bluuebunny/crossref_metadata_2025 huggingface dataset:
Modulation of the ubiquitin‐proteasome proteolytic pathway by eicosapentaenoic acid supplementation in a model of progressive malignancy
Authors: Mikhail AT , Babcock TA , Jho DH , Helton WS , Brodsky IG , Espat NJ
Published: May 2008

BACKGROUND: A benefit for eicosapentaenoic acid (EPA) supplementation for protein maintenance in cancer patients exists, although specific mechanisms are unknown. As the ubiquitin‐proteasome proteolytic (UPP) pathway has been implicated in protein use in malignancy, we determined mRNA levels for UPP components in the liver and muscles from EPA‐treated rats bearing the methylcholanthrene (MCA) fibrosarcoma. METHODS: Rats implanted with MCA tumor were divided into 3 groups on day 13: EPA (5 g/kg per day plus 10 IU vitamin E/g fat), corn oil (5 g/kg per day plus 10 IU vitamin E/g fat), and saline (5 g/kg per day plus 10 IU E/g saline). On day 29, tumor volume (TV) was determined; liver and quadriceps muscles were also excised to determine gene expression of C2, C3, E2(14k), and E3alpha by reverse transcription‐polymerase chain reaction (RT‐PCR). RESULTS: EPA‐treated rats demonstrated a reduced TV of 21% compared with the 28% and 30% TV of corn oil‐ and saline‐treated rats, respectively. Muscle mRNA levels of E2(14k) and E3alpha in EPA‐treated animals were decreased compared with corn oil‐ and saline‐treated animals. EPA treatment also decreased hepatic C2, C3, and E2(14k) mRNA levels compared with saline treatment. CONCLUSION: EPA supplement decreased skeletal muscle E2(14k), E3alpha, and hepatic C2 mRNA levels compared with the isocaloric, isonitrogenous corn oil supplement, supporting a treatment‐specific effect. The decrease in hepatic C3 and E2(14k) mRNA levels induced by EPA were partly because of caloric benefit and partly attributable to a treatment‐specific effect. Additionally, differences in the hepatic and muscle gene expressions of UPP components suggested an organ‐specific effect for omega‐3 fatty acid activity.
Growth factor regulation of PC4/TIS7, an immediate early gene expressed during gut adaptation after resection
Authors: Swietlicki E , Iordanov H , Fritsch C , Yi L , Levin MS , Rubin DC
Published: May 2008

BACKGROUND: To define the molecular mechanisms underlying the intestinal adaptive response after partial small bowel resection, we previously identified a cohort of genes regulated in the remnant adaptive ileum. One is PC4/TIS7, an immediate early gene preferentially up‐regulated during the first 48 hours after resection. To further the mechanisms that regulate gut adaptation, we sought to identify upstream regulators of PC4/TIS7 expression. METHODS: PC4/TIS7 expression in adaptive versus transection control mouse gut was examined at 48 hours after 50% intestinal resection, and its cellular localization was determined by immunohistochemistry. The effects of intestinotrophic peptides and growth factors on PC4/TIS7 expression were examined in vitro in the crypt epithelial cell line IEC 18 and in vivo in the mouse. RESULTS: PC4/TIS7 was expressed in the cytoplasm of IEC 18 cells and in adaptive mouse ileal crypt and villus enterocytes. Epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) increased PC4/TIS7 mRNA levels in postconfluent, quiescent IEC 18 cells, but insulin‐like growth factor 1 (IGF‐1) and nerve growth factor (NGF) had no effect. A stable derivative of glucagon‐like peptide 2 (GLP‐2), r(gly2)GLP‐2, was most potent in increasing PC4/TIS7 expression; however, stimulation of proliferation and differentiation were not observed. To determine the effect of GLP‐2 on PC4/TIS7 expression in vivo, r(gly2)GLP‐2 was administered intraperitoneally to mice. PC4/TIS7 mRNA expression was increased in small bowel in response to GLP‐2 compared with vehicle control. CONCLUSIONS: These results suggest that PC4/TIS7 plays a role in intracellular signaling in the intestinal epithelium during the adaptive response, possibly as a common downstream effector for several intestinotrophic growth factors.
Clinical trial of interactive and videotaped educational interventions reduce infection, reactive depression, and rehospitalizations for sepsis in patients on home parenteral nutrition
Authors: Smith CE , Curtas S , Kleinbeck SV , Werkowitch M , Mosier M , Seidner DL , Steiger E
Published: May 2008

BACKGROUND: Patients receiving long‐term home parenteral nutrition (HPN) have catheter‐related infections, reactive depression, and other recurrent problems that decrease their quality of life. The aim of this study was to evaluate the Interactive Educational Videotaped Interventions (IEVI) designed to prevent HPN complications of catheter‐related bloodstream infection (CR‐BSI), to prevent reactive depression (from Diagnostic and Statistical Manual of Mental Disorders, 4th Edition definition), and to increase patients' frequency of problem‐solving with professionals. METHODS: A randomized placebo‐controlled clinical trial was used to test IEVI that engaged patients in infection and depression prevention and problem‐solving activities with professionals. The primary outcome measure was CR‐BSIs, while reactive depression and problem solving were secondary outcomes. Quality of life and satisfaction with interventions, also secondary outcomes, were evaluated at 18 months. RESULTS: Compared with controls, there was a lower frequency in the experimental group of CRBSIs (chi2 = 4.82, p =.03), reactive depression (chi2 = 4.50, p =.03), and rehospitalization for CR‐BSIs (chi2 = 5.73, p =.01). There was greater use of problem solving in the experimental group (chi2 = 4.33, p =.038). These differences occurred at the primary endpoint of 6 months after administration of the interventions. At the 18‐month follow‐up, there were fewer CR‐BSIs (chi2 = 4.42, p =.035), and fewer hospitalizations for infection (chi2 = 5.729, p =.01). CONCLUSIONS: The IEVI reduced CR‐BSIs and reactive depression and increased problem solving with professionals. IEVI use also can result in fewer hospitalizations and improved quality of life. Long‐term improvement did not occur for reactive depression and problem‐solving outcomes because patients used these less often.
The use of a rapid in situ test in the detection of central venous catheter‐related bloodstream infection: a prospective study
Authors: Bong JJ , Kite P , Ammori BJ , Wilcox MH , McMahon MJ
Published: May 2008

