Enteral Nutrition 17:165–170, 1993)
Effect of Enteral Feeding on Intestinal Epithelial Proliferation and Fecal Bile Acid Profiles in the Rat
Authors: Thomas M.G. , Owen R.W. , Alexander B. , Williamson R.C.N.
Published: May 2008

The preservation of colonic mucosal mass requires the presence of feces; thus, colonic hypoplasia develops with enteral feeding. Fermentable soy fiber may maintain fecal bulk and prevent mucosal atrophy. We therefore compared the effects of Enrich (containing soy fiber) with Ensure (fiber‐free) on mucosal mass, fecal bile acids, and cell proliferation in the rat. Sprague‐Dawley rats (n = 20) were randomized into groups receiving either standard rat food, Enrich, or Ensure. After 4 weeks, rats were weighed and killed at intervals after administration of vincristine sulfate (1 mg/kg intraperitoneally), which was given to induce metaphase arrest within the intestinal crypts and to allow calculation of crypt cell production rate. Fecal free bile acids and neutral steroids were analyzed using gas‐liquid chromatography and gas‐liquid chromatography mass spectrometry. Nucleic acid concentrations in the small and large intestine and crypt cell production rate in the small bowel were unaffected by diet. In the proximal large bowel, both enteral diets produced a marked reduction in crypt cell production rate to values only 5% to 7.5% of control values (p <.001). In the midcolon of rats fed Ensure, there was a similar reduction, but this hypoplastic effect was completely prevented by Enrich. Without an elevation in the lithocolic acid to deoxycholic acid ratio, secondary bile acid concentrations were increased in rats receiving Enrich (p <.05 to.01) but not in those receiving Ensure. Thus, fermentable soy fiber diets may prevent the midcolonic mucosal hypoplasia induced by enteral feeding. (Journal of Parenteral and Enteral Nutrition 17:210–213, 1993)
Early vs Delayed Vitamin A Supplementation in Very‐Low‐Birth‐Weight Infants
Authors: Robbins Sandra T. , Fletcher Anne B.
Published: May 2008

The purpose of this trial was to test the hypothesis that vitamin A adequacy may decrease the incidence of bronchopulmonary dysplasia (BPD) in very‐low‐birth‐weight infants. Serum vitamin A levels were measured and the effects of two regimens of vitamin A supplementation on the incidence of BPD were compared. There were 24 infants in each of two groups with a mean birth weight less than 1000 g, a mean gestational age of 27 weeks, and similar sexual and racial mixes. In group I, vitamin A levels were measured after 1 week of parenteral nutrition and, if low, the infant was given a 2000‐IU supplement intramuscularly three times a week, beginning on the 10th to 14th day of life. In group II, the same supplementation was begun on the second to fourth day of life. In both groups, when enteral feedings reached 60 kcal/kg per day, 2500 IU/d vitamin A was given orally. The incidence of oxygen support at 28 days was similar in both groups, although in group II there was a trend toward less vigorous ventilatory support. χ2 analysis showed that a significantly smaller proportion of infants in group II had BPD at 36 weeks' gestational age than in group I. Length of neonatal intensive care unit stay was significantly reduced from 81 to 60 days. We conclude that vitamin A supplementation should be administered early to small, premature infants who are at risk for BPD and that monitoring of plasma levels is essential. (Journal of Parenteral and Enteral Nutrition 17:220–225, 1993)
Effect of a Liquid Diet With and Without Soluble Fiber Supplementation on Intestinal Transit and Cholecystokinin Release in Volunteers
Authors: Meier R. , Beglinger C. , Schneider H. , Rowedder A. , Gyr K.
Published: May 2008

The effect of adding fiber to liquid formula diets on gastrointestinal transit is still controversial. Different fiber types (soluble vs insoluble) and different methodology of transit time measurements yielded variable results. Factors affecting transit include colonic fermentation, neural, and hormonal factors. We have therefore compared the effects of a standardized normal diet and two liquid formula diets with and without supplementation of a soluble fiber (21 g/L) on orocecal transit time measured by the hydrogen lactulose breath test, colonic transit time measured by radiopaque markers with an abdominal x‐ray, bowel movements, stool consistency, and cholecystokinin release in 12 healthy male volunteers. The diets were consumed in a randomized order, each one for 7 days. The addition of soluble fiber did not affect orocecal transit time. Colonic transit time, however, was significantly prolonged (55 h) with fiber supplementation compared with the liquid diet (39 h) and the self‐selected diet (30 h) (p<.01). Stool frequency and consistency was not significantly affected. During administration of both liquid diets, fasting cholecystokinin concentrations were significantly elevated compared with the concentrations found with a self‐selected diet (p <.05). The fasting cholecystokinin concentration correlated significantly with the increase of segmental (right colon) colonic transit time (p =.02). The prolongation of colonic transit time in liquid diet‐fed volunteers might be caused by the combined effect of increased colonic fermentation and high basal cholecystokinin concentrations. (Journal of Parenteral and Enteral Nutrition 17:231–235, 1993)