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  1. Effects of early parenteral iron combined erythropoietin in preterm infants

    PubMed Central

    Qiao, Linxia; Tang, Qingya; Zhu, Wenying; Zhang, Haiyan; Zhu, Yuefang; Wang, Hua

    2017-01-01

    Abstract Backgroud: The aim of the study was to evaluate the effect of early parenteral iron supplementation combined erythropoietin for prevention of anemia in preterm infants. Methods: In total, 96 preterm infants were randomly assigned to 3 groups: a control group receiving standard parenteral nutrition (group 1: n = 31), an iron-supplemented group (group 2: IS, n = 33), and an iron-supplemented combined erythropoietin group (group 3: IS+EPO, n = 32). The primary objective was to assess hemoglobin (Hb) levels. The secondary objectives included assessment of red blood cell counts (RBC), mean cell volume (MCV), serum iron, ferritin, percentages of reticulocyte (RET), total iron binding capacity (TIBC) and oxidative stress, which was assessed by measuring plasma levels of malondialdehyde and superoxide dismutase at baseline and at 2 weeks. The blood routine indices including Hb, RBC, MCV, and percentages of RET were measured at corrected age of 1 and 3 months. Results: At 2 weeks of life, the percentages of reticulocyte in group 2 and group 3 were significantly higher than those in group 1 (2.1±0.4, 2.5±0.3, and 1.7±0.3, respectively, P < 0.001, P<0.001), whereas TIBC were significantly lower than those in group 1 (36.7±4.6, 36.0±4.7, and 41.6 ± 5.2 respectively, P = 0.011, P = 0.006). There were no significant differences in RBC counts, the levels of hemoglobin, ferritin, malondialdehyde, and superoxide dismutase among the 3 groups at 2weeks of life. RBC, Hb, MCV, body weight, body length, and head circumference at a corrected age of 1 month did not differ among 3 groups. At corrected age of 3months, more infants in the control group had abnormal Hb and MCV levels (Hb levels: 114.3 ± 21.3, 123.7 ± 31.6, and 125.1 ± 21.2, P = 0.021, P = 0.034, respectively; MCV: 74.1 ± 3.5, 78.3 ± 4.7 and 79.1 ± 5.2, P = 0.017, P = 0.012, respectively), whereas cases of oral iron, cases of breastfeeding

  2. Early Enteral Combined with Parenteral Nutrition Treatment for Severe Traumatic Brain Injury: Effects on Immune Function, Nutritional Status and Outcomes(△).

    PubMed

    Ming-Chao, Fan; Qiao-Ling, Wang; Wei, Fang; Yun-Xia, Jiang; Lian-di, Li; Peng, Sun; Zhi-Hong, Wang

    2016-11-20

    Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN) with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patients with severe traumatic brain injury (STBI). Methods A prospective randomized control trial was carried out from January 2009 to May 2012 in Neurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow Coma Scale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were admi- nistrated EN, PN or EN+PN treatments respectively. The indexes of nutritional status, immune function, complications and clinical outcomes were examined and compared statistically. Results There were 120 patients enrolled in the study, with 40 pationts in each group. In EN+PN group, T lymthocyte subsets CD3+%, CD4+%, ratio of CD3+/CD25+, ratio of CD4+/CD8+, the plasma levels of IgA, IgM, and IgG at 20 days after nutritional treatment were significantly increased compared to the baseline(t=4.32-30.00, P<0.01), and they were significantly higher than those of PN group (t=2.44-14.70; P<0.05,or P<0.01) with exception of CD4+/CD8+, higher than those of EN group (t=2.49-13.31, P<0.05, or P<0.01) with exceptions of CD3+/CD25+, CD4+/CD8+, IgG and IgM. For the nutritional status, the serum total protein, albumin, prealbumin and hemoglobin were significantly higher in the EN (t=5.87-11.91; P<0.01) and EN+PN groups (t=6.12-13.12; P<0.01) than those in PN group after nutrition treatment. The serum prealbumin was higher in EN+PN group than that in EN group (t=2.08; P<0.05). Compared to the PN group, the complication occurrence rates of EN+PN group were significantly lower in stress ulcer (22.5% vs. 47.5%; χ(2)= 8.24, P<0.01), intracranial infection (12.5% vs 32.5%;χ(2)= 6.88, P<0.01) and pyemia (25.0% vs. 47.5%; χ(2)= 6.57, P<0.05). Compared to the EN group, the complication occurrence rates of EN+PN group were significantly lower in

  3. The Technical and Financial Effects of Parenteral Supplementation with Selenium and Vitamin E during Late Pregnancy and the Early Lactation Period on the Productivity of Dairy Cattle

    PubMed Central

    Bayril, T.; Yildiz, A. S.; Akdemir, F.; Yalcin, C.; Köse, M.; Yilmaz, O.

    2015-01-01

    This study aimed to determine the effects of parenteral selenium (Se) and vitamin E supplementation on economic impact, milk yield, and some reproductive parameters in high-yield dairy cows in the dry period and in those at the beginning of lactation. At the beginning of the dry period, cows (n = 323) were randomly divided into three groups as follows: Treatment 1 (T1), Treatment 2 (T2), and Control (C). Cows in group T1 received this preparation 21 days before calving and on calving day, and cows in group T2 received it only on calving day. The cows in the control group did not receive this preparation. Supplementation with Se increased Se serum levels of cows treated at calving day (p<0.05). Differences in milk yield at all weeks and the electrical conductivity values at the 8th and 12th weeks were significant (p<0.05). Supplementation with Se and Vitamin E decreased the incidence of metritis, the number of services per conception and the service period, but had no effects on the incidence of retained fetal membrane. A partial budgeting analysis indicated that Se supplementation was economically profitable; cows in group T1 averaged 240.6$ per cow, those in group T2 averaged 224.6$ per cow. Supplementation with Se and Vitamin E has been found to increase serum Se levels, milk yield, and has positive effects on udder health by decreasing milk conductivity values and incidence of sub-clinical mastitis. PMID:26104521

  4. Effect of fasting and parenteral alimentation on PIPIDA scintigraphy

    SciTech Connect

    Potter, T.; McClain, C.J.; Shafer, R.B.

    1983-08-01

    Ten patients were prospectively studied using 99mTc-PIPIDA imaging to evaluate the effects of fasting and parenteral alimentation on gallbladder function. Three of ten patients had initial nonvisualization of the gallbladder for up to 2 hr, yet had normal visualization on repeat imaging performed after resumption of oral intake or after parenteral alimentation was discontinued. 99mTc-PIPIDA imaging should be interpreted with caution in patients fitting into either of these groups.

  5. Early combined parenteral and enteral nutrition for pancreaticoduodenectomy – Retrospective cohort analysis

    PubMed Central

    Probst, Pascal; Keller, Daniel; Steimer, Johannes; Gmür, Emanuel; Haller, Alois; Imoberdorf, Reinhard; Rühlin, Maya; Gelpke, Hans; Breitenstein, Stefan

    2016-01-01

    Background Suggested guidelines for nutritional support after pancreaticoduodenectomy are still controversial. Recent evidence suggests that combining enteral nutrition (EN) with parenteral nutrition (PN) improves outcome. For ten years, patients have been treated with Early Combined Parenteral and Enteral Nutrition (ECPEN) after PD. The aim of this study was to report on rationale, safety, effectiveness and outcome associated with this method. Methods Consecutive PD performed between 2003 and 2012 were analyzed retrospectively. Early EN and PN was standardized and started immediately after surgery. EN was increased to 40 ml/h (1 kcal/ml) over 24 h, while PN was supplemented based on a daily energy target of 25 kcal/kg. Standard enteral and parenteral products were used. Results Sixty-nine patients were nutritionally supplemented according to ECPEN. The median coverage of kcal per patients related to the total caloric requirements during the entire hospitalization (nutrition balance) was 93.4% (range: 100%–69.3%). The nutritional balance in patients with needle catheter jejunostomy (NCJ) was significantly higher than in the group with nasojejunal tube (97.1% vs. 91.6%; p < 0.0001). Mortality rate was 5.8%, while major complications (Clavien-Dindo 3–5) occurred in 21.7% of patients. Neither the presence of preoperative malnutrition nor the application of preoperative immunonutrition was associated with postoperative clinical outcome. Conclusion This is the first European study of ECPEN after PD. ECPEN is safe and, especially in combination with NCJ, provides comprehensive coverage of caloric requirements during the postoperative phase. Clinical controlled trials are needed to investigate potential benefits of complete energy supplementation during the early postoperative phase after PD. PMID:26955477

  6. Parenteral Vaccination Can Be an Effective Means of Inducing Protective Mucosal Responses

    PubMed Central

    Freytag, Lucy C.

    2016-01-01

    The current paradigm in vaccine development is that nonreplicating vaccines delivered parenterally fail to induce immune responses in mucosal tissues. However, both clinical and experimental data have challenged this concept, and numerous studies have shown that induction of mucosal immune responses after parenteral vaccination is not a rare occurrence and might, in fact, significantly contribute to the protection against mucosal infections afforded by parenteral vaccines. While the mechanisms underlying this phenomenon are not well understood, the realization that parenteral vaccination can be an effective means of inducing protective mucosal responses is paradigm-shifting and has potential to transform the way vaccines are designed and delivered. PMID:27122485

  7. Early enteral nutrition vs parenteral nutrition following pancreaticoduodenectomy: Experience from a single center

    PubMed Central

    Lu, Jian-Wen; Liu, Chang; Du, Zhao-Qing; Liu, Xue-Min; Lv, Yi; Zhang, Xu-Feng

    2016-01-01

    AIM: To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition (TPN) and early enteral nutrition supplemented with parenteral nutrition (EEN + PN). METHODS: Three hundred and forty patients receiving pancreaticoduodenectomy (PD) from 2009 to 2013 at our center were enrolled retrospectively. Patients were divided into two groups depending on postoperative nutrition support scheme: an EEN + PN group (n = 87) and a TPN group (n = 253). Demographic characteristics, comorbidities, preoperative biochemical parameters, pathological diagnosis, intraoperative information, and postoperative complications of the two groups were analyzed. RESULTS: The two groups did not differ in demographic characteristics, preoperative comorbidities, preoperative biochemical parameters or pathological findings (P > 0.05 for all). However, patients with EEN + PN following PD had a higher incidence of delayed gastric emptying (16.1% vs 6.7%, P = 0.016), pulmonary infection (10.3% vs 3.6%, P = 0.024), and probably intraperitoneal infection (18.4% vs 10.3%, P = 0.059), which might account for their longer nasogastric tube retention time (9 d vs 5 d, P = 0.006), postoperative hospital stay (25 d vs 20 d, P = 0.055) and higher hospitalization expenses (USD10397 vs USD8663.9, P = 0.008), compared to those with TPN. CONCLUSION: Our study suggests that TPN might be safe and sufficient for patient recovery after PD. Postoperative EEN should only be performed scrupulously and selectively. PMID:27076767

  8. Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis.

    PubMed

    Peng, J; Cai, J; Niu, Z-X; Chen, L-Q

    2016-05-01

    Early postoperative enteral nutrition (EN) after esophagectomy in esophageal cancer patient has been reported to be correlated with a better rehabilitation than parenteral nutrition (PN). However, a robust conclusion has not been achieved. Therefore, we performed a meta-analysis to compare the postoperative EN and PN in patients with esophageal cancer undergoing esophagectomy. Three electronic databases were searched for eligible studies to be included in the meta-analysis. The summary relative risk/weighted mean difference (RR/WMD) estimates and corresponding 95% confidence interval (CI) were calculated using fixed- and random-effects models. Ten studies met the inclusion criteria. The analysis demonstrated that the early postoperative EN could significantly decrease the pulmonary complications (RR = 0.37, 95% CI = 0.22-0.62, P = 0.00, test for heterogeneity: I(2) = 0.0%, P = 0.89) and anastomotic leakage (RR = 0.46, 95% CI = 0.22-0.96, P = 0.04, test for heterogeneity: I(2) = 0.0%, P = 0.66) compared with PN. On the eighth postoperative day, the EN group had a higher levels of albumin (WMD = 1.84, 95% CI = 0.47-3.21, P = 0.01, test for heterogeneity: I(2) = 84.5%, P = 0.00) and prealbumin (WMD = 12.96, 95% CI = 3.63-22.29, P = 0.01, test for heterogeneity: I(2) = 0.0%, P = 0.63) compared with the PN group. However, there was no difference in digestive complications between these two approaches (RR = 1.30, 95% CI = 0.79-2.13, P = 0.30, test for heterogeneity: I(2) = 0.0%, P = 0.97). For patients with esophageal cancer following esophagectomy, the early postoperative EN support could decrease the morbidity of severe complications, such as pulmonary complications and anastomotic leakage, and maintain patients at a better nutritional status than parenteral nutrion support.

  9. Parenteral Lipid Tolerance and Adverse Effects: Fat Chance for Trouble?

    PubMed

    Wanten, Geert J A

    2015-09-01

    Lipid emulsions (LEs) are indispensable sources of fuel calories and (essential) fatty acids (FAs) in modern parenteral nutrition formulations. The use of LE, however, also remains associated with the development of adverse effects. Intolerance for LE mostly becomes apparent upon the development of patient complaints or disturbed blood function tests, mainly of the liver. These issues may be associated with the composition, stability, or the infusion rate of the emulsion. Also, altered balances of (anti)oxidants or the presence or absence of protective or toxic bioactive agents such as phytosterols and tocopherol in LE may lead to complications, especially in already vulnerable patients with an inflammatory condition. While the oldest available LEs are based on pure soybean oil (SO-LE), rich in the proinflammatory ω-6 polyunsaturated fatty acid linoleic acid, more recent next-generation LEs where alternative FA sources such as olive and fish oil (partially) replace soybean oil to lower the content of linoleic acid seem safe and effective. Especially LEs containing fish oil (FO-LE) have less proinflammatory characteristics that promise to convey beneficial effects on immune system and organ functions, although much of the available evidence awaits more robust clinical validation.

  10. Early nasogastric feeding versus parenteral nutrition in severe acute pancreatitis: A retrospective study

    PubMed Central

    Tao, Yulong; Tang, Chengwu; Feng, Wenming; Bao, Ying; Yu, Hongbin

    2016-01-01

    Objective: To compare the efficacy and safety of early nasogastric enteral nutrition (EN) with total parenteral nutrition (TPN) in patients with severe acute pancreatitis (SAP). Methods: From July 2008 to July 2014,185 patients with SAP admitted to our centre were enrolled in this retrospective study. They were divided into EN group (n=89) and TPN group (n=96) based on the nutrition support modes. Patients in EN group received nasogastric EN support, while patients in TPN group received TPN support within 72 hours of disease onset. The medical records were reviewed and clinical factors were retrospectively analyzed. Results: There were no significant differences in baseline characteristics between two groups. EN group had significantly lower incidence of pancreatic infections (P=0.0333) and extrapancreatic infections (P=0.0431). Significantly shorter hospital stay (P=0.0355) and intensive-care stay (P=0.0313) were found in EN group. TPN group was found to have significantly greater incidence of multiple organ dysfunction syndrome (MODS) (P=0.0338) and mortality (P=0.0382). Moreover, the incidence of hyperglycemia was significantly higher in TPN group (P=0.0454). Conclusions: Early nasogastric EN was feasible and significantly decreased the incidence of infectious complications as well as the frequency of MODS and mortality caused by SAP. PMID:28083056

  11. Early Parenteral Nutrition in Patients with Biliopancreatic Mass Lesions, a Prospective, Randomized Intervention Trial

    PubMed Central

    Krüger, Janine; Meffert, Peter J.; Vogt, Lena J.; Gärtner, Simone; Steveling, Antje; Kraft, Matthias; Mayerle, Julia; Lerch, Markus M.; Aghdassi, Ali A.

    2016-01-01

    Purpose Patients with biliopancreatic tumors frequently suffer from weight loss and cachexia. The in-hospital work-up to differentiate between benign and malignant biliopancreatic lesions requires repeated pre-interventional fasting periods that can aggravate this problem. We conducted a randomized intervention study to test whether routine in-hospital peripheral intravenous nutrition on fasting days (1000 ml/24 h, 700 kcal) has a beneficial effect on body weight and body composition. Material and Methods 168 patients were screened and 100 enrolled in the trial, all undergoing in-hospital work-up for biliopancreatic mass lesions and randomized to either intravenous nutrition or control. Primary endpoint was weight loss at time of hospital discharge; secondary endpoints were parameters determined by bioelectric impedance analysis and quality of life recorded by the EORTC questionnaire. Results Within three months prior to hospital admission patients had a median self-reported loss of 4.0 kg (25*th: -10.0 kg and 75*th* percentile: 0.0kg) of body weight. On a multivariate analysis nutritional intervention increased body weight by 1.7 kg (95% CI: 0.204; 3.210, p = 0.027), particularly in patients with malignant lesions (2.7 kg (95% CI: 0.71; 4.76, p < 0.01). Conclusions In a hospital setting, patients with suspected biliopancreatic mass lesions stabilized their body weight when receiving parenteral nutrition in fasting periods even when no total parenteral nutrition was required. Analysis showed that this effect was greatest in patients with malignant tumors. Further studies will be necessary to see whether patient outcome is affected as well. Trial Registration ClinicalTrials.gov NCT02670265 PMID:27861546

  12. Early enteral and parenteral nutrition on immune functions of neurocritically ill patients.

    PubMed

    Qi, S Y; Wang, W T; Chen, C Y; Chu, Z D; Liu, X J; Liu, X J

    2016-01-01

    This study was designed to investigate the influence of early enteral and parenteral nutrition on immune functions of neurocritically ill patients. Patients who were admitted to the neurological intensive care unit (ICU) of The Second Affiliated Hospital of Zhengzhou University between May 2014 and January 2016 were selected. They had been hospitalized for more than one week and received enteral nutrition (EN) via nasogastric tube, with a gross energy of 25 kcal/(Kg • d). Patients were divided into EN group, EN + early PN (EPN) group and EN + supplemental PN (SPN) group according to the time of PN support. Differences in patients’ general information and changes in serum protein and immune indexes were compared between the three groups. On admission, patients’ Glasgow coma scale (GCS), age, immune functions and protein indexes had no obvious differences between the three groups. After nutritional support, serum protein level reduced in the EN group while prealbumin (PALB) and retinol binding protein (RBP) increased in the EN + EPN group and EN + SPN group after one week of admission to hospital, and the differences were statistically significant (p less than 0.05). Total protein (TP), albumin (ALB), PALB and transferrin (TRF) increased significantly in the EN + EPN group and EN + SPN group compared with the EN group (p < 0.05); before and after treatment, an increase was found in ALB in the EN + EPN group in comparison with EN + SPN group, with a notable difference (p < 0.05); C3, C4, immunoglobulin M (IgM) and immunoglobulin A (IgA) increased in the EN + SPN group after nutritional support compared with before treatment, and the difference was statistically significant (p < 0.05). Moreover, immunoglobulin G (IgG) and IgA in the EN + EPN group increased after nutritional support comparing to prior to nutritional support, and the difference was statistically significant (p < 0.05). After nutritional treatment, IgA and IgG increased markedly in the EN + EPN group

  13. The effect of acute discontinuation of total parenteral nutrition.

    PubMed Central

    Wagman, L D; Newsome, H H; Miller, K B; Thomas, R B; Weir, G C

    1986-01-01

    The present study was undertaken to assess the impact of acute discontinuation (AD) of total parenteral nutrition (TPN) on serum glucose, insulin, and glucagon levels and on the generation of symptomatic hypoglycemia. Fifty studies were performed in 48 patients. In none of the 30 studies of 1 hour duration nor in the 20 studies of 8 hours duration was there a single episode of symptomatic hypoglycemia. One patient had a glucose below normal (60 mg/dl) during the first hour after AD. Glucose and insulin concentrations were elevated at the start of TPN discontinuation but returned to normal values within 60 minutes and remained there during the successive 7 hours of study. Although glucagon levels were slightly elevated at zero time, no significant decrease occurred. There was no evidence for counter-regulation based on the patterns of glucose and hormone levels. With some restrictions, acute discontinuation is a safe, rapid method of ending a prolonged TPN infusion. PMID:3094465

  14. Effects of Formulation Variables and Storage Conditions on Light Protected Vitamin B12 Mixed Parenteral Formulations

    PubMed Central

    Monajjemzadeh, Farnaz; Ebrahimi, Fatemeh; Zakeri-Milani, Parvin; Valizadeh, Hadi

    2014-01-01

    Purpose: In this research the effect of vitamin B1 and B6 on cyanocobalamin stability in commercial light protected parenteral formulations and upon adding stabilizing agents will be investigated and best formulation composition and proper storage condition will be introduced. Methods: In this research some additives such as co solvents and tonicity adjusters, surfactants, antioxidants and chelating agents as well as buffer solutions, were used to improve the stability of the parenteral mixed formulations of B12 in the presence of other B vitamins (B1 and B6). Screening tests and accelerated stability tests were performed according to ICH guidelines Q1A (R2). Results: Shelf life evaluation revealed the best formulation and the proper storage condition. The results indicated the first kinetic models for all tested formulations and the optimum pH value was determined to be 5.8. There was no evidence of B12 loss when mixed with B1 and B6 in a medical syringe at room temperature for maximum of 8 hours. Conclusion: It is necessary to formulate vitamin B12 mixed parenteral solutions using proper phosphate buffers (pH=5.8) and to indicate “Store in refrigerator” on the mixed parenteral formulations of vitamin B12 with other B vitamins, which has not been expressed on the label of tested Brand formulations at the time of this study. PMID:25436187

  15. Effects of oral and parenteral selenium supplements on residues in meat, milk and eggs.

    PubMed

    Beale, A M; Fasulo, D A; Craigmill, A L

    1990-01-01

    Oral and parenteral preparations of Se are used worldwide to prevent and treat nutritional muscular dystrophy and other Se deficiency syndromes. There are extensive published data on the effects of oral supplementation on Se residues in food animal products. Very little published data exist on the effects of parenteral administration on Se residues, even for cattle and swine in which parenteral preparations are used extensively. The distribution of Se into kidney and liver appears to be equivalent for both forms of supplementation. Elimination of Se in milk is greater after parenteral administration and correlates with high plasma Se levels, however the milk excretion drops quickly and after 4 d returns to control levels (Little et al. 1979). Of particular interest is the finding that up to 18% of Se in an oral diet may be excreted in milk (Maus et al. 1980). Use of Se supplements in poultry results in increased levels of Se in liver, kidney, and eggs. Distribution of Se into liver and kidney is much greater than into breast muscle indicating a greater capacity of these organs to accumulate Se. Excretion of Se into eggs results in Se levels equivalent to those in liver and kidney, indicating that eggs are an important route of Se excretion in laying hens (Ort and Latshaw 1978). When Se supplementation stops, the liver, kidney, and egg white and yolk residues decline quickly to control values within 1-2 wk. Breast muscle Se content changes little during supplementation and after withdrawal of supplementation. Oral and parenteral selenium supplementation in swine result in greater accumulation of Se in liver and kidney than in muscle. Oral selenium supplementation also increases the excretion of Se into milk. This method has been used to prevent Se deficiency disease in piglets (Mahan et al. 1975). Oral supplementation with 0.1 ppm Se, as sodium selenate, did not result in levels of Se in blood, meat, or viscera at slaughter (Jenkins and Winter 1973). Despite the

  16. Early enteral nutrition in combination with parenteral nutrition in elderly patients after surgery due to gastrointestinal cancer

    PubMed Central

    Huang, Dongping; Sun, Zhufeng; Huang, Jianwei; Shen, Zhaozai

    2015-01-01

    Objective: To evaluate the therapeutic effects of nutritional support via different routes in elderly patients after surgery for gastrointestinal (GI) cancer. Methods: 105 patients with GI cancer were randomly divided into early enteral nutrition (EEN) group (n = 35), total parenteral nutrition (TPN) group (n = 35) and EN+PN group (n = 35). Results: The nutrition status and immunity were significantly compromised in all patients, while the liver function was improved at 3 days after surgery as compared to those before surgery. At 7 days after surgery, they returned to preoperative level. The nutrition status was comparable among 3 groups at 3 and 7 days after surgery (P > 0.05). ALT, AST, ALP and GGT in TNP group were significantly higher than those in EEN group and EN+PN group (P < 0.05), whereas there was no significant difference in the liver function between EEN group and EN+PN group (P > 0.05). The CD3+ cells, CD4+ cells and CD4/CD8 in EEN group and EN+PN group were significantly higher than those in TPN group (P < 0.05), but significant difference was not observed between EEN group and EN+PN group (P > 0.05). The NK cells in EN+PN group were significantly higher than in TPN group (P < 0.01). The incidence of diarrhea in EEN group was significantly higher than in TPN group and EN+PN group (P < 0.05). Conclusion: EN+PN is superior to EEN alone and TPN alone in the old patients with GI cancer in reducing the postoperative complications, improving the immunity and decreasing the hospital stay. PMID:26550350

  17. Study of teduglutide effectiveness in parenteral nutrition-dependent short-bowel syndrome subjects.

    PubMed

    Vipperla, Kishore; O'Keefe, Stephen J

    2013-11-01

    Loss of intestinal absorptive capacity from congenital defect, surgical resection or mucosal disease results in short bowel syndrome (SBS)-associated intestinal failure. In the past, few medical management options were available besides dietary modification, controlling diarrhea or high stomal output, and providing parenteral fluid, electrolyte and nutrient support (parenteral support). Recent research on strategies to enhance the intestinal absorptive capacity focused on glucagon-like peptide-2, an intestinotrophic hormone that has been shown to increase the villus height and crypt depth, and decrease gastric motility and intestinal secretory losses. STEPS is a Phase III randomized double-blinded controlled trial in which teduglutide, a recombinant analog of glucagon-like peptide-2, or placebo was given subcutaneously to SBS patients for 24 weeks. A clinically meaningful response, defined as a 20-100% reduction in parenteral support volume, was achieved in 63% of the treatment group compared with 30% in the placebo group (p = 0.002) without an increase in serious side effects. Teduglutide offers a new targeted approach to SBS-associated intestinal failure management. Its specific role in clinical practice remains to be evaluated.

  18. Effects of different parenteral nutrition infusions in a patient with short bowel syndrome.

    PubMed

    Weng, Chia-Chee; Chen, Yun

    2015-01-01

    In this case study, we demonstrate the effects of different lipid emulsions on liver function in a 52-year-old woman with short bowel syndrome who was totally dependent on parenteral nutrition. Over a 13-month period after small bowel resection and jejunostomy, we followed the patient's plasma triglycerides and liver enzyme levels as well as body weight and discomfort levels. During the first 3 months when parenteral nutrition including a lipid emulsion containing 50% soybean oil/50% medium-chain triglyerides was administered daily, the patient reported feeling unwell (experiencing dizziness and palpitations) and her triglycerides and liver enzyme levels rose to 366 mg/dL and 145 U/L (alanine aminotransferase [ALT]), respectively; these levels recovered when this emulsion was discontinued. For the following 9 months, an emulsion containing 80% olive oil and 20% soybean oil was administered, and the patient's triglycerides (182 mg/dL) did not increase to abnormal levels and liver enzyme levels were only mildly elevated (109 U/L). The patient felt well and her body weight increased from 51 kg to 55 kg during this period. These results suggest that parenteral nutrition with a reduced soybean oil content may better preserve liver function in patients with short bowel syndrome.

  19. Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma.

    PubMed Central

    Kudsk, K A; Croce, M A; Fabian, T C; Minard, G; Tolley, E A; Poret, H A; Kuhl, M R; Brown, R O

    1992-01-01

    To investigate the importance of route of nutrient administration on septic complications after blunt and penetrating trauma, 98 patients with an abdominal trauma index of at least 15 were randomized to either enteral or parenteral feeding within 24 hours of injury. Septic morbidity was defined as pneumonia, intra-abdominal abscess, empyema, line sepsis, or fasciitis with wound dehiscence. Patients were fed formulas with almost identical amounts of fat, carbohydrate, and protein. Two patients died early in the study. The enteral group sustained significantly fewer pneumonias (11.8% versus total parenteral nutrition 31.%, p less than 0.02), intra-abdominal abscess (1.9% versus total parenteral nutrition 13.3%, p less than 0.04), and line sepsis (1.9% versus total parenteral nutrition 13.3%, p less than 0.04), and sustained significantly fewer infections per patient (p less than 0.03), as well as significantly fewer infections per infected patient (p less than 0.05). Although there were no differences in infection rates in patients with injury severity score less than 20 or abdominal trauma index less than or equal to 24, there were significantly fewer infections in patients with an injury severity score greater than 20 (p less than 0.002) and abdominal trauma index greater than 24 (p less than 0.005). Enteral feeding produced significantly fewer infections in the penetrating group (p less than 0.05) and barely missed the statistical significance in the blunt-injured patients (p = 0.08). In the subpopulation of patients requiring more than 20 units of blood, sustaining an abdominal trauma index greater than 40 or requiring reoperation within 72 hours, there were significantly fewer infections per patient (p = 0.03) and significantly fewer infections per infected patient (p less than 0.01). There is a significantly lower incidence of septic morbidity in patients fed enterally after blunt and penetrating trauma, with most of the significant changes occurring in the

  20. Safety, therapeutic effectiveness, and cost of parenteral iron therapy.

    PubMed

    Asma, Suheyl; Boga, Can; Ozdogu, Hakan

    2009-07-01

    Patients have to discontinue the use of oral iron therapy due to the development of side effects and lack of long-term adherence to medication for iron deficiency anemia. This study aimed to evaluate the therapeutic effectiveness, safety, and cost of intravenous iron sucrose therapy. The computerized database and medical records of 453 patients diagnosed with iron deficiency anemia who received intravenous iron sucrose therapy for iron deficiency anemia between 2004 and 2008 were reviewed. The improvement of hematologic parameters and cost of therapy were evaluated 4 weeks after therapy. 453 patients (443 females, 10 males; age: 44.2 +/- 12.3 years) received iron sucrose therapy. Mean hemoglobin, hematocrit, and mean corpuscular volume values were 8.2 +/- 1.4 g/dL, 26.9 +/- 3.8%, and 66.1 +/- 7.8 fL, respectively, before therapy and 11.5 +/- 1.0 g/dL, 35.8 +/- 2.5%, 76.5 +/- 6.1 fL, respectively, after therapy (P < 0.001). A mean ferritin level of 3.4 +/- 2.4 ng/mL before therapy increased to 65.9 +/- 40.6 ng/mL after therapy (P < 0.001). All patients responded to intravenous iron therapy (transferrin saturation values of the patients were >50%). The mean cost of therapy was 143.07 +/- 29.13 US dollars. The therapy was well tolerated. Although the cost of intravenous iron sucrose therapy may seem high, a lack of adherence to therapy and side effects including gastrointestinal irritation during oral iron therapy were not experienced during intravenous therapy.

  1. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis.