BACKGROUND: Acridine orange leukocyte cytospin (AOLC) is a highly sensitive and specific test for the detection of catheter‐related bloodstream infection (CRBSI). We evaluated the role of the AOLC test in early detection or exclusion of CRBSI and compared the cost of managing patients with suspected CRBSI. METHODS: On the day of clinical suspicion of CRBSI, blood samples were obtained from the catheters for the AOLC test, and peripheral blood samples were obtained for quantitative blood cultures. Catheters with positive AOLC results were immediately removed for culture and replaced if necessary. Catheters with negative AOLC tests were left in situ. We compared the catheter lifespan in patients with suspected CRBSI who had positive and negative AOLC tests and calculated the cost of using the AOLC test to prevent indiscriminate catheter removal. RESULTS: Fifty patients with suspected CRBSI were tested and prospectively followed up. Catheters were removed in 10 patients (20%) with a positive AOLC test, and CRBSI was confirmed in each case subsequently. Selective removal of catheters based on AOLC tests significantly extended the lifespan of catheters compared with an indiscriminate removal of catheters based on clinical suspicion of CRBSI (median, 24 versus 11 days; p <.0001). The cost of an AOLC test and selective catheter replacement strategy was significantly lower than the cost of routine removal and replacement of catheters (median, pounds sterling 9.53 versus pounds sterling 64.20; p <.0001). CONCLUSION: The AOLC test enables a rapid detection of CRBSI, avoids unnecessary removal of catheters, and provides a cost‐efficient management approach in patients with suspected CRBSI.
Specialized nutrition support: the pediatric perspective
Authors: Schwenk WF
Published: May 2008

Nutrition support may be more important in children than in adults. The first reports of the use of parenteral nutrition and of parentaneous endoscopic gastrostomies were in children. A number of unresolved questions in this area remain and will be answered by a coordinated effort of the nutrition community.
Clinical aspects of essential fatty acid metabolism: Jonathan Rhoads Lecture
Authors: Bistrian BR
Published: May 2008

The clinical implications of the metabolism of the 2 essential fatty acids, linoleic and alpha‐linolenic acid, are most clearly related to the membrane phospholipid concentrations of their elongation and desaturation products, arachidonic, eicosapentaenoic, and docosahexaenoic acid. Levels of these very long chain polyunsaturated fatty acids can be altered by diet, prematurity, and disease which can affect growth (nutritional repletion) and the intensity and character of systemic inflammation as well as cognitive and visual function in infants.
Inhibition of activator protein‐1 transcription factor activation by omega‐3 fatty acid modulation of mitogen‐activated protein kinase signaling kinases
Authors: Babcock TA , Kurland A , Helton WS , Rahman A , Anwar KN , Espat NJ
Published: May 2008

BACKGROUND: Lipopolysaccharide (LPS)‐stimulated macrophages (Mphi) produce excess tumor necrosis factor (TNF), and the direct inhibition of IkappaB phosphorylation and its subsequent separation from the nuclear factor kappaB (NFkappaB)‐IkappaB complex has been experimentally supported as a mechanism for omega‐3 fatty acid (FA) inhibition of this TNF response. However, TNF production is a “late” event in the LPS‐induced Mpsi inflammatory cascade, and in addition to NFkappaB‐associated pathways, a separate transcription factor, activator protein‐1 (AP‐1) is an important pathway for Mpsi proinflammatory cytokine production. The mitogen‐activated protein kinase (MAPK) cascade regulates both NFkappaB‐IkappaB‐‐and AP‐1‐associated gene transcription through several cross‐amplifying phosphorylation kinases, specifically p44/42 [ie, extracellular signal‐regulated kinase (ERK) 1/2], p38, and c//jun N‐terminal kinase (JNK)/stress‐activated protein kinase (SAPK). The activation of these kinases occurs in the proximal MAPK cascade and activation modulates AP‐1 activation. In this set of experiments, it was hypothesized that inhibition of MAPK signaling phosphorylation kinases by omega‐3 fatty acids in a model of LPS‐stimulated Mphi(s) would alter the activation of the proinflammatory cytokine transcription factor AP‐1. METHODS: RAW 264.7 cells were pretreated with a sterile, commercially available, pharmaceutical grade omega‐3 FA emulsion, equivalent grade omega‐6 FA emulsion, or Dulbecco's modified eagles medium (media alone) for 4 hours. Cells were washed twice and exposed to LPS for 15 minutes. Total cell lysates were collected, and both total and phosphorylated portions of the p44/42, p38, and JNK/SAPK proteins were determined by Western blotting. AP‐1 nuclear translocation was determined by electromobility shift assay. RESULTS: Phosphorylation of p44/42 and JNK/SAPK proteins of the MAPK pathways in LPS‐stimulated Mpsi(s) was significantly reduced by omega‐3 FA treatment compared with Mphi treated with omega‐6 FA or media alone. In contrast, phosphorylation of p38 was not inhibited in the presence of omega‐3 or (omega‐6 FA treatment compared with media alone. Omega‐3 FA pretreatment inhibited AP‐1 activation. CONCLUSIONS: omega‐3 FA inhibited p44/42 and JNK/SAPK phosphorylation; however, p38 remained unchanged. Phosphorylation of p44/42 and JNK/SAPK are the immediate prior steps in AP‐1 activation. Attenuated AP‐1 activation and subsequent attenuated gene‐level proinflammatory cytokine elaboration is anticipated after inhibition of these MAPK intermediates and is confirmed by the reduction in AP‐1 activity. These results provide further evidence for the transcriptional level regulation in the elaboration of proinflammatory cytokines by omega‐3 FA in this Mphi model.
Oral glutamine and the healing of colonic anastomoses in rats
Authors: da Costa MA , Campos AC , Coelho JC , de Barros AM , Matsumoto HM
Published: May 2008

