bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Thrombolytic Therapy for Occlusion of Long‐Term Catheters
Authors: Monturo Cheryl Ann , Dickerson Roland N. , Mullen James L. 
Published: May 2008

Nineteen ambulatory outpatients requiring a tunneled central venous access device with catheter occlusion were studied. Mean catheter life was 7.9 ± 8.2 months (range, from 1–36 months) at the time of the occlusion.Urokinase (5000 units/ml) was injected in sufficient amount to fill the internal volume of the catheter and allowed to stay for 5 to 10 min before attempting to aspirate. Repeated aspiration attempts were performed every 5 to 10 min for a maximum of 30 to 60 min or patency. In the event catheter patency was not restored, the thrombolytic solution was aspirated from the catheter and a maximum of two additional trials were instituted. Results included clearance of four out of 15 withdrawal occlusions (27%) and two out of four resistance to infusion occlusions (50%). Overall, successful catheter clearance occurred in six out of 19 occlusions (32%).The efficacy rate of thrombolytic therapy for successfully clearing occluded catheters at our institution using conventional low‐dose thrombolytic therapy is markedly lower than previously reported rates of 57 to 100%. The reasons for this discrepancy may reflect differences in dosage of thrombolytic agent, method of administration, frequency of monitoring of catheter patency, and catheter life. (Journal of Parenteral and Enteral Nutrition 14:312–314, 1990)
Glutamine or Fiber Supplementation of a Defined Formula Diet: Impact on Bacterial Translocation, Tissue Composition, and Response to Endotoxin
Authors: Barber Annabel E. , Jones William G. , Minei Joseph P. , Fahey Thomas J. , Moldawer Lyle L. , Rayburn Joseph L. , Fischer Eva , Keogh Christopher V. , Shires G. Tom , Lowry Stephen F. 
Published: May 2008

Despite provision of adequate calories, defined formula diets in rats lead to bacterial translocation (BT), fatty infiltration of the liver, and an increased susceptibility to endotoxin. These deleterious effects may be due in part to a loss of intestinal barrier integrity resulting from bowel atrophy. Defined formula diets lack both glutamine and fiber, substances which may help maintain intestinal mass. To determine whether supplementation of defined formula diets with either glutamine or fiber might prevent bowel atrophy and, thus, BT, hepatic steatosis, and the altered response to endotoxin, Wistar rats were fed (1) defined formula diet ad libitum (DFD), (2) (DFD + 2% (w/v) glutamine, (GLUT), or (3) DFD + 2% (w/ v) psyllium (FIBER). Rats given standard food isocalorically pair‐fed to DFD were used as controls. Nutritional status was assessed by daily weight gain, as well as the ability to maintain serum albumin, hematocrit and white blood counts. After 2 weeks of these feeding regimens, animals were sacrificed, and organ weights and composition were determined, with rates of bacterial translocation determined bv mesenteric lymph node. abdominal viscera, and cecal cultures. Additional animals receiving the same experimental diets were subsequently challenged with endotoxin and observed for mortality with rates of post‐endotoxin BT and the responses of acute phase proteins and cytokines measured.All dietary regimens resulted in equivalent weight gain and other nutritional parameters. Both glutamine and fiber supplementation maintained small bowel mass, but only GLUT preserved normal jejunal mucosal architecture. Neither fiber nor glutamine supplementation prevented cecal bacterial overgrowth or BT, resulting from the DFD. Mortality after endotoxin challenge was similar in all three groups receiving DFD regardless of supplementation, although GLUT was associated with a significantly (p < 0.01 vs DFD) lower incidence of bacteremia. Supplementation with glutamine or fiber did not result in differences in circulating acute phase protein or cytokine responses to endotoxin. Thus, although both glutamine and fiber supplementation of DFD prevent loss of bowel mass, neither substance resulted in effective protection against spontaneous BT, or endotoxin‐induced translocation or mortality. (Journal of Parenteral and Enteral Nutrition 14:335–343, 1990)
Delayed Pneumothorax after Subclavian Vein Catheterization
Authors: Plaus William J. 
Published: May 2008