    PubMed Central

    Moore, F A; Feliciano, D V; Andrassy, R J; McArdle, A H; Booth, F V; Morgenstein-Wagner, T B; Kellum, J M; Welling, R E; Moore, E E

    1992-01-01

    This two-part meta-analysis combined data from eight prospective randomized trials designed to compare the nutritional efficacy of early enteral (TEN) and parenteral (TPN) nutrition in high-risk surgical patients. The combined data gave sufficient patient numbers (TEN, n = 118; TPN, n = 112) to adequately address whether route of substrate delivery affected septic complication incidence. Phase I (dropouts excluded) meta-analysis confirmed data homogeneity across study sites, that TEN and TPN groups were comparable, and that significantly fewer TEN patients experienced septic complications (TEN, 18%; TPN, 35%; p = 0.01). Phase II meta-analysis, an intent-to-treat analysis (dropouts included), confirmed that fewer TEN patients developed septic complications. Further breakdown by patient type showed that all trauma and blunt trauma subgroups had the most significant reduction in septic complications when fed enterally. In conclusion, this meta-analysis attests to the feasibility of early postoperative TEN in high-risk surgical patients and that these patients have reduced septic morbidity rates compared with those administered TPN. PMID:1386982

  2. Metabolic effects of recombinant human growth hormone in patients receiving parenteral nutrition.

    PubMed Central

    Ziegler, T R; Young, L S; Manson, J M; Wilmore, D W

    1988-01-01

    Recombinant human methionyl growth hormone (Protropin) (Genetech, Inc., San Francisco, CA) administered to normal volunteers receiving hypocaloric parenteral nutrition minimized weight loss and induced positive nitrogen balance. To evaluate whether growth hormone (GH) can promote anabolism in surgical patients, 11 stable malnourished individuals were studied. In the initial trial, subjects received a constant parenteral infusion of a hypocaloric diet that provided approximately 1100 kcal/24 hr and 1.3 g protein/kg/24 hr for at least 2 weeks. During 1 week, GH 10 mg was given subcutaneously daily, whereas the other week served as the control. Daily balance studies demonstrated that administration of GH resulted in significant retention of nitrogen (+3.4 g/24 h) and phosphorus (+218 mg/24 h), despite provision of only 60% of caloric requirements. With GH, serum blood urea nitrogen (BUN) and potassium fell, whereas glucose and insulin tended to rise, and levels of insulin-like growth factor 1 increased three to fourfold. Weight gain occurred with GH and was associated with positive mineral and water balance. Six patients received GH (10 mg subcutaneously daily) for 13-25 consecutive days after an initial control week. Significant nitrogen and phosphorus retention occurred over the entire period of GH administration, and no significant side effects were observed. In these depleted patients, GH caused significant and sustained nitrogen retention over a wide range of nutritional support. GH appears to enhance the efficacy of parenteral nutrition in stable individuals requiring repletion of body protein. Images Fig. 2. Fig. 3. Fig. 4. PMID:3133995

  3. Comparison of the effects of enteral feeding with continuous and intermittent parenteral nutrition on hepatic triglyceride secretion in human beings

    SciTech Connect

    Isabel-Martinez, L.; Skinner, C.; Parkin, A.; Hall, R.I.

    1989-03-01

    Plasma triglyceride turnover was measured during steady-state conditions in 22 postoperative patients. Nine had received nutritional support with an enteral regimen, seven had received an equivalent regimen as continuous parenteral nutrition, and six received the same parenteral regimen as a cyclical infusion. After 5 days of nutritional support, each patient received an intravenous bolus of tritiated glycerol. Plasma radiolabeled triglyceride content was measured during the subsequent 24 hours. The data were analyzed by means of a simple deterministic model of plasma triglyceride kinetics and compared with the results obtained by stochastic analysis. The rates of hepatic triglyceride secretion obtained by deterministic analysis were higher than those obtained by the stochastic approach. However, the mode of delivery of the nutritional regimen did not affect the rate of hepatic triglyceride secretion regardless of the method of analysis. The results suggest that neither complete nutritional bypass of the gastrointestinal tract nor interruption of parenteral nutrition in an attempt to mimic normal eating has any effect on hepatic triglyceride secretion. Any beneficial effect that enteral feeding or cyclical parenteral nutrition may have on liver dysfunction associated with standard parenteral nutrition appears to be unrelated to changes in hepatic triglyceride secretion.

  4. Updated cost-effectiveness analysis of supplemental glutamine for parenteral nutrition of intensive-care patients

    PubMed Central

    Pradelli, L; Povero, M; Muscaritoli, M; Eandi, M

    2015-01-01

    Background/Objectives: Intravenous (i.v.) glutamine supplementation of parenteral nutrition (PN) can improve clinical outcomes, reduce mortality and infection rates and shorten the length of hospital and/or intensive care unit (ICU) stays compared with standard PN. This study is a pharmacoeconomic analysis to determine whether i.v. glutamine supplementation of PN remains both a highly favourable and cost-effective option for Italian ICU patients. Subjects/Methods: A previously published discrete event simulation model was updated by incorporating the most up-to-date and clinically relevant efficacy data (a clinically realistic subgroup analysis from a published meta-analysis), recent cost data from the Italian health-care system and the latest epidemiology data from a large Italian ICU database (covering 230 Italian ICUs and more than 77 000 patients). Sensitivity analyses were performed to test the robustness of the results. Results: Parenteral glutamine supplementation can significantly improve ICU efficiency in Italy, as the additional cost of supplemented treatment is more than completely offset by cost savings in hospital care. Supplementation was more cost-effective (cost-effectiveness ratio (CER)=€35 165 per patient discharged alive) than standard, non-supplemented PN (CER=€40 156 per patient discharged alive), and it resulted in mean cost savings of €4991 per patient discharged alive or €1047 per patient admitted to the hospital. Sensitivity analyses confirmed the robustness of these results. Conclusions: Alanyl-glutamine supplementation of PN is a clinically and economically attractive strategy for ICU patients in Italy and may be applicable to selected ICU patient populations in other countries. PMID:25469466

  5. Effectiveness of enteral and parenteral nutrition in the nutritional management of children with Wilms' tumors.

    PubMed

    Rickard, K A; Kirksey, A; Baehner, R L; Grosfeld, J L; Provisor, A; Weetman, R M; Boxer, L A; Ballantine, T V

    1980-12-01

    The effectiveness of enteral and parenteral feeding in supporting a satisfactory nutrition status and/or reversing protein-energy malnutrition was evaluated in nine children, ages 1 to 7 years (eight female), with Wilms' tumors. At the onset of treatment, eight patients received comprehensive enteral nutrition (CEN) which included intense nutritional counseling and oral supplements while one received total parenteral nutrition (TPN). Despite CEN, the initial, intense treatment period was associated with a decreased energy intake (64 +/- 27% Recommended Dietary Allowances), dramatic weight loss (22 +/- 7% by 26 +/- 17 days from the beginning of treatment), decreased skinfold thickness (< 10th percentile), and decreased albumin concentrations (< 3.2 g/dl). Four of those who initially received CEN subsequently required TPN. A total of five patients received TPN for a mean of 31 days (range 11 to 60); kcal averaged 105 +/- 9% Recommended Dietary Allowances during weight gain. At onset of TPN, the mean albumin, transferrin, total lymphocyte count were 3.02 +/- 0.45 g/dl, 155 +/- 40 mg/dl, and, 655 +/- 437/mm3, respectively; all children had abnormal anthropometric measurements and anergy to recall skin test antigens. TPN for 28 or more days supported weight gain (+ 2.44 kg), increased serum albumin (+ 0.58 +/- 0.47 g/dl) and transferrin (+ 76 +/- 34 mg/dl), and reversed anergy despite low total lymphocyte counts. During maintenance treatment, nutritional status was maintained or restored with CEN in the group who responded. These preliminary data document the severity of protein-energy malnutrition which accompanies initial, intense treatment of children with Wilms' tumors, the nutritional and immunological benefits of TPN during continuing intense treatment and the effectiveness of CEN in maintaining a satisfactory nutritional status during maintenance treatment.

  6. Effects of short-chain fatty acid-supplemented total parenteral nutrition on intestinal pro-inflammatory cytokine abundance.

    PubMed

    Milo, L A; Reardon, K A; Tappenden, K A

    2002-09-01

    We examined the effect of short-chain fatty acid-supplemented total parenteral nutrition on proinflammatory cytokine levels in piglets. Piglets (N = 22) received either standard total parenteral nutrition or total parenteral nutrition supplemented with short-chain fatty acids. After seven days of continuous nutrient infusion, proinflammatory cytokine (TNF-alpha, IL-1beta, IL-6) abundance in plasma, jejunal, and ileal samples and small intestinal myeloperoxidase was determined using western blotting. No differences were seen in TNF-alpha small intestinal abundance. IL-1beta was higher in the small intestine of the short-chain fatty acid group (P < 0.05). IL-6 was higher in intestinal samples of the short-chain fatty acid group (P = 0.05), with the ileum having a greater abundance of IL-6 than the jejunum (P < 0.005). No differences in proinflammatory cytokine abundance in the plasma or tissue myeloperoxidase were seen. These results indicate short-chain fatty acids beneficially increase small intestinal abundance of IL-1beta and IL-6 during total parenteral nutrition administration, while not affecting systemic production of these cytokines or intestinal inflammation.

  7. Early parenteral nutrition alone or accompanying enteral nutrition in critically ill patients: a systematic review and meta-analysis.

    PubMed

    Wan, Xiao; Gao, Xuejin; Tian, Feng; Wu, Chao; Wang, Xinying

    2015-01-01

    背景:尽管一些大样本临床研究已经探究了早期肠外营养(early parenteral nutrition, ePN)在危重症患者的作用,但对于其疗效并没有达成共识,而且在 这一领域也未见相关的meta 分析报道。本研究的目的就是探究早期肠外营养 在危重症患者中的治疗作用。方法:选取含有早期肠外营养的临床治疗的文 献,对其数据进行meta 分析,并根据患者是否合并使用早期肠内营养(early enteral nutrition,eEN)再进行亚组分析。结果:本研究总计纳入5 篇随机对 照研究(randomized control trials,RCTs)。结果显示,早期肠外营养组患者 与对照组患者死亡率无明显差异(相对危险度:1.05, 95%置信区间:0.96, 1.16) 。此外, 与对照组相比, 早期肠外营养组患者机械通气时间缩短 (p=0.007,相对危险度:-0.95,95%置信区间:-1.64, -0.27),但是总住院时 间延长(p<0.001,相对危险度:3.76,95%置信区间:2.25, 5.28)。结论:本 meta 分析表明,入院24-48 小时以内的早期肠外营养并不会影响危重症患者死 亡率。因此,肠内营养禁忌或者仅可使用低剂量肠内营养的患者无需使用早期 肠外营养进行补充。.

  8. In vitro hemorheological effects of parenteral agents used in peripheral arterial disease

    NASA Astrophysics Data System (ADS)

    Biro, Katalin; Sandor, Barbara; Toth, Andras; Koltai, Katalin; Papp, Judit; Rabai, Miklos; Toth, Kalman; Kesmarky, Gabor

    2014-05-01

    Peripheral arterial disease (PAD) is a frequent manifestation of systemic atherosclerosis. In PAD hemorheological parameters were defined as risk factors in a number of studies and several therapeutic agents were tried in these conditions. Our study aims to investigate and compare the in vitro hemorheological effects of various drugs generally used in the parenteral treatment of intermittent claudication and critical limb ischemia. Blood samples of healthy male volunteers were incubated with iloprost, alprostadil, pentoxifylline, sulodexide or pentosan polysulfate at calculated therapeutic serum concentration. Hematocrit (Hct) was determined by microhematocrit centrifuge. Plasma and apparent whole blood viscosities (WBV) were evaluated by capillary viscometer. Red blood cell aggregation was measured by LORCA (laserassisted optical rotational cell analyzer) aggregometer, and LORCA ektacytometer was used for measuring erythrocyte deformability at 37°C. Iloprost, alprostadil, and pentoxifylline incubation did not have any significant effect on plasma and apparent WBV. Elongation index increased in samples incubated with alprostadil at low shear stresses 0.95 and 0.53 Pa (p < 0.05). Sulodexide significantly improved WBV and Hct/WBV ratio (p < 0.05). Incubation with pentosan polysulfate resulted in higher WBV, lower Hct/WBV ratio and deterioration in the aggregation parameters (p < 0.05). Sulodexide may have beneficial effect on a macrorheological parameter; alprostadil may improve a microrheological parameter. Hemorheological alterations could be important in PAD patients with hampered vasodilator capacity.

  9. Effects of postoperative parenteral nutrition with different lipid emulsions in patients undergoing major abdominal surgery

    PubMed Central

    Demirer, Seher; Sapmaz, Ali; Kepenekci, Ilknur; Aydintug, Semih; Balci, Deniz; Sonyurek, Pinar; Kose, Kenan

    2016-01-01

    Purpose This study was designed to investigate the effects of total parenteral nutrition (PN) using different lipid emulsions in patients undergoing major abdominal surgery. Methods Fifty-two patients were randomized to receive soybean oil + medium chain triglycerides (MCT) (group I), soybean oil + olive oil (group II), soybean oil + olive oil + fish oil (group III) as a lipid source. PN was started on postoperative day 1 and patients were maintained on PN for a minimum period of 4 days. Laboratory variables (CRP, prealbumin, transferrin) were measured before surgery and on postoperative days. Results Three treatment groups were included in the study. Patients in group I received long chain triglycerides (LCT) + LCT/MCT emulsion (%75 LCT + %25 LCT/MCT); Patients in group II received olive oil based emulsion (80% olive oil + 20% soybean oil, ClinOleic); Patients in group III received fish oil in addition to olive oil based emulsion (%85 ClinOleic + %15 Omegaven; Fresenius Kabi). The following 14 parameters were assessed: body weight, CRP, prealbumin, transferrin, tumor necrosis factor-α, interleukin-6, total antioxidant status, thiobarbituric acid reactive substances, oxidized low density lipoprotein-2, complete blood cell, international normalized ratio, D-dimer, activated partially thromboplastin time, prothrombin time. All other parameters showed no differences among the groups. Conclusion The results of our trial demonstrate a potential beneficial effect of soybean oil/olive oil based lipid emulsions for use in PN regarding inflammatory response and oxidant capacity in the treatment of patients. PMID:27904853

  10. Effects of Lipid Emulsion and Multivitamins on the Growth of Microorganisms in Peripheral Parenteral Nutrition Solutions

    PubMed Central

    Kuwahara, Takashi; Kaneda, Shinya; Shimono, Kazuyuki; Inoue, Yoshifumi

    2013-01-01

    Background: Blood stream infections caused by Bacillus cereus or Serratia marcescens in patients receiving peripheral parenteral nutrition (PPN) have occasionally been reported in Japan, but these microorganisms are not major causes of blood stream infections in patients receiving total parenteral nutrition via a central venous catheter. In Japan, commercially available PPN solutions contain amino acids, glucose, and electrolytes, but not contain lipid emulsion (LE) and multivitamins (MV). In this study, the effects of LE and MV on the growth of microorganisms such as Bacillus cereus, Serratia marcescens, Staphylococcus aureus, and Candida albicans in PPN solutions were investigated. Methods: A commercial 3% amino acid and 7.5% glucose solution with electrolytes (AF) was used as the base solution to prepare test solutions (LAF, AFV, and LAFV) containing LE, MV, or both. Specifically, 20% LE was added to AF in a ratio of 1:9 to prepare LAF. MV was added to AF and LAF to prepare AFV and LAFV, respectively. A specified number of each microorganism was added to each 100 mL of AF, LAF, AFV, and LAFV in sterile plastic flasks, and all flasks were allowed to stand at room temperature. The number of colony forming units per mL of each microorganism was counted at 0, 24, and 48 hours after the addition of each microorganism. Results: Both Bacillus cereus and Serratia marcescens increased rapidly in AF as well as in LAF, AFV, and LAFV. Staphylococcus aureus did not increased in AF, but increased slightly in LAF and increased rapidly in AFV and LAFV. Candida albicans increased slightly in AF and increased rapidly in LAF, AFV, and LAFV. Conclusions: The results suggest the followings: if microbial contamination occurs, 1) Bacillus cereus and Serratia marcescens can grow rapidly in PPN solutions consisting of amino acids, glucose and electrolytes; 2) Staphylococcus aureus cannot grow without LE and MV, but can grow rapidly with MV; 3) Candida albicans can grow slowly without LE

  11. Effect of total parenteral nutrition, systemic sepsis, and glutamine on gut mucosa in rats

    NASA Technical Reports Server (NTRS)

    Yoshida, S.; Leskiw, M. J.; Schluter, M. D.; Bush, K. T.; Nagele, R. G.; Lanza-Jacoby, S.; Stein, T. P.

    1992-01-01

    The effect of the combination of total parenteral nutrition (TPN) and systemic sepsis on mucosal morphology and protein synthesis was investigated. Rats were given a standard TPN mixture consisting of glucose (216 kcal.kg-1.day-1), lipid (24 kcal.kg-1.day-1), and amino acids (1.5 g N.kg-1.day-1) for 5 days. On the 5th day the rats (n = 37) were randomized into four groups according to diet as follows: 1) control nonseptic on standard TPN, 2) control nonseptic on TPN with glutamine, 3) septic on standard TPN, and 4) septic with the TPN supplemented with glutamine. Twenty hours after the injection of Escherichia coli, the rats were given a 4-h constant infusion of [U-14C]leucine to determine the mucosal fractional protein synthesis rates. The following results were obtained. 1) Histological examination showed that systemic sepsis caused tissue damage to the ileum and jejunum. 2) Glutamine supplementation attenuated these changes. 3) There were no visible changes to the colon either from glutamine supplementation or sepsis. 4) Sepsis was associated with an increase in mucosal protein synthesis and decreased muscle synthesis. 5) Addition of glutamine to the TPN mix further increased protein synthesis in the intestinal mucosa of septic rats.

  12. Cost and effectiveness of omega-3 fatty acid supplementation in Chinese ICU patients receiving parenteral nutrition

    PubMed Central

    Wu, Guo Hao; Gao, Jian; Ji, Chun Yan; Pradelli, Lorenzo; Xi, Qiu Lei; Zhuang, Qiu Lin

    2015-01-01

    Background and objectives Clinical evidence supports the use of omega-3 polyunsaturated fatty acid (PUFA)-enriched lipid emulsions in place of standard lipid emulsions in parenteral nutrition (PN) for intensive care unit (ICU) patients, but uptake may be limited by higher costs. We compared clinical and economic outcomes for these two types of lipid emulsion in the Chinese ICU setting. Methods We developed a pharmacoeconomic discrete event simulation model, based on efficacy data from an international meta-analysis and patient characteristics, resource consumption, and unit costs from a Chinese institutional setting. Probabilistic sensitivity analyses were undertaken to assess the effects of uncertainty around input parameters. Model predictive validity was assessed by comparing results with data observed in a patient subset not used in the modeling. Results The model predicted that omega-3 PUFA-enriched emulsion (Omegaven® 10% fish oil emulsion) would dominate standard lipid emulsions, with better clinical outcomes and lower overall health care costs (mean savings ~10,000 RMB), mainly as a result of faster recovery and shorter hospital stay (by ~6.5 days). The external validation process confirmed the reliability of the model predictions. Conclusion Omega-3 PUFA-enriched lipid emulsions improved clinical outcome and decreased overall costs in Chinese ICU patients requiring PN. PMID:26170701

  13. Effect of various lipid emulsions on total parenteral nutrition-induced hepatosteatosis in rats.

    PubMed

    Nakagawa, M; Hiramatsu, Y; Mitsuyoshi, K; Yamamura, M; Hioki, K; Yamamoto, M

    1991-01-01

    The effect of various lipid emulsions on the development of fatty liver during total parenteral nutrition (TPN) was investigated in rats given TPN for 7 days. Medium-chain triglycerides (MCT), long-chain triglycerides (LCT), chemically defined triglycerides (CDT; structured lipid with a high purity of 94.3%), and a mixture of MCT and LCT (MIX) were prepared as the lipid emulsions. TPN provided 350 kcal/kg/day, with a nonprotein calorie/nitrogen ratio of 160. The TPN-1 group received 10% nonprotein calories and the TPN-2 group received 30% nonprotein calories. MCT TPN was found to have some disadvantages, especially with regard to nitrogen balance and plasma albumin levels. Total cholesterol and phospholipids tended to be high in the MCT TPN group. The hepatic lipid content was higher in the lipid-free TPN and the MCT TPN groups, and lower in the CDT and LCT TPN groups. Histologically, the livers of the MIX, CDT, and LCT TPN groups showed less fatty change than those of the FREE and MCT groups.

  14. Dry influenza vaccines: towards a stable, effective and convenient alternative to conventional parenteral influenza vaccination.

    PubMed

    Tomar, Jasmine; Born, Philip A; Frijlink, Henderik W; Hinrichs, Wouter L J

    2016-11-01

    Cold-chain requirements, limited stockpiling potential and the lack of potent immune responses are major challenges of parenterally formulated influenza vaccines. Decreased cold chain dependence and stockpiling can be achieved if vaccines are formulated in a dry state using suitable excipients and drying technologies. Furthermore, having the vaccine in a dry state enables the development of non-parenteral patient friendly dosage forms: microneedles for transdermal administration, tablets for oral administration, and powders for epidermal, nasal or pulmonary administration. Moreover, these administration routes have the potential to elicit an improved immune response. This review highlights the rationale for the development of dried influenza vaccines, as well as processes used for the drying and stabilization of influenza vaccines; it also compares the immunogenicity of dried influenza vaccines administered via non-invasive routes with that of parenterally administered influenza vaccines. Finally, it discusses unmet needs, challenges and future developments in the field of dried influenza vaccines.

  15. The choleretic effect of nonsteroidal anti-inflammatory drugs in total parenteral nutrition-associated cholestasis.

    PubMed

    Nussinovitch, M; Zahavi, I; Marcus, H; Hackelman, B; Dinari, G

    1996-12-01

    Cholestasis is a frequent problem in patients on total parenteral nutrition (TPN) therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs), especially aspirin, cause choleresis in animals. We studied the effect of aspirin on bile flow and bile salt secretion in TPN-associated cholestasis in rats. Four groups of 6-10 animals each received either 154 mM NaCl (saline) or 2.5% amino acid solution (TRAVASOL, Travenol, Israel) and 10% glucose i.v. (TPN) for 3 h. During the second and third hours, taurocholate, the main bile salt in rats, was infused at a rate of 10 micromol/min per kg to prevent bile salt pool depletion. Aspirin, one of the main NSAIDs, was infused during the last 2 h into animals with or without TPN treatment at a rate of 100 mg/kg. Bile was directly collected from the common bile duct for 3 h. Rats given TPN showed a significant reduction in bile flow and bile salt secretion rate compared to control groups: 20.89 vs. 29.60 microl/min per kg (P <0.02) and 0.37 vs. 0.65 micromol/min per kg (P <0.0001), respectively. Aspirin had a significant choleretic effect and was able to overcome the bile flow and bile salt secretion rate reduction caused by TPN; 33.07 vs. 20.89 microl/min per kg (P <0.002) and 0.66 vs. 0.37 micromol/min per kg (P <0.0001), respectively. These results may have clinical implications for TPN-associated cholestasis.

  16. Effect of retrograde aminophylline administration on calcium and phosphate solubility in neonatal total parenteral nutrient solutions.

    PubMed

    Kirkpatrick, A E; Holcombe, B J; Sawyer, W T

    1989-12-01

    The effect of retrograde administration of aminophylline injection on calcium and phosphate solubility in neonatal total parenteral nutrient (TPN) solutions was studied. Neonatal TPN solutions containing two amino acids solutions in three concentrations (Travasol 1% and 2% and TrophAmine 2%) were formulated. Calcium and phosphate salts were added to achieve calcium concentrations of 10, 15, 20, 25, 30, or 40 meq/L and phosphorus concentrations of 10, 15, 20, 25, 30, or 40 mmol/L. Samples were inspected visually after 18-24 hours; solutions free of precipitation were then infused through two parallel syringe-pump systems designed to simulate clinical conditions for TPN solution administration to a 1-kg neonate. To one system, a 7.5-mg aminophylline dose was added as a manual retrograde injection; sterile water for injection was added as a manual retrograde injection to the other system. The solutions were inspected throughout a one-hour infusion period for precipitate formation in the i.v. apparatus, and the pH of the effluents was determined. Concurrent aminophylline administration resulted in visible precipitate in all but a few of the solutions tested. The solution containing Travasol 2%, calcium 10 meq/L, and phosphorus 10 mmol/L remained clear, as did the solutions containing TrophAmine 2% and the following concentrations of calcium and phosphorus: calcium 10 meq/L and phosphorus 10, 15, or 20 mmol/L; calcium 15 meq/L and phosphorus 10 or 15 mmol/L; and calcium 20 meq/L and phosphorus 10 or 15 mmol/L. An average increase in pH of 0.63 unit was noted in all solutions.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Urinary saturation and nephrocalcinosis in preterm infants: effect of parenteral nutrition.

    PubMed Central

    Hoppe, B; Hesse, A; Neuhaus, T; Fanconi, S; Forster, I; Blau, N; Leumann, E

    1993-01-01

    Urinary lithogenic and inhibitory factors were studied in 27 preterm infants; 16 had total parenteral nutrition (TPN) and 11 had breastmilk with an additional glucose-sodium chloride infusion. Urines were collected for 24 hours on day 2 (period A), day 3 (B), and once between days 4 and 10 (C). Urinary calcium oxalate saturation was calculated by the computer program EQUIL 2. Renal ultrasonography was performed every second week until discharge. The calcium/creatinine ratio increased in infants on TPN (A 0.91; C 1.68 mol/mol) and was significantly higher at period C than that in infants on breastmilk/infusion (A 0.52; C 0.36). The oxalate/creatinine ratio was persistently higher with TPN (203 mmol/mol) than with breastmilk/infusion (98; 137). The citrate/creatinine remained constant with TPN (0.44 mol/mol), whereas it increased significantly with breastmilk/infusion (0.26; 0.49). Calcium/citrate rose considerably with TPN, but decreased with breastmilk/infusion to a significantly lower level than with TPN. The urinary calcium oxalate saturation increased with TPN (2.4; 4.5) and decreased with breastmilk/infusion (2.1; 1.5) to a significantly lower value than with TPN. Nephrocalcinosis developed in two infants on TPN. Mean daily calcium intake was similar in both groups, whereas protein, sodium, and phosphorus intake were significantly higher on TPN. It is concluded that the increase in urinary calcium oxalate saturation observed with TPN is due to the combined effect of an increased urinary calcium excretion and higher urinary oxalate/creatinine and calcium/citrate ratios. The changes observed are likely to be caused by TPN itself, which differs in several respects from breastmilk feeding. PMID:8215570

  18. [Artificial nutrition in children (II): parenteral access].

    PubMed

    Estevão-Costa, José

    2014-01-01

    Parenteral nutrition is crucial when the use of the gastrointestinal tract is not feasible. This article addresses the main techniques for parenteral access in children, its indications, insertion details and maintenance, and complications. The type of venous access is mainly dictated by the expected duration of parenteral nutrition and by the body weight/stature. The peripheral access is viable and advantageous for parenteral nutrition of short duration (< 2 weeks); a tunneled central venous catheter (Broviac) is usually necessary in long-term parenteral nutrition (> 3 weeks); a peripherally introduced central catheter is an increasingly used alternative. Parenteral accesses are effective and safe, but the morbidity and mortality is not negligible particularly in cases of short bowel syndrome. Most complications are related to the catheter placement and maintenance care, and can be largely avoided when the procedures are carried out by experienced staff under strict protocols.

  19. Total parenteral nutrition - infants

    MedlinePlus

    ... medlineplus.gov/ency/article/007239.htm Total parenteral nutrition - infants To use the sharing features on this page, please enable JavaScript. Total parenteral nutrition (TPN) is a method of feeding that bypasses ...

  20. Effect of sodium metabisulfite on hydrogen peroxide production in light-exposed pediatric parenteral amino acid solutions.

    PubMed

    Brawley, V; Bhatia, J; Karp, W B

    1998-06-15

    The effect of sodium metabisulfite (MBS) on hydrogen peroxide (HP) production in model and commercial amino acid solutions exposed to phototherapy light was studied. Model and commercial pediatric amino acid solutions were prepared such that the amino acid concentration was 1%. MBS concentration, riboflavin concentration, and duration of exposure to phototherapy light were varied to determine the effect on HP production. Control solutions were kept in the dark. HP production was assayed in the model amino acid solutions by using potassium iodide in the presence of ammonium molybdate. In all experiments, HP production was measured at 360 nm in the presence and absence of catalase. In light-exposed solutions, HP production increased linearly for several hours and reached a plateau by eight hours. A mean maximum of 940 microM was produced (data pooled for all solutions). No detectable HP was generated in the solutions kept in the dark. After two hours of light exposure, it was necessary to add at least 10 times more MBS than is typically found in commercial total parenteral nutrient solutions to scavenge all the HP produced. An average of up to 940 microM of HP was produced in model and commercial pediatric parenteral 1% amino acid solutions in the presence of phototherapy light and clinically relevant concentrations of riboflavin and MBS. Light exposure decreased the antioxidant effect of MBS.

  1. Carnitine deficiency in premature infants receiving total parenteral nutrition: effect of L-carnitine supplementation.

    PubMed

    Schmidt-Sommerfeld, E; Penn, D; Wolf, H

    1983-06-01

    To investigate whether L-carnitine supplementation may correct nutritional carnitine deficiency and associated metabolic disturbances in premature infants receiving total parenteral nutrition, an intravenous fat tolerance test (1 gm/kg Intralipid over four hours) was performed in 29 premature infants 6 to 10 days of age (15 receiving carnitine supplement 10 mg/kg . day L-carnitine IV, and 14 receiving no supplement). Total carnitine plasma values were normal or slightly elevated in supplemented but decreased in nonsupplemented infants. In both groups, fat infusion resulted in an increase in plasma concentrations of triglycerides, free fatty acids, D-beta-hydroxybutyrate, and short-chain and long-chain acylcarnitine, but total carnitine values did not change. After fat infusion, the free fatty acids/D-beta-hydroxybutyrate ratios were lower and the increase of acylcarnitine greater in supplemented infants of 29 to 33 weeks' gestation than in nonsupplemented infants of the same gestational age. This study provides evidence that premature infants of less than 34 weeks' gestation requiring total parenteral nutrition develop nutritional carnitine deficiency with impaired fatty acid oxidation and ketogenesis. Carnitine supplementation improves this metabolic disturbance.