BACKGROUND: Recent evidence has suggested that glutamine is one of the primary energy sources of the colon. The aim of this study was to evaluate the effects of oral glutamine supplementation on the healing of colonic anastomoses in rats. METHODS: Forty‐eight adult male Wistar rats, weighing 174.41 +/‐ 37.39 g, were housed in individual cages. All rats had free access to water and standard rat chow. The rats were randomized to receive daily, for 7 days before the operation and during the postoperative period, 10% L‐glutamine (GLN group) or 10% glycine (GLY group) in isonitrogenous and isovolumetric solutions (1.5 g/kg per day), through an orogastric tube. On the eighth day, rats were anesthetized and subjected to 2 colonic transections, one 6 cm distal from the ileocecal valve and another 5 cm distal from the first transection. Bowel continuity was restored by 2 end‐to‐end, single layer, everted, anastomoses with 8 interrupted sutures (6–0 nylon). After the operation, the rats were kept in individual cages and had free access to water and rat chow. One‐half of the rats in each group were killed either on postoperative day 3 or 8, and the 2 colonic anastomoses of each animal were resected and stored in 0.9% saline and 10% formalin for tensile strength and histologic (hematoxylineosin and collagen densitometry) studies, respectively. Student's t‐test and Kruskal Wallis tests were used for statistical analysis. RESULTS: Total rupture strength was significantly higher in the GLN group (GLN: 0.068 +/‐ 0.045 kgf versus GLY: 0.042 +/‐ 0.027 kgf, p =.04). The mean monocytes infiltrate was significantly smaller in the GLN group (p =.04). The collagen densitometry analysis demonstrated greater percent area of type I (mature) in the GLN group compared with GLY (58.65 +/‐ 11.70% versus 41.79 +/‐ 10.54%, p =.0000), respectively. Subgroup analyses according to the day of rat death were still significant: GLN 3: 54.22 +/‐ 10.02% versus GLY 3: 41.92 +/‐ 13.31% (p =.04) and GLN 8: 62.63 +/‐ 12.13% versus GLY 8: 41.67 +/‐ 7.69% (p =.0004). Type III collagen (immature) percent area was significantly smaller in the GLN group's colonic anastomoses (GLN: p =.0000; GLN 3: p =.04 and GLN 8: p =.0003, respectively). CONCLUSIONS: Perioperative oral glutamine supplementation increases total rupture strength and improves the percent area of mature collagen at the anastomoses sites on postoperative days 3 and 8.
Keratinocyte growth factor improves epithelial function after massive small bowel resection
Authors: Yang H , Wildhaber BE , Teitelbaum DH
Published: May 2008

BACKGROUND: Massive small bowel resection with subsequent short bowel syndrome (SBS) leads to the acute loss of epithelial cell (EC) absorptive function. Keratinocyte growth factor (KGF) has been shown to improve EC growth, although little is known about KGF activity on EC function after SBS. We hypothesized that KGF would improve epithelial function in a mouse SBS model. METHODS: Adult C57BL/6J mice were randomized to a 55% mid‐small bowel resection (SBS), SBS with KGF administration (SBSKGF), or sham‐operated (Control) group, and were killed at 7 days. Ussing chambers were used to study epithelial function. Short circuit current (Isc) was monitored. EC absorption was studied by measuring (1) glucose [3‐O‐methyl‐D‐[1–3H]glucose (3‐OMG)] absorption; (2) sodium coupled amino acid (alanine) absorption; and (3) changes in Isc by using the absorptive agent D‐glucose (stimulated Na+ absorption). Epithelial barrier function was measured with transepithelial resistance (TER) and transmural passage of 3H‐mannitol (Papp). ECs were separated along the crypt‐villus axis with laser capture microdissection. Epithelial KGF receptor (KGFR) mRNA expression was studied using real time reverse transcriptase‐polymerase chain reaction (RT‐PCR). RESULTS: KGF administration increased the basic ion transport activity and net transepithelial absorption of 3‐OMG and sodium‐coupled alanine absorption. SBS significantly decreased epithelial ion transport, including the Na+ absorption stimulated by D‐glucose and L‐alanine. KGF administration partially improves Na+ absorption. KGF had no apparent effect on the TER and 3H‐mannitol permeability in this study. KGF upregulated EC KGFR mRNA expression, predominately in the crypt and lower portion of the villus. CONCLUSIONS: KGF administration improves epithelial absorptive function and stimulates intestinal proliferation after SBS. This suggests that KGF improves intestinal adaptation after SBS and may have clinical applicability.
Retraction: Pump‐Assisted Versus Gravity‐Controlled Enteral Nutrition in Long‐Term Percutaneous Endoscopic Gastrostomy Patients: A Prospective Controlled Trial
Authors: Shang Edward , Sturm Joerg W. , Post Stefan
Published: May 2008

The authors of the above article have requested its withdrawal, notifying the Journal that the clinical trials described in the article were not conducted as written in the article. The Editor‐in‐Chief, the American Society for Parenteral and Enteral Nutrition, and the Publisher have determined to retract the article.
Intestinal and multivisceral transplantation: dynamics of nutritional management and functional autonomy
Authors: Rovera GM , Schoen RE , Goldbach B , Janson D , Bond G , Rakela J , Graham TO , O'Keefe S , Abu‐Elmagd K
Published: May 2008