One hundred fourteen patients having 121 subclavian venipunctures were studied retrospectively. Eight pneumothoraces occurred (6.6%) and were most frequent after the insertion of large catheters, or when the subclavian area was distorted by previous venipuncture or radiation.Delayed pneumothorax occurred in five patients. This unusual diagnosis was made radiographically 8 to 96 hr postoperatively in response to the appearance of new pulmonary symptoms. Delayed pneumothorax required treatment with tube thoracostomy more frequently than immediate pneumothorax.This study establishes the approximate incidence of delayed pneumothorax for the first time. The relative frequency of this complication may challange the cost effectiveness of pneumothorax diagnosis by chest films done within 1 or 2 hr of subclavian venipuncture. An alternative diagnostic protocol is considered. (Journal of Parenteral and Enteral Nutrition 14:414–415, 1990)
Protein Metabolism Assessed by 1–13C Leucine Infusions in Patients Undergoing Bone Marrow Transplantation
Authors: Keller U. , Kraenzlin M.E. , Gratwohl A. , Thélin A. , Straumann E. , Arnaud M.J. , Speck B. , Stauffacher W. 
Published: May 2008

Patients receiving cytoreductive therapy and bone marrow transplantation (BMT) are known to develop marked protein catabolism. To assess the contribution of whole body protein breakdown, amino acid oxidation and incorporation into proteins, plasma leucine kinetics (1‐13C‐leucine infusion technique) were determined in six patients five times within 14 days before and after cytoreductive therapy (Cyclophosphamide and total body irradiation) and marrow transplantation. Nitrogen balance became negative (—0.20 ± 0.04 g/ Kg/24 hr) after cyclophosphamide (p < 0.01) and was ‐0.25 ± 0.05 g/Kg/24 hr 7 days after BMT in spite of total parenteral nutrition.Plasma leucine concentration increased after BMT by 67% (p < 0.0015). Leucine plasma appearance was 1.20 ± 0.15 μmol/ kg/min before treatment, it increased slightly and transiently after cyclophosphamide, and increased again from day 5 to day 7 after BMT (p < 0.01), suggesting increased protein breakdown. Leucine oxidation increased from 0.27 ± 0.07 before therapy to 0.97 ± 0.16 μmol/kg/min (p < 0.02) after cyclophosphamide and BMT. Nonoxidative leucine disappearance rate decreased slightly from 0.92 ± 0.08 to 0.75 ± 0.16 μmol/kg/min after BMT (ns). Leucine metabolic clearance rate decreased from 11.8 ± 1.65 before therapy to 6.9 ± 0.70 ml/kg/min (p < 0.02) after cytoreductive therapy. After BMT it increased again to 9.9 ± 1.5 ml/kg/min (p < 0.02). The results demonstrate that patients undergoing cytoreductive therapy and bone marrow transplantation develop negative nitrogen balance due to increased protein breakdown associated with increased leucine oxidation and increased metabolic clearance rate. Leucine incorporation into proteins (protein synthesis) was not altered inspite of an increase in plasma leucine concentration. (Journal of Parenteral and Enteral Nutrition 14:480–484, 1990)
Central Catheter‐Related Infections: Comparison of Pulmonary Artery Catheters and Triple Lumen Catheters for the Delivery of Hyperalimentation in a Critical Care Setting
Authors: Horowitz Harold W. , Dworkin Brad M. , Savino John A. , Byrne Daniel W. , Pecora Nanette A. 
Published: May 2008

We prospectively studied the risk of catheter‐related sepsis (CRS) in 75 critically ill patients who received total parenteral nutrition (TPN) through 158 pulmonary artery catheters (PACs) and 214 triple‐lumen catheters (TLCs). We relied on semiquantitative cultures of the catheter tips, peripheral blood cultures in febrile patients and clinical response to catheter removal to diagnose catheter‐related sepsis. The infection rate was 2.5% (4/158) of PACs and 6.5% (14/214) of TLCs (p=0.124). Colonization rates were 29.1% for PACs and 32% for TLCs. PACs were left in place a significantly shorter length of time than TLCs, 3.1 vs 5.1 days (p<0.005). Guidewire exchanges and subclavian vein insertions were associated with a decreased rate of CRS when compared to new insertions and internal jugular vein insertions, respectively.We conclude that pulmonary artery catheters can be used safely for the delivery of hyperalimentation in critically ill patients with no increased risk for catheter‐related sepsis compared to triple‐lumen catheters. The use of the PAC in this manner allows for the use of a single central venous catheter for the delivery of hyperalimentation and hemodynamic monitoring. (Journal of Parenteral and Enteral Nutrition 14:588‐592, 1990)
Dietary Manipulation of Methotrexate‐Induced Enterocolitis
Authors: Jian Shou  , Lieberman Michael D. , Hofmann Kurt , Leon Pablo , Redmond H. Paul , Davies Helen , Daly John M. 
Published: May 2008