  2. Home initiation of parenteral nutrition.

    PubMed

    Newton, Alyce F; DeLegge, Mark H

    2007-02-01

    Parenteral nutrition (PN) has been successfully initiated in the home since the early 1990s. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Standards for Specialized Nutrition Support: Home Care Patients, Safe Practices for Parenteral Nutrition, and Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients do not contain specific information on the initiation of home PN (HPN). Peer-reviewed, published guidelines are necessary to provide safe and appropriate initiation of HPN. Certain patients should not have PN initiated in the home, such as those with organ failure, uncontrolled diabetes, or uncorrectable electrolyte abnormalities. Excellent candidates for initiation of HPN include patients who have failed enteral feedings, have gastrointestinal (GI) diseases without excessive GI losses, or those with an oncology diagnosis and inability to tube feed. One concern of initiation of HPN is the potential for refeeding syndrome. Refeeding syndrome can be prevented when patients are properly evaluated and managed before initiation of PN. Refeeding syndrome can be avoided by rehydration with fluid and electrolytes before initiation of HPN to normalize blood chemistry when necessary and by starting with a moderate-volume, low-carbohydrate HPN solution compounded with optimal potassium, phosphorus, and magnesium content, and slowly advanced to goal. The "start low and go slow" motto of nutrition support should continue to be followed, but more specific guidelines are needed to assist nutrition support clinicians with safe and appropriate initiation of HPN.

  3. Parenteral iron dextran therapy: a review.

    PubMed

    Burns, D L; Mascioli, E A; Bistrian, B R

    1995-01-01

    Iron dextran was introduced more than 30 yr ago for the parenteral treatment of iron deficiency anemia that is refractory to oral therapy. Iron dextran is a preparation of ferric hydroxide complexed with a low molecular weight fraction of dextran. Iron deficiency anemia is one of the most common nutritional deficiency diseases and occurs worldwide secondary to inadequate dietary iron, usually with excessive gastrointestinal blood losses. Repletion of iron stores is often complicated by intolerance to oral iron supplementation and may require parenteral iron. Parenteral iron can be administered via the intramuscular or intravenous route either directly or as an additive to total parenteral nutrition. Both routes of administration can cause various side effects and a test dose is recommended before therapeutic administration to assess the risk for anaphylaxis. Although the efficacy and safety of parenteral iron dextran have been convincingly demonstrated, supplementation may be contraindicated in the setting of infection.

  4. Effects of luminal nutrient absorption, intraluminal physical stimulation, and intravenous parenteral alimentation on the recovery responses of duodenal villus morphology following feed withdrawal in chickens.

    PubMed

    Tarachai, P; Yamauchi, K

    2000-11-01

    The aim of this study was to clarify which of the following three factors induces villus morphological recovery best: enteral nutrient absorption, intraluminal physical stimulation, or intravenous parenteral alimentation. At 142 d, male White Leghorn chickens (Gallus gallus domesticus) were divided into eight groups of five birds each as follows: 1) access given ad libitum to a commercial layer mash diet (CP, 17.5%; ME, 2,830 kcal/kg) (control), 2) 5-d feed withdrawal (feed withdrawal), 3) 3-d feed withdrawal (3-FW), followed by refeeding the same diet as the control for 2 d (refeeding), 4) 3-FW followed by force-feeding enteral hyperalimentation (enteral), 5) 3-FW followed by force-feeding an indigestible (nonabsorbable) substance (kaolin), 6) 3-FW followed by force-feeding water for 2 d (force-fed control), 7) 3-FW followed by parenteral hyperalimentation (parenteral), and 8) 3-FW followed by no alimentation (sham control) for 2 d. In the refeeding and enteral groups, BW significantly recovered (P < 0.05), and in the parenteral group, BW tended to increase, suggesting that nutrients were enterally and parenterally absorbed, respectively. The BW in the remaining three groups showed a significant decrease (P < 0.05), indicating that kaolin could not be absorbed enterally. Compared with the feed withdrawal group, villus height, cell mitosis, and villus tip surface morphology of refeeding and enteral groups exhibited rapid villus morphological recovery. Villus morphological recovery of the enteral group appears to have been caused by enteral nutrient absorption. However, villus morphology in the kaolin treatment was not different from that in the feed withdrawal group, which suggests that intraluminal physical stimulation had no effect on villus morphological recovery. On the other hand, the parenteral group showed no effect on villus morphological recovery, which suggests that the parenteral nutrient supplied to the villi via the blood could not induce villus

  5. Parenteral nutrition supplemented with short-chain fatty acids: effect on the small-bowel mucosa in normal rats.

    PubMed

    Koruda, M J; Rolandelli, R H; Bliss, D Z; Hastings, J; Rombeau, J L; Settle, R G

    1990-04-01

    When enteral nutrition is excluded from animals maintained solely with total parenteral nutrition (TPN), atrophy of the intestinal mucosa is observed. Short-chain fatty acids (SCFAs) are produced in the colon by the fermentation of dietary carbohydrates and fiber polysaccharides and have been shown to stimulate mucosal-cell mitotic activity in the intestine. This study compared the effects of an intravenous and an intracecal infusion of SCFAs on the small-bowel mucosa. Rats received standard TPN, TPN with SCFAs (sodium acetate, propionate, and butyrate), TPN with an intracecal infusion of SCFAs, or rat food. After 7 d jejunal and ileal mucosal weights, DNA, RNA, and protein were determined. Standard TPN produced significant atrophy of the jejunal and ileal mucosa. Both the intracecal and intravenous infusion of SCFAs significantly reduced the mucosal atrophy associated with TPN. The intravenous and intracolonic infusion of SCFAs were equally effective in inhibiting small-bowel mucosal atrophy.

  6. Beneficial effect of prolonged total parenteral nutrition in a very malnourished cystic fibrosis patients.

    PubMed

    Antonelli, M; Cappello, G; Cortinovis, A M; De Pinto, M; Bertasi, S

    1990-01-01

    A very malnourished Cystic Fibrosis (CF) patient was treated with integrative Parenteral Nutrition (PN). With a mean caloric supplementation of 2,550 Kcal/day a weight gain of 6.5 Kg was achieved. In spite of severe pulmonary complications (pneumotorax and pneumomediastinum), pO2 increased from 53 to 72 mmHg and pCO2 from 38 to 56 mm Hg. General conditions improved, appetite was restored and the patient cleared off continuous oxygen therapy; he left the hospital and did not present any more pulmonary exacerbations. In the following 8-month period he maintained a daily caloric intake of 80 Kcal/kg with a further weight gain of 4.5 Kg.

  7. Parenteral Nutrition: Amino Acids.

    PubMed

    Hoffer, Leonard John

    2017-03-10

    There is growing interest in nutrition therapies that deliver a generous amount of protein, but not a toxic amount of energy, to protein-catabolic critically ill patients. Parenteral amino acids can achieve this goal. This article summarizes the biochemical and nutritional principles that guide parenteral amino acid therapy, explains how parenteral amino acid solutions are formulated, and compares the advantages and disadvantages of different parenteral amino acid products with enterally-delivered whole protein products in the context of protein-catabolic critical illness.

  8. Parenteral Nutrition: Amino Acids

    PubMed Central

    Hoffer, Leonard John

    2017-01-01

    There is growing interest in nutrition therapies that deliver a generous amount of protein, but not a toxic amount of energy, to protein-catabolic critically ill patients. Parenteral amino acids can achieve this goal. This article summarizes the biochemical and nutritional principles that guide parenteral amino acid therapy, explains how parenteral amino acid solutions are formulated, and compares the advantages and disadvantages of different parenteral amino acid products with enterally-delivered whole protein products in the context of protein-catabolic critical illness. PMID:28287411

  9. Effects of glucose or fat calories in total parenteral nutrition on fat metabolism and systemic inflammation in rats.

    PubMed

    Ling, Pei-Ra; Andersson, Charlotte; Strijbosch, Robert; Lee, Sang; Silvestri, Anthony; Gura, Kathleen M; Puder, Mark; Bistrian, Bruce R

    2011-02-01

    This study compared the effects of total parenteral nutrition (TPN) by central vein with or without fat provided at maintenance energy requirement on fatty acid metabolism, de novo lipogenesis, and the risk of hepatic and systemic inflammation in rats. Study 1 was conducted in 2 groups: high glucose (HG), where fat-free TPN was given at maintenance levels of 180 kcal/(kg d), and low glucose (LG), where fat-free TPN containing 30% fewer calories at 126 kcal/(kg d) was provided by reducing 54 kcal/(kg d) from parenteral glucose. Study 2 contained 3 TPN groups: 1 LG group at 126 kcal/(kg d) and 2 groups at 180 kcal/(kg d) with 30% of total calories (54 kcal/[kg d]) either from soybean or fish oil emulsion. In both studies, animals fed a chow diet ad libitum were included. Plasma and hepatic triglyceride and phospholipid fatty acid profiles, enzymes indicating hepatic injury, and C-reactive protein levels (CRP) reflecting systemic injury were measured. In study 1, evidence of de novo lipogenesis was noted in LG and was more prominent in HG with elevation of CRP in HG. In study 2, de novo lipogenesis was reduced by adding either fat to LG to achieve maintenance energy levels. Moreover, adding fat as soybean oil but not fish oil significantly increased plasma and hepatic triglyceride and also elevated aspartate aminotransferase and CRP levels, reflecting inflammation. Thus, in rats, either hypocaloric feeding as glucose-based TPN or TPN provided at maintenance energy levels with the addition of fish oil limits hepatic lipid accumulation and prevents the evidence of hepatic and systemic injury found with maintenance level TPN as glucose only or glucose plus soybean oil.

  10. Odd-numbered medium-chain triglycerides (trinonanoin) in total parenteral nutrition: effects on parameters of fat metabolism in rabbits.

    PubMed

    Linseisen, J; Wolfram, G

    1993-01-01

    Odd-numbered medium-chain triglycerides (MCTs) might combine the advantages of "usual" MCTs applied in clinical nutrition with lower ketogenic action and the release of three carbon units. To test subacute toxicity, trinonanoin/long-chain triglyceride (LCT) (7/3 wt/wt) fat emulsions were given to rabbits (n = 8) for 11 days (7 h/d) within a total parenteral nutrition regimen at a dose of 46.5% of total daily energy. Comparisons were made with rabbits receiving equicaloric amounts of MCT/LCT (7/3, wt/wt) or pure LCT fat emulsions, as well as with orally fed controls. The trinonanoin/LCT emulsion was well tolerated by all animals. Body weight changes showed no statistically significant differences between groups. The enzymatic determination of triglycerides, non-esterified fatty acids, and free glycerol concentrations in plasma samples revealed similar results for both MCT groups. However, ketone body concentrations (3-hydroxybutyrate) were significantly lower after trinonanoin/LCT emulsion administration. In the trinonanoin/LCT group, the plasma concentrations of propionic acid as well as of other short-chain fatty acids continuously increased; on days 10 and 11, elevated amounts of propionic acid were also detected in the urine. The histologic examination of the gut mucosa revealed no distinct differences between groups. On the basis of the presented data, the trinonanoin/LCT emulsion showed no inferiority to "usual" MCT/LCT emulsions. The lower ketogenic effect as well as the marked increase in plasma short-chain fatty acid concentrations may encourage further testing of this substrate for total parenteral nutrition.

  11. Antifertility and mutagenic effects in mice from parenteral administration of di-2-ethylhexyl phthalate (DEHP)

    SciTech Connect

    Agarwal, D.K.; Lawrence, W.H.; Autian, J.

    1985-01-01

    The subcutaneous administration of 1-10 mg of undiluted di-(2-ethylhexyl)phthalate (DEHP) to adult male ICR mice on d 1, 5, and 10 was followed by mating, one to one, with untreated adult virgin females. A single mating at d 21 resulted in a reduction in the incidence of pregnancies in the DEHP-treated groups. On the other hand, repeated matings with fresh females starting on d 2, 6, 11, 16, and 21, and at weekly intervals through 8 wk, revealed no perceptible effect of DEHP on the incidence of pregnancy. Examination of surgically exposed uteri and ovaries of pregnant females on d 13 of gestation revealed an increase in the incidence of preimplantation losses and early fetal deaths in the DEHP-treated groups; consequently, there were fewer viable fetuses per pregnancy. Mutagenic indices for DEHP, calculated as percent ratios of (1) preimplantation losses/implantations per pregnancy and (2) early fetal deaths/implantations per pregnancy, suggested a dominant lethal mutation effect in the treated mice. These effects tend to be more pronounced on the postmiotic stage of germ-cell development.

  12. The Effect of Fish Oil-Based Lipid Emulsion and Soybean Oil-Based Lipid Emulsion on Cholestasis Associated with Long-Term Parenteral Nutrition in Premature Infants

    PubMed Central

    Wang, Leilei; Zhang, Jing; Gao, Jiejin; Qian, Yan; Ling, Ya

    2016-01-01

    Purpose. To retrospectively study the effect of fish oil-based lipid emulsion and soybean oil-based lipid emulsion on cholestasis associated with long-term parenteral nutrition in premature infants. Methods. Soybean oil-based lipid emulsion and fish oil-based lipid emulsion had been applied in our neonatology department clinically between 2010 and 2014. There were 61 qualified premature infants included in this study and divided into two groups. Soybean oil group was made up of 32 premature infants, while fish oil group was made up of 29 premature infants. Analysis was made on the gender, feeding intolerance, infection history, birth weight, gestational age, duration of parenteral nutrition, total dosage of amino acid, age at which feeding began, usage of lipid emulsions, and incidence of cholestasis between the two groups. Results. There were no statistical differences in terms of gender, feeding intolerance, infection history, birth weight, gestational age, duration of parenteral nutrition, total dosage of amino acid, and age at which feeding began. Besides, total incidence of cholestasis was 21.3%, and the days of life of occurrence of cholestasis were 53 ± 5.0 days. Incidence of cholestasis had no statistical difference in the two groups. Conclusion. This study did not find the different role of fish oil-based lipid emulsions and soybean oil-based lipid emulsions in cholestasis associated with long-term parenteral nutrition in premature infants. PMID:27110237

  13. Total parenteral nutrition.

    PubMed

    Domínguez-Cherit, Guillermo; Borunda, Delia; Rivero-Sigarroa, Eduardo

    2002-08-01

    In recent months, numerous reports concerning total parenteral nutrition in critically ill patients have been published, including the guidelines and recommendations of the American Society for Parenteral and Enteral Nutrition. The old controversy regarding the use of the enteral versus parenteral route still exists. Although the enteral route is indicated in those patients with normal gastrointestinal function, the parenteral route is obviously beneficial in several clinical conditions and appears to be associated with few procedure-related complications when performed by experienced clinicians. There is also continued interest in the supplementation of parenteral formulas with nutrients that were previously considered nonessential, such as arginine, glutamine, and omega-3 fatty acids, but that may become essential in the setting of critical illness.

  14. Parenteral iron supplementation.

    PubMed

    Kumpf, V J

    1996-08-01

    Indications for the use of parenteral iron are limited to conditions in which the oral supplementation of iron is not possible or fails. An overview of iron balance and iron requirements is presented to describe situations in which iron supplementation may be required. When parenteral iron supplementation is required, careful attention to proper dosing and administration is necessary to optimize efficacy and safety. The purpose of this article is to review the literature regarding the clinical use of parenteral iron therapy and provide guidelines on dosing and administration. Methods of iron dextran administration, including the IV and intramuscular injection of undiluted drug and total dose infusion, are compared. Complications associated with the use of parenteral iron are also be reviewed. Finally, the use of iron supplementation in patients receiving parenteral nutrition care explored.

  15. The Effect of Individualized Versus Standardized Parenteral Nutrition on Body Weight in Very Preterm Infants

    PubMed Central

    Evering, Vincent H. M.; Andriessen, Peter; Duijsters, Carola E. P. M.; Brogtrop, Jeroen; Derijks, Luc J. J.

    2017-01-01

    Background This study was designed to evaluate whether standardizing total parenteral nutrition (TPN) is at least non-inferior to TPN with individualized composition in premature infants with a gestational age (GA) < 32 weeks. Methods In this retrospective cohort study, all preterm born in or transferred to Maxima Medical Center (MMC) within 24 hours after birth with a GA < 32 weeks were included. The individualized group (2011) was compared to the partially standardized group (2012) and completely standardized group (2014) consequently. The primary endpoint was difference in growth. Secondary endpoints included differences in electrolyte concentrations. Results A total of 299 preterm were included in this study. When comparing weight gain, the infants in the (partially) standardized group demonstrated significantly (P < 0.05) less weight loss during the first days of life and grew faster subsequently in the following days than the individualized TPN regimen. Furthermore, significant differences in abnormal serum sodium, chloride, calcium, creatinine, magnesium and triglycerides values were demonstrated. Conclusion TPN with a (partially) standardized composition revealed to be at least non-inferior to TPN with an individualized composition. PMID:28270894

  16. Parenteral nutrition: never say never

    PubMed Central

    2015-01-01

    This review emphasizes the benefits of parenteral nutrition (PN) in critically ill patients, when prescribed for relevant indications, in adequate quantities, and in due time. Critically ill patients are at risk of energy deficit during their ICU stay, a condition which leads to unfavorable outcomes, due to hypercatabolism secondary to the stress response and the difficulty to optimize feeding. Indirect calorimetry is recommended to define the energy target, since no single predictive equation accurately estimates energy expenditure. Energy metabolism is intimately associated with protein metabolism. Recent evidence calls for adequate protein provision, but there is no accurate method to estimate the protein requirements, and recommendations are probably suboptimal. Enteral nutrition (EN) is the preferred route of feeding, but gastrointestinal intolerance limits its efficacy and PN allows for full coverage of energy needs. Seven recent articles concerning PN for critically ill patients were identified and carefully reviewed for the clinical and scientific relevance of their conclusions. One article addressed the unfavorable effects of early PN, although this result should be more correctly regarded as a consequence of glucose load and hypercaloric feeding. The six other articles were either in favor of PN or concluded that there was no difference in the outcome compared with EN. Hypercaloric feeding was not observed in these studies. Hypocaloric feeding led to unfavorable outcomes. This further demonstrates the beneficial effects of an early and adequate feeding with full EN, or in case of failure of EN with exclusive or supplemental PN. EN is the first choice for critically ill patients, but difficulties providing optimal nutrition through exclusive EN are frequently encountered. In cases of insufficient EN, individualized supplemental PN should be administered to reduce the infection rate and the duration of mechanical ventilation. PN is a safe therapeutic option

  17. Parenteral microemulsions: an overview.

    PubMed

    Date, Abhijit A; Nagarsenker, M S

    2008-05-01

    Parenteral delivery of the hydrophobic drugs is a very challenging task. The conventional approaches such as use of co-solvents, oily vehicles and modern approaches such as mixed micelles, liposomes, complexation with cyclodextrins and emulsions have several limitations. Microemulsions have evolved as a novel vehicle for parenteral delivery of the hydrophobic drugs. Their interesting features such as spontaneity of formation, ease of manufacture, high solubilization capacity and self-preserving property make them the vehicle of choice. The review focuses on the excipients available for formulation of the parenteral microemulsions and describes the investigations reported for the various classes of therapeutic agents.

  18. Parenteral iron therapy options.

    PubMed

    Silverstein, Scott B; Rodgers, George M

    2004-05-01

    Parenteral iron therapy is occasionally necessary for patients intolerant or unresponsive to oral iron therapy, for receiving recombinant erythropoietin therapy, or for use in treating functional iron deficiency. There are now three parenteral iron products available: iron dextran, ferric gluconate, and iron sucrose. We summarize the advantages and disadvantages of each product, including risk of anaphylaxis and hypersensitivity, dosage regimens, and costs. The increased availability of multiple parenteral iron preparations should decrease the need to use red cell transfusions in patients with iron-deficiency anemia.

  19. Parenteral iron dextran therapy.

    PubMed

    Kumpf, V J; Holland, E G

    1990-02-01

    Parenteral iron therapy is indicated in patients with iron-deficiency anemia associated with conditions that interfere with the ingestion or absorption of oral iron. Replacement doses of iron required to replenish iron stores are based on body weight and the observed hemoglobin value. Methods of administering iron dextran are reviewed, including intramuscular and intravenous injections of the undiluted drug, intravenous infusion of a diluted preparation, and as an addition to parenteral nutrition solutions. The overall incidence of adverse reactions associated with the parenteral administration of iron is low, but the potential for an anaphylactic reaction requires that an initial test dose be given followed by careful patient observation.

  20. Parenteral nutrition: indications, risks and nursing care.

    PubMed

    Fletcher, Jane

    Parenteral nutrition is a recognised method of feeding patients with specific clinical conditions, most notably those with various forms of intestinal failure who cannot be fed enterally. However, it has several associated risks including sepsis, and metabolic and electrolyte imbalances. The aim of this article is to enhance nurses' understanding of parenteral nutrition and how this differs from oral or enteral nutrition, indications for use and the potential risks involved. Appropriate vascular access is discussed as well as the clinical monitoring that is required to ensure complications of therapy are detected quickly. A greater understanding of the issues associated with parenteral nutrition allows nurses caring for patients receiving parenteral nutrition to ensure safe and effective care.

  1. Effect of myrrh and thyme on Trichinella spiralis enteral and parenteral phases with inducible nitric oxide expression in mice.

    PubMed

    Attia, Rasha A H; Mahmoud, Abeer E; Farrag, Haiam Mohammed Mahmoud; Makboul, Rania; Mohamed, Mona Embarek; Ibraheim, Zedan

    2015-12-01

    Trichinellosis is a serious disease with no satisfactory treatment. We aimed to assess the effect of myrrh (Commiphora molmol) and, for the first time, thyme (Thymus vulgaris L.) against enteral and encysted (parenteral) phases of Trichinella spiralis in mice compared with albendazole, and detect their effect on inducible nitric oxide synthase (iNOS) expression. Oral administration of 500 mg/kg of myrrh and thyme led to adult reduction (90.9%, 79.4%), while 1,000 mg/kg led to larvae reduction (79.6%, 71.3%), respectively. Administration of 50 mg/kg of albendazole resulted in adult and larvae reduction (94.2%, 90.9%). Positive immunostaining of inflammatory cells infiltrating intestinal mucosa and submucosa of all treated groups was detected. Myrrh-treated mice showed the highest iNOS expression followed by albendazole, then thyme. On the other hand, both myrrh and thyme-treated groups showed stronger iNOS expression of inflammatory cells infiltrating and surrounding encapsulated T. spiralis larvae than albendazole treated group. In conclusion, myrrh and thyme extracts are highly effective against both phases of T. spiralis and showed strong iNOS expressions, especially myrrh which could be a promising alternative drug. This experiment provides a basis for further exploration of this plant by isolation and retesting the active principles of both extracts against different stages of T. spiralis.

  2. Effect of myrrh and thyme on Trichinella spiralis enteral and parenteral phases with inducible nitric oxide expression in mice

    PubMed Central

    Attia, Rasha AH; Mahmoud, Abeer E; Farrag, Haiam Mohammed Mahmoud; Makboul, Rania; Mohamed, Mona Embarek; Ibraheim, Zedan

    2015-01-01

    Trichinellosis is a serious disease with no satisfactory treatment. We aimed to assess the effect of myrrh (Commiphora molmol) and, for the first time, thyme (Thymus vulgaris L.) against enteral and encysted (parenteral) phases of Trichinella spiralis in mice compared with albendazole, and detect their effect on inducible nitric oxide synthase (iNOS) expression. Oral administration of 500 mg/kg of myrrh and thyme led to adult reduction (90.9%, 79.4%), while 1,000 mg/kg led to larvae reduction (79.6%, 71.3%), respectively. Administration of 50 mg/kg of albendazole resulted in adult and larvae reduction (94.2%, 90.9%). Positive immunostaining of inflammatory cells infiltrating intestinal mucosa and submucosa of all treated groups was detected. Myrrh-treated mice showed the highest iNOS expression followed by albendazole, then thyme. On the other hand, both myrrh and thyme-treated groups showed stronger iNOS expression of inflammatory cells infiltrating and surrounding encapsulated T. spiralis larvae than albendazole treated group. In conclusion, myrrh and thyme extracts are highly effective against both phases of T. spiralis and showed strong iNOS expressions, especially myrrh which could be a promising alternative drug. This experiment provides a basis for further exploration of this plant by isolation and retesting the active principles of both extracts against different stages of T. spiralis. PMID:26676322

  3. Effects of parenteral fish oil lipid emulsions on colon morphology and cytokine expression after experimental colitis.

    PubMed

    Garib, Ricardo; Garla, Priscila; Torrinhas, Raquel S; Bertevello, Pedro L; Logullo, Angela F; Waitzberg, Dan L

    2013-01-01

    Objetivo: Estudiar los efectos de los diferentes protocolos de infusión de la emulsion de lípidos de aceite de pescado (Fole) sobre la inflamación aguda en el modelo de colitis en la rata. Material y métodos: Ratas Wistar macho adultas (n = 51) fueron asignados al azar en 5 grupos para recibir infusión parenteral de solución salina (SS) o emulsión de lípidos de aceite de soja (SO), como controles, y Fole compone de: aceite de pescado solo (FO), una mezcla (9:1 v/v) de SO con FO (SO/FO), o 30% de aceite de soja, 30% triglicéridos de cadena media, 25% de aceite de oliva, y 15% de aceite de pescado (SMOF). Después de 72 h de infusión intravenosa, colitis experimental fue inducida con ácido acético. Después de 24 h, las muestras de colon se analizaron para determinar cambios histológicos y citoquinas. Resultados: En relación en el SS grupo, necrosis macroscópica fue menos frecuente en el grupo FO y necrosis histológica fue más frecuente en el grupo de SMOF. Existe una relación directa e inversa de colon interleuquina (IL) -1 e IL-4, respectivamente, con necrosis histológica. En comparación con el grupo SS, en el FO hubo aumento de IL-4 e IFN-gamma y disminución de TNF-alfa, SO/FO disminuyó TNF-alfa, y en el SMOF hubo aumento de IL-1 y la disminución de IL-4. Conclusión: En la colitis inducida por ácido acético, la infusion aislada de Fole compuesto de aceite de pescado por sí solo fue más ventajosa en la atenuacion de la inflamacióndo que la infusión de Fole contiendo otros aceites, y esta diferencia puede ser debida las influencias de su diferente contenido de ácido graso.

  4. [Indication and effectiveness of endoscopic percutaneous gastrostomy as a route of parenteral alimentation for the home care patient].

    PubMed

    Ueda, T; Hida, S; Higasa, K; Shinomiya, S; Matsumoto, T; Fukuoka, K; Yamanaka, E; Ozaki, S; Takayama, E

    2000-12-01

    We are managing 8 home care patients who have a gastrostomy made using an endoscopic percutaneous technique as a route of parenteral alimentation. Based on our experience, the preconditions for an endoscopic percutaneous gastrostomy as a route of parenteral alimentation are 1. normal gastrointestinal function, 2. difficulty in swallowing, 3. possibility that the caregiver can manage the gastrostomy. When we performed an endoscopic percutaneous gastrostomy as a route of parenteral alimentation for 8 home care patients, we obtained the several advantages mentioned below. 1. Swallowing pneumonia was prevented. 2. Adequate amount of alimental liquid could be infused. 3. Patient could take a bath or shower with the gastrostomy, and good QOL was realized. 4. The home care patient with the gastrostomy could have a satisfactorily long life.

  5. New parenteral anticoagulants in development.

    PubMed

    Gómez-Outes, Antonio; Suárez-Gea, Maria Luisa; Lecumberri, Ramón; Rocha, Eduardo; Pozo-Hernández, Carmen; Vargas-Castrillón, Emilio

    2011-02-01

    The therapeutic armamentarium of parenteral anticoagulants available to clinicians is mainly composed by unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), fondaparinux, recombinant hirudins (i.e. bivalirudin, desirudin, lepirudin) and argatroban. These drugs are effective and safe for prevention and/or treatment of thromboembolic diseases but they have some drawbacks. Among other inconveniences, UFH requires regular anticoagulant monitoring as a result of variability in the anticoagulant response and there is a risk of serious heparin-induced thrombocytopaenia (HIT). LMWH, fondaparinux and recombinant hirudins are mainly cleared through the kidneys and their use in patients with severe renal insufficiency may be problematic. LMWH is only partially neutralized by protamine while fondaparinux and recombinant hirudins have no specific antidote. Novel anticoagulants in development for parenteral administration include new indirect activated factor Xa (FXa) inhibitors (idrabiotaparinux, ultra-low-molecular-weight heparins [semuloparin, RO-14], new LMWH [M118]), direct FXa inhibitors (otamixaban), direct FIIa inhibitors (flovagatran sodium, pegmusirudin, NU172, HD1-22), direct FXIa inhibitors (BMS-262084, antisense oligonucleotides targeting FXIa, clavatadine), direct FIXa inhibitors (RB-006), FVIIIa inhibitors (TB-402), FVIIa/tissue factor inhibitors (tifacogin, NAPc2, PCI-27483, BMS-593214), FVa inhibitors (drotrecogin alpha activated, ART-123) and dual thrombin/FXa inhibitors (EP217609, tanogitran). These new compounds have the potential to complement established parenteral anticoagulants. In the present review, we discuss the pharmacology of new parenteral anticoagulants, the results of clinical studies, the newly planned or ongoing clinical trials with these compounds, and their potential advantages and drawbacks over existing therapies.

  6. Surgery and transplantation – Guidelines on Parenteral Nutrition, Chapter 18

    PubMed Central

    Weimann, A.; Ebener, Ch.; Holland-Cunz, S.; Jauch, K. W.; Hausser, L.; Kemen, M.; Kraehenbuehl, L.; Kuse, E. R.; Laengle, F.

    2009-01-01

    In surgery, indications for artificial nutrition comprise prevention and treatment of catabolism and malnutrition. Thus in general, food intake should not be interrupted postoperatively and the re-establishing of oral (e.g. after anastomosis of the colon and rectum, kidney transplantation) or enteral food intake (e.g. after an anastomosis in the upper gastrointestinal tract, liver transplantation) is recommended within 24 h post surgery. To avoid increased mortality an indication for an immediate postoperatively artificial nutrition (enteral or parenteral nutrition (PN)) also exists in patients with no signs of malnutrition, but who will not receive oral food intake for more than 7 days perioperatively or whose oral food intake does not meet their needs (e.g. less than 60–80%) for more than 14 days. In cases of absolute contraindication for enteral nutrition, there is an indication for total PN (TPN) such as in chronic intestinal obstruction with a relevant passage obstruction e.g. a peritoneal carcinoma. If energy and nutrient requirements cannot be met by oral and enteral intake alone, a combination of enteral and parenteral nutrition is indicated. Delaying surgery for a systematic nutrition therapy (enteral and parenteral) is only indicated if severe malnutrition is present. Preoperative nutrition therapy should preferably be conducted prior to hospital admission to lower the risk of nosocomial infections. The recommendations of early postoperative re-establishing oral feeding, generally apply also to paediatric patients. Standardised operative procedures should be established in order to guarantee an effective nutrition therapy. PMID:20049072

  7. Effects unrelated to anti-inflammation of lipid emulsions containing fish oil in parenteral nutrition for adult patients.