OBJECTIVE: The objective of this study was to describe the dynamics of nutrition management of intestinal transplant recipients and allograft functional autonomy. METHODS: Intestinal absorptive functions and recipient nutritional status were monitored during the 12‐month study period. Absorption was evaluated with D‐xylose absorption and fecal fat excretion. Indices for nutrition were body weight, anthropometric measures, and serum albumin. RESULTS: Before transplant, all patients were total parenteral nutrition (TPN) dependent and well nourished. By the first postoperative month, all 22 recipients were tolerating enteral feeding. By 3 months, all recipients had begun oral feeding, with 13 off TPN and 7 off enteral feeds. By 6 months, 16 recipients were off TPN, and by the end of the 12th month, 17 (77%) were free of TPN. Although all 22 recipients were completely weaned off TPN during the first posttransplant year, 10 required temporary reinstitution of therapy at different points. Full nutritional autonomy was achieved at 3 months by 3 recipients, at 6 months by 8 recipients, and at 12 months by 12 (55%) recipients. CONCLUSIONS: These results reflect our early experience that led to surgical refinement of the operation and evolution of the recipient postoperative management. Nonetheless, even in this initial cohort, most of the engrafted intestines restored the recipient nutritional autonomy, and all survivors remained well nourished.
Joint Commission for Accreditation of Health Care Organizations guidelines: too late to intervene for nutritionally at‐risk surgical patients
Authors: Kudsk KA , Reddy SK , Sacks GS , Lai HC
Published: May 2008

BACKGROUND: Joint Commission for Accreditation of Health Care Organizations (JCAHO) guidelines recommend nutritional screening within 24 hours of hospital admission, with full nutrition assessment if at‐risk. This study examines whether these guidelines detect surgical patients who may benefit from preoperative nutrition support. METHODS: A retrospective chart review was conducted for patients undergoing nonemergent esophageal, gastric, pancreatic, or colon surgery between 1996 and 2001 to determine dates of admission, day of surgery, and timing of documented nutrition screening and assessment. RESULTS: Most patients undergo surgery within 24 hours of admission, and undergo initial screening or full assessment after surgery. Twenty percent of patients are admitted for diagnostic testing, preoperative cardiovascular workup, or medical management preoperatively and are assessed 5 to 6 days before surgery, but these are the minority. CONCLUSION: Because of the high incidence of nonemergent surgeries that occur within 24 hours of admission, screening and assessment by JCAHO guidelines cannot detect patients who may benefit from preoperative nutrition support. Systems to identify these patients must be implemented earlier in nutrition screening and assessment.
Single dose of glutamine enhances myocardial tissue metabolism, glutathione content, and improves myocardial function after ischemia‐reperfusion injury
Authors: Wischmeyer PE , Jayakar D , Williams U , Singleton KD , Riehm J , Bacha EA , Jeevanandam V , Christians U , Serkova N
Published: May 2008

BACKGROUND: Myocardial ischemia and reperfusion (I/R) injury causes significant morbidity and mortality. Protection against I/R injury may occur via preservation of tissue metabolism and ATP content, preservation of reduced glutathione, and stimulation of heat shock protein (HSP) synthesis. Supplementation with glutamine (GLN) has been reported to have beneficial effects on all of these protective pathways. Thus, we hypothesized that GLN pretreatment given to the rat in vivo would protect the myocardium against I/R‐induced dysfunction. METHODS: GLN (0.52 g/kg, intraperitoneally, given as alanine‐glutamine dipeptide), alanine alone (0.23 g/kg), or a Ringer's lactate solution (control) was administered to Sprague‐Dawley rats 18 hours before heart excision, perfusion, exposure to global ischemia (15 minutes) and reperfusion (1 hour). Tissue metabolites were analyzed via magnetic resonance spectroscopy. RESULTS: In control and alanine‐treated animals, I/R injury resulted in cardiac dysfunction, indicated by a decrease in cardiac output. Administration of GLN 18 hours before I/R injury preserved cardiac output after reperfusion. Metabolic analysis of the myocardial tissue revealed that [/R injury led to significant diminution of myocardial tissue glutamate, ATP content, accumulation of myocardial lactate, and a reduction in reduced glutathione content in control animals. GLN significantly reduced the deleterious changes in myocardial metabolism and improved reduced glutathione content. No changes in pre‐ or post‐I/R injury HSP expression were observed after GLN administration. CONCLUSIONS: These observations demonstrate that remote in vivo administration of GLN before cardiac I/R injury can improve post‐I/R cardiac function. This effect may be mediated via improved myocardial metabolism and enhanced reduced glutathione content.
N‐acetyl‐L‐tyrosine as a tyrosine source in adult parenteral nutrition
Authors: Hoffer LJ , Sher K , Saboohi F , Bernier P , MacNamara EM , Rinzler D
Published: May 2008

BACKGROUND: N‐acetyl‐L‐tyrosine (NAT) is commonly used in place of tyrosine in parenteral nutrition, but human studies carried out to date indicate considerable amounts of it are excreted unchanged in the urine. NAT retention has not been well studied in parenterally fed adults. METHODS: NAT retention was measured in 13 adults receiving continuous parenteral nutrition with Aminosyn II 15% (Abbott Laboratories, Abbott Park, IL). RESULTS: Approximately 35% of administered NAT was excreted unchanged in the urine, with no important effect of infusion rate, N balance, or level of renal function on this value. Sufficient NAT was retained that the prescription of 1 g total amino acids/kg x day(‐1) using this product exceeded the combined recommended dietary allowance for aromatic amino acids CONCLUSION: As used in the clinical setting, the phenylalanine and NAT composition of Aminosyn II is sufficient to meet the combined aromatic amino acid needs of adults with normal phenylalanine hydroxylase activity.
Body composition of neonates from fan beam dual energy X‐ray absorptiometry measurement
Authors: Hammami M , Koo WW , Hockman EM
Published: May 2008