Administration of chemotherapy is limited by host toxicity, which is often manifested by severe enterocolitis. This study evaluated the effects of a liquid, elemental, chemically defined diet (ED) supplemented with 2% glutamine (Glu‐ED) compared with a polypeptide diet (PPD) on the morbidity and mortality after methotrexate (MTX) administration. Fischer 344 rats (n=80) were fed either a regular rat chow diet (RD), a 2% glycine supplemented elemental diet (Gly‐ED), a 2% glutamine‐supplemented elemental diet (GLU‐ED), and a glycine‐supplemented polypeptide diet(Gly‐PPD) for 7 days prior to administration of MTX (20 mg/kg, ip). After 72 hours, eight rats per group were killed; portal vein and vena cava blood, mesenteric lymph nodes (MLN), liver, small intestine, and cecum were sampled for bacterial culture. Remaining animals were followed to calculate survival.One hundred percent of the Gly‐PPD and 25% of the Glu‐ED animals survived compared with 0% of the Gly‐ED animals. Our data showed that ED resulted in an increased quantity of intestinal Gram‐negative bacteria and diminished intestinal mucosal height and mucosal DNA/protein content. The polypeptide diet prevented intestinal mucosal atrophy, avoided MTX‐induced enterocolitis and significantly improved animal survival compared with an elemental diet with or without glutamine supplementation. (Journal of Parenteral and Enteral Nutrition 15 :307–312, 1991)
Diet and Cimetidine Induce Comparable Changes in Theophylline Metabolism in Normal Subjects K.E. ANDERSON, R.B. MCCLEERY, E.S. VESELL, F.F. VICKERS, A. KAPPAS Hepatology 13:941–946, 1991
Authors: Demetriou Achilles A. 
Published: May 2008

This study examines the effects of diet and cimetidine on theophylline metabolism in 12 men. Subjects, all nonsmokers within 15% of their ideal body weight, were 23 to 26 years of age and had no unusual dietary habits. Energy needs were calculated using the Harris‐Benedict equation. Subjects were placed either on a high‐protein, low‐carbohydrate diet (44% of total calories as protein, 35% as carbohydrate, and 21% as fat) or a low‐protein, high‐carbohydrate diet (10% of total calories as protein, 70% as carbohydrate, and 20% as fat) for 15 days on each diet. The order of the dietary periods was reversed in one half of the subjects, and there was a 24‐day washout period between the two dietary periods. Cimetidine (800 mg/d at bedtime) was administered on days 10 to 15 of each dietary period. Aminophylline (3 mg of theophylline base/kg body weight) was administered intravenously as a bolus over 20 to 30 minutes on days 8 and 15 of each dietary period. Blood was withdrawn before and at 1, 2, 4, 6, 8, 12, and 24 hours after the end of the infusion for determination of theophylline plasma levels by high‐pressure liquid chromatography. Theophylline metabolism was studied under four experimental conditions in all 12 subjects. Thus, the effect of: (1) diet change (changing from a high‐progein to a high‐carbohydrate diet), (2) diet change during concurrent cimetidine administration, (3) cimetidine during a high‐protein diet, and (4) the combination of cimetidine and the opposite change in diet (from high carbohydrate to high protein) were examined.Diet change (high protein to high carbohydrate) reduced mean theophylline clearance by 30 ± 10% (p < 0.012). Diet change (high protein to high carbohydrate) during concurrent cimetidine administration, resulted in 23 ± 9% reduction in theophylline clearance (p < 0.016). During a high‐protein diet, cimetidine decreased mean theophylline clearance by 37 ± 5% (p < 0.0009). During a high‐carbohydrate diet, cimetidine decreased theophylline clearance by 30 ± 5% (p < 0.0014). Depending on the direction of change in the protein/carbohydrate ratio, the effects of diet and cimetidine were either additive (theophylline clearance was slower during a high‐carbohydrate diet and cimetidine administration) or counteractive (an increase in the protein/carbohydrate ratio partially counteracts the inhibitory effect of cimetidine).The authors conclude that diet and drugs can have similar effects on hepatic drug metabolism rates in humans. Therefore, during treatment with a drug having a narrow therapeutic index, it would be important to consider not only potential drug‐drug interactions but also drug‐diet interactions. Such interactions could result in either subtherapeutic or excessive drug levels.
Glucose Metabolism and Thermogenesis During Glucose and Insulin Infusion in Severely Underweight Patients
Authors: Gallen Ian W. , Macdonald Ian A. , Allison Simon P. 
Published: May 2008