    PubMed

    Mateu de Antonio, Javier; Florit-Sureda, Marta

    2017-02-01

    Several reviews and meta-analyses on modulated inflammatory and immunologic responses after the administration of omega-3 polyunsaturated fatty acids (PUFAs) in different diseases and conditions have been published. However, omega-3 PUFAs exert several other actions which are not directly related to immunologic or inflammatory responses. The aim of this paper was to review the effects which are not directly related to immunologic and inflammatory responses of intravenous lipid emulsions (IVLEs) containing fish oil (FO) in parenteral nutrition (PN) for adult patients. IVLEs containing FO could have a role in the prevention of alterations in liver enzyme tests (LETs) or PN-associated liver disease (PNALD). Studies using FO doses of ≥ 0.150 mg/kg/day or IVLEs with high FO concentration reported more positive results than those with lower doses. Once PNALD was developed, the use of IVLEs exclusively composed of FO at doses of 0.25-1 g of FO/kg/day for several weeks could attenuate or even eradicate cholestasis and liver alteration. IVLEs containing FO seemed to have faster blood clearance, and this could be beneficial for some patients. Some studies also suggested a possible improvement of respiratory function by the administration of these IVLEs. In general, IVLEs containing FO were safe. Their use did not increase oxidative stress but, in contrast, increased plasma tocopherol content. They did not alter insulin sensitivity or glycemic control, and studies have found no relevant clinical effect on platelet aggregation or hemostasis. In conclusion, the use of IVLEs containing FO in PN may be beneficial with regard to older IVLEs, in addition to the modulation of systemic inflammation response.

  8. Effects of phosphate buffer in parenteral drugs on particle formation from glass vials.

    PubMed

    Ogawa, Toru; Miyajima, Makoto; Wakiyama, Naoki; Terada, Katsuhide

    2013-01-01

    The characteristics of inorganic particles generated in glass vials filled with phosphate buffer solutions were investigated. During storage, particles were visually detected in the phosphate buffer solution in particular glass vials which pass compendial tests of containers for injectable drugs. These particles were considered to be different from ordinal glass delamination, which has been reported in a number of papers because the particles were mainly composed of Al, P and O, but not Si. The formation of the particles accelerated at higher storage temperatures. Among the surface treatments tested for the glass vials, sulfur treatment showed a protective effect on the particle formation in the vials, whereas the SiO(2) coating did not have any protective effects. It was found that the elution ratio of Al and Si in the solution stored in the glass vials after the heating was similar to the ratio of Al and Si in borosilicate glass. However, the Al concentration decreased during storage (5°C, 6 months), and consequently, particle formation was observed in the solution. Adding citrate, which is a chelating agent for Al, effectively suppressed the particle formation in the heated solution. When 50 ppb and higher concentrations of Al ion were added to the phosphate buffer solution, the formation of white particles containing Al, P and O was detected. It is suggested that a phosphate buffer solution in a borosilicate glass vial has the ability to form particles due to interactions with the Al that is eluted from the glass during storage.

  9. The Effectiveness of Early Intervention.

    ERIC Educational Resources Information Center

    Guralnick, Michael J., Ed.

    This book reviews research on the effectiveness of early intervention for children with disabilities or who are at risk. Program factors for children at risk and with disabilities, the effects of early intervention on different types of disabilities, and the outcomes of early intervention are explored. Chapters include: "Second-Generation Research…

  10. Differential effects of orally versus parenterally administered qinghaosu derivative artemether in dogs.

    PubMed

    Classen, W; Altmann, B; Gretener, P; Souppart, C; Skelton-Stroud, P; Krinke, G

    1999-11-01

    Artemether (AM) is an antimalarial drug derived from artemisinin (Qinghaosu), an extract of the herb Artemisia annua L., sweet wormwood. Its antiparasitic effect is that of a schizontocide and is explained by rapid uptake by parasitized erythrocytes and interaction with a component of hemoglobin degradation resulting in formation of free radicals. It has been shown to exhibit a high clinical cure rate. Previous animal safety studies with Qinghaosu derivatives revealed dose-dependent neurotoxicity with movement disturbances and neuropathic changes in the hindbrain of intramuscularly treated dogs, rats and monkeys. Such effects have not been seen in man. The objective of our present studies was to compare the effects of high levels of AM administered to dogs p.o. versus i.m. In a pilot study 20 mg/kg/day of AM was given i.m. to groups of 3 male Beagle dogs for 5 and 30 days, respectively. Clinical signs of neurotoxicity were noted in some individual dogs from test day 23 on. One dog had to be sacrificed pre-term. Hematologic findings indicated a hypochromic, microcytic anemia. Microscopic examination demonstrated neuropathic changes only at 30 days, but not at 5 days. The animals had neuronal and secondary axonal damage, most prominent in the cerebellar roof, pontine and vestibular nuclei, and in the raphe/paralemniscal region. The affected neurons showed loss of Nissl substance, cytoplasmic eosinophilia, shrinkage of the nucleus and in advanced stages scavenging by microglia. In a subsequent experiment, AM was administered to groups of 4 male and 4 female dogs, respectively, at 8 daily doses of 0, 20, 40 and 80 mg/kg i.m., or 0, 50, 150 and 600 mg/kg p.o. Neurologic signs were seen at high i.m. doses only. In most animals they were inconspicuous and consisted of reduced activity with convulsions seen in single dogs shortly before death. Neuronal damage occurred in all animals at 40 and 80 mg/kg following i.m. treatment. At 20 mg/kg minimal effects occurred in 5

  11. Effects of enteral and parenteral feeding of malnourished rats on body composition.

    PubMed

    Kudsk, K A; Stone, J M; Carpenter, G; Sheldon, G F

    1982-11-01

    Many studies have reported similar weight gains and nitrogen balance in groups of well-nourished animals fed either orally or intravenously, but none have investigated the effects on malnourished animals. After protein depleting for 14 days, rats were refed with a D25-4.25% amino acid solution orally ad lib, by gastrostomy, or intravenously. IV animals gained more weight with greater body fat formation than either enteral group but had lower intestinal mass and nitrogen. Route of administration influenced substrate utilization in malnourished animals fed identical diets. We conclude that weight gain cannot be used as a comparative indicator of nitrogen retention between malnourished animals fed enterally and those fed intravenously.

  12. Aerosol and parenteral pneumocandins are effective in a rat model of pulmonary aspergillosis.

    PubMed Central

    Kurtz, M B; Bernard, E M; Edwards, F F; Marrinan, J A; Dropinski, J; Douglas, C M; Armstrong, D

    1995-01-01

    The pneumocandins are semisynthetic analogs of echinocandin-like compounds that have shown efficacy in animal models of systemic candidiasis, disseminated aspergillosis, and pneumocystis pneumonia. However, the most common form of Aspergillus infection in susceptible patients is pulmonary aspergillosis, which was not directly tested in the mouse models used in the past. We have evaluated three pneumocandins, L-693,989, L-731,373, and L-733,560, in a rat model of pulmonary aspergillosis. Male Sprague-Dawley rats were treated for 2 weeks with cortisone and tetracycline and fed a low-protein diet before being inoculated via the trachea with 10(6) conidia of Aspergillus fumigatus H11-20. In the absence of drug treatment, the animals developed a progressive, rapidly fatal bronchopneumonia. All three pneumocandins at doses of 5 mg/kg (intraperitoneally [i.p.] every 12 h [q12h]) were effective in delaying mortality in this model. Survival at day 7 postinfection was 20% among controls (n = 10 for all groups), while it was 60, 80, and 90% in groups that were treated with L-693,989, L-731,373, and L-733,560, respectively. In another trial, survival at day 7 postinfection was 25% among controls (n = 8 for all groups); it was 87.5% in a group treated with amphotericin B (0.5 mg/kg i.p. q12h) and was 100% in a group treated with L-733,560 (0.625 mg/kg i.p. q12h). In a separate trial, aerosol L-693,989 administered 2 h before infection (5 mg/kg) delayed mortality. Eight of the 10 animals treated with aerosol L-693,989 survived for 7 days, whereas only 2 of 10 control animals survived. We conclude that the pneumocandins we tested were highly effective in an animal model of pulmonary aspergillosis. PMID:7486919

  13. Sepsis, parenteral vaccination and skin disinfection

    PubMed Central

    Cook, Ian F.

    2016-01-01

    ASBSTRACT Disinfection should be required for all skin penetrative procedures including parenteral administration of vaccines. This review analyses medically attended infectious events following parenteral vaccination in terms of their microbiological aetiology and pathogenesis. Like ‘clean’ surgical site infections, the major pathogens responsible for these events were Staphylococcal species, implicating endogenous con-tamination as a significant source of infection. As 70% isopropyl alcohol swabbing has been shown to effectively disinfect the skin, it would be medico-legally difficult to defend a case of sepsis with the omission of skin disinfection unless the very low risk of this event was adequately explained to the patient and documented prior to vaccination. There was a significant cost-benefit for skin disinfection and cellulitis. Skin disinfection in the context of parenteral vaccination represents a new paradigm of medical practice; the use of a low cost intervention to prevent an event of very low prevalence but of significant cost. PMID:27295449

  14. Effect of parenteral iron on serum electrolytes of the baby pig.

    PubMed

    Ku, P K; Miller, E R; Ullrey, D E

    1983-09-01

    Twenty-eight 4-d-old nursing pigs were used in two trials to evaluate the effects of im injection of iron (Fe) from Fe-dextran upon subsequent serum mineral concentrations. An im injection of 150 mg of Fe from Fe-dextran was given to all pigs (n = 17) in trial 1. Serum Fe concentration increased rapidly from an initial mean of 65 to 3,466 micrograms/dl at 6 h postinjection (PI), 5,712 micrograms/dl at 24 h PI, then fell to 317 micrograms/dl at 4 d PI, 143 micrograms/dl at 7 d PI and remained about 100 micrograms/dl at 14, 21 and 28 d PI. Concentrations of other serum minerals did not appear to be influenced by the Fe-dextran injection. Treatments of Pigs (n = 11) in trial 2 were no injection, injection of dextran only, injection of 100 mg Fe from Fe-dextran and injection of 200 mg Fe from Fe-dextran. Serum Fe concentration increased rapidly after Fe-dextran injection, rising to a peak of 11,028 micrograms/dl at 6 h PI from the 100-mg Fe injection and 17,012 micrograms/dl at 6 h PI from the 200-mg Fe injection. Serum Fe concentration dropped steadily in pigs that were given no injection or injected with dextran only. Seven days after trial 2 started, all pigs that had received no injection or dextran only were injected with 100 mg Fe from Fe-dextran.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Efficacy and Effects of Parenteral Pethidine or Meptazinol and Regional Analgesia for Pain Relief during Delivery. A Comparative Observational Study

    PubMed Central

    Singer, J.; Jank, A.; Amara, S.; Stepan, P. D. H.; Kaisers, U.; Hoehne, C.

    2016-01-01

    Background: Peripartum anesthesia may consist of parenteral opioids and/or regional analgesia. There is only limited data in the literature comparing both methods in daily obstetric practice. This observational study investigated the opioids pethidine and meptazinol as well as regional analgesics with regard to their administration, efficacy, side effects and subjective maternal satisfaction with therapy. The rates of secondary regional analgesia administration after administration of the respective opioid served as a means of evaluating treatment. Methods: This study collected data on pain management during vaginal delivery in a German university hospital over a twelve month period. Severity of pain was measured intrapartum using a numerical rating scale. Maternal, neonatal and delivery-related data were obtained postpartum from the clinical records and from the mothers using a questionnaire. Results: The study is based on data obtained from 449 deliveries. Pain relief achieved by the administration of pethidine and meptazinol was similarly low; maternal satisfaction with the respective therapy was high. Meptazinol was usually administered intravenously (83 % vs. 6 %; p < 0.001), repeatedly (27 % vs. 6 %; p < 0.001) and closer to the birth (1.9 ± 2.7 h vs. 2.6 ± 2.8 h; p < 0.05) compared to pethidine. Secondary regional analgesia was more common after the administration of pethidine (16 % vs. 8 %; p < 0.05). Regional analgesia resulted in greater pain relief compared to opioid therapy (78 % vs. 24 % after 30 min; p < 0.001) and was associated with longer times to delivery (7.6 ± 2.5 h vs. 5.7 ± 2.5 h; p < 0.001) and higher levels of maternal satisfaction with therapy (6.1 ± 1.2 vs. 4.8 ± 1.6 on a 7-point scale; p < 0.001). Conclusion: In daily clinical practice, meptazinol can be adapted more readily to changes during birth and requires less secondary analgesia. Regional neuraxial

  16. History of parenteral nutrition.

    PubMed

    Dudrick, Stanley J

    2009-06-01

    The concept of feeding patients entirely parenterally by injecting nutrient substances or fluids intravenously was advocated and attempted long before the successful practical development of total parenteral nutrition (TPN) four decades ago. Realization of this 400 year old seemingly fanciful dream initially required centuries of fundamental investigation coupled with basic technological advances and judicious clinical applications. Most clinicians in the 1950's were aware of the negative impact of starvation on morbidity, mortality, and outcomes, but only few understood the necessity for providing adequate nutritional support to malnourished patients if optimal clinical results were to be achieved. The prevailing dogma in the 1960's was that, "Feeding entirely by vein is impossible; even if it were possible, it would be impractical; and even if it were practical, it would be unaffordable." Major challenges to the development of TPN included: (1) formulate complete parenteral nutrient solutions (did not exist), (2) concentrate substrate components to 5-6 times isotonicity without precipitation (not easily done), (3) demonstrate utility and safety of long-term central venous catheterization (not looked upon with favor by the medical hierarchy), (4) demonstrate efficacy and safety of long-term infusion of hypertonic nutrient solutions (contrary to clinical practices at the time), (5) maintain asepsis and antisepsis throughout solution preparation and delivery (required a major culture change), and (6) anticipate, avoid, and correct metabolic imbalances or derangements (a monumental challenge and undertaking). This presentation recounts approaches to, and solution of, some of the daunting problems as really occurred in a comprehensive, concise and candid history of parenteral nutrition.

  17. Liver membrane composition after short-term parenteral nutrition with and without taurine in guinea pigs: the effect to taurine.

    PubMed

    Guertin, F; Roy, C C; Lepage, G; Yousef, I; Tuchweber, B

    1993-09-01

    Having recently demonstrated that taurine supplementation prevents total parenteral nutrition (TPN)-induced cholestasis, we chose to use this model to examine plasma membrane composition in relation to bile formation. Male guinea pigs received daily a mixture of glucose and of the amino acid solution Travasol with or without added taurine (1.2 mM). After 3 days, bile was collected and liver plasma membrane fractions enriched in sinusoidal lateral membrane and bile canalicular membrane domains were isolated. In animals receiving TPN alone, bile flow and biliary secretory rate of bile acid and bicarbonate decreased significantly compared with controls. Although membrane ATPases (Na+K+ and Mg+) were unchanged, TPN induced an increase in the lipid to protein ratio and a decrease of polyunsaturated fatty acids, in conjunction with a higher content of diene conjugates in sinusoidal lateral membrane fractions. Taurine corrected these changes and, in addition, reduced significantly the cholesterol to phospholipid ratio in both membrane fractions. The data show that changes in liver cell membranes occur in TPN-induced cholestasis and suggest that free radical injury may play a role. As taurine prevented cholestasis as well as membrane changes, it is suggested that taurine should be added to amino acid solutions used for parenteral nutrition.

  18. Early initiation of low-level parenteral dextrose induces an accelerated diabetic phenotype in septic C57BL/6J mice

    PubMed Central

    Singamsetty, Srikanth; Shah, Faraaz Ali; Guo, Lanping; Watanabe, Yoshio; McDonald, Sherie; Sharma, Rohit; Zhang, Yingze; Alonso, Laura C.; O’Donnell, Christopher P.; McVerry, Bryan J.

    2016-01-01

    Development of hyperglycemia during sepsis is associated with increased morbidity and mortality. Nutritional support is common practice in the intensive care unit, but the metabolic effects are not well understood. The purpose of this study is to determine the effect of early low-level calorie provision on the development of hyperglycemia in a clinically relevant murine model of sepsis. C57BL/6J mice underwent femoral arterial and venous catheterization followed by cecal ligation and puncture (CLP) or sham surgery and low-dose intravenous dextrose or saline infusion. Blood glucose, plasma insulin, and cytokines were measured after 24 h. Additional septic mice underwent hyperinsulinemic-euglycemic clamps or received intravenous insulin concurrent with dextrose to determine whole-body insulin sensitivity and test the efficacy of insulin to reverse hyperglycemia. Neither dextrose infusion nor CLP alone induced hyperglycemia. Early initiation of low-level dextrose in septic mice produced a variable glycemic response: 49% maintained euglycemia (blood glucose <200) and 27% developed severe hyperglycemia (blood glucose≥600). Hyperglycemia was associated with increased inflammation and reduced insulin secretion and sensitivity compared with control mice or CLP mice maintaining euglycemia. Insulin prevented the progression to severe hyperglycemia but was ineffective in reestablishing glycemic control once hyperglycemia had developed. In conclusion, early initiation of clinically relevant low-level dextrose (~20% daily caloric requirements) precipitated hyperglycemia akin to an acute diabetic phenotype in septic mice characterized by decreased insulin sensitivity, decreased insulin secretion, and an increased inflammatory response. PMID:26624964

  19. The Development of Total Parenteral Nutrition.

    PubMed

    Nakayama, Don K

    2017-01-01

    The first patient to receive complete nourishment of a patient by intravenous infusion independent of the alimentary tract was an infant girl born with near-total small bowel atresia. Total parenteral nutrition, the intravenous infusion of nutrients, has been attempted since Harvey's description of the circulatory system in the early 17th century. The modern era of parenteral nutrition began in the early 20th century, when infusions of glucose, plasma, and emulsified fat into humans proved feasible. Robert Elman, working in the 1930s and 1940s, demonstrated that carefully prepared protein hydrolysates could be safely infused intravenously and incorporated by the body. Stanley Dudrick and Douglas Wilmore, surgeon researchers at the University of Pennsylvania, worked through the many details of preparation, administration, and clinical monitoring in beagle puppies before testing them on adult patients malnourished from a variety of surgical complications and gastrointestinal conditions. They applied their techniques and formulations on a newborn wasting away from congenital absence of the small bowel, the baby growing and developing for several months while being nourished completely by total parenteral nutrition. Their techniques, inspired by patients with progressive malnutrition from devastating intestinal conditions and malformations, form the basis of the practice of intravenous nutrition practiced today.

  20. Parenteral nutrition-induced anaphylaxis.

    PubMed

    Pomeranz, S; Gimmon, Z; Ben Zvi, A; Katz, S

    1987-01-01

    A case report of a 4-yr-old child who developed an anaphylactic reaction to parenteral nutrition is presented. Dermal allergy tests demonstrated a sensitivity to Travasol solution and Armour multivitamin 2 solution. This is the first reported case known to us of such a response to elemental parenteral nutrition.

  1. Effect of parenteral nutrition supplemented with short-chain fatty acids on adaptation to massive small bowel resection.

    PubMed

    Koruda, M J; Rolandelli, R H; Settle, R G; Zimmaro, D M; Rombeau, J L

    1988-09-01

    After massive small bowel resection, total parenteral nutrition (TPN) is prescribed to maintain nutritional status. However, TPN reduces the mass of the remaining intestinal mucosa, whereas adaptation to small bowel resection is associated with increased mucosal mass. Short-chain fatty acids (SCFAs) have been shown to stimulate mucosal cell mitotic activity. This study determined whether the addition of SCFAs to TPN following small bowel resection would prevent intestinal mucosal atrophy produced by TPN. Adult rats underwent an 80% small bowel resection and then received either standard TPN or TPN supplemented with SCFAs (sodium acetate, propionate, and butyrate). After 1 wk, jejunal and ileal mucosal weights, deoxyribonucleic acid, ribonucleic acid, and protein contents were measured and compared with the parameters obtained at the time of resection. Animals receiving TPN showed significant loss of jejunal mucosal weight, deoxyribonucleic acid, ribonucleic acid, and protein and ileal mucosal weight and deoxyribonucleic acid after small bowel resection, whereas animals receiving SCFA-supplemented TPN showed no significant change in the jejunal mucosal parameters and a significant increase in ileal mucosal protein. These data demonstrate that SCFA-supplemented TPN reduces the mucosal atrophy associated with TPN after massive bowel resection and thys may facilitate adaptation to small bowel resection.

  2. Third generation cephalosporins in the parenteral to oral switch.

    PubMed

    Rimmer, D

    1994-01-01

    In the present economic climate, it is increasingly necessary to ensure the cost-effectiveness of all aspects of healthcare. The expenditure on medications in a hospital is largely determined by the workload and throughput, but efforts to rationalise the use of medications will result in benefits both in patient care and overall costs. The purpose of this report is to discuss the advantages of switching from parenteral to oral cephalosporin therapy after the initial stage of infection treatment, the potential of presently available oral cephalosporins for use in a parenteral-to-oral switch regimen, and the outcome of a parenteral-to-oral switch programme, which used parenteral cefotaxime and oral cefixime, implemented at Hillingdon Hospital.

  3. Compatibility: drugs and parenteral nutrition

    PubMed Central

    Miranda, Talita Muniz Maloni; Ferraresi, Andressa de Abreu

    2016-01-01

    ABSTRACT Objective Standardization and systematization of data to provide quick access to compatibility of leading injectable drugs used in hospitals for parenteral nutrition. Methods We selected 55 injectable drugs analyzed individually with two types of parenteral nutrition: 2-in-1 and 3-in-1. The following variables were considered: active ingredient, compatibility of drugs with the parenteral nutrition with or without lipids, and maximum drug concentration after dilution for the drugs compatible with parenteral nutrition. Drugs were classified as compatible, incompatible and untested. Results After analysis, relevant information to the product’s compatibility with parental nutrition was summarized in a table. Conclusion Systematization of compatibility data provided quick and easy access, and enabled standardizing pharmacists work. PMID:27074235

  4. Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) for infective endocarditis: a safe and effective model.

    PubMed

    Pajarón, Marcos; Fernández-Miera, Manuel F; Allende, Iciar; Arnaiz, Ana M; Gutiérrez-Cuadra, Manuel; Cobo-Belaustegui, Manuel; Armiñanzas, Carlos; de Berrazueta, Jose R; Fariñas, Maria C; Sanroma, Pedro

    2015-03-01

    The safety and efficacy of treatment of infectious endocarditis (IE) was evaluated within a program of hospital-in-home (HIH) based on self-administered outpatient parenteral antimicrobial therapy (S-OPAT). IE episodes (n=48 in 45 patients; 71% middle-aged males) were recruited into the HIH program between 1998 and 2012. Following treatment stabilization at the hospital they returned home for HIH in which a physician and/or a nurse supervised the S-OPAT. Safety and efficacy were evaluated as mortality, re-occurrence, and unexpected re-admission to hospital. Of the episodes of IE, 83.3% had comorbidities with a mean score of 2.3 on the Charlson index and 1.5 on the Profund index; 60.4% had pre-existing valve disease (58.6% having had surgical intervention); 8.3% of patients had suffered a previous IE episode; 62.5% of all episodes affected a native valve; 45.8% being mitral; 70.8% of infection derived from the community. In 75% of the episodes there was micro-organism growth, of which 83.3% were Gram positive. Overall duration of antibiotic treatment was 4.8 weeks; 60.4% of this time corresponding to HIH. Re-admission occurred in 12.5% of episodes of which 33.3% returned to HIH to complete the S-OPAT. No deaths occurred during HIH. One year after discharge, 2 patients had recurrence and 5 patients died, in 2 of whom previous IE as cause-of-death could not be excluded. In conclusion, the S-OPAT schedule of hospital-in-home is safe and efficacious in selected patients with IE.

  5. Effects of parenteral infusion with fish-oil or safflower-oil emulsion on hepatic lipids, plasma amino acids, and inflammatory mediators in septic rats.

    PubMed

    Chao, C Y; Yeh, S L; Lin, M T; Chen, W J

    2000-04-01

    This study was designed to investigate the effects of preinfusion with total parenteral nutrition (TPN) using fish-oil (FO) versus safflower-oil (SO) emulsion as fat sources on hepatic lipids, plasma amino-acid profiles, and inflammatory-related mediators in septic rats. Normal rats, with internal jugular catheters, were assigned to two different groups and received TPN. TPN provided 300 kcal. kg(-1). d(-1), with 40% of the non-protein energy as fat. All TPN solutions were isonitrogenous and identical in nutrient composition except for the fat emulsion, which was made of SO or FO. After receiving TPN for 6 d, each group of rats was further divided into control and sepsis subgroups. Sepsis was induced by cecal ligation and puncture; control rats received sham operation. All rats were classified into four groups as follows: FO control group (FOC; n = 7), FO sepsis group (FOS; n = 8), SO control group (SOC; n = 8), and SO sepsis group (SOS; n = 9). The results of the study demonstrated that plasma concentrations of triacylglycerol and non-esterified fatty acids did not differ between the FO and SO groups, regardless of whether the animals were septic. SOS had significantly higher total lipids and cholesterol content in the liver than did the SOC group. The FOS group, however, showed no difference from the FOC group. Plasma leucine and isoleucine levels were significantly lower in the SOS group than in the SOC group, whereas no difference in these two amino acids was observed between the FOC and FOS groups. Plasma arginine levels were significantly lower in both septic groups than in the groups without sepsis when either FO or SO was infused. Plasma glutamine levels, however, did not differ across groups. No differences in interleukin-1beta, interleukin-6, tumor necrosis factor-alpha, or leukotriene B(4) concentrations in peritoneal lavage fluid were observed between the two septic groups. These results suggest that catabolic reaction in septic rats preinfused with FO

  6. Plasma trace metals during total parenteral alimentation.

    PubMed

    Solomons, N W; Layden, T J; Rosenberg, I H; Vo-Khactu, K; Sandstead, H H

    1976-06-01

    The plasma concentrations of the trace metals zinc and copper were studied prospectively in 13 patients with gastrointestinal diseases treated with parenteral alimentation (TPA) for periods of from 8 days to 7 1/2 weeks. Plasma copper levels fell rapidly and consistently in all patients, with an overall rate of - 11 mug per 100 ml per week. Zinc concentrations declined in 10 of 13 patients at a more gradual rate. Analysis of the standard parenteral alimentation fluids revealed zinc content equivalent to 50% of the daily requirement and a negligible content of copper. From combined analysis of plasma zinc, hair zinc, and taste acuity, there is evidence that increased utilization or redistribution within the body may effect plasma concentrations in some patients. Neither an increase in urinary excretion nor a primary decrease in plasma binding proteins appeared to be a major factor in lowering plasma trace metal concentrations. These findings indicate that a marked decrease in plasma copper is regular and a decline in plasma zinc is common during TPA using fluids unsupplemented with trace metals. Supplementation of parenteral alimentation fluids with the trace metals zinc and copper is recommended.

  7. Nutritional support teams: the cooperation among physicians and pharmacists helps improve cost-effectiveness of home parenteral nutrition (HPN).

    PubMed

    Pietka, Magdalena; Watrobska-Swietlikowska, Dorota; Szczepanek, Kinga; Szybinski, Piotr; Sznitowska, Małgorzata; Kłęk, Stanisław

    2014-09-12

    Introducción: La nutrición parenteral domiciliaria (NPD) moderna requiere la elaboración de preparados a medida. Las peticiones de los médicos en cuanto a la composición de estos preparados muchas veces difieren de los principios farmacéuticos, lo que suscita la necesidad de elaboración de preparados ex-tempore o unas pruebas de estabilidad que garanticen la almacenamiento a largo plazo. Estas estrategias no resultan rentables. El objetivo del estudio consistió en utilizar la cooperación entre médicos y farmacéuticos para asegurar tanto la rentabilidad, como la elaboración a medida de los preparados NPD. Métodos: La primera parte del estudio consistió en el análisis pormenorizado de las prescripciones para los 47 pacientes con una NPD más exigente (27 mujeres y 20 hombres, edad media 53,1 años) tratados en un centro NPD para crear el menor número posible de preparados de larga duración. La segunda parte del estudio consistió en pruebas de estabilidad y modificaciones. Resultados: El análisis demostró que eran necesarias más de 137 variaciones para cubrir todas las exigencias de macro y micronutrientes. Su costo como soluciones ex-tempore resultó extremadamente elevado (más de 110.000 EUROS/mes) debido a la logística, e igualmente alto en caso de requerirse una prueba de estabilidad (68.500 EUROS). Así, la prescripción fue preparada de novo por el equipo de médicos y farmacéuticos y se diseñaron cuatro modelos básicos. Las dificultades principales fueron el agua y los electrolitos, en particular magnesio y calcio. Las pruebas de estabilidad fracasaron en uno de los preparados debido a la alta concentración de electrolitos. Esto fue corregido, y la nueva fórmula supero la prueba. A partir de ahí se emplearon cinco modelos básicos para la creación de nuevas bolsas. El costo de esta actividad supuso 3.700 EUROS (p.

  8. The effect of parenteral alimentation fluid, undiluted with saline or fresh sera, on the growth of Candida albicans in vitro at 37 degrees C.

    PubMed

    Lederer, T; Rippon, J; Baldwin, S; Pachman, L M

    1975-02-28

    Parenteral alimentation is often complicated by Candida albicans infection which may be fatal. This study investigated the effect of alimentation fluid (Aminosol) on C. albicans' growth in vitro. It was found that concentrated Aminosol (1400 millisomoles) maintained C. albicans in a viable state but inhibited replication. Dilution of alimentation fluid to physiological concentrations (300 milliosmoles) with either saline or aged pooled normal sera promoted in vitro growth of C. albicans which was equivalent to that obtained in BHI broth and was slightly less than that obtained in Sabouraud's broth. The effects of fresh sera with full complement activity were also investigated. In fresh sera appropriately diluted with physiological saline, some clumping of the yeasts was observed and all formed germ tubes. Growth as defined by budding or the formation of hyphae was inhibited. When Aminosol was diluted to 300 milliosomoles with fresh sera, all yeasts were noted to be in clumps with germ tubes as well as continually growing hyphae. Growth was approximately equal to that seen in Aminosol similarly diluted with saline.

  9. Long-term parenteral nutrition

    PubMed Central

    Ladefoged, Karin; Jarnum, Stig

    1978-01-01

    Nineteen patients (11 women and eight men) aged 20-68 received long-term parenteral nutrition, mostly at home, for six to 63 months (mean 19 months). Indications for LTPN were extensive, active Crohn's disease in three patients, intestinocutaneous fistulas in three, and short-bowel syndrome in the remaining 13 patients. Subclavian or intra-atrial (Broviac) catheters were most commonly used, for which the average life was four and seven months respectively. Complications of long-term parenteral nutrition included pneumothorax in four out of 48 subclavian vein punctures. Catheter-induced thrombosis of central veins was shown by phlebography 17 times in nine patients, and eight episodes of total occlusion occurred. Two of these patients had pulmonary infarction. Nineteen episodes of catheter sepsis occurred in 11 patients, but only one was fatal. Complications related to intestinal disease included intra-abdominal abscesses and intestinal fistulas, and disturbances of liver function. Five patients died, though in only two was death related to long-term parenteral nutrition. One of these patients died from catheter sepsis, the other had subdural haematoma possibly caused by anticoagulant treatment. Eight of the 14 surviving patients still needed parenteral nutrition. All received a disability pension, but six had an acceptable quality of life with almost normal social activities. Despite problems such as difficulties in maintaining standardised infusion programmes, it was concluded that long-term parenteral nutrition at home is practicable and consistent with an acceptable quality of life. ImagesFIG 2 PMID:98199

  10. Oral and parenteral therapy with saperconazole (R 66905) of invasive aspergillosis in normal and immunocompromised animals.