BACKGROUND: Fan beam dual energy x‐ray absorptiometry (FB DXA) has recently been validated for the measurement of body composition in small subjects. This study represents the first report of body composition (bone mineral content, fat mass, and lean mass) in human neonates measured by FB DXA. METHODS: FB DXA measurements were performed in 73 healthy singleton neonates with mean +/‐ SD birth weights 3354 +/‐ 316 g (range, 2720 to 3982 g) and gestational ages 39.5 +/‐ 1.2 weeks (range, 37 to 42 weeks). There were 26 white (11 male infants, 15 female infants), 42 African American (17 male infants, 25 female infants), and 5 Hispanic (4 male infants, 1 female infant) infants. The predictive ability of physiologic parameters to predict body composition measurements was determined with regression analysis. RESULTS: The mean +/‐ SD for bone mineral content was 89.3 +/‐ 14.1 g, fat mass was 485 +/‐ 14.1 g, and lean mass was 2898 +/‐ 281.5 g. Weight was significantly correlated with all DXA measurements and was the single best predictor of body composition. Weight alone contributed 32% to 98% of the variance of the DXA measured parameters. Gender, race, and length were additional predictors that could be forced into a predictive equation for selected DXA dependent variables according to statistical significance. An independent gender effect was also demonstrated, with male infants having higher lean mass but lower fat mass. CONCLUSIONS: Our data in human neonates demonstrated the ability of FB DXA to measure body composition. Body weight is the best physiologic predictor of overall body composition. There is also an independent gender effect on soft tissue body composition.
The prevalence of coagulation abnormalities in hospitalized patients receiving lipid‐based parenteral nutrition
Authors: Duerksen DR , Papineau N
Published: May 2008

BACKGROUND: Vitamin K is not a component of the multivitamin preparation added to parenteral nutrition (PN) solutions, and hospitalized patients receiving parenteral nutrition support are at risk of developing vitamin K deficiency. METHODS: In this study, 84 consecutive patients receiving PN were followed up prospectively to determine the incidence of a raised international normalized ratio (INR). All patients received lipid in their PN, which contains approximately 30 microg of vitamin K/100 mL. RESULTS: Patients were followed up for the course of PN or up to 4 weeks if they needed longer total parenteral nutrition. A raised INR compared with baseline developed in 3.6% of patients. All elevations were mild, and no patients developed clinical bleeding. CONCLUSIONS: It may be unnecessary to routinely supplement patients with vitamin K if they are receiving a lipid emulsion containing significant amounts of vitamin K. For patients receiving warfarin therapy, it will be important for nutrition support services to be aware of the vitamin K content of the lipid emulsion they are using as patients receiving a multivitamin preparation containing vitamin K and lipid emulsion may receive increased amounts of vitamin K, which could lead to warfarin resistance.
A simple equation to estimate the osmolarity of neonatal parenteral nutrition solutions
Authors: Pereira‐da‐Silva L , Virella D , Henriques G , Rebelo M , Serelha M , Videira‐Amaral JM
Published: May 2008

A predictive equation of osmolarity that correlates closely with the measured osmolality was determined. Taking into account that an osmometer is not available in most clinical settings, the proposed equation appears to provide a quick and simple osmolarity calculation of neonatal parenteral nutrition solutions. OBJECTIVE: We measured the osmolalities of neonatal parenteral nutrition (PN) solutions to determine if these values may be predicted by a simple equation for calculation of their osmolarity values. METHODS: The osmolalities of 101 consecutive different final PN admixtures, prepared for 36 neonates, were measured by the freezing point depression method. The respective intra‐assay and interassay coefficients of variation were always <2.1%. Linear multivariate regression analysis was used to determine a predictive equation of osmolarity that correlates closely with the value of measured osmolality. RESULTS: The mean (SD) osmolality of the final PN admixtures was 749.7 (165.4) mOsm/kg. The best‐fitted equation, with a coefficient of discrimination R2 =.95 (R2 =.90 for samples between 500 and 1000 mOsm/L) is osmolarity (mOsm/L) = (nitrogen x 0.8) + (glucose x 1.235) + (sodium x 2.25) + (phosphorus x 5.43)‐50, with the concentration of components in mmol/L. Adapting the equation in our daily practice, using g/L for glucose and amino acids, mg/L for phosphorus, and mEq/L for sodium, the equation is osmolarity (mOsm/L) = (amino acid x 8) + (glucose x 7) + (sodium x 2) + (phosphorus x 0.2) ‐ 50, with a similar R2. CONCLUSIONS: Taking into account that an osmometer is not available in most clinical settings, the proposed equation appears to provide a quick and simple osmolarity calculation of neonatal PN solutions, thus allowing more accurate decisions to be taken regarding the choice of route and rate of administration of PN solutions.
The impact of nursing practice on the history and effectiveness of total parenteral nutrition
Authors: Guenter P , Curtas S , Murphy NL , Orr M
Published: May 2008

Nutrition support nursing grew out of the development of total parenteral nutrition in the late 1960s. Nurses contributed to the development of safe and effective delivery of parenteral nutrition and continue to serve on nutrition and metabolic teams in a variety of ways. Research demonstrating the positive effect of the nurse and the team are presented here, along with the history, evolution, and current state of nutrition support nursing.
Effect of IV dextrose administration on glucose metabolism during surgery
Authors: Schricker T , Lattermann R , Wykes L , Carli F
Published: May 2008