This study investigates the effects of gross loss of body weight on glucose disposal (GD), storage (GS), oxidation (GO), and the thermogenic response (TR) during hyperinsulinemic euglycemic glucose infusion in 9 underweight but nourished patients (UP) and in 3 of the patients after weight gain (WGP). In UP, baseline metabolic rate (MR) was 4.1 ± 0.2 kJ/min and respiratory exchange ratio (RER) 0.97 ± 0.02. During the final 30 minutes of hyperinsulinemia MR rose by 0.32 ± 0.07 kJ/min (p <.01) and RER rose to 1.09 ± 0.03 (p <.01). GD was 61 ± 3 μmol/kg per minute, GO 35 ± 1 μmol/ kg per minute, and GS 26 ± 4 μmol/kg per minute. The energy cost of glucose storage as glycogen was 0.15 kJ/min, and as lipid was 0.2 kJ/min. In WGP baseline MR was 4.5 ± 0.4 kJ/ min and RER was 0.91 ± 0.03. During hyperinsulinemia MR rose by 0.63 ± 0.2 kJ/min, RER rose to 0.93 ± 0.02, GD was 53 ± 4 μmol/kg per minute, GO was 30 ± 3 μmol/kg per minute, and GS was 23 ± 1 μmol/kg per minute. The energy cost for this glucose storage was 0.22 kJ/min.Therefore, during hyperinsulinemia in UP, GD, and TR are similar, but GO is greater and GS is less than previously reported in healthy subjects. However, this TR is entirely accounted for by the energy cost of glucose storage with no evidence of facultative thermogenesis. In WGP, all responses were similar to those in healthy subjects, and the TR was in excess of that required of the energy cost of glucose storage. (Journal of Parenteral and Enteral Nutrition 16:5–10, 1992)
The Prognostic Inflammatory and Nutritional Index in Traumatized Patients Receiving Enteral Nutrition Support K. L. VEHE, R. O. BROWN, D. A. KUHL, ET AL Journal of The American College of Nutrition 10:355–363, 1991
Authors: Claxton Betty 
Published: May 2008

This study examines the value of the Prognostic Inflammatory and Nutritional Index (PINI), first proposed by Ingenbleek and Carpentier in 1985,1 as a clinical assessment tool in critically ill traumatized patients. The PINI combines measurements of serum C‐reactive protein (CRP), α1‐acid glycoprotein (AAG), prealbumin (PA), and albumin (ALB) concentrations to produce a single score. The hypothesis is that this assessment system will be more complete because it takes into account changes in inflammatory response markers and, therefore, may be superior to other predictive indices.This study included 15 critically ill trauma patients receiving enteral nutrition support. Patients were placed on a nutritionally complete formula providing 1.4 g of protein/kg per day and 32 kcal/kg per day 8 ± 3 days after injury and were maintained on this diet for 19 ± 8 days. The PINI decreased significantly (p <.05) from 186 ± 202 at baseline to 116 ± 86 on day 4 and 27 ± 40 on day 14. Nitrogen balance increased significantly during the same time period. Serum CRP concentration decreased significantly, whereas serum PA and ALB concentrations increased significantly and AAG concentration did not change. A statistically significant positive correlation was noted between the PINI and CRP concentration (r =.72, P =.0001) and a statistically significant negative correlation was noted between PINI and PA (r = 51, p =.0018).This study demonstrates that the decline in PINI noted in this group of enterally fed patients is largely due to the decline in the serum CRP concentration. It is speculated that the large impact of the serum CRP concentration on the PINI, demonstrated here and in a previous study,2 could allow use of serum CRP measurements alone as a prognostic indicator in this group of critically ill patients.
The Dipeptide Alanyl‐Glutamine Prevents Intestinal Mucosal Atrophy in Parenterally Fed Rats
Authors: Tamada Horacio , Nezu Rchiro , Imamura Ikuo , Matsuo Yoshinobu , Takagi Yoji , Kamata Shinkichi , Okada Akira 
Published: May 2008