    PubMed Central

    Van Cutsem, J; Van Gerven, F; Janssen, P A

    1989-01-01

    Saperconazole (R 66905) is a broad-spectrum antifungal triazole with potent in vitro activity against Aspergillus spp. A total of 279 strains were tested in brain heart infusion broth. Development of the Aspergillus spp. was completely inhibited at 0.1 and 1 microgram of saperconazole per ml for 80.3 and 99.6% of the strains, respectively. Normal and immunocompromised guinea pigs were infected intravenously with Aspergillus fumigatus and treated orally, intravenously, or intraperitoneally with saperconazole or intraperitoneally with amphotericin B. Leukopenia, neutropenia, lymphocytosis, and monocytosis were obtained with mechlorethamine hydrochloride; leukopenia, neutrophilia, and lymphopenia were obtained with cyclophosphamide. Saperconazole was dissolved for oral treatment in polyethylene glycol and for parenteral treatment in cyclodextrins. Amphotericin B was given parenterally as Fungizone (E.R. Squibb & Sons). Treatment was given once daily for 14 days. An early starting treatment was efficacious, but the activity of saperconazole was maintained even when the onset of the treatment was delayed to the moribund state. The activity of saperconazole was not altered in immunocompromised animals. Saperconazole was clearly superior to amphotericin B and free of side effects. The oral and parenteral formulations of saperconazole were equipotent. The systemic activity of saperconazole in guinea pigs was confirmed in invasive aspergillosis in pigeons. PMID:2619273

  11. Multimodal analgesia without routine parenteral narcotics for total hip arthroplasty.

    PubMed

    Maheshwari, Aditya Vikram; Boutary, Myriam; Yun, Andrew G; Sirianni, Leigh Ellen; Dorr, Lawrence D

    2006-12-01

    Methods for managing pain after a total hip replacement have changed substantially in the past 5 years. We documented the outcome of patients treated with a multimodal pain program designed to avoid parenteral narcotics. Avoidance of parenteral narcotics can essentially eliminate the complications of respiratory depression, ileus, and narcotic-induced hypotension. It can minimize nausea and vomiting which cause dissatisfaction with an operation. Twenty-one of 140 patients (15%) needed parenteral narcotics postoperatively with only nine patients (6.4%) using parenteral narcotics after the day of surgery. Mean pain scores were below 3 of 10 on all postoperative days. There were no patients with respiratory depression or ileus, and four (2.9%) with urinary retention. Nausea occurred with 35 patients (25%) in the recovery room and in 28 patients (20%) thereafter. Emesis occurred in five patients (3.6%) with two incidences in the recovery room. One hundred and thirty-eight patients (98.6%) were discharged home at a mean of 2.7 seven days postoperatively with 98 (70%) on a single assistive device. The multimodal pain management program, which avoided parenteral narcotics, was effective in providing pain relief, nearly eliminating emesis, and eliminating the severe complications of respiratory depression, urinary tract infection and ileus, as well as accelerating function.

  12. Ertapenem: a new opportunity for outpatient parenteral antimicrobial therapy.

    PubMed

    Tice, Alan D

    2004-06-01

    Ertapenem is a parenteral carbapenem antimicrobial with pharmacological properties that allow it to be given once daily. This makes it a consideration for outpatient parenteral antimicrobial therapy (OPAT). In comparison with information from the OPAT Outcomes Registry, ertapenem seems well suited for the types of infections and bacteria that are commonly treated with OPAT, plus it has additional activity against anaerobic bacteria. This added spectrum makes it possible to treat complicated skin/skin-structure, complicated intra-abdominal and pelvic infections with a single antibiotic instead of the multiple agents that have usually been required. Ertapenem is also comparable to other OPAT antimicrobials in terms of adverse effects and clinical outcomes. This antimicrobial can be given with any delivery model, although its stability when mixed is such that daily preparation or self-mixing systems need to be considered. Ertapenem should be added to the growing list of once-daily parenteral antibiotics that can be given to outpatients.

  13. Compartment syndrome due to extravasation of peripheral parenteral nutrition: extravasation injury of parenteral nutrition

    PubMed Central

    Park, Huee Jin; Kim, Kyung Hoon; Lee, Hyuk Jin; Jeong, Eui Cheol; Kim, Kee Won

    2015-01-01

    Compartment syndrome is a rare but devastating condition that can result in permanent neuromuscular or soft tissue injuries. Extravasation injuries, among the iatrogenic causes of compartment syndrome, occur under a wide variety of circumstances in the inpatient setting. Total parenteral nutrition via a peripheral route is an effective alternative for the management of critically ill children who do not obtain adequate nutrition via the oral route. However, there is an inherent risk of extravasation, which can cause compartment syndrome, especially when detected at a later stage. Herein, we report a rare case of compartment syndrome and skin necrosis due to extravasation, requiring emergency fasciotomy and skin graft in a 7-month-old boy who was treated with peripheral parenteral nutrition via a pressurized infusion pump. Although we cannot estimate the exact time at which extravasation occurred, the extent and degree of the wound suggest that the ischemic insult was prolonged, lasting for several hours. Pediatric clinicians and medical teams should carefully examine the site of insertion of the intravenous catheter, especially in patients receiving parenteral nutrition via a peripheral intravenous catheter with a pressurized infusion pump. PMID:26692883

  14. Effects of parenteral infusion with medium-chain triglycerides and safflower oil emulsions on hepatic lipids, plasma amino acids and inflammatory mediators in septic rats.

    PubMed

    Yeh, S; Chao, C; Lin, M; Chen, W

    2000-04-01

    This study was designed to investigate the effects of preinfusion with total parenteral nutrition (TPN) using medium-chain triglycerides (MCT) versus safflower oil (SO) emulsion as fat sources on hepatic lipids, plasma amino acid profiles, and inflammatory-related mediators in septic rats. Normal rats, with internal jugular catheters, were divided into two groups and received TPN. TPN provided 300kcal/kg/day with 40% of the non-protein energy provided as fat. All TPN solutions were isonitrogenous and identical in nutrient composition except for the fat emulsion, which was made of SO or a mixture of MCT and soybean oil (9:1) (MO). After receiving TPN for 6 days, each group of rats was further divided into control and sepsis subgroups. Sepsis was induced by cecal ligation and puncture, whereas control rats received sham operation. All rats were classified into four groups as follows: MCT control group (MOC, n= 8), MCT sepsis group (MOS, n= 8), safflower oil control group (SOC, n= 8), and safflower oil sepsis group (SOS, n= 11). The results of the study demonstrated that the MOS group had lower hepatic lipids than did the SOS group. Plasma leucine and isoleucine levels were significantly lower in the SOS than in the SOC group, but no differences in these two amino acids were observed between the MOC and MOS groups. Plasma arginine levels were significantly lower in septic groups than in those without sepsis despite whether MCT or safflower oil was infused. Plasma glutamine and alanine levels, however, did not differ between septic and non-septic groups either in the SO or MO groups. No differences in interleukin-1b, interleukin-6, tumor necrosis factor-alpha, and leukotriene B(4)concentrations in peritoneal lavage fluid were observed between the two septic groups. These results suggest that catabolic reaction is septic rats preinfused MCT is not as obvious as those preinfused safflower oil. Compared with safflower oil, TPN with MCT administration has better effects on

  15. [The effect of parenteral citicoline on visual functions and life quality of patients with primary open-angle glaucoma].

    PubMed

    Frolov, M A; Gonchar, P A; Barashkov, V I; Kumar, V; Morozova, N S; Frolov, A M; Kazakova, K A

    2011-01-01

    The effect of nootropic drug citicoline on visual functions, perimetric indexes of static automated perimetry, morphometric characteristics of retinal tomography and life quality of patients with primary open-angle glaucoma (POAG) stage I-III and normalized intraocular pressure (IOP) was studied. 40 patients aged 46-78 years old with POAG stage I-III and normalized IOP were treated with citicoline. Among them there were 24 female and 16 male. The patients were divided into 2 equal groups--experimental and control. Patients of both groups were treated with intravenous citicoline for 10 days. The dose of citicoline in experimental group was 1000 mg/day, in control--500 mg/day. After treatment in both groups visual functions, perimetric indexes of static automated perimetry, morphometric characteristics of retinal tomography and life quality showed improvement. Citicoline has significant neuroprotective effect preventing apoptosis.

  16. Managing an outpatient parenteral antibiotic therapy team: challenges and solutions

    PubMed Central

    Halilovic, Jenana; Christensen, Cinda L; Nguyen, Hien H

    2014-01-01

    Outpatient parenteral antimicrobial therapy (OPAT) programs should strive to deliver safe, cost effective, and high quality care. One of the keys to developing and sustaining a high quality OPAT program is to understand the common challenges or barriers to OPAT delivery. We review the most common challenges to starting and managing an OPAT program and give practical advice on addressing these issues. PMID:24971015

  17. Parenteral nutrition in short bowel syndrome patients, regardless of its duration, increases serum proinflammatory cytokines.

    PubMed

    Bizari, Letícia; da Silva Santos, Andressa Feijó; Foss, Norma Tiraboschi; Marchini, Júlio Sérgio; Suen, Vivian Marques Miguel

    2016-07-01

    Short bowel syndrome is a severe malabsorption disorder, and prolonged parenteral nutrition is essential for survival in some cases. Among the undesirable effects of long-term parenteral nutrition is an increase in proinflammatory cytokines. The aim of the present study was to measure the serum levels of interleukin-6, interleukin-10, tumor necrosis factor alpha, and transforming growth factor beta, in patients with short bowel syndrome on cyclic parenteral nutrition and patients who had previously received but no longer require parenteral nutrition. The study was cross-sectional and observational. Three groups were studied as follows: Parenteral nutrition group, 9 patients with short bowel syndrome that receive cyclic parenteral nutrition; Oral nutrition group, 10 patients with the same syndrome who had been weaned off parenteral nutrition for at least 1 year prior to the study; Control group, 13 healthy adults, matched for age and sex to parenteral and oral groups. The following data were collected: age, tobacco use, drug therapies, dietary intake, body weight, height, blood collection. All interleukins were significantly higher in the parenteral group compared with the control group as follows: interleukin-6: 22 ± 19 vs 1.5 ± 1.4 pg/mL, P= .0002; transforming growth factor β: 854 ± 204 vs 607 ± 280 pg/mL, P= .04; interleukin-10: 8 ± 37 vs 0.6 ± 4, P= .03; tumor necrosis factor α: 20 ± 8 vs 8 ± 4 pg/mL, P< .0001. We concluded that parenteral nutrition in short bowel syndrome patients, regardless of its duration, increases serum proinflammatory cytokines.

  18. Zinc deficiency in a parenteral nutrition-dependent patient during a parenteral trace element product shortage.

    PubMed

    Franck, Andrew J

    2014-07-01

    Parenteral nutrition product shortages are common and place vulnerable patients at risk for nutrient deficiencies. This case report describes a parenteral nutrition-dependent patient who was found to have zinc deficiency during a parenteral nutrition product shortage. The management of the patient's zinc deficiency is described.

  19. Perspectives on parenteral micronutrient shortages.

    PubMed

    Mirtallo, Jay M

    2015-02-01

    Micronutrients are essential components of parenteral nutrition (PN). Problems related to deficiency and toxicity occur during routine practice, which could be related to the content of commercial sources, inadequate prescribed doses, and the high frequency of at-risk patients receiving PN. Shortages of commercial products result in increased risk of deficiency. Even though there are recommendations to conserve supplies for those at highest risk, practices that provide no micronutrients or doses less than desired are not safe. This article reviews the evidence describing patients at risk for micronutrient deficiency, the rationale for micronutrient product reformulation, and characteristics of deficiency observed during shortages of micronutrient products.

  20. Innovative Parenteral and Enteral Nutrition Therapy for Intestinal Failure

    PubMed Central

    Le, Hau D.; Fallon, Erica M.; de Meijer, Vincent E.; Malkan, Alpin D.; Puder, Mark; Gura, Kathleen M.

    2010-01-01

    Children with intestinal failure suffer from insufficient intestinal length or function, making them dependent on parenteral nutrition (PN) for growth and survival. PN and its components are associated with many complications ranging from simple electrolyte abnormalities to life-threatening PN-associated liver disease, which is also called intestinal failure-associated liver disease (ILALD). From a nutrition perspective, the ultimate goal is to provide adequate caloric requirements and make the transition from PN to full enteral Nutrition (EN) successful. Upon review of the literature, we have summarized the most effective and innovative PN and EN therapies for this patient population. Antibiotic-coated catheters and antibiotic or ethanol locks can be implemented, as they appear effective in reducing catheter-related infection and thus further reduce the risk of IFALD. Lipid emulsions should be given judiciously. The use of an omega-3 fatty acid-based formulation should be considered in patients who develop IFALD. Trophic feeding is important for intestinal adaptation, and EN should be initiated early to help wean patients from PN. Long term management of children with IF continues to be an emerging field. We have entered uncharted territory as more children survive complications of IF, including IFALD. Careful monitoring and individualized management to ensure maintenance of growth with avoidance of complications are the keys to successful patient outcomes. PMID:20123271

  1. Intravenous lipids in home parenteral nutrition.

    PubMed

    Pironi, Loris; Agostini, Federica; Guidetti, Mariacristina

    2015-01-01

    Intravenous lipid emulsions (IVLEs) are an important component of the nutritional admixtures for patients on long-term home parenteral nutrition (HPN) for chronic intestinal failure (CIF). IVLEs are primarily used as a source of energy and essential fatty acids, and the content of polyunsaturated fatty acids (PUFAs) is the most important characteristic of IVLEs. IVLEs rich in n-6 PUFAs may have a pro-inflammatory effect, whereas those rich in n-3 PUFAs may exert an anti-inflammatory effect. Other components to be considered are the risk of lipid peroxidation and the contents of α-tocopherol and phytosterols. Published studies were reviewed to determine the effects of the commercially available IVLEs on essential fatty acid status, liver function tests, lipid peroxidation and inflammatory indices, and α-tocopherol status, as well as their clinical safety and efficacy in patients on HPN. Investigations on the efficacy of fish oil-based IVLEs, which are rich in n-3 PUFAs, in the treatment of parenteral nutrition-associated liver disease (PNALD) in adult patients on HPN for CIF were also analyzed. The current commercial IVLE formulations have similar clinical safety profiles and efficacies and can prevent the development of essential fatty acid deficiency in adults on HPN for CIF. IVLE with a low content of n-6 PUFAs and with or without increased n-3 PUFA content may reduce the risk of PNALD. Fish oil-based IVLE, which is rich in n-3 PUFAs, may be effective in reversing hepatic cholestasis due to PNALD.

  2. Parenteral lipids: safety aspects and toxicity.

    PubMed

    Wanten, Geert J A

    2015-01-01

    Lipid emulsions (LEs) used in modern parenteral nutrition formulations are indispensable sources of calories and (essential) fatty acids ((E)FAs). Several generations of LEs based on various FA sources have been developed, and issues related to their safe use deserve attention. The relevant issues concern LE composition, stability and sterility, while other problems are related to the lipid infusion rate, including hypertriglyceridemia and lipid overload syndrome. The FA structure of LEs translates into effects on inflammatory processes and immune cell function and affects the functions of organs, such as the liver and lungs. In addition, disturbed balances of (anti)oxidants and the presence of other bioactive agents in LEs, such as phytosterols, are mechanisms that may underlie the potential adverse effects. Lipid emulsions (LEs) are key components of parenteral nutrition (PN) that bypass the need for (essential) fatty acids ((E)FAs) and provide sufficient energy to decrease the need for the infusion of large amounts of dextrose, thus preventing its associated complications. The oldest available LEs are based on soybean oil (SO-LE) and meet these requirements. (Pre)clinical evidence suggests that various, next-generation LEs based on alternative oil sources are safe and effective; particularly, those based on fish oil (FO-LEs) have less pro-inflammatory characteristics that may convey beneficial effects on the immune system and organ functions. With the exception of decreased liver damage with the use of FO-LEs instead of SO-LEs, the clinical relevance of many of these data needs further validation.

  3. Pediatric Parenteral Nutrition-Associated Liver Disease.

    PubMed

    Israelite, Jill C

    Pediatric parenteral nutrition-associated liver disease (PNALD) is typically defined as a decrease in bile flow that is independent of a mechanical obstruction and of any other underlying liver disease. It is most often seen in pediatric patients receiving parenteral nutrition support. Up to 50% to 66% of children receiving long-term parenteral nutrition are reported to be diagnosed with PNALD. The goal of treatment for PNALD is advancement to full enteral nutrition and elimination of dependence on parenteral nutrition support. Achieving this goal is not always possible, especially in patients with short bowel syndrome. The following review article highlights some of the current treatment strategies focused on prevention or correction of PNALD as noted in current American Society for Parenteral and Enteral Nutrition guidelines.

  4. Total parenteral nutrition for the very low birth weight infant.

    PubMed

    Patel, Pinkal; Bhatia, Jatinder

    2017-02-01

    Preterm infants, especially very low birth weight (VLBW; <1500 g) and extremely low birth weight (ELBW; <1000 g) infants, are susceptible to growth failure in postnatal life if nutritional demands are not met. Poor postnatal growth in preterm infants is associated with adverse neurodevelopmental outcomes during childhood. Early parental nutrition is of paramount importance to provide appropriate protein and energy in VLBW infants when enteral nutrition is not feasible or is suboptimal. An "early and aggressive" approach of parenteral nutrition in preterm infants has been shown to prevent protein catabolism, induce positive nitrogen balance and improve postnatal growth.

  5. Effect of amino acid composition of parenteral solutions on nitrogen retention and metabolic response in very-low-birth weight infants.

    PubMed

    Chessex, P; Zebiche, H; Pineault, M; Lepage, D; Dallaire, L

    1985-01-01

    To evaluate the influence of amino acid preparations on the metabolic response of parenterally fed immature newborn infants, nitrogen retention and plasma amino acid concentrations were compared in very-low-birth-weight infants given two parenteral regimens differing only by the composition of the infused amino acids (Travasol 10% blend B and Vamin 7%). The intakes of fluid, nitrogen, and calories were comparable. The nitrogen retention was 72% +/- 7% with Vamin and 65% +/- 6% with Travasol. The differences in plasma amino acid concentrations were consistent with the composition of the amino acid solutions. During the infusion of Vamin the increased intake of aromatic amino acids resulted in high plasma levels of tyrosine (256 +/- 233 mumol/L, range 67 to 894 mumol/L). The infusion of Travasol resulted in high plasma levels of methionine (114 +/- 39 mumol/L, range 53 to 260 mumol/L) and an elevated load of glycine, which was accompanied by an abnormally high urinary loss of this amino acid. Despite these metabolic imbalances, the growth rate over the whole study was adequate. These results emphasize the importance of the composition of amino acid solutions on the metabolic response of the very immature preterm infant.

  6. Refeeding syndrome: screening, incidence, and treatment during parenteral nutrition.

    PubMed

    Walmsley, Russell S

    2013-12-01

    The possible deleterious effects of feeding after a period of prolonged starvation have been known for over 60 years. The resultant biochemical disturbance, symptoms, and signs have been termed the refeeding syndrome (RS). The key to the pathophysiology is the stimulation of insulin release resulting in anabolic activity. Depleted electrolyte and micronutrient stores are overwhelmed and cellular function disrupted. A concise definition of RS is not agreed and hampers interpretation of clinical data. Hypophosphatemia and appearance of tissue edema/pathological fluid shifts are the most often agreed diagnostic criteria. The characteristics of particular patient groups at risk have been recognized for some time, and there are guidelines from the National Institute for Clinical Excellence in the UK to aid recognition of individuals at high risk along with protocols for initiating nutrition. Using loose diagnostic criteria, RS appears to occur in 4% of cases of parenteral nutrition (PN) when case records were reviewed by experts in a large study into PN care in the UK. Disappointingly, prescribers recognized only 50% of at risk cases. Early data from a similar study in New Zealand appear to show a similar pattern. Prospective series looking at patients receiving nutrition support in institutions with Nutrition Support Teams have found an incidence of 1-5%. RS is still underrecognized. Patients receiving PN should be counted as being in a high-risk category and feeding protocols to avoid RS applied. Low rates of RS then occur and death from this cause be avoided.

  7. Total management of short gut secondary to midgut volvulus without prolonged total parenteral alimentation.

    PubMed

    Tepas, J J; MacLean, W C; Kolbach, S; Shermeta, D W

    1978-12-01

    Absorption studies in rats have shown that intestinal adaptation after catastrophic injury can be stimulated by early enteral feeding. Using this concept, we have devised a technique of early initiation and advancement of oral feedings that begins with Cho-Free and Polycose and gradually adds sucrose and MCT in increasing proportions. The increasing complexity and caloric density of this diet provide sufficient nutrition to allow weaning from total parenteral alimentation within 2--3 wk. Our preliminary experience in babies with midgut volvulus, necrotizing enterocolitis, and gastroschisis has been successful and uncomplicated. These patients have demonstrated consistent weight gain and have been spared the complications associated with prolonged parenteral alimentation.

  8. Preliminary study on the effect of parenteral naloxone, alone and in association with calcium gluconate, on bone healing in an ovine "drill hole" model system

    PubMed Central

    Petrizzi, Lucio; Mariscoli, Massimo; Valbonetti, Luca; Varasano, Vincenzo; Langhoff, Jens D; Von Rechenberg, Brigitte

    2007-01-01

    Background Several diseases affect bone healing and physiology. Many drugs that are commonly used in orthopaedics as "analgesics" or anti-inflammatory agents impair bone healing. Stressful conditions are associated with decreased serum osteocalcin concentration. High endorphin levels alter calcium metabolism, blocking the membrane channels by which calcium normally enters cells. The consequent decrease of intracellular calcium impairs the activities of calcium-related enzymes. Naloxone is a pure opioid antagonist. Morphine-induced osteocalcin inhibition was abolished when osteoblasts were incubated with naloxone. Naloxone restored the altered cellular and tissue physiology by removing β-endorphins from specific receptors. However, this is only possible if the circulating Ca concentration is adequate. The aim of the present study was to evaluate the efficacy of parenteral naloxone administration in inducing fast mineralization and callus remodelling in a group of sheep with a standardised bone lesion. Methods Twenty ewes were randomly assigned to 4 treatment groups. Group A acted as control, group B received a solution of calcium gluconate, group C a solution of naloxone, and group D a solution of calcium gluconate and naloxone. A transverse hole was drilled in the left metacarpus, including both cortices, then parenteral treatment was administered intramuscularly, daily for four weeks. Healing was evaluated by weekly radiographic examination for eight weeks. For quantitative evaluation, the ratio of the radiographic bone density between the drill area and the adjacent cortical bone was calculated. After eight weeks the sheep were slaughtered and a sample of bone was collected for histopathology Results Group D showed a higher radiographic ratio than the other groups. Sheep not treated with naloxone showed a persistently lower ratio in the lateral than the medial cortex (P < 0.01). Histopathology of bone samples showed more caverns and fewer osteoblasts in group D

  9. Toxicity of parenteral iron dextran therapy.

    PubMed

    Burns, D L; Pomposelli, J J

    1999-03-01

    Parenteral iron dextran is efficacious and safe for iron repletion in patients with iron-deficiency anemia. The risk for developing reactions to parenteral iron infusion can be attenuated if patients are carefully selected. Patients with underlying autoimmune disease, malnutrition with indolent infection, and risk for iron overload syndromes should be carefully monitored for complications. Further, the rate of infusion and the route of administration of iron dextran play roles in the risk of adverse reactions. The purpose of this review is to identify and elucidate the mechanisms of the acute and chronic toxicities associated with parenteral iron dextran use.

  10. 21 CFR 201.323 - Aluminum in large and small volume parenterals used in total parenteral nutrition.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... used in total parenteral nutrition. 201.323 Section 201.323 Food and Drugs FOOD AND DRUG ADMINISTRATION... parenteral nutrition. (a) The aluminum content of large volume parenteral (LVP) drug products used in total parenteral nutrition (TPN) therapy must not exceed 25 micrograms per liter (µg/L). (b) The package insert...

  11. 21 CFR 201.323 - Aluminum in large and small volume parenterals used in total parenteral nutrition.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... used in total parenteral nutrition. 201.323 Section 201.323 Food and Drugs FOOD AND DRUG ADMINISTRATION... parenteral nutrition. (a) The aluminum content of large volume parenteral (LVP) drug products used in total parenteral nutrition (TPN) therapy must not exceed 25 micrograms per liter (µg/L). (b) The package insert...

  12. 21 CFR 201.323 - Aluminum in large and small volume parenterals used in total parenteral nutrition.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... used in total parenteral nutrition. 201.323 Section 201.323 Food and Drugs FOOD AND DRUG ADMINISTRATION... parenteral nutrition. (a) The aluminum content of large volume parenteral (LVP) drug products used in total parenteral nutrition (TPN) therapy must not exceed 25 micrograms per liter (µg/L). (b) The package insert...

  13. 21 CFR 201.323 - Aluminum in large and small volume parenterals used in total parenteral nutrition.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... used in total parenteral nutrition. 201.323 Section 201.323 Food and Drugs FOOD AND DRUG ADMINISTRATION... parenteral nutrition. (a) The aluminum content of large volume parenteral (LVP) drug products used in total parenteral nutrition (TPN) therapy must not exceed 25 micrograms per liter (µg/L). (b) The package insert...

  14. 21 CFR 201.323 - Aluminum in large and small volume parenterals used in total parenteral nutrition.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... used in total parenteral nutrition. 201.323 Section 201.323 Food and Drugs FOOD AND DRUG ADMINISTRATION... parenteral nutrition. (a) The aluminum content of large volume parenteral (LVP) drug products used in total parenteral nutrition (TPN) therapy must not exceed 25 micrograms per liter (µg/L). (b) The package insert...

  15. WHO sponsored collaborative studies on nutritional anaemia in India. The effect of parenteral iron administration in the control of anaemia of pregnancy.

    PubMed

    Sood, S K; Ramachandran, K; Rani, K; Ramalingaswami, V; Mathan, V I; Ponniah, J; Baker, S J

    1979-11-01

    1. The relative efficacy of oral and parenteral iron administration in the prophylaxis and treatment of Fe-deficiency anaemia of pregnancy has been studied. 2. Intravenous administration of Fe by total dose infusion of Fe dextran was not superior to oral Fe 120 mg/d, 6 d/week for 10-12 weeks. 3. Intramuscular Fe dextran, 100 mg twice per week for 10-12 weeks, produced a significantly greater rise in mean haemoglobin concentration than oral Fe therapy. 4. The superiority of intramuscular Fe as compared with intravenous Fe is probably related to the different handling of the Fe dextran by the reticulo-endothelial system. 5. In spite of the better response to intramuscular Fe dextran, it is not recommended for public health practice because of the risks associated with its use and the much higher cost of the preparation and its delivery.

  16. Community parenteral therapy project: a pilot study.

    PubMed

    Foster, L; McMurray, A

    1998-01-01

    The pilot study reported in this paper was devised to develop and compare service delivery models that would achieve the provision of high quality parenteral therapy care to patients in the Gold Coast District Health Service community. All data were collected on 113 patients for a 12-month period, January to December 1996. The study compared the provision of outreach nursing services and contracted nursing services on measures of satisfaction and cost. The study showed that patient and carers indicated a preference for community care, medical officers advocated the benefits of administering parenteral therapies in the community, general practitioners were interested in managing future community parenteral therapies, and contracted (nurse) service providers endorsed the development of a parenteral therapy resource centre. The findings also revealed considerable potential cost savings in community-based care.

  17. American Society for Parenteral & Enteral Nutrition

    MedlinePlus

    ... Resources Continuing Education Certification Claim CE Credits Clinical Nutrition Week eLearning Center Professional Development Webinars Calendar of ... Guidelines Clinical Practice Library Standards Malnutrition Awareness Parenteral ... Resources Practice and Research Toolkits Online Store Research ...

  18. A Call to Action to Bring Safer Parenteral Micronutrient Products to the U.S. Market.

    PubMed

    Vanek, Vincent W; Borum, Peggy; Buchman, Alan; Fessler, Theresa A; Howard, Lyn; Shenkin, Alan; Valentine, Christina J

    2015-08-01

    The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) started an intensive review of commercially available parenteral vitamin and trace element (TE) products in 2009. The chief findings were that adult multi-TE products currently available in the United States (U.S.) provide potentially toxic amounts of manganese, copper, and chromium, and neonatal/pediatric multi-TE products provide potentially toxic amounts of manganese and chromium. The multivitamin products appeared safe and effective; however, a separate parenteral vitamin D product is needed for those patients on standard therapy who continue to be vitamin D depleted and are unresponsive to oral supplements. The review process also extended to parenteral choline and carnitine. Although choline and carnitine are not technically vitamins or trace elements, choline is an essential nutrient in all age groups, and carnitine is an essential nutrient in infants, according to the Food and Nutrition Board of the Institute of Medicine. A parenteral choline product needs to be developed and available. Efforts are currently under way to engage the U.S. Food and Drug Administration (FDA) and the parenteral nutrient industry so A.S.P.E.N.'s recommendations can become a commercial reality.

  19. Total parenteral nutrition induces liver steatosis and apoptosis in neonatal piglets

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Total parenteral nutrition (TPN) induces a high rate of liver disease in infants, yet the pathogenesis remains elusive. We used neonatal piglets as an animal model to assess early events leading to TPN-mediated liver injury. Newborn piglets (n = 7) were nourished for 7 d on TPN or enteral nutrition ...

  20. [The partial parenteral nutrition of preterm infants with a body weight < 1000 g: the effects of an infusion of human albumin on plasma amino acid concentration].

    PubMed

    Cassata, N; Didato, M; Faranda, C; Fazio, M; Giaccone, G; Gioeli, R; La Francesca, G; Sulliotti, G; Priolisi, A

    1993-01-01

    This paper concerns with the changes of plasma amino acid (AA) concentrations of N. 10 ELBW infants receiving a regimen of partial parenteral nutrition including human serum albumin (HSA) as a protein supply. The plasma AA concentration has been compared with VLBW infants orally fed with human milk (HM) or human milk supplemented with human milk protein (HMP). As for the essential AA: in comparison to VLBW infants fed HM, the plasma concentration of VAL, PHE and LYS is significantly higher, that of THR, MET, LEU and HIS is similar, whereas that of ILE is significantly lower; in comparison to VLBW infants fed HMP, with the exception of PHE whose plasma concentration is higher, concentration of essential AA significantly lower; the percentage ratio between plasma concentration and intake is in the range of 1,4 to 3,3, except for LYS (= 0.83), indicating a good efficacy of the i.v. administered HSA as AA source, or a slow plasma clearance or a sustained flux of AA from body protein catabolism. Further researches are needed to investigate these aspects and the intermediate steps between i.v. infusion of HSA and the utilization of the component AA for body protein synthesis.