BACKGROUND: The inhibitory influence of exogenous dextrose on glucose production has been shown to be less pronounced during injury and sepsis. This protocol was designed to investigate the effect of i.v. hypocaloric dextrose on glucose metabolism during elective abdominal surgery. METHODS: Fourteen patients with rectal cancer were studied under fasting conditions and toward the end of a 3‐hour infusion of dextrose (2 mg.kg‐1 per minute) either in absence (control group, n = 7) or presence of colonic surgery (surgery group, n = 7). Endogenous glucose production was determined by using primed continuous infusions of [6,6–2H2]glucose before and during dextrose administration. We also measured the plasma concentrations of glucose, lactate, cortisol, glucagon, and insulin. RESULTS: The administration of dextrose decreased the endogenous glucose production in all patients (p <.05). This decrease was less pronounced during surgery (p <.05). Plasma glucose concentration increased during dextrose infusion in both groups (p <.05), with higher values in the surgery group than in the control group (p <.05). Plasma concentrations of lactate and glucagon remained unaltered. Dextrose infusion increased the plasma insulin concentrations to the same extent in both groups (p <.05). Cortisol plasma levels increased only in the surgery group (p <.05). CONCLUSIONS: Surgical stress blunts the inhibitory effect of i.v. dextrose on endogenous glucose production.
In utero malnutrition influences wound healing of newborn rats as measured by tensile strength and collagen deposition
Authors: Coelho‐Lemos IC , Campos AC , de Almeida M , Schuler SL , Gurmini J , Malafaia O , Andrade DF
Published: May 2008

BACKGROUND: Studies have investigated the consequences of intrauterine malnutrition on birth weight and overall survival but not on wound healing. This study aims to assess the influence of in utero malnutrition on wound healing of newborn rats. METHODS: Pregnant Wistar rats were divided into 2 groups. Study rats were given 50% of the food intake of controls throughout pregnancy in a pair‐fed manner. The body weight and length of the newborns were measured. Newborns were breast‐fed until day 21, when a laparotomy was performed. The effect of the laparotomy was assessed by measure of the wound strength and collagen deposition at postoperative day (POD) 7 (n = 15) and POD 21 (n = 15). RESULTS: The body weight and length of newborns of malnourished mothers were significantly smaller at birth compared with controls (respectively, 4.5 +/‐ 0.1 g vs 5.8 +/‐ 0.1 g, p =.0003 and 4.6 +/‐ 0.1 cm vs 5.2 +/‐ 0.1 cm, p =.0003). Maximum, rupture, and tensile strength of malnourished newborns were smaller than controls on POD 7 (0.281 +/‐ 0.031 vs 0.470 +/‐ 0.031, p =.0061, 0.112 +/‐ 0.06 kgf vs 0.173 +/‐ 0.08 kgf, p =.0495 and 0.019 +/‐ 0.002 kgf/mm2 vs 0.024 +/‐ 0.003 kgf/mm2, p =.050, respectively). On POD 21, only tensile strength remained lower (0.044 +/‐ 0.003 kgf/mm2 vs 0.058 +/‐ 0.003 kgf/mm2, p =.0477). Type I collagen deposition of malnourished newborns was similar to controls on POD 7 (57.69 +/‐ 10.06 vs 48.34 +/‐ 15.65, p =.3187) and on POD 21 (75.6 +/‐ 7.21 vs 80.0 +/‐ 9.92, p =.4212). CONCLUSIONS: In utero malnutrition decreases the abdominal wound strength of newborn rats but not the collagen deposition, suggesting that breast‐feeding nutrition is effective in recovering the collagen deposition but not overall wound strength.
L‐arginine‐enriched parenteral nutrition affects lymphocyte phenotypes of gut‐associated lymphoid tissue
Authors: Fukatsu K , Ueno C , Maeshima Y , Hara E , Nagayoshi H , Omata J , Mochizuki H , Hiraide H
Published: May 2008

BACKGROUND: Experimentally, total parenteral nutrition (TPN) diminishes gut‐associated lymphoid tissue (GALT) cell numbers and function. Although glutamine supplementation is known to reverse TPN‐induced changes in GALT, effects of another conditionally essential amino acid, L‐arginine (ARG), on GALT remain unclear. METHODS: Twenty‐two male Institute of Cancer Research mice were randomized to standard TPN (0.3% arginine, STD‐total parenteral nutrition) or 1% ARG‐enriched TPN (ARG‐total parenteral nutrition). After 5 days of feeding, lymphocytes were harvested from Peyer's patches (PP), the lamina propria, and intraepithelial (IE) spaces of the small intestine to determine cell yields. Lymphocyte phenotypes (alphabetaTCR, gammadeltaTCR, CD4, CD8, and B220 as a B cell marker) were determined using flow cytometry. IgA levels in washings of the small intestine, upper respiratory tract, and lungs were measured with ELISA. RESULTS: ARG‐total parenteral nutrition did not affect lymphocyte yields. The percentages of CD4+ cells in PP and IE, and alphabetaTCR+ cells in PP, were significantly higher in the ARG‐total parenteral nutrition than in the STD‐total parenteral nutrition mice, without marked differences in other phenotypes examined. There were no significant differences in intestinal and respiratory tract IgA levels between the 2 groups of mice. CONCLUSIONS: One percent ARG supplementation of TPN does not improve GALT cell number or mucosal IgA level but benefits to increase CD4+ cell percentages in GALT.
Does a multidisciplinary total parenteral nutrition team improve patient outcomes? A systematic review
Authors: Naylor CJ , Griffiths RD , Fernandez RS
Published: May 2008