This study was performed to determine whether the addition of alanyl‐glutamine (Ala‐Gln) can prevent intestinal mucosal atrophy induced by standard solution of total parenteral nutrition (S‐TPN). Forty‐one male Sprague‐Dawley rats weighing 250 g were randomly divided into four groups: group I was killed after overnight fasting; group II received S‐TPN. The other groups received S‐TPN supplemented with amino acids other than glutamine (group III) or supplemented with Ala‐Gln 2 g/100 mL (group IV); both solutions were isocaloric and isonitrogenous. After 1 week of TPN the rats were killed, and the duodenum, proximal jejunum, mid‐small bowel, and distal ileum were obtained for morphologic and functional analysis.Weight gain did not differ significantly among these four groups, and there was no difference in nitrogen balance between groups III and IV. Serum glutamine in group IV (102.8 ± 13.3 μmol/dL) was significantly increased (p <.05) compared with groups I, II, and III (66.2 ± 3.9, 55.7 ± 7.8, and 61.3 ± 10.8 μmol/dL, respectively). Mucosal wet weight, protein, RNA, sucrase, and maltase of group IV were significantly increased (p <.05) compared with groups II and III. Villus height was significantly increased (p <.05) in the jejunum of group IV rats compared with groups II and III, but not in any other segments of the intestine. No significant changes were observed in crypt depth among all groups. Diamine oxidase in groups II, III, and IV was significantly decreased (p <.05) compared with group I in all segments except for the ileum. Significant decreases (p <.05) in mucosal weight, RNA content, maltase, sucrase, and diamine oxidase activity were observed in groups II and III compared with group I. These results provide further evidence that administration of S‐TPN solution results in significant mucosal atrophy. The results also indicate that the specific addition of Ala‐Gln to S‐TPN may preserve or enhance intestinal mucosal cellularity and function. Thus, alanyl‐glutamine, the stable form of glutamine, may be a suitable form for inclusion in TPN formulas. (Journal of Parenteral and Enteral Nutrition 16:110–116, 1992)
Measuring Body Fat: Calibrating the Rulers. Intermethod Comparisons in 389 Normal Caucasian Subjects R. N. PIERSON, JR, J. WANG, S. B. HEYMSFIELD, ET AL American Journal of Physiology 261 (Endocrinology and Metabolism 24):E103‐E108, 1991
Authors: Goldstein Richard E. 
Published: May 2008

In this study from Columbia University, 389 (156 men and 233 women) healthy white subjects ranging from 19 to 94 years, with body mass index ranging from 15 to 35 kg/m2, had their body fat measured using eight different methods. These methods included anthropometric assessments as defined by Durnin and Womersley1 and Steinkamp et al,2 underwater weighing, total body potassium, dual‐photon absorptiometry, total body water, total body electrical conductivity, and bioelectric impedance analysis. All subjects were studied after an overnight fast. Statistical analysis of the data utilized repeated‐measures analysis of variance to test the hypothesis that the eight methods yielded the same average percent of body fat. Pearson correlation coefficients were calculated for each pair of body fat measurements. Linear regression equations were calculated for each pair of methods and for each method using age as an independent variable. The reliability of the methods was calculated using the intraclass correlation coefficient; the coefficient of variation of each method was also calculated.Table I summarizes the coefficients of variation and reliability intraclass correlations for the eight methods tested. It is important to note the low coefficients of variation in dual‐photon absorptiometry and underwater weighing and the high coefficient of variation using total body potassium. Table II summarizes the average percent body fat measurements for men and women using the various methods. Of note is that the use of bioelectric impedance analysis and total body electrical conductivity consistently resulted in the lowest values for percent body fat, whereas the use of total body potassium and anthropometric measurements, as defined by Steinkamp et al,2 consistently resulted in the highest values for percent body fat. Additional data presented by the authors demonstrate correlations between percent body fat, measured by the different methods, and the linear regression equations of percent fat with age. The investigators conclude their data presentation with a full‐page table of intermethod linear regression equations for men and women. The purpose of this table is to serve as a type of Rosetta stone. It provides the slopes and intercepts (and standard estimate of the error and r 2 values) to be used to translate results obtained using one method to those that would be expected using any of the other methods according to the general formula y = mx + b.