  1. [Routine comparison of trace element deficiencies during parenteral alimentation].

    PubMed

    du Cailar, J; Mathieu-Daudé, J C; Kienlen, J; Béssou, D; Griffe, O; Bélé-Binda

    1977-01-01

    In 50 patients aged between 3 and 84 years treated in a multidisciplinary Intensive Care Unit and receiving parenteral alimentation, deficiency in certain trace elements or electrolytes (Cu++, Zn++, Mn++, Co++, PO-4, Mg++) was prevented or treated by the administration of a glucose solution (MB 147 G) enriched in trace elements. The aim of the present study was to demonstrate, on the basis of assay of serum levels of the trace elements involved, with the exception of Mn and Co, the effectiveness of treatment. Reference values were determined on the one hand in healthy individuals for normal figures and secondly on subjects included in the study, already on parenteral alimentation for several days, before treatment with MB 147 G, in order to demonstrate the existence of a deficiency (patient control values). In the case of PO--4, however, the patient control values concerned at one and the same time subjects in the study before treatment with MB 147 G and other patients receiving parenteral alimentation who were not part of the trial. MB 147 G solution was presented in units of 500 ml associated with glucose of varying concentrations (15 p. 100, 30 p. 100, 50 p. 100). The average daily amount administered, over a period of 236 days, was 3 unites per 24 hours, corresponding to an intake of copper of 3.78 mg, 3.90 mg of zinc, 0.20 mg of manganese, 0.24 mg of cobalt, 363 mg of magnesium, 240 mg of calcium and 15 mEz of phosphates. The results show that levels of copper, zinc, magnesium and phosphates were low during parenteral alimentation. The administration of MB 147 G resulted in a significant increase in these values, without there being any evidence of accumulation.

  2. Effects of early enteral micro-feeding on neonatal serum Vitamin D levels

    PubMed Central

    Hu, Liang; Yin, Xiangdang; Chu, Haifeng; Zheng, Guangli

    2015-01-01

    Objective: To evaluate the effects of early enteral micro-feeding on neonatal serum vitamin D levels, and to analyze the application value of glutamine. Methods: One hundred ninty neonates enrolled in intensive care unit were randomly divided into a treatment group and a control group (n=95) that were both given enteral and parenteral nutrition support. Meanwhile, the treatment group was fed formula milk containing 0.3 g/(kg·d) glutamine as enteral nutrition support for 14 days. Results: The weight of the treatment group increased significantly faster than that of the control group did (P<0.05). The treatment group had significantly higher milk amount and calorie intake than those of the control group (P<0.05), and neonates in the treatment group who reached calorie intake of 50/80/100 kcal/kg/d were significantly younger (P<0.05). Meanwhile, the treatment group was significantly less prone to feeding intolerance than the control group (P<0.05). After 14 days of feeding, the serum motilin, gastrin and vitamin D levels of both groups all increased, with significant intra-group and inter-group differences. Such levels of the treatment group significantly exceeded those of the control group (P<0.05). Conclusion: Supplementing early enteral micro-feeding with glutamine promoted the absorption of neonatal routine nutrients and vitamin D, obviously regulated gastrointestinal hormones, and elevated weight as a result. PMID:26870119

  3. ESPEN Guidelines on Parenteral Nutrition: intensive care.

    PubMed

    Singer, Pierre; Berger, Mette M; Van den Berghe, Greet; Biolo, Gianni; Calder, Philip; Forbes, Alastair; Griffiths, Richard; Kreyman, Georg; Leverve, Xavier; Pichard, Claude; ESPEN

    2009-08-01

    Nutritional support in the intensive care setting represents a challenge but it is fortunate that its delivery and monitoring can be followed closely. Enteral feeding guidelines have shown the evidence in favor of early delivery and the efficacy of use of the gastrointestinal tract. Parenteral nutrition (PN) represents an alternative or additional approach when other routes are not succeeding (not necessarily having failed completely) or when it is not possible or would be unsafe to use other routes. The main goal of PN is to deliver a nutrient mixture closely related to requirements safely and to avoid complications. This nutritional approach has been a subject of debate over the past decades. PN carries the considerable risk of overfeeding which can be as deleterious as underfeeding. Therefore the authors will present not only the evidence available regarding the indications for PN, its implementation, the energy required, its possible complementary use with enteral nutrition, but also the relative importance of the macro- and micronutrients in the formula proposed for the critically ill patient. Data on long-term survival (expressed as 6 month survival) will also be considered a relevant outcome measure. Since there is a wide range of interpretations regarding the content of PN and great diversity in its practice, our guidance will necessarily reflect these different views. The papers available are very heterogeneous in quality and methodology (amount of calories, nutrients, proportion of nutrients, patients, etc.) and the different meta-analyses have not always taken this into account. Use of exclusive PN or complementary PN can lead to confusion, calorie targets are rarely achieved, and different nutrients continue to be used in different proportions. The present guidelines are the result of the analysis of the available literature, and acknowledging these limitations, our recommendations are intentionally largely expressed as expert opinions.

  4. Marchiafava: Bignami Disease Treated with Parenteral Thiamine

    PubMed Central

    Nemlekar, Saumitra Shankar; Mehta, Ritambhara Yeshwant; Dave, Kamlesh Rushikray; Shah, Nilima Deepak

    2016-01-01

    Marchiafava - Bignami disease is rare sequelae of chronic alcohol use. We present a case with transient ischemic attack like presentation and its management with parenteral thiamine. A 53 year old male with history of country liquor use since 32 years was brought to hospital with acute onset of delirium & mild weakness involving motor functions of left side of the body, non-reactive planters and exaggerated tendon reflexes on left side. The MRI showed bilateral hyper intense signal on T2W and FLAIR images & Hypo intense lesion on T1W images involving body, genu and splenium of corpus callosum. The features are suggestive of Marchiafava - Bignami Disease. There have been few guidelines for management of MBD and literature supports use of parenteral thiamine 500mg leading to remission of symptoms and symptomatic improvement. It is advisable to use parenteral thiamine in all cases as it overlaps management of other co-morbidities of chronic alcoholism. PMID:27114628

  5. Parenteral amino acid intakes in critically ill children

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Parenteral amino acid formulas used in parenteral nutrition have a variable composition. To determine the amino acid intake of parenterally fed, critically ill children, and compare it with recommended dietary allowances (RDA) established by the Institute of Medicine (IOM), we retrospectively review...

  6. Prefilled syringes: An innovation in parenteral packaging

    PubMed Central

    Makwana, Sagar; Basu, Biswajit; Makasana, Yogita; Dharamsi, Abhay

    2011-01-01

    Parenteral administration of pharmaceutical products is one of the most popular methods used to produce quick onset of action and also 100% bioavailability. Main problem occurs with the parenteral drug delivery is lack of convenience, affordability, accuracy, sterility, safety etc. Such drawbacks with this delivery system makes it less preferable. Hence, all the disadvantages of these systems can be easily overcome by use of prefilled syringes. The objective of this review article is to provide information regarding prefilled syringes; it's method of preparation, direction to use, advantages, its future scope, and development. PMID:23071944

  7. Chromium deficiency during total parenteral nutrition.

    PubMed

    Freund, H; Atamian, S; Fischer, J E

    1979-02-02

    Chromium is required for maintenance of normal glucose tolerance. After complete bowel resection and five months of total parenteral nutrition, severe glucose intolerance, weight loss, and a metabolic encephalopathy-like confusional state developed in a patient. Serum chromium levels were at the lowest normal level. Supplementation of 150 microgram of chromium per day reversed the glucose intolerance, reduced insulin requirements, and resulted in weight gain and the disappearance of encephalopathy. The low levels of chromium and response to chromium supplementation suggest that chromium deficiency can arise in long-term total parenteral nutrition.

  8. Parenteral opioids for maternal pain management in labour

    PubMed Central

    Ullman, Roz; Smith, Lesley A; Burns, Ethel; Mori, Rintaro; Dowswell, Therese

    2014-01-01

    Background Parenteral opioids are used for pain relief in labour in many countries throughout the world. Objectives To assess the acceptability, effectiveness and safety of different types, doses and modes of administration of parenteral opioids given to women in labour. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 April 2011) and reference lists of retrieved studies. Selection criteria We included randomised controlled trials examining the use of intramuscular or intravenous opioids (including patient controlled analgesia) for women in labour. We looked at studies comparing an opioid with another opioid, placebo, other non-pharmacological interventions (TENS) or inhaled analgesia. Data collection and analysis At least two review authors independently assessed study eligibility, collected data and assessed risk of bias. Main results We included 57 studies involving more than 7000 women that compared an opioid with placebo, another opioid administered intramuscularly or intravenously or compared with TENS to the back. The 57 studies reported on 29 different comparisons, and for many outcomes only one study contributed data. Overall, the evidence was of poor quality regarding the analgesic effect of opioids, satisfaction with analgesia, adverse effects and harm to women and babies. There were few statistically significant results. Many of the studies had small sample sizes, and low statistical power. Overall findings indicated that parenteral opioids provided some pain relief and moderate satisfaction with analgesia in labour, although up to two-thirds of women who received opioids reported moderate or severe pain and/or poor or moderate pain relief one or two hours after administration. Opioid drugs were associated with maternal nausea, vomiting and drowsiness, although different opioid drugs were associated with different adverse effects. There was no clear evidence of adverse effects of opioids on the newborn. We

  9. Omega-3 Fatty Acids in Modern Parenteral Nutrition: A Review of the Current Evidence.

    PubMed

    Klek, Stanislaw

    2016-03-07

    Intravenous lipid emulsions are an essential component of parenteral nutrition regimens. Originally employed as an efficient non-glucose energy source to reduce the adverse effects of high glucose intake and provide essential fatty acids, lipid emulsions have assumed a larger therapeutic role due to research demonstrating the effects of omega-3 and omega-6 polyunsaturated fatty acids (PUFA) on key metabolic functions, including inflammatory and immune response, coagulation, and cell signaling. Indeed, emerging evidence suggests that the effects of omega-3 PUFA on inflammation and immune response result in meaningful therapeutic benefits in surgical, cancer, and critically ill patients as well as patients requiring long-term parenteral nutrition. The present review provides an overview of the mechanisms of action through which omega-3 and omega-6 PUFA modulate the immune-inflammatory response and summarizes the current body of evidence regarding the clinical and pharmacoeconomic benefits of intravenous n-3 fatty acid-containing lipid emulsions in patients requiring parenteral nutrition.

  10. Epigenetic effects of early developmental experiences.

    PubMed

    Gudsnuk, Kathryn M A; Champagne, Frances A

    2011-12-01

    Early-life adversity can affect brain development and behavior. Emerging evidence from studies on both humans and rodents suggests that epigenetic mechanisms may play a critical role in shaping our biology in response to the quality of the environment. This article highlights the research findings suggesting that prenatal maternal stress, postnatal maternal care, and infant neglect/abuse can lead to epigenetic variation, which may have long-term effects on stress responsivity, neuronal plasticity, and behavior.

  11. Recent developments in protein and peptide parenteral delivery approaches

    PubMed Central

    Patel, Ashaben; Cholkar, Kishore; Mitra, Ashim K

    2014-01-01

    Discovery of insulin in the early 1900s initiated the research and development to improve the means of therapeutic protein delivery in patients. In the past decade, great emphasis has been placed on bringing protein and peptide therapeutics to market. Despite tremendous efforts, parenteral delivery still remains the major mode of administration for protein and peptide therapeutics. Other routes such as oral, nasal, pulmonary and buccal are considered more opportunistic rather than routine application. Improving biological half-life, stability and therapeutic efficacy is central to protein and peptide delivery. Several approaches have been tried in the past to improve protein and peptide in vitro/in vivo stability and performance. Approaches may be broadly categorized as chemical modification and colloidal delivery systems. In this review we have discussed various chemical approaches such as PEGylation, hyperglycosylation, mannosylation, and colloidal carriers including microparticles, nanoparticles, liposomes, carbon nanotubes and micelles for improving protein and peptide delivery. Recent developments on in situ thermosensitive gel-based protein and peptide delivery have also been described. This review summarizes recent developments on some currently existing approaches to improve stability, bioavailability and bioactivity of peptide and protein therapeutics following parenteral administration. PMID:24592957

  12. Bell's palsy and parenteral inactivated influenza vaccine.

    PubMed

    Stowe, Julia; Andrews, Nick; Wise, Lesley; Miller, Elizabeth

    2006-01-01

    Concern about a possible increased risk of Bell's palsy after parenteral inactivated influenza vaccine was raised following the publication in 2004 of a Swiss study in which there was an increased risk following the nasal inactivated formulation of the vaccine. When data from passive reporting systems in the United States and the United Kingdom were examined there was some evidence of increased reporting following the parenteral vaccine. A large population based study using the General Practice Research Database (GPRD) was therefore performed to test the hypothesis that there was an increased risk of Bell's palsy in the three months following parenteral inactivated influenza vaccine. The risk was also assessed for the same period following pneumococcal vaccine and was stratified into three age groups (<45, 45-64 and 65+ years). Relative incidence (RI) estimates were calculated using the self-controlled case-series method and showed no evidence of an increased risk in the three months following parenteral inactivated influenza vaccine RI 0.92 (95% confidence interval 0.78-1.08). There was also no evidence of an increased risk in any age group or following pneumococcal vaccine. A significant increase was seen on the day of vaccination (day 0) probably due to opportunistic recording of cases.

  13. PARENTERAL NUTRITION INDICATIONS, ADMINISTRATION, AND MONITORING

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Parenteral nutrition (PN) can be lifesaving or life threatening, depending on when and how it is used. In infants and children who are unable to meet their nutritional requirements over extended periods, it can prevent death from malnutrition. On the other hand, if appropriate attention is not paid ...

  14. Accelerated in vitro release testing methods for extended release parenteral dosage forms

    PubMed Central

    Shen, Jie; Burgess, Diane J.

    2012-01-01

    Objectives This review highlights current methods and strategies for accelerated in vitro drug release testing of extended release parenteral dosage forms such as polymeric microparticulate systems, lipid microparticulate systems, in situ depot-forming systems, and implants. Key findings Extended release parenteral dosage forms are typically designed to maintain the effective drug concentration over periods of weeks, months or even years. Consequently, “real-time” in vitro release tests for these dosage forms are often run over a long time period. Accelerated in vitro release methods can provide rapid evaluation and therefore are desirable for quality control purposes. To this end, different accelerated in vitro release methods using United States Pharmacopoeia (USP) apparatus have been developed. Different mechanisms of accelerating drug release from extended release parenteral dosage forms, along with the accelerated in vitro release testing methods currently employed are discussed. Conclusions Accelerated in vitro release testing methods with good discriminatory ability are critical for quality control of extended release parenteral products. Methods that can be used in the development of in vitro-in vivo correlation (IVIVC) are desirable, however for complex parenteral products this may not always be achievable. PMID:22686344

  15. Treatment of iron deficiency anemia: are monomeric iron compounds suitable for parenteral administration?

    PubMed

    Gupta, A; Crumbliss, A L

    2000-11-01

    Iron deficiency is the most common nutritional problem worldwide, especially in the developing countries. Oral iron supplementation programs have failed because of noncompliance and gastrointestinal toxicity, thereby necessitating parenteral administration of iron. For parenteral administration, only iron-carbohydrate complexes are currently used, because monomeric iron salts release free iron, thereby causing oxidant injury. However, iron-carbohydrate complexes also have significant toxicity, and they are expensive. We have proposed the hypothesis that monomeric iron salts can be safely administered by the parenteral route if iron is tightly complexed to the ligand, thereby causing clinically insignificant release of free iron, and the kinetic properties of the compound allow rapid transfer of iron to plasma transferrin. A detailed analysis of the physicochemical and kinetic properties reveals that ferric iron complexed to pyrophosphate or acetohydroxamate anions may be suitable for parenteral administration. We have demonstrated that infusion of ferric pyrophosphate into the circulation via the dialysate is safe and effective in maintaining iron balance in patients undergoing maintenance hemodialysis. Parenteral administration of monomeric iron compounds is a promising approach to the treatment of iron deficiency in the general population and merits further investigation.

  16. Reversal of growth arrest in adolescents with Crohn's disease after parenteral alimentation.

    PubMed

    Layden, T; Rosenberg, F; Nemchausky, G; Elson, C; Rosenberg, I

    1976-06-01

    Growth arrest and delayed onset of puberty often complicate childhood onset Crohn's disease of the small bowel (granulomatous enteritis). Nutritional deficits arising from inadequate dietary intake, malabsorption, and increased caloric needs may contribute to growth retardation. To assess whether a sustained high caloric and nitrogen intake could reestablish growth, 4 children with extensive Crohn's disease of the small bowel were studied before and after parenteral alimentation which was instituted for symtomatic disease control. Weight gain, positive nitrogen balance, and improved nutritional status were achieved during parenteral alimentation in each patient. In 2 patients weight gain was sustained using oral nutritional supplements, and a substantial increase in linear skeletal growth continued in the ensuing months. One patient entered puberty within 4 months of parenteral alimentation and another had the onset of menarche and the development of secondary sex characteristics 4 months after parenteral alimentation and resection of diseased bowel. Growth may be reestablished in some growth-arrested children if intake is sufficient to establish a sustained positive caloric and nitrogen balance. Nutritional requirements imposed by the demands of growth and active disease and often compounded by the catabolic effects of corticosteroids may be excessive; growth may occur only if these needs are met orally and/or parenterally.

  17. Supplementation of total parenteral nutrition solutions with ferrous citrate.

    PubMed

    Sayers, M H; Johnson, D K; Schumann, L A; Ivey, M F; Young, J H; Finch, C A

    1983-01-01

    Daily infusion of a total parenteral nutrition (TPN) formulation containing 1 liter of 5.5% Travasol provides less than 0.1 milligrams of iron. By comparison, a formulation which includes a liter of 10% Travamin provides 2 milligrams of iron per day. To meet iron requirements in patients infusing formulations containing Travasol, iron was added as ferrous citrate. In in virto experiments, 74% of this iron was available to transferrin. In seven patients in whom in vivo availability was tested by red cell incorporation, the mean availability was 81%. Ferrous citrate is recommended as a safe, effective additive to TPN solutions for adult patients requiring iron supplements.

  18. [Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): gastrointestinal surgery].

    PubMed

    Sánchez Álvarez, C; Zabarte Martínez de Aguirre, M; Bordejé Laguna, L

    2011-11-01

    Gastrointestinal surgery and critical illness place tremendous stress on the body, resulting in a series of metabolic changes that may lead to severe malnutrition, which in turn can increase postsurgical complications and morbidity and mortality and prolong the hospital length of stay. In these patients, parenteral nutrition is the most widely used form of nutritional support, but administration of enteral nutrition early in the postoperative period is effective and well tolerated, reducing infectious complications, improving wound healing and reducing length of hospital stay. Calorie-protein requirements do not differ from those in other critically-ill patients and depend on the patient's underlying process and degree of metabolic stress. In patients intolerant to enteral nutrition, especially if the intolerance is due to increased gastric residual volume, prokinetic agents can be used to optimize calorie intake. When proximal sutures are used, tubes allowing early jejunal feeding should be used. Pharmaconutrition is indicated in these patients, who benefit from enteral administration of arginine, omega 3 and RNA, as well as parenteral glutamine supplementation. Parenteral nutrition should be started in patients with absolute contraindication for use of the gastrointestinal tract or as complementary nutrition if adequate energy intake is not achieved through the enteral route.

  19. Sodium N-(methylsulfonyl)-N-(4-nitro-2-phenoxyphenyl)sulfamate: a water-soluble nimesulide prodrug for parenteral use.

    PubMed

    Rapposelli, Simona; Digiacomo, Maria; Franchi, Silvia; Moretti, Sara; Pinza, Mario; Sacerdote, Paola; Balsamo, Aldo

    2010-10-04

    Several nimesulide preparations (i.e., tablet form, gels) have been marketed, but no parenteral solution has achieved the market because of their low wettability and unsatisfactory chemical-physical properties required for parenteral use. In this paper we describe the synthesis of the nimesulide prodrug 1 and its anti-inflammatory and antihyperalgesic properties. Pharmacological studies, carried out to evaluate the in vivo anti-inflammatory and analgesic activities of compound 1 and nimesulide, showed that sodium sulfamate 1 is an effective nimesulide prodrug that can be administered by parenteral route, undergoing a satisfactory absorption and an extensive transformation into the active nimesulide compound. Moreover, the evaluation of the plasma concentrations of nimesulide after rat treatment with compound 1 showed an increased and dose-dependent release of nimesulide. In contrast, the plasma concentrations of nimesulide, after "native" drug administration, still remain substantially unchanged. These preliminary results prompt further investigations on this prodrug as a possible candidate for parenteral use.

  20. [Outpatient parenteral antibiotic therapy (OPAT): the Lausanne experience supporting new perspectives].

    PubMed

    Moulin, Estelle; Boillata, Noémie; De Vallière, Serge

    2016-04-13

    With the increase of infections without option for an oral treatment, the systematic use of hospitalization overloads the healthcare system and causes growing political concern. For carefully selected patients, outpatient parenteral antibiotic therapy is an interesting alternative, with more than 40 years of experience in several countries. In this perspective, an outpatient parenteral antibiotic therapy (OPAT) unit was established in Lausanne two years ago. This article aims to describe its activity. Its practice, involving especially self-administration, seems to be safe, efficacious and cost-effective, as long as international good practice recommendations are applied.

  1. Parenteral nutrition in the malnourished: dialysis, cancer, obese, and hyperemesis gravidarum patients.

    PubMed

    Lau, Mary Theresa

    2011-01-01

    Malnutrition is a complication of many disease processes and can have deleterious effects on patient care outcomes. Providing adequate nutritional support requires a plan that is tailored to the individual needs of the patient and occasionally requires the use of parenteral nutrition. The varied nutritional needs of malnourished dialysis, cancer, obese, and hyperemesis gravidarum patients will be discussed. The infusion nurse specialist is a vital member of the nutrition support team in the care and recovery of the malnourished patient who requires parenteral nutrition.

  2. [Elevated serum lithium concentration due to switch from parenteral nutrition alone to parenteral with enteral nutrition].

    PubMed

    Goto, Hidekazu; Tomita, Takashi; Doki, Shotaro; Nakanishi, Rie; Kojima, Chikako; Yoneshima, Mihoko; Yoshida, Tadashi; Tanaka, Katsuya; Kohda, Yukinao

    2015-01-01

    We report a patient with elevated serum lithium concentration caused by switching from parenteral nutrition alone to parenteral with enteral nutrition. A 73-year-old female inpatient was treated with lithium carbonate 600 mg/d for manic episodes of bipolar disorder. Her serum lithium level was maintained at 0.57-0.79 mEq/L. She was administered total parenteral nutrition owing to difficulty in oral intake. Her diet contained 4.8-5.8 g/d of sodium chloride. After this, parenteral with enteral nutrition was initiated. The total sodium chloride intake decreased from 6.3 to 3.0-4.0 g/d following this change. On day 15 after initiation of parenteral with enteral nutrition, her serum lithium level increased to 1.17 mEq/L, which is closer to the upper therapeutic range limit. Therefore enteral nutrition was stopped immediately, and an electrolyte solution was administered instead of enteral nutrition. An antibiotic agent was also simultaneously administered because of infection. The total amount of sodium chloride administered was increased to 7.0 g/d during this treatment. Four days after treatment, the serum lithium level returned to 0.57 mEq/L. This case suggests that administration of appropriate sodium chloride nutrition is important during treatment with lithium carbonate, because disposition of lithium ion is paralleled to that of sodium.

  3. Metabolic acidosis during parenteral nutrition: Pathophysiological mechanisms

    PubMed Central

    Dounousi, Evangelia; Zikou, Xanthi; Koulouras, Vasilis; Katopodis, Kostas

    2015-01-01

    Total parenteral nutrition (TPN) is associated with metabolic complications including metabolic acidosis (MA), one of the main disorders of acid-base balance. The main causes involved in the appearance of MA during TPN administration are the metabolism of cationic amino acids and amino acids containing sulfuric acid (exogenous addition), the titratable acidity of the infused parenteral solution, the addition of acidificant agents (hydrochloric acid, acetic acid), thiamine deficiency, disruption of carbohydrate and lipid metabolic pathways and D-fructose administration. Moreover, hypophosphatemia that appears during TPN therapy contributes significantly to the maintenance of MA. This review describes in a comprehensive way the pathophysiological mechanisms involved in the appearance of MA induced by intravenous administration of TPN products most commonly used in critically ill-patients. PMID:25983433

  4. Intravenous Lipid Emulsions in Parenteral Nutrition123

    PubMed Central

    Fell, Gillian L; Nandivada, Prathima; Gura, Kathleen M; Puder, Mark

    2015-01-01

    Fat is an important macronutrient in the human diet. For patients with intestinal failure who are unable to absorb nutrients via the enteral route, intravenous lipid emulsions play a critical role in providing an energy-dense source of calories and supplying the essential fatty acids that cannot be endogenously synthesized. Over the last 50 y, lipid emulsions have been an important component of parenteral nutrition (PN), and over the last 10–15 y many new lipid emulsions have been manufactured with the goal of improving safety and efficacy profiles and achieving physiologically optimal formulations. The purpose of this review is to provide a background on the components of lipid emulsions, their role in PN, and to discuss the lipid emulsions available for intravenous use. Finally, the role of parenteral fat emulsions in the pathogenesis and management of PN-associated liver disease in PN-dependent pediatric patients is reviewed. PMID:26374182

  5. Early Agriculture: Land Clearance and Climate Effects

    NASA Astrophysics Data System (ADS)

    Ruddiman, W. F.

    2013-12-01

    In the 2003 AGU Emiliani Lecture, I proposed the 'early anthropogenic hypothesis' --the idea that major anthropogenic effects on greenhouse gases and climate occurred thousands of years before the industrial era. In the decade since then, several dozen published papers have argued its pros and cons. In the 2013 Tyndall History of Global Change Lecture I will update where matters now stand. I will show figures from the 2003 Climate Change paper that laid out the initial hypothesis, and then update subsequent evidence from ice-core drilling, archeology, and land-use histories. The primary claims in the 2003 hypothesis were these: (1) the CH4 rise since 5000 years ago is anthropogenic; (2) the CO2 rise since 7000 years ago is also anthropogenic; (3) the amount of carbon emitted from preindustrial deforestation was roughly twice the amount released during the industrial era; (4) global temperature would have been cooler by about 0.8oC by the start of the industrial era if agricultural CO2 and CH4 emissions had not occurred; (5) early anthropogenic warming prevented the inception of new ice sheets at high northern latitudes; and (6) pandemics and other population catastrophes during the last 2000 years caused CO2 decreases lasting decades to centuries. The new evidence shows that these claims have held up well. The late-Holocene CO2 and CH4 rises are anomalous compared to average gas trends during previous interglaciations of the last 800,000 years. Land-use models based on historical data simulate pre-industrial CO2 carbon releases more than twice the industrial amounts. Archeological estimates of CH4 emissions from expanding rice irrigation account for much of the late Holocene CH4 rise, even without including livestock emissions or biomass burning. Model simulations show that the large pre-industrial greenhouse-gas emissions indicated by these historical and archeological estimates would have warmed global climate by more than 1oC and prevented northern glacial

  6. Taurolidine in Pediatric Home Parenteral Nutrition Patients.

    PubMed

    Hulshof, Emma Claire; Hanff, Lidwien Marieke; Olieman, Joanne; de Vette, Susanna; Driessen, Gert-Jan; Meeussen, Conny; Escher, Johanna Caroline

    2017-02-01

    To reduce the incidence of catheter-related bloodstream infections in home parenteral nutrition patients, the use of taurolidine was introduced in the Sophia Children's Hospital in 2011. This introduction led to a reduction in catheter-related bloodstream infections: 12.7/1000 catheter days before the use of taurolidine, compared with 4.3/1000 catheter days afterwards (n = 7) [relative risk = 0.36, 95% confidence interval: 0.20-0.65 (P = 0.018)].

  7. Total parenteral nutrition in diabetic rats

    SciTech Connect

    Norcross, E.D.; Stein, T.P.

    1986-03-01

    Parenteral Nutrition with hypertonic glucose is frequently given to diabetic patients. Large amounts of insulin can be required. The purpose of this investigation was to develop a totally parenterally nourished diabetic rat model. 200 g Female Sprague Dawley rats were made diabetic by i.v. injection of streptozotocin (50 mg/kg). Rats were then allowed to recover for at least 1 week before undergoing surgical insertion of a central venous catheter for parenteral feeding. TPN was begun 3 days after surgery. Prior to this they were allowed unlimited access to food and water. Control (non-streptozotocin treated) rats were run at the same time. Protein turnover was investigated by using /sup 15/N glycine. Preliminary results: diabetic rats given mostly fat as a calorie source survived well in the absence of exogenous insulin whereas those that were given glucose only as their non-protein calorie source showed poor survival even with exogenous insulin. N balance and protein turnover in the lipid treated diabetic rats were comparable to the non-diabetic control rats.

  8. Course and outcome of parenteral nutrition-associated cholestasis in neonates

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Parenteral nutrition-associated cholestasis (TPN-Chol) leads to significant morbidity and mortality. To assess the safety and effectiveness of potential interventions, it is necessary to evaluate the natural history of TPN-Chol. This retrospective review was undertaken to evaluate the typical course...

  9. [Safety aspects of parenteral iron supplementation therapies in patients with chronic kidney disease].

    PubMed

    Potthoff, S A; Münch, H G

    2013-06-01

    Iron deficiency often occurs in patients with chronic kidney disease and can be effectively treated with parenteral supplementation of iron. In these patients, prompt application of iron therapy can help to reduce the dependence of erythropoietin-stimulating agents and effectively treat anemia. Correct evaluation of iron metabolism in CKD patients can be difficult. Duration of and response to therapy should always be considered while planning parenteral supplementation of iron. The main safety aspects of parenteral iron preparations relate to their possible anaphylactic potential and the potential induction of oxidative stress due to the release of free iron. However, parenteral iron supplementation is usually safe and without major side effects. Regarding current data, none of the iron preparations is showing definitive superiority. Although uncommon, iron preparations containing dextran can lead to severe side effects, therefore these preparations appear to have an inferior safety profile. Due to limited data, a comparison of third-generation iron preparations with previous preparations is not possible. Recently, for the first time, the third generation iron preparation ferumoxytol has been directly compared to iron sucrose. From this data and others, it remains unclear whether third generation iron preparations show safety-relevant superiority.