BACKGROUND: Total parenteral nutrition (TPN) is a specialized form of nutrition support. The complexity associated with the management of patients receiving TPN therapy has led to the development of multidisciplinary TPN teams. The purpose of this review was to critically analyze the literature and present the best available evidence that investigated the effectiveness of multidisciplinary TPN teams in the provision of TPN to adult hospitalized patients. METHODS: A systematic review of studies identified from the Cochrane Library (2001, Issue 4), CINAHL, Complete MEDLINE, Complete Biomedical Collection, Complete Nursing Collection, and EMBASE, published in any language. RESULTS: Eleven studies, 4 with concurrent controls and 7 with historical controls, were eligible for inclusion in the review. Results of the studies indicate that the incidence of total mechanical complications is reduced in patients managed by the TPN team. However, the benefit of the TPN team in the reduction of catheter‐related sepsis remains inconclusive. Four of the 5 studies reported fewer total metabolic and electrolyte abnormalities in patients cared for by the team, and these patients were more likely to receive their optimal caloric intake. However it was unclear if the management of the patients by the TPN team prevented the inappropriate use of TPN therapy. Although only 2 studies (n = 356) investigated total costs associated with management of patients by the TPN teams, there was evidence that a team approach is a cost‐effective strategy. CONCLUSIONS: Overall, the general effectiveness of the TPN team has not been conclusively demonstrated. There is evidence that patients managed by TPN teams have a reduced incidence of total mechanical complications; however, it is unclear if there is a reduction in catheter‐related sepsis and metabolic and electrolyte complications. The available evidence, although limited, suggests financial benefits from the introduction of multidisciplinary TPN teams in the hospital setting.
Use of clonidine to decrease intestinal fluid losses in patients with high‐output short‐bowel syndrome
Authors: McDoniel K , Taylor B , Huey W , Eiden K , Everett S , Fleshman J , Buchman TG , Alpers D , Klein S
Published: May 2008

BACKGROUND: Some patients who have short bowel syndrome (SBS) have high intestinal outputs, which increases the risk of dehydration and fluid‐electrolyte abnormalities and impairs quality of life. METHODS: We evaluated the use of clonidine, an alpha2‐adrenergic receptor agonist, in 2 patients with SBS and high intestinal outputs, who were refractory to conventional therapy with antidiarrheal and antisecretory agents (loperamide, belladonna, opiates, somatostatin, histamine2 receptor antagonists and proton pump inhibitors). The first patient (case 1) was a 29‐year‐old woman who had 175 cm of small bowel anastamosed to 8 cm of descending colon, ending in a colostomy. The second patient (case 2) was a 22‐year‐old man who had 30 cm of jejunum anastomosed to 30 cm of sigmoid colon and rectum. RESULTS: The addition of clonidine, 0.1 mg per os (PO) 2 times per day, to the treatment regimen of case 1 decreased her ostomy output from approximately 4 L/day to approximately 1 L/day, eliminating the need for parenteral nutrition and fluids and decreasing the need for opiate therapy. The addition of clonidine, 0.2 mg PO 2 times per day in case 2 resulted in decreased rectal outputs from approximately 4 L/day to approximately 1.5 L/day. CONCLUSIONS: These results demonstrate that clonidine can effectively reduce intestinal fluid and electrolyte losses and should be considered as an additional treatment option in patients with SBS and high intestinal outputs.
Effect of enteral nutrition of monoacetoacetin on bacterial translocation in burned rats
Authors: Takahata T , Ohira M , Nishiguchi Y , Sawai M , Ueda N , Naito S , Kato N , Yukioka H , Hirakawa K
Published: May 2008

BACKGROUND: Bacterial translocation (BT) occurs under stress, and enteral nutrition is said to be effective in counteracting this effect. The usefulness of i.v. nutrition of monoacetoacetine (MA) under stress has been reported previously, and we studied the effect of enteral nutrition of MA as it is related to BT. METHODS: Rats were given 13.6% MA or 15% glucose (Glu) via gastrostomy, and after 4 days a 30% full‐thickness burn was made. Before and after administration of the burn, we measured serum cytokines; amounts of bacteria in the mesenteric lymph node (MLN), liver, and spleen (estimation of BT); mucosal thickness of the terminal ileum; and body weight changes. To confirm the effectiveness of MA in the small intestine, we estimated succinyl‐CoA:3‐oxoacid CoA‐transferase (SCOT) expression in the terminal ileum by immunohistochemical staining and Western blot analysis. RESULTS: At 6 hours after burn, all cytokines were lower, and BT in the MLN was inhibited significantly in the MA group. Ileal mucosal thickness was not significantly different, but mucosa was more edematous in the Glu group. At 3 days after burn injury, BT was significantly inhibited in the MLN and liver, and the ileal mucosa was significantly thicker in the MA group. Body weight loss after burn injury was significantly smaller in the MA group. SCOT expression was the strongest at 6 hours after burn injury by Western blot analysis but not by immunohistochemical staining. CONCLUSIONS: Enteral nutrition of MA may be useful for the inhibition of intestinal mucosal atrophy and the prevention of multiple organ dysfunction syndrome caused by the inhibition of BT and subsequent overproduction of cytokines.
Technical considerations for fan‐beam dual‐energy x‐ray absorptiometry body composition measurements in pediatric studies
Authors: Hammami M , Koo WW , Hockman EM
Published: May 2008

BACKGROUND: A piglet model was used to determine the influence of frequently encountered situations in clinical studies of infants and young children on fan‐beam dual‐energy x‐ray absorptiometry (DXA) measurements. METHODS: DXA scans of piglets (640 g to 21,100 g) were acquired in the infant and adult mode and were analyzed with 1 infant, 1 pediatric, and 3 versions of adult software. RESULTS: The effect of repositioning of the piglets from the center to the periphery of the scanning table on DXA measurements included an average difference of up to 0.5% for total weight, 5.0% for bone mineral content, 5.6% for bone mineral density, 1.3% for lean mass, and 21.9% for fat mass (< or =.05, all comparisons) although no significant changes occurred when the piglets were scanned in symmetrical positions on either edge of the scanning table. Different posture (prone vs supine and side), varied number of blankets overlaid or wrapped around the piglet, and parenteral but not enteral bolus feeding could significantly alter fan‐beam DXA measurements to varying extents. Adult and pediatric software underestimated bone area and bone mineral content but overestimated bone mineral density, lean mass, fat mass, and total weight compared with infant software measurements. However, strong predictive relationships among these fan‐beam DXA data in subjects >10 kg allow systematic corrections of data from different scan modes and different software. CONCLUSIONS: Attention to details and consistency in the technique for scan acquisition and analysis are critical to the generation of meaningful data and to allow for detection of true differences in DXA measurements of small subjects.
Effect of Recombinant Human Growth Hormone and Enteral Nutrition on Short Bowel Syndrome
Authors: Weiming Zhu , Ning Li , Jieshou Li
Published: May 2008