  10. Chronic parenteral nutrition reduces lean tissue growth and induces insulin resistance in neonatal piglets

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Most very low birthweight infants receive their nutrition parenterally prior to achieving full enteral feedings. Recent studies indicate that infants born less than 32 weeks gestation showed evidence of insulin resistance at 4 to 10 years. However, there is little information regarding the effect of...

  11. L-carnitine and cancer cachexia. II. Effects of lipid emulsion used in total parenteral nutrition on parameters of hemostasis and inflammatory state in L-carnitine deficiency in myocytes.

    PubMed

    Szefel, Jarosław; Kruszewski, Wiesław Janusz; Ciesielski, Maciej; Szajewski, Mariusz; Kawecki, Krzysztof; Jankun, Jerzy; Lysiak-Szydłowska, Wiesława

    2012-07-01

    Cancer cachexia (CC), a progressive loss of body mass, leads to malnutrition and deficiencies of essential substances including polyunsaturated fatty acids (PUFAs) and L-carnitine (LC). The availability of these 2 compounds determines the rate of eicosanoid synthesis, which modulates inflammatory processes and hemostasis. We compared the effects of administration of emulsions containing long chain triglycerides (LCTs) relative to a 50:50 mix of medium chain triglycerides (MCTs) with LCTs on hemostasis and inflammatory reactions in patients with CC. The study was conducted on 50 patients with CC (23 women, 27 men) aged 66 ± 11 years with a mean loss in body weight of 21 ± 9% in the previous 6 months. Twenty patients received MCTs/LCTs while 30 received LCTs. Total parenteral nutrition (TPN) was administered using the 'all in one' method (25 kcal/kg/day, protein 1.2 g/kg/day). Selected parameters of coagulation and inflammatory state were evaluated on days 1, 5, 7 and 11 of TPN. Initial concentrations of D-dimers, fibrinogen, plasminogen activator inhibitor type 1 (PAI-1), fibronectin, CRP and IL-6 significantly exceeded the upper limit of the reference values. After 10 days of TPN, we detected significant differences in inflammatory state and hemostasis. Immunological state and hemostasis varied depending on the type of fat emulsion administered. The most likely reasons are the 2-fold higher concentrations of PUFAs in LCTs relative to MCTs/LCTs and a deficiency of LC in skeletal muscles. Both of these factors may contribute to the observed increase in the rate of eicosanoid synthesis.

  12. [Guidelines for specialized nutritional and metabolic support in the critically ill-patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): severe acute pancreatitis].

    PubMed

    Bordejé Laguna, L; Lorencio Cárdenas, C; Acosta Escribano, J

    2011-11-01

    Severe acute pancreatitis (SAP) causes local and systemic complications leading to high catabolic, hypermetabolic and hyperdynamic stress states with marked morbidity and mortality. In the last decade, nutritional support has become a key element in the treatment of SAP. Thus, specialized nutrition is indicated from admission, with enteral nutrition being preferred to parenteral nutrition. Enteral nutrition should be initiated early using infusion through the jejunum beyond the ligament of Treitz to minimize pancreatic stress. There are no specific studies that establish the type of diet to be used but experts recommend the use of polymeric diets. Parenteral nutrition, without a specific formula, is indicated in patients with SAP who are intolerant to enteral nutrition or when the clinical signs of pancreatitis are exacerbated or aggravated by enteral nutrition. Even so, a minimal level of enteral infusion should be maintained to preserve the trophic effect of the intestinal mucosa. In the last few years, several studies of the administration of immunomodulatory diets in patients with SAP have been carried out to demonstrate their effects on the course of the disease. However, there are few clear recommendations on the prognostic benefits of pharmaconutrient enriched diets in these patients. There is substantial scientific evidence suggesting that the only clear indication for pharmaconutrition in patients with SAP is parenteral glutamine administration, which is recommended by all clinical guidelines with distinct grades of evidence.

  13. Stability of sulbactam/ampicillin in diluents for parenteral administration.

    PubMed

    Mushinsky, R F; Reynolds, M L; Nicholson, C A; Crider, L L; Forcier, G A

    1986-01-01

    Compatibility studies were conducted of sulbactam/ampicillin in infusion diluents that are reported to be compatible with ampicillin sodium. A high-performance liquid chromatographic system that simultaneously detects sulbactam and ampicillin was used to determine whether the infusion diluents and the conditions of use recommended for ampicillin sodium are applicable to sulbactam/ampicillin. The results show that the sulbactam/ampicillin preparation for parenteral administration is compatible with all diluents recommended for ampicillin sodium. In all diluents sulbactam was more stable than ampicillin. At the end of the reported use periods, the average retention value for sulbactam in the combination solutions was 96% (range, 91%-101%), whereas the average retention value for ampicillin in the same solutions was 90% (range, 84%-95%). The presence of sulbactam had no adverse effect on the stability of ampicillin. The average retention value for ampicillin alone in the same diluents was 92% (range, 82%-99%). The conditions of use for sulbactam/ampicillin in diluents for parenteral administration are unrestricted by the presence of sulbactam and are, in fact, governed by those of ampicillin sodium.

  14. Parenteral arginine infusion in humans: nutrient substrate or pharmacologic agent?

    PubMed

    Sigal, R K; Shou, J; Daly, J M

    1992-01-01

    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 mumol/L and 191 +/- 76 mumol/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.

  15. Femoral venous catheters: a safe alternative for delivering parenteral alimentation.

    PubMed

    Friedman, B; Kanter, G; Titus, D

    1994-04-01

    Femoral vein catheterization is an alternative method of obtaining central venous access. Placement of femoral venous catheters (FVCs) is possible in the majority of patients, suitable for most indications, and associated with a low complication rate during insertion. We wished to determine the incidence of infections or other complications resulting when parenteral nutrition was delivered through FVCs. Fifty-two patients were followed from a hospital-wide population including patients in the critical care units. Triple-lumen catheters were placed by using the sterile Seldinger technique, and sites were examined daily for inflammation. Bacteriologic surveillance was accomplished by submitting the catheter tip for semiquantitative cultures. If catheter line sepsis was suspected, blood samples for cultures were drawn through the catheter and peripherally. The rate of occurrence of colonized catheters was 9.6% (five of 52), and catheter sepsis was found in one case (1.9%). Other than inflammation at six (11.5%) of 52 catheter sites, noninfectious complications of FVCs were not found. On the basis of these findings, we consider FVC-delivered parenteral alimentation a safe and effective alternative to other forms of central venous access.

  16. Effective Early Learning: Mapping Diversity and Tracking Development.

    ERIC Educational Resources Information Center

    Pascal, Christine

    This paper describes and reviews the Effective Early Learning (EEL) Research Project's approach to quality evaluation and improvement in early childhood settings in the United Kingdom which focuses primarily on enhancing the effectiveness of the early learning experiences of young children. The project began work in May 1993 and is completing its…

  17. Fish oils in parenteral nutrition: Why could these be important for gastrointestinal oncology?

    PubMed Central

    Ferguson, Lynnette R

    2015-01-01

    By the time a gastroenterology patient is moved to parenteral nutrition, he or she is usually in poor health. All parenteral nutrition formulae contain essential nutrients, avoiding components that could cause an adverse reaction. The lipid component is often provided by a soy extract, containing all the fatty acids considered to be essential in the diet. Several trials have considered parenteral nutrition formulas with added fish oils, high in the long chain omega-3 polyunsaturated fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Given the range of biological functions associated with such compounds, especially in reducing inflammatory symptoms, this move would appear rational. However, while data from such trials are often positive, there has been variability among results. Some of this variability could be caused by environmental contaminants in the fish, and/or oxidation of the lipids because of poor storage. The situation is complicated by a recent report that fish oils may counter the effects of platinum chemotherapy. However, this effect associated with a minor component, hexadeca-4,7,10,13-tetraenoic acid. It is suggested that pure DHA and EPA would be beneficial additions to parenteral nutrition, reducing the probability of carcinogenesis and enhancing rational disease management. However, the jury is still out on fish oils more generally. PMID:26380055

  18. Effect of Early Expressed Human Milk on Insulin-Like Growth Factor 1 and Short-Term Outcomes in Preterm Infants

    PubMed Central

    Serrao, Francesca; Papacci, Patrizia; Costa, Simonetta; Giannantonio, Carmen; Cota, Francesco; Vento, Giovanni; Romagnoli, Costantino

    2016-01-01

    Aims Preterm breast milk contains high levels of bioactive components, including insulin-like growth factor 1 (IGF-1), that are reduced by Holder pasteurization. Animal studies have shown that milk-borne IGF-1 is likely absorbed intact in a bioactive form by the intestines. The aim of this study was to assess if early non-pasteurized expressed breast milk nutrition may affect IGF-1 plasma levels in premature infants. We also investigated the possible association between early expressed milk nutrition and short-term outcomes. Methods Fifty-two preterm infants with gestational age < 31 weeks were divided into two groups according to expressed breast milk intake (< or ≥ 50 mL/Kg/day) until 32 weeks of postmenstrual age when blood sampling for IGF-1 analysis was performed. Results In our population, early expressed breast milk does not affect IGF-1 plasma levels (p 0.48). An association was observed between early expressed milk nutrition and a lower incidence of bronchopulmonary dysplasia, sepsis, feeding intolerance, need for parenteral nutrition and length of hospitalization. Conclusions Contrary to the results in some animal studies, our results did not seem to show that early expressed breast milk can help to maintain postnatal IGF-1 near foetal levels in preterm infants. The observed protective effect of expressed breast milk on short-term outcomes can be the starting point for further study of the effects of non-pasteurized human milk in preterm infants. PMID:27973552

  19. Early effect of SiGe heterojunction bipolar transistors

    NASA Astrophysics Data System (ADS)

    Xu, Xiao-Bo; Zhang, He-Ming; Hu, Hui-Yong; Qu, Jiang-Tao

    2012-06-01

    The standard Early voltage of the SGP model is generalized for SiGe NPN heterojunction bipolar transistors (HBTs). A new compact formulation of the Early voltage compatible with the SGP model is presented. The impact of the Ge profile on Early effect is shown and validated by experiments. The model can be applied to the SGP model for circuit simulation.

  20. Parenteral sulfur amino acid requirements in septic infants

    Technology Transfer Automated Retrieval System (TEKTRAN)

    To investigate parenteral methionine requirements of critically ill, septic infants, we conducted an investigation involving 12 infants (age 2+/-1 years; weight 13+/-2kg) using the intravenous indicator amino acid oxidation and balance technique. They received a balanced parenteral amino acid formul...

  1. Timing of (supplemental) parenteral nutrition in critically ill patients: a systematic review.

    PubMed

    Bost, Rianne Bc; Tjan, Dave Ht; van Zanten, Arthur Rh

    2014-01-01

    Supplemental parenteral nutrition (SPN) is used in a step-up approach when full enteral support is contraindicated or fails to reach caloric targets. Recent nutrition guidelines present divergent advices regarding timing of SPN in critically ill patients ranging from early SPN (<48 h after admission; EPN) to postponing initiation of SPN until day 8 after Intensive Care Unit (ICU) admission (LPN). This systematic review summarizes results of prospective studies among adult ICU patients addressing the best timing of (supplemental) parenteral nutrition (S)PN. A structured PubMed search was conducted to identify eligible articles. Articles were screened and selected using predetermined criteria and appraised for relevance and validity. After critical appraisal, four randomized controlled trials (RCTs) and two prospective observational studies remained. One RCT found a higher percentage of alive discharge from the ICU at day 8 in the LPN group compared to EPN group (p = 0.007) but no differences in ICU and in-hospital mortality. None of the other RCTs found differences in ICU or in-hospital mortality rates. Contradicting or divergent results on other secondary outcomes were found for ICU length of stay, hospital length of stay, infection rates, nutrition targets, duration of mechanical ventilation, glucose control, duration of renal replacement therapy, muscle wasting and fat loss. Although the heterogeneity in quality and design of relevant studies precludes firm conclusions, it is reasonable to assume that in adult critically ill patients, there are no clinically relevant benefits of EPN compared with LPN with respect to morbidity or mortality end points, when full enteral support is contraindicated or fails to reach caloric targets. However, considering that infectious morbidity and resolution of organ failure may be negatively affected through mechanisms not yet clearly understood and acquisition costs of parenteral nutrition are higher, the early

  2. Oxidation of parenteral lipid emulsion by ambient and phototherapy lights: potential toxicity of routine parenteral feeding.

    PubMed

    Neuzil, J; Darlow, B A; Inder, T E; Sluis, K B; Winterbourn, C C; Stocker, R

    1995-05-01

    Vitamin E can be a prooxidant in isolated lipoprotein suspensions. Because lipid emulsions used in parenteral nutrition are lipoprotein-like suspensions rich in polyunsaturated fatty acids and vitamin E, we hypothesized that vitamin E may act as a prooxidant in lipid emulsions, as it is in lipoprotein suspensions. We therefore exposed an intravenously administered lipid emulsion (Intralipid) to a single spotlight commonly used in the treatment of neonatal jaundice, and measured the formation of triglyceride hydroperoxides by using high-performance liquid chromatography with postcolumn chemiluminescence detection. Concentrations of these hydroperoxides in different batches of fresh intralipid were usually approximately 10 mumol/L but increased up to 60 times after exposure to phototherapy light for a period of 24 hours, even though significant amounts of vitamin E were present at the end of the exposure. Triglyceride hydroperoxides were formed during phototherapy light exposure whether the intralipid was in plastic tubing used routinely for infusion or in glass containers. Ambient light also caused significant peroxidation of the formula lipids, although to a much lesser extent than observed with phototherapy light. For infants in the neonatal intensive care unit who were receiving intralipid but not phototherapy, solutions being infused at the end of 24 hours contained a mean of 40 mumol/L hydroperoxides. For infants receiving phototherapy, the mean was 97 mumol/L. Phototherapy light-induced formation of triglyceride hydroperoxides was prevented by covering the intralipid with aluminum foil or supplementation with sodium ascorbate before light exposure. We conclude that intralipid is highly susceptible to oxidation and that elevated levels of oxidized lipids can be formed during its clinical use, especially when intralipid infusion is combined with phototherapy. Because lipid hydroperoxides are cytotoxic and can cause adverse effects, inadvertent infusion of rancid

  3. Iron distribution and histopathological characterization of the liver and heart of β-thalassemic mice with parenteral iron overload: Effects of deferoxamine and deferiprone.

    PubMed

    Yatmark, Paranee; Morales, Noppawan Phumala; Chaisri, Urai; Wichaiyo, Surasak; Hemstapat, Warinkarn; Srichairatanakool, Somdet; Svasti, Saovaros; Fucharoen, Suthat

    2014-09-01

    The liver and heart are the major target organs for iron accumulation and iron toxicity in β-thalassemia. To mimic the phenomenon of heavy iron overload resulting from repeated blood transfusions, a total of 180 mg of iron dextran was intraperitoneally injected into C57BL/6J mice (WT) and heterozygous β-globin knockout mice ((mu)β(th-3/+), BKO). The effects of deferiprone and deferoxamine in this model were investigated. The iron was distributed homogenously throughout the 4 liver lobes (left, caudate, right and median) and was present in hepatocytes, Kupffer cells and the sinusoidal space. Iron accumulation in phagocytic macrophages, recruitment of hepatic lymphocytes and nucleus membrane degeneration were observed as a result of iron overload in the WT and BKO mice. However, the expansion of hepatic extramedullary hematopoiesis was observed only in the BKO mice with iron overload. In the heart, the iron accumulated in the cardiac interstitium and myocytes, and moderate hypertrophy of the myocardial fibers and cardiac myocyte degeneration were observed. Although the total liver iron was not significantly altered by iron chelation therapy, image analysis demonstrated a difference in the efficacies of two iron chelators. The major site of chelation was the extracellular compartment, but treatment with deferiprone also resulted in intracellular iron chelation. Interestingly, iron chelators reversed the pathological changes resulting from iron overload in WT and BKO mice despite being used for only a short treatment period. We suggest that some of these effects may be secondary to the anti-inflammatory activity of the chelators.

  4. Two doses of parenterally administered split influenza virus vaccine elicited high serum IgG concentrations which effectively limited viral shedding upon challenge in mice.

    PubMed

    Hovden, A-O; Cox, R J; Madhun, A; Haaheim, L R

    2005-10-01

    We have previously found that whole influenza virus vaccine induced a more rapid and stronger humoral response, particularly after the first dose of vaccine, than split virus vaccine in mice. In this study, we have evaluated the protective efficacy of whole and split influenza virus vaccines in mice using a nonlethal upper respiratory tract challenge model. We have also investigated the immunological correlates associated with no or very little viral shedding after viral challenge. Vaccination resulted in reduced viral shedding and shortened the duration of infection by at least 2 days. After one dose of vaccine, whole virus vaccine generally resulted in less viral shedding than split virus vaccine. In contrast, two doses of split virus vaccine, particularly the highest vaccine strengths of 15 and 30 microg HA, most effectively limited viral replication and these mice had high concentrations of prechallenge influenza-specific serum IgG. The vaccine formulation influenced the IgG2a/IgG1 ratio, and this IgG subclass profile was maintained upon challenge to some extent, although it did not influence the level of viral shedding. The concentration of postvaccination serum IgG showed an inverse relationship with the level of viral shedding after viral challenge. Therefore, serum IgG is an important factor in limiting viral replication in the upper respiratory tract upon challenge of an antigenically similar virus.

  5. Home parenteral nutrition in chronic intestinal failure.

    PubMed Central

    Bisset, W M; Stapleford, P; Long, S; Chamberlain, A; Sokel, B; Milla, P J

    1992-01-01

    In children with severe failure of intestinal function, intravenous nutrition is at present the only treatment able to maintain adequate nutrition for prolonged periods of time. Over the last five years we have discharged 10 patients home on parenteral nutrition for a total of 25 patient years and here the outcome of these children is presented. Of the 10 patients, one has discontinued home parenteral nutrition (HPN), seven patients remain well, one patient has recently moved to the USA, and one patient has died after major abdominal surgery. All children had either normal or an accelerated rate of growth on HPN and developmentally all have progressed well. All the children over 5 years attend normal schools. The major complication of treatment was line sepsis with an overall rate of one episode in 476 days and a total of nine central lines (five patients) have required replacement giving an average line life of 680 days. For those children unfortunate enough to suffer from severe intestinal failure, HPN is preferable to prolonged hospital treatment and offers the chance of a good quality of life with prolonged survival. PMID:1739322

  6. ASPEN statement on parenteral nutrition standardization.

    PubMed

    Kochevar, Marty; Guenter, Peggi; Holcombe, Beverly; Malone, Ainsley; Mirtallo, Jay

    2007-01-01

    In response to questions regarding use of standardized parenteral nutrition (PN) formulations, the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) developed a Task Force to address some of these issues. A.S.P.E.N. envisions standardized PN as a broader issue rather than simply using a standardized, commercially available PN product. A standardized process for PN must be explored in order to improve patient safety and clinical appropriateness, and to maximize resource efficiency. A standardized process may include use of standardized PN formulations (including standardized, commercial PN products) but also includes aspects of ordering, labeling, screening, compounding, and administration of PN. A safe PN system must exist which minimizes procedural incidents and maximizes the ability to meet individual patient requirements. Using clinicians with nutrition support therapy expertise will contribute to that safe PN system. The purpose of this statement is to present the published literature associated with standardized PN formulations, to provide recommendations, and to identify areas in need of future research.

  7. Parenteral nutrition product shortages: impact on safety.

    PubMed

    Holcombe, Beverly

    2012-03-01

    The drug shortage crisis continues in the United States and threatens the integrity of the pharmaceutical supply chain and compromises patient care, especially patients requiring parenteral nutrition (PN) therapy. The number of new drug shortages has increased rapidly over the past 5 years, with the most significant increase in sterile injectable products. The most common reason for a shortage of a sterile injectable medication is a product quality issue. Two surveys of healthcare professionals have assessed the impact of drug shortages on patient safety. Participants in one survey reported over 1000 medication errors or patient adverse events as the result of shortages. The American Society for Parenteral and Enteral Nutrition also conducted a survey of healthcare professionals regarding PN product shortages and the associated patient care implications. Safety risks were reported throughout the entire PN process, from procurement of PN products to patient outcomes. Providing PN therapy during product shortages requires vigilance and continuous assessment of the entire PN process to optimize patient care quality and avoid patient harm.

  8. An exclusively based parenteral fish-oil emulsion reverses cholestasis.

    PubMed

    Triana Junco, Miryam; García Vázquez, Natalia; Zozaya, Carlos; Ybarra Zabala, Marta; Abrams, Steven; García de Lorenzo, Abelardo; Sáenz de Pipaón Marcos, Miguel

    2014-10-25

    Prolonged parenteral nutrition (PN) leads to liver damage. Recent interest has focused on the lipid component of PN. A lipid emulsion based on w-3 fatty acids decrease conjugated bilirubin. A mixed lipid emulsion derived from soybean, coconut, olive, and fish oils reverses jaundice. Here we report the reversal of cholestasis and the improvement of enteral feeding tolerance in 1 infant with intestinal failure-associated liver disease. Treatment involved the substitution of a mixed lipid emulsion with one containing primarily omega-3 fatty acids during 37 days. Growth and biochemical tests of liver function improved significantly. This suggests that fat emulsions made from fish oils may be more effective means of treating this condition compared with an intravenous lipid emulsion containing soybean oil, medium -chain triglycerides, olive oil, and fish oil.

  9. Commercial premixed parenteral nutrition: Is it right for your institution?

    PubMed

    Miller, Sarah J

    2009-01-01

    Two-compartment premixed parenteral nutrition (PN) products are heavily promoted in the United States. These products may present safety advantages over PN solutions mixed by a local pharmacy, although clinical data to support this assertion are scarce. Multicompartment products can be labor-saving for pharmacy and therefore may be cost-effective for some institutions. Before adopting such products for use, an institution must determine that standardized PN solutions are acceptable for many or most of their patients compared with customized PN compounded specifically for individual patients. A larger selection of premixed products is available in Europe and some other parts of the world compared with the United States. Availability of a broader selection of products in the United States, including 3-compartment bags and a wider range of macronutrient concentrations and volumes, may make the use of such products more desirable in the future.

  10. Intradialytic parenteral nutrition in hemodialysis patients: Acute and chronic intervention.

    PubMed

    Avery-Lynch, Margaret

    2006-01-01

    Protein and calorie malnutrition have been encountered more frequently than expected in the hemodialysis patients. Intradialytic parenteral nutrition (IDPN) has been documented to improve nutritional status in hemodialysis patients in both acute and chronic settings (Henrich, 1996). The aim of this study was to support the usage of IDPN in our malnourished hemodialysis patients. Serum concentration of albumin is one of the main indicators of mortality in the dialysis population. The serum albumin concentration for six out of eight of our hemodialysis (HD) patients receiving IDPN increased significantly. There was a mean increase of 7.0 g/L of plasma albumin for the eight patients assessed. These results demonstrate that IDPN is an effective nutritional intervention for malnourished hemodialysis patients.

  11. High-dose parenteral ascorbate enhanced chemosensitivity of ovarian cancer and reduced toxicity of chemotherapy.

    PubMed

    Ma, Yan; Chapman, Julia; Levine, Mark; Polireddy, Kishore; Drisko, Jeanne; Chen, Qi

    2014-02-05

    Ascorbate (vitamin C) was an early, unorthodox therapy for cancer, with an outstanding safety profile and anecdotal clinical benefit. Because oral ascorbate was ineffective in two cancer clinical trials, ascorbate was abandoned by conventional oncology but continued to be used in complementary and alternative medicine. Recent studies provide rationale for reexamining ascorbate treatment. Because of marked pharmacokinetic differences, intravenous, but not oral, ascorbate produces millimolar concentrations both in blood and in tissues, killing cancer cells without harming normal tissues. In the interstitial fluid surrounding tumor cells, millimolar concentrations of ascorbate exert local pro-oxidant effects by mediating hydrogen peroxide (H(2)O(2)) formation, which kills cancer cells. We investigated downstream mechanisms of ascorbate-induced cell death. Data show that millimolar ascorbate, acting as a pro-oxidant, induced DNA damage and depleted cellular adenosine triphosphate (ATP), activated the ataxia telangiectasia mutated (ATM)/adenosine monophosphate-activated protein kinase (AMPK) pathway, and resulted in mammalian target of rapamycin (mTOR) inhibition and death in ovarian cancer cells. The combination of parenteral ascorbate with the conventional chemotherapeutic agents carboplatin and paclitaxel synergistically inhibited ovarian cancer in mouse models and reduced chemotherapy-associated toxicity in patients with ovarian cancer. On the basis of its potential benefit and minimal toxicity, examination of intravenous ascorbate in combination with standard chemotherapy is justified in larger clinical trials.

  12. Intestine, immunity and parenteral nutrition in an era of preferred enteral feeding

    PubMed Central

    Barrett, Meredith; Demehri, Farokh R.; Teitelbaum, Daniel H.

    2015-01-01

    PURPOSE OF REVIEW To review the benefits of enteral nutrition (EN) in contrast to the inflammatory consequences of administration of parenteral nutrition (PN) and enteral deprivation. To present the most recent evidence for the mechanisms of these immunologic changes and discuss potential areas for modification to decrease infectious complications of its administration. RECENT FINDINGS There is significant data supporting the early initiation of EN in both medical and surgical patients unable to meet their caloric goals via oral intake alone. Despite the preference for EN, some patients are unable to utilize their gut for nutritious gain and therefore require PN administration, along with its infectious complications. The mechanisms behind these complications are multifactorial and have yet to be fully elucidated. Recent study utilizing both animal and human models has provided further information regarding PN's deleterious effect on intestinal epithelial barrier function along with the complications associated with enterocyte deprivation. SUMMARY Changes associated with PN administration and enteral deprivation are complex with multiple potential areas for modification to allow for safer administration. Recent discovery of the mechanisms behind these changes present exciting areas for future study as to make PN administration in the enterally deprived patient safer. PMID:26154279

  13. Immunonutrition – the influence of early postoperative glutamine supplementation in enteral/parenteral nutrition on immune response, wound healing and length of hospital stay in multiple trauma patients and patients after extensive surgery

    PubMed Central

    Lorenz, Kai J.; Schallert, Reiner; Daniel, Volker

    2015-01-01

    Introduction: In the postoperative phase, the prognosis of multiple trauma patients with severe brain injuries as well as of patients with extensive head and neck surgery mainly depends on protein metabolism and the prevention of septic complications. Wound healing problems can also result in markedly longer stays in the intensive care unit and general wards. As a result, the immunostimulation of patients in the postoperative phase is expected to improve their immunological and overall health. Patients and methods: A study involving 15 patients with extensive ENT tumour surgery and 7 multiple-trauma patients investigated the effect of enteral glutamine supplementation on immune induction, wound healing and length of hospital stay. Half of the patients received a glutamine-supplemented diet. The control group received an isocaloric, isonitrogenous diet. Results: In summary, we found that total lymphocyte counts, the percentage of activated CD4+DR+ T helper lymphocytes, the in-vitro response of lymphocytes to mitogens, as well as IL-2 plasma levels normalised faster in patients who received glutamine-supplemented diets than in patients who received isocaloric, isonitrogenous diets and that these parameters were even above normal by the end of the second postoperative week. Summary: We believe that providing critically ill patients with a demand-oriented immunostimulating diet is fully justified as it reduces septic complications, accelerates wound healing, and shortens the length of ICU (intensive care unit) and general ward stays. PMID:26734536

  14. 21 CFR 310.509 - Parenteral drug products in plastic containers.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 5 2014-04-01 2014-04-01 false Parenteral drug products in plastic containers... Parenteral drug products in plastic containers. (a) Any parenteral drug product packaged in a plastic... parenteral drug product for intravenous use in humans that is packaged in a plastic immediate container on...

  15. 21 CFR 310.509 - Parenteral drug products in plastic containers.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Parenteral drug products in plastic containers... Parenteral drug products in plastic containers. (a) Any parenteral drug product packaged in a plastic... parenteral drug product for intravenous use in humans that is packaged in a plastic immediate container on...

  16. 21 CFR 310.509 - Parenteral drug products in plastic containers.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 5 2013-04-01 2013-04-01 false Parenteral drug products in plastic containers... Parenteral drug products in plastic containers. (a) Any parenteral drug product packaged in a plastic... parenteral drug product for intravenous use in humans that is packaged in a plastic immediate container on...

  17. 21 CFR 310.509 - Parenteral drug products in plastic containers.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Parenteral drug products in plastic containers... Parenteral drug products in plastic containers. (a) Any parenteral drug product packaged in a plastic... parenteral drug product for intravenous use in humans that is packaged in a plastic immediate container on...

  18. 21 CFR 310.509 - Parenteral drug products in plastic containers.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 5 2012-04-01 2012-04-01 false Parenteral drug products in plastic containers... Parenteral drug products in plastic containers. (a) Any parenteral drug product packaged in a plastic... parenteral drug product for intravenous use in humans that is packaged in a plastic immediate container on...

  19. Pediatric parenteral nutrition-associated liver disease and cholestasis: Novel advances in pathomechanisms-based prevention and treatment.

    PubMed

    Orso, Giuseppe; Mandato, Claudia; Veropalumbo, Claudio; Cecchi, Nicola; Garzi, Alfredo; Vajro, Pietro

    2016-03-01

    Parenteral nutrition constitutes a life-saving therapeutic tool in patients unable to ingest/absorb oral or enteral delivered nutrients. Liver function tests abnormalities are a common therapy-related complication, thus configuring the so-called Parenteral Nutrition Associated Liver Disease (PNALD) or cholestasis (PNAC). Although the damage is frequently mild, and resolves after discontinuation of parenteral nutrition, in some cases it progresses into cirrhotic changes, especially in neonates and infants. We present a literature review focusing on the pathogenetic mechanisms-driven prevention and therapies for the cases where parenteral nutrition cannot be discontinued. Ursodeoxycholic acid has been proposed in patients with cholestatic hepatopathy, but its efficacy needs to be better established. Little evidence is available on efficacy of anti-oxidants, antibiotics, probiotics and anti TNFα. Lipid emulsions based on fish oil with a high content of long-chain polyunsaturated fatty acids ω-3 appear effective both in decreasing intrahepatic inflammation and in improving biliary flow. Most recent promising variations such as soybean/MCT/olive/fish oil emulsion [third generation lipid emulsion (SMOFlipid)] are under investigation. In conclusion, we remark the emergence of a number of novel pathomechanisms underlying the severe liver impairment damage (PNALD and PNAC) in patients treated with parenteral nutrition. Only few traditional and innovative therapeutic strategies have hitherto been shown promising.