Background: Studies showed that bowel rehabilitation therapy, including recombinant human growth hormone (rhGH), nutrition support, glutamine, and dietary fiber, promotes intestinal adaptation in patients with short bowel syndrome. The aim of the current study was to determine if enteral nutrition and rhGH are effective in weaning short bowel patients off total parenteral nutrition (TPN). Methods: Thirty‐seven patients with short bowel syndrome received bowel rehabilitation therapy for 4 weeks. Thirty‐four patients were treated within 2 years after short bowel syndrome. Treatment included nutrition support from enteral nutrition 500 to 1500 kcal/d, oral glutamine 0.6 g/kg/d, plus a high‐carbohydrate and low‐fat diet. Once patients were in positive nitrogen balance, rhGH 0.05 mg/kg/d was administered for 3 weeks. Results: All patients completed the treatment; there were no deaths caused by malnutrition. Intestinal absorptive capacity and plasma levels of proteins were significantly improved after treatment (p< .05). Of the 23 patients who have been followed for >2 years after bowel rehabilitation therapy, 21 patients (57%) weaned off parenteral nutrition, among which 18 (49%) patients lived on a high‐carbohydrate and low‐fat diet supplemented with enteral nutrition, and 3 patients were free of enteral nutrition and relied on high‐carbohydrate and low‐fat diet alone. The minimal intestinal length for these patients was 15 cm with ileocecal valve and intact colon in adults. Conclusions: Providing patients with enteral nutrition, glutamine, dietary fiber, and rhGH during bowel rehabilitation therapy allows weaning from TPN in a significant number of patients.
Elevation of Asymmetric Dimethylarginine (ADMA) in Patients Developing Hepatic Failure After Major Hepatectomy
Authors: Nijveldt Robert J. , Teerlink Tom , Siroen Michiel P. C. , van der Hoven Ben , Prins Hubert A. , Wiezer Marinus J. , Meijer Catharina , van der Sijp Joost R. M. , Cuesta Miguel A. , Meijer Sybren , van Leeuwen Paul A. M.
Published: May 2008

Background: Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of the arginine–nitric oxide pathway. It is conceivable that its concentration is tightly regulated by urinary excretion and degradation by the enzyme dimethylarginine dimethylaminohydrolase, which is highly expressed in the liver. In rats, we showed a high net hepatic uptake of ADMA. Therefore, we aimed to confirm the role of the liver in humans and hypothesized elevated ADMA levels after major liver resection by a reduction of functional liver mass and injury to the remnant liver. Methods: Patients undergoing a major hepatic resection (HEP, n = 17) or major abdominal surgery (MAS, n = 12) were included and followed in time. In addition, ADMA levels were measured in 4 patients having severe hepatic failure after a liver resection. Plasma ADMA concentration was measured by high‐performance liquid chromatography. Results: Preoperatively and on days 1, 3, and 5, plasma levels of ADMA were higher in HEP patients when compared with MAS patients. In HEP patients with prolonged (>7 days) hepatic injury, ADMA levels were especially elevated. On the first postoperative day, ADMA significantly correlated to bilirubin concentration (r = .528, p < .05) as a marker of postoperative hepatic function. Besides, in patients with severe hepatic failure, ADMA levels were highly elevated. Conclusions: In the present study, evidence was found for the role of the liver in the elimination of ADMA in humans. Increased levels of ADMA occur in the postoperative course after a major hepatic resection, especially when liver function is severely impaired. Further studies need to assess the role of ADMA in the development of complications after liver surgery.
Resting Energy Expenditure in the Parenterally Fed Pediatric Population With Crohn's Disease
Authors: Cormier Kathryn , Mager Diana , Bannister Louise , Fortin Marie , Richards Helen , Jackson Cheryl , Pencharz Paul
Published: May 2008

Background: Malnutrition is a common sequela of Crohn's disease (CD) and may result in reduced skeletal muscle function and growth retardation. Energy requirements of parenterally fed hospitalized pediatric patients with active CD were measured using indirect calorimetry, to assess whether Food Agriculture Organization (FAO)/World Health Organization (WHO)/United Nations University (UNU) equations provide appropriate estimations of energy requirements in this patient population. Methods: Twenty hospitalized patients with active CD fed exclusively via parenteral nutrition (PN) were investigated. A chart review and patient interviews were conducted to assess disease duration, location, laboratory parameters, and symptomology associated with CD. Disease severity was quantified using the Pediatric Crohn's Disease Activity Index. Each subject underwent indirect calorimetry, bioelectrical impedance analysis, and anthropometric assessment once the ordered PN met estimated macronutrient requirements of each patient (predicted resting energy expenditure × 1.3). Predicted resting energy expenditure (REE) was determined using the FAO/WHO/UNU equations. Results: REE showed a strong correlation with predicted REE (r 2 = .73, p < .01). Conclusions: Measured REE did not significantly differ from predicted resting energy requirements. This indicates that REE for the parenterally fed pediatric patients with CD can be accurately predicted using the FAO/WHO/UNU equations.