  20. Parenteral nutrition-induced hepatobiliary dysfunction in infants and prepubertal rabbits.

    PubMed

    Loff, S; Kränzlin, B; Moghadam, M; Dzakovic, A; Wessel, L; Back, W; Hosie, S; Wirth, H; Waag, K L

    1999-01-01

    We analyzed clinical, biochemical, and histo- logic parameters of ten infants with parenteral nutrition-induced hepatobiliary dysfunction. The data were compared with the results of a rabbit model. All infants were born prematurely with low birth weight. Their clinical diagnoses were necrotizing enterocolitis (6), gastroschisis (1), intrauterine volvulus (1), and lung hypoplasia (2). All required total (TPN) or partial parenteral nutrition for at least 8 weeks. All had repeated episodes of infections or sepsis. A rise in bilirubin and aminotransferase levels occurred after a minimum of 5 weeks; peak bilirubin levels ranged from 4 to 14 mg% and aminotransferases from 40 to 140 IU/l. One child later developed gallstones. Liver biopsies after 1 to 24 months showed fibrosis, bile-duct proliferation, cholestasis, and hydropic degeneration. All of the above-mentioned clinical factors have been accused of causing the observed biochemical and histologic changes. In our rabbit model we were able to produce almost identical symptoms by TPN alone: gallbladder distension, sludge, and stones developed after 1-4 weeks of TPN as well as uncharacteristic changes in aminotransferases and bilirubin after 4 weeks. Liver histology revealed severe hydropic degeneration of zone 3 as early as 1 week after beginning TPN. A rise of fibrosis and bile-duct proliferation after 1 to 4 weeks of infusion was statistically significant. Cholestasis, as was observed in the infants, could not be detected. In our model, all alterations observed could be attributed exclusively to TPN. We therefore assume that TPN was the true cause of the dysfunction. In a second experimental series infusions were reduced to 80% PN and free access to lab chow. These animals produced normal feces, indicating physiologic enteral stimulation. They developed the same degenerative and proliferative histologic changes, whereas gallbladder distension, sludge, and stones were not noted. We conclude that: (1) The TPN solution

  1. Severe Hypothyroidism From Iodine Deficiency Associated With Parenteral Nutrition.

    PubMed

    Golekoh, Marjorie C; Cole, Conrad R; Jones, Nana-Hawa Yayah

    2016-11-01

    Parenteral nutrition is crucial for supply of nutrients in children who cannot tolerate a full enteral diet. In the United States, it is not standard of care to give iodine to children dependent on parenteral nutrition, hence iodine is not routinely included in the micronutrient package. Herein, we present a case of a boy with hypothyroidism secondary to iodine deficiency after prolonged exclusive use of parenteral nutrition. Our case highlights the importance of screening for iodine deficiency and administering timely iodine supplementation in these at-risk children to prevent iatrogenic hypothyroidism.

  2. Stability issues of parenteral chemotherapy drugs.

    PubMed

    de Lemos, Mário L; Hamata, Linda

    2007-03-01

    The pharmacist often needs to have all the information required to prepare and to assign an expiry date for parenteral products of antineoplastic agents. The pharmaceutical manufacturers usually provide data on how to prepare their products and the associated physicochemical stability. Standard reference texts also provide additional summary information of other primary data. However, it is not uncommon to find knowledge gaps in this area. Hence, additional extrapolation and consensus on interpretation is often needed to address issues not covered by data from the pharmaceutical manufacturers, standard reference texts, or official guidelines. Some of the key issues have been identified in our recent development of a chemotherapy preparation and stability chart. These include use of data from different brands, expiry date of original vial and final products, risk of contamination, infusion volume and stability, multi-day home-use products, syringe preparations, and products to be used immediately. Potential approaches to address these common issues are described in this article.

  3. Anchoring effects on early autobiographical memories.

    PubMed

    Greenberg, Daniel L; Bishara, Anthony J; Mugayar-Baldocchi, Marino A

    2017-02-28

    Studies of childhood memory typically show that our earliest memories come from between three and four years of age. This finding is not universal, however. The age estimate varies across cultures and is affected by social influences. Research from the judgments and decision-making literature suggests that these estimates might also involve a judgment under uncertainty. Therefore, they might be susceptible to less social influences such as heuristics and biases. To investigate this possibility, we conducted two experiments that used anchoring paradigms to influence participants' estimates of their age during early autobiographical memories. In Experiment 1, participants answered either a high-anchor or a low-anchor question, and were warned that the anchor was uninformative; they went on to estimate their age during their earliest autobiographical memory. In Experiment 2, we replicated Experiment 1 and extended the design to examine additional early autobiographical memories. In both experiments, participants in the low-anchor condition gave earlier age estimates than those in the high-anchor condition. These results provide new insights into the methods used to investigate autobiographical memory. Moreover, they show that reports of early autobiographical memories can be influenced by a relatively light touch - a change to a single digit in a single question.

  4. Effects of Critical Thinking Intervention for Early Childhood Teacher Candidates

    ERIC Educational Resources Information Center

    Han, Heejeong Sophia; Brown, E. Todd

    2013-01-01

    This study is based on an intervention designed to enhance early childhood teacher candidates' critical thinking abilities. The concept, elements, standards, and traits of critical thinking were integrated into the main course contents, and the effects of the intervention were examined. The results indicated that early childhood teacher…

  5. Evidence of Effective Early Numeracy Models. CEELO FastFacts

    ERIC Educational Resources Information Center

    Schilder, D.

    2014-01-01

    In this "Fast Facts," a state requested information on supporting districts' use of effective models and approaches to improve children's early literacy and numeracy outcomes. In response, Center on Enhancing Early Learning Outcomes (CEELO) staff reviewed key research including information from the What Works Clearinghouse obtained by…

  6. Early Intervention Services: Effectively Supporting Maori Children and their Families

    ERIC Educational Resources Information Center

    Berryman, Mere; Woller, Paul

    2011-01-01

    This paper examines Early Intervention (EI) service provision from within one Ministry of Education region in New Zealand. It does this in order to better understand what works well and what needs to change if children from Maori families, of Early Childhood age, are to be provided with the most effective EI services. By engaging with Maori…

  7. Parenteral glutamine supplementation in critical illness: a systematic review

    PubMed Central

    2014-01-01

    Introduction The potential benefit of parenteral glutamine (GLN) supplementation has been one of the most commonly studied nutritional interventions in the critical care setting. The aim of this systematic review was to incorporate recent trials of traditional parenteral GLN supplementation in critical illness with previously existing data. Methods All randomized controlled trials of parenterally administered GLN in critically ill patients conducted from 1997 to 2013 were identified. Studies of enteral GLN only or combined enteral/parenteral GLN were excluded. Methodological quality of studies was scored and data was abstracted by independent reviewers. Results A total of 26 studies involving 2,484 patients examining only parenteral GLN supplementation of nutrition support were identified in ICU patients. Parenteral GLN supplementation was associated with a trend towards a reduction of overall mortality (relative risk (RR) 0.88, 95% confidence interval (CI) 0.75, 1.03, P = 0.10) and a significant reduction in hospital mortality (RR 0.68, 95% CI 0.51, 0.90, P = 0.008). In addition, parenteral GLN was associated with a strong trend towards a reduction in infectious complications (RR 0.86, 95% CI 0.73, 1.02, P = 0.09) and ICU length of stay (LOS) (WMD –1.91, (95% CI -4.10, 0.28, P = 0.09) and significant reduction in hospital LOS (WMD -2.56, 95% CI -4.71, -0.42, P = 0.02). In the subset of studies examining patients receiving parenteral nutrition (PN), parenteral GLN supplementation was associated with a trend towards reduced overall mortality (RR 0.84, 95% CI 0.71, 1.01, P = 0.07). Conclusions Parenteral GLN supplementation given in conjunction with nutrition support continues to be associated with a significant reduction in hospital mortality and hospital LOS. Parenteral GLN supplementation as a component of nutrition support should continue to be considered to improve outcomes in critically ill patients. PMID:24745648

  8. Omega-3 Fatty Acids in Modern Parenteral Nutrition: A Review of the Current Evidence

    PubMed Central

    Klek, Stanislaw

    2016-01-01

    Intravenous lipid emulsions are an essential component of parenteral nutrition regimens. Originally employed as an efficient non-glucose energy source to reduce the adverse effects of high glucose intake and provide essential fatty acids, lipid emulsions have assumed a larger therapeutic role due to research demonstrating the effects of omega-3 and omega-6 polyunsaturated fatty acids (PUFA) on key metabolic functions, including inflammatory and immune response, coagulation, and cell signaling. Indeed, emerging evidence suggests that the effects of omega-3 PUFA on inflammation and immune response result in meaningful therapeutic benefits in surgical, cancer, and critically ill patients as well as patients requiring long-term parenteral nutrition. The present review provides an overview of the mechanisms of action through which omega-3 and omega-6 PUFA modulate the immune-inflammatory response and summarizes the current body of evidence regarding the clinical and pharmacoeconomic benefits of intravenous n-3 fatty acid-containing lipid emulsions in patients requiring parenteral nutrition. PMID:26959070

  9. Enhanced antimalarial activity by a novel artemether-lumefantrine lipid emulsion for parenteral administration.

    PubMed

    Ma, Yufan; Lu, Tingli; Zhao, Wen; Wang, Ying; Chen, Ting; Mei, Qibing; Chen, Tao

    2014-10-01

    Artemether and lumefantrine (also known as benflumetol) are difficult to formulate for parenteral administration because of their low aqueous solubility. Cremophor EL as an emulsion excipient has been shown to cause serious side effects. This study reports a method of preparation and the therapeutic efficacies of novel lipid emulsion (LE) delivery systems with artemether, lumefantrine, or artemether in combination with lumefantrine, for parenteral administration. Their physical and chemical stabilities were also evaluated. Furthermore, the in vivo antimalarial activities of the lipid emulsions developed were tested in Plasmodium berghei-infected mice. Artemether, lumefantrine, or artemether in combination with lumefantrine was encapsulated in an oil phase, and the in vivo performance was assessed by comparison with artesunate for injection. It was found that the lumefantrine lipid emulsion (LUM-LE) and artemether-lumefantrine lipid emulsion (ARM-LUM-LE-3) (1:6) began to decrease the parasitemia levels after only 3 days, and the parasitemia inhibition was 90% at doses of 0.32 and 0.27 mg/kg, respectively, with immediate antimalarial effects greater than those of the positive-control group and constant antimalarial effects over 30 days. LUM-LE and ARM-LUM-LE-3 demonstrated the best performance in terms of chemical and physical stabilities and antiplasmodial efficacy, with a mean particle size of 150 nm, and they have many favorable properties for parenteral administration, such as biocompatibility, physical stability, and ease of preparation.

  10. Right atrial thrombus associated with subclavian catheter developed due to total parenteral nutrition application

    PubMed Central

    Sahin, Nursel; Basarici, Ibrahim; Erbasan, Ozan

    2016-01-01

    Central venous catheterization as a frequent routine clinical procedure may have significant complications. Mechanical complications may occur during catheter placement, whereas thromboembolic and infectious complications can be seen during follow-up. Total parenteral nutrition (TPN) associated central venous catheterizations may result in early mechanical complications and thrombotic and infectious complications in the long term. This paper describes a patient diagnosed as mitochondrial neurogastrointestinal encephalomyopathy requiring long-term central venous catheterization for TPN implementation, who had an infected thrombus on the catheter tip resected by cardiac surgery. PMID:27212985

  11. A multicenter, retrospective study of patients with pulmonary arterial hypertension transitioned from parenteral prostacyclin therapy to inhaled iloprost

    PubMed Central

    Channick, Richard N.; Frantz, Robert P.; Kawut, Steven M.; Palevsky, Harold; Tumuluri, Ramagopal; Sulica, Roxana; Lauto, Paula O.; Benton, Wade W.; de Boisblanc, Bennett

    2013-01-01

    Pulmonary arterial hypertension (PAH) is characterized by progressive increases in pulmonary vascular resistance, leading to right heart failure and death. Guidelines recommend customization of treatment, necessitating the development of effective strategies for transitioning patients among treatments. In this study, we characterized our experience with patient transitions from parenteral prostacyclin to inhaled iloprost. We retrospectively assessed records from 11 centers of 37 consecutive patients with PAH aged ≥ 18 years who were treated with intravenous (IV) or subcutaneous (SC) prostacyclin analogues and transitioned to inhaled iloprost. The transition period began on the first day of inhaled iloprost with the intent of discontinuing parenteral prostacyclin and ended on the first day on inhaled iloprost free of parenteral prostacyclin. Persistence was defined as the absence of (1) parenteral prostacyclin while remaining on inhaled iloprost during post-transition Days 1-90 and (2) no reinitiation of parenteral prostacyclin during post-transition Days 90-365. All patients were clinically stable before transitioning to inhaled iloprost. The mean age was 46.5 years, 70.3% were female, 51.4% had idiopathic PAH, and 43.0% were in New York Heart Association Functional Class III. Among patients with an overlapping transition, the mean transition period was 10.5 days. A transition dosing algorithm was used in 10 patients (27.0%). At one year, 78.4% of the patients remained persistent on inhaled iloprost and 81.1% were free of clinical worsening. In selected patients on background oral PAH therapy, transitioning from parenteral prostacyclin to inhaled iloprost appears safe and feasible and is associated with long-term success. Further study is needed to define the optimal patient selection criteria and transition algorithm. PMID:24015339

  12. Alterations in pentobarbital pharmacokinetics in response to parenteral and enteral alimentation in the rat.

    PubMed

    Knodell, R G; Spector, M H; Brooks, D A; Keller, F X; Kyner, W T

    1980-12-01

    Recent in vitro observations suggest that the intestine, in addition to the liver, may be an important organ of first-pass drug metabolism. While a variety of changes in intestinal morphology and function in response to continuous parenteral and enteral nutrition have been documented, the effect of different routes of alimentation on intestinal drug metabolism has not been previously investigated. Objectives of this study were to assess the contribution of intestinal pentobarbital metabolism to overall in vivo pentobarbital pharmacokinetics in the rat and to determine if differences in pentobarbital pharmacokinetics were seen between parenterally and enterally nourished animals. After 7 days of continuous infusion of amino acid-glucose mixture via a gastric or jugular vein catheter, pharmacokinetic parameters were determined after 40 mg/kg of pentobarbital was given orally or into the portal or femoral vein. Reduced systemic availability of pentobarbital after oral administration as compared to portal vein injection was seen in both alimentation groups indicating that significant intestinal metabolism of pentobarbital occurred in vivo. Total area under the pentobarbital plasma concentration-time curve was significantly greater in parenterally nourished animals as compared with enterally alimented animals after oral, portal vein and systemic vein drug administration. Differences in pentobarbital, pharmacokinetics between the two alimentation groups appeared to be primarly due to effects on hepatic pentobarbital metabolism. While the mechanism producing these changes has not been defined, differences in gut hormones release and/or pancreatic secretion in response to the two routes of alimentation may be contributory. The widespread use of enteral and parenteral alimentation in clinical medicine suggests that studies to determine if nutrition route of administration similarly influences drug metabolism in humans may be indicated.

  13. A familiar font drives early emotional effects in word recognition.

    PubMed

    Kuchinke, Lars; Krause, Beatrix; Fritsch, Nathalie; Briesemeister, Benny B

    2014-10-01

    The emotional connotation of a word is known to shift the process of word recognition. Using the electroencephalographic event-related potentials (ERPs) approach it has been documented that early attentional processing of high-arousing negative words is shifted at a stage of processing where a presented word cannot have been fully identified. Contextual learning has been discussed to contribute to these effects. The present study shows that a manipulation of the familiarity with a word's shape interferes with these earliest emotional ERP effects. Presenting high-arousing negative and neutral words in a familiar or an unfamiliar font results in very early emotion differences only in case of familiar shapes, whereas later processing stages reveal similar emotional effects in both font conditions. Because these early emotion-related differences predict later behavioral differences, it is suggested that contextual learning of emotional valence comprises more visual features than previously expected to guide early visual-sensory processing.

  14. Fish oil–based lipid emulsions in the treatment of parenteral nutrition-associated liver disease: An ongoing positive experience

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We previously reported the beneficial effect of fish oil-based lipid emulsions (FOLEs) as monotherapy in the treatment of parenteral nutrition-associated liver disease (PNALD). In this report, we share our ongoing experience at Texas Children's Hospital, Houston, in the use of FOLE in treatment of P...

  15. Hyperammonemia during total parenteral nutrition in children.

    PubMed

    Seashore, J H; Seashore, M R; Riely, C

    1982-01-01

    Serial blood ammonia (NH3) determinations in 19 low birth weight (LBW) infants, 14 term neonates and 12 children receiving total parenteral nutrition (TPN) have shown that 73% of patients had one or more elevated NH3 values (greater than 150 micrograms/dl). The mean blood NH3 was 220 +/- 13 micrograms/dl in LBW infants, 180 +/- 9 micrograms/dl in 10 infants, and 140 +/- 7 micrograms/dl in children. All of these values are significantly higher than normal (p less than 0.001). There was no difference in incidence or mean blood ammonia concentration between patients receiving casein hydrolysate and those receiving a crystalline amino acid solution. Only four patients were symptomatic and several infants remained fully alert despite blood NH3 concentration in excess of 400 micrograms/dl. One infant who had sustained hyperammonemia was given another amino acid source (Travasol) containing 1.2 mmol/dl of arginine; blood NH3 promptly fell to the normal range. However, six of seven additional infants had hyperammonemia while receiving Travasol (mean = 184 micrograms/dl). Hyperammonemia is common during TPN in children, often is not recognized clinically, and occurs with equal frequency in infants and older children. The high levels observed in LBW infants may be due to hepatic immaturity. Blood NH3 concentration should be monitored frequently during TPN. Persistent hyperammonemia should be treated by decreasing protein content of the infusate. The role of supplemental arginine is unclear.

  16. Early-life nutritional effects on the female reproductive system.

    PubMed

    Chan, K A; Tsoulis, M W; Sloboda, D M

    2015-02-01

    There is now considerable epidemiological and experimental evidence indicating that early-life environmental conditions, including nutrition, affect subsequent development in later life. These conditions induce highly integrated responses in endocrine-related homeostasis, resulting in persistent changes in the developmental trajectory producing an altered adult phenotype. Early-life events trigger processes that prepare the individual for particular circumstances that are anticipated in the postnatal environment. However, where the intrauterine and postnatal environments differ markedly, such modifications to the developmental trajectory may prove maladaptive in later life. Reproductive maturation and function are similarly influenced by early-life events. This should not be surprising, because the primordial follicle pool is established early in life and is thus vulnerable to early-life events. Results of clinical and experimental studies have indicated that early-life adversity is associated with a decline in ovarian follicular reserve, changes in ovulation rates, and altered age at onset of puberty. However, the underlying mechanisms regulating the relationship between the early-life developmental environment and postnatal reproductive development and function are unclear. This review examines the evidence linking early-life nutrition and effects on the female reproductive system, bringing together clinical observations in humans and experimental data from targeted animal models.

  17. Engineering Oral and Parenteral Amorphous Amphotericin B Formulations against Experimental Trypanosoma cruzi Infections.

    PubMed

    Rolón, Miriam; Serrano, Dolores R; Lalatsa, Aikaterini; de Pablo, Esther; Torrado, Juan Jose; Ballesteros, Maria Paloma; Healy, Anne Marie; Vega, Celeste; Coronel, Cathia; Bolás-Fernández, Francisco; Dea-Ayuela, Maria Auxiliadora

    2017-04-03

    Chagas disease (CD) is a parasitic zoonosis endemic in most mainland countries of Central and South America affecting nearly 10 million people, with 100 million people at high risk of contracting the disease. Treatment is only effective if received at the early stages of the disease. Only two drugs (benznidazole and nifurtimox) have so far been marketed, and both share various limitations such as variable efficacy, many side effects, and long duration of treatment, thus reducing compliance. The in vitro and in vivo efficacy of poly-aggregated amphotericin B (AmB), encapsulated poly-aggregated AmB in albumin microspheres (AmB-AME), and dimeric AmB-sodium deoxycholate micelles (AmB-NaDC) was evaluated. Dimeric AmB-NaDC exhibited a promising selectivity index (SI = 3164) against amastigotes, which was much higher than those obtained for licensed drugs (benznidazole and nifurtimox). AmB-AME, but not AmB-NaDC, significantly reduced the parasitemia levels (3.6-fold) in comparison to the control group after parenteral administration at day 7 postinfection. However, the oral administration of AmB-NaDC (10-15 mg/kg/day for 10 days) resulted in a 75% reduction of parasitemia levels and prolonged the survival rate in 100% of the tested animals. Thus, the results presented here illustrate for the first time the oral efficacy of AmB in the treatment of trypanosomiasis. AmB-NaDC is an easily scalable, affordable formulation prepared from GRAS excipients, enabling treatment access worldwide, and therefore it can be regarded as a promising therapy for trypanosomiasis.

  18. Drug delivery and drug targeting with parenteral lipid nanoemulsions - A review.

    PubMed

    Hörmann, Karl; Zimmer, Andreas

    2016-02-10

    Lipid nanosized emulsions or nanoemulsions (NE) are oil in water dispersions with an oil droplet size of about 200nm. This size of oil droplets dispersed in a continuous water phase is a prerequisite for the parenteral, namely intravenous administration. Many parenteral nutrition and drug emulsions on the market confirm the safe use of NE over years. Parenteral emulsions loaded with APIs (active pharmaceutical ingredients) are considered as drug delivery systems (DDS). DDS focuses on the regulation of the in vivo dynamics, such as absorption, distribution, metabolism, and extended bioavailability, thereby improving the effectiveness and the safety of the drugs. Using an emulsion as a DDS, or through the use of surface diversification of the dispersed oil droplets of emulsions, a targeted increase of the API concentration in some parts of the human body can be achieved. This review focuses on NE similar to the marketed once with no or only low amount of additional surfactants beside the emulsifier from a manufacturing point of view (technique, used raw materials).

  19. Growth and hepatic composition in the guinea pig after long-term parenteral hyperalimentation

    SciTech Connect

    Lu, C.J.H.; Redmond, D.; Baggs, R.B.; Schecter, A.; Gasiewicz, T.A.

    1986-08-01

    This study examined the feasibility of maintaining male Hartley guinea pigs on long-term hyperalimentation. Data from animals fed ad libitum, but infused with 0.9% saline, indicated that there was minimal effect from catheter implantation, sepsis, or the infusion of large volumes of fluid. This group compared with animals fed and watered ad libitum demonstrated a nearly identical growth rate serum chemistry, tissue weights, and hepatic composition and morphology. Animals infused with a total parenteral diet demonstrated growth rates of 4.06 +/- 1.46 g/day for up to 25 days. Loss of infused animals was due in varying degrees to sepsis, mechanical failure, improper placement of the cannula, loss of patency, and death from unknown causes. Morphological analysis of animals fed by total parenteral nutrition revealed an altered distribution and increased size of lipid droplets in hepatic parenchymal and Kupffer cells and glycogen accumulation by the parenchymal cells. Decreased hepatic content of total protein and lipid, as well as cytochrome P450, was also observed. Similarly, serum values of triglyceride were decreased in animals fed by the total parenteral diet. This study indicated that the guinea pig fed by hyperalimentation may be a useful animal model for a number of clinical and basic research applications.

  20. Therapeutic Interchange of Parenteral Anticoagulants: Challenges for Pharmacy and Therapeutics Committees.

    PubMed

    Amin, Alpesh

    2011-11-07

    This is a review of key factors for pharmacy and therapeutics committees to consider when developing a therapeutic interchange (TI) program for venous thromboembolism (VTE) prophylaxis. Recent patient safety initiatives aimed at reducing the incidence of hospital-acquired VTE may increase the prescribing of thromboprophylactic agents recommended in VTE management guidelines. As a result, more pharmacy and therapeutics committees may consider TI programs for parenteral anticoagulants. However, the TI of anticoagulants appears challenging at this time. Firstly, the therapeutic equivalence of the commonly prescribed parenteral anticoagulants, enoxaparin, dalteparin and fondaparinux, has not been established. Secondly, because of the wide range of clinical indications for these anticoagulants, a blanket agent-specific TI program could lead to off-label use. Use of an indication-specific TI program could be difficult to manage administratively, and may cause prescribing confusion and errors. Thirdly, careful dosing and contraindications of certain parenteral anticoagulants in special patient populations, such as those with renal impairment, further impact the suitability of these agents for inclusion in TI programs. Finally, although TI may appear to offer lower drug-acquisition costs, it is important to determine its effect on all cost parameters and ultimately ensure that the care of patients requiring VTE prophylaxis is not compromised.

  1. The Effect of Early Marriages and Early Childbearing on Women's Nutritional Status in India.

    PubMed

    Goli, Srinivas; Rammohan, Anu; Singh, Deepti

    2015-08-01

    The consequences of early childbearing on the growth and nutritional status of women in India has not been quantified in previous studies. Our study aimed to fill this gap by analysing the association between early marriage and early childbearing on nutritional status of Indian women, with a focus on Bihar and Andhra Pradesh, the two states accounting for the highest proportion of women marrying and giving first birth before 18 years of age. Our findings revealed that a substantial number of women were married before 18 years and thereby exposed to early pregnancy. Furthermore, a significantly higher proportion of women in the 'thin' category were married before 18 years, both in the Indian sample (33 %, p < 0.001) and in the selected states, Andhra Pradesh (31 %, p < 0.001) and Bihar (43 %, p < 0.001), compared to those women married at higher ages. Similarly, across all our samples women whose first birth was before age 18 years also had a significantly higher probability of being in the 'thin' category across all our samples. This pattern was also observed for associations between early childbirth and anemia levels. We conclude that the net effect of the early age at marriage and age at first birth on nutritional status is significant. Our results underline the need for preventing early marriages and the consequent high adolescent pregnancies in India, particularly in high prevalence states. This will help to improve nutritional status and health care utilisation among women, thereby, prevent maternal and child mortality and thus, achieve the MDGs 4-5.

  2. Stayers and Leavers: Early-Career Teacher Effectiveness and Attrition

    ERIC Educational Resources Information Center

    Henry, Gary T.; Bastian, Kevin C.; Fortner, C. Kevin

    2011-01-01

    Research on teacher development reports significant early-career increases in teacher effectiveness, but the extent to which this is attributable to the development of teachers who persist or to the attrition of less effective teachers is unclear. In this study of novice teachers in North Carolina public schools, the authors investigated the…

  3. The Self-Reference Effect on Memory in Early Childhood

    ERIC Educational Resources Information Center

    Cunningham, Sheila J.; Brebner, Joanne L.; Quinn, Francis; Turk, David J.

    2014-01-01

    The self-reference effect in memory is the advantage for information encoded about self, relative to other people. The early development of this effect was explored here using a concrete encoding paradigm. Trials comprised presentation of a self- or other-image paired with a concrete object. In Study 1, 4- to 6-year-old children (N = 53) were…

  4. MAMMARY GLAND DEVELOPMENT: EARLY LIFE EFFECTS FROM THE ENVIRONMENT

    EPA Science Inventory

    Mammary Gland Development: Early Life Effects from the Environment

    S.E. Fenton. Reproductive Toxicology Division, National Health and Environmental Effects Laboratory, ORD, U.S. EPA, Research Triangle Park, NC 27711.

    As signs of precocious puberty in girls reach ...

  5. Traumatic Brain Injury in Early Childhood: Developmental Effects and Interventions.

    ERIC Educational Resources Information Center

    Lowenthal, Barbara; Lowenthal, Barbara

    1998-01-01

    Describes the unique effects of traumatic brain injury (TBI) on development in early childhood and offers suggestions for interventions in the cognitive, language, social-emotional, motor, and adaptive domains. Urges more intensive, long-term studies on the immediate and long-term effects of TBI. (Author/DB)

  6. Safety of refrigerated storage of admixed parenteral fluids.

    PubMed Central

    Weil, D C; Arnow, P M

    1988-01-01

    Many hospital pharmacies are reluctant to store admixed parenteral fluids longer than 24 to 48 h because of concern about possible microbial contamination. We evaluated the safety of prolonged refrigerated storage of admixtures by culturing mixtures in 471 bags prepared routinely in a hospital pharmacy and stored at 4 degrees C for up to 15 days. Low-level contamination (1 CFU per bag) was found in 3 of 253 solutions of saline and/or glucose into which nonantibiotic additives had been injected. None of 171 saline and/or glucose solutions with antibiotic additives or 47 parenteral nutrition fluids was culture positive. The risk of contamination did not increase with duration of storage, and none of 107 bags stored greater than or equal to 5 days was culture positive. Laboratory studies to measure growth of bacteria and fungi in glucose infusate and parenteral nutrition solutions confirmed that storage at 4 degrees C suppresses growth. Eight of twelve bacterial isolates grew in glucose solutions at 25 degrees C, while none grew at 4 degrees C. Of 13 species of bacteria and fungi inoculated in parenteral nutrition fluids, 8 proliferated at 25 degrees C and none proliferated at 4 degrees C. We conclude that refrigerated storage of parenteral fluids for up to 1 week following admixture, as permitted by Centers for Disease Control guidelines, does not appear to increase the risk of microbial contamination when standard aseptic procedures for admixing and storage are followed. PMID:3183025

  7. LASTING BIOLOGICAL EFFECTS OF EARLY ENVIRONMENTAL INFLUENCES

    PubMed Central

    Lee, Chi-Jen; Dubos, René

    1968-01-01

    A lasting depression of body weight was consistently produced in SPF mice by infecting them orally 2 days after birth with a nonlethal, bacteria-free filtrate, prepared from the intestine of young SPF mice previously infected with an unidentified agent. Neonatal infection caused a decrease of muscle DNA and of muscle and brain protein in the adults. No other effect was detected in the chemical composition of various organs. Incorporation of 14C-amino acid into the acid precipitable fractions of liver, kidney, muscle, and brain was lower in infected than in control animals. No difference in incorporation was recognized in the thymus and spleen. The free amino acid pool of adults, measured as blood levels of free amino nitrogen, was decreased by neonatal infection. Surprisingly, the food intake of young animals infected neonatally was higher than that of the controls, measured on the basis of body weight. Their fecal excretion of nitrogen was also higher. The comparative responses of infected and control adults to a stressful situation was measured by giving them intravenously the antituberculous vaccine BCG. Under these conditions, the mice infected neonatally excreted some 20% more nitrogen in their urine and 40% more in their feces than did the controls. The mechanisms through which neonatal infection caused a lasting weight depression are discussed in the light of these metabolic findings. PMID:5691984

  8. Premixed Parenteral Nutrition Solution Use in Children

    PubMed Central

    Crill, Catherine M.

    2015-01-01

    OBJECTIVES: In response to national drug shortages, our institution established criteria for the use of commercial premixed parenteral nutrition (PN) solutions in select pediatric patients. Although these solutions have been marketed for use in children, there are no data in this patient population. The objective of this study was to review our use of commercial premixed PN solutions in children. METHODS: This was a retrospective review of patients ≤18 years of age who received a premixed PN solution from October 2010 to April 2012. All premixed PN courses were assessed for incidence of premixed PN discontinuation due to laboratory abnormalities. Estimated goal and actual protein and total caloric intake were evaluated for premixed PN courses that were continued for >48 hours. RESULTS: Sixty-nine patients received 74 courses of premixed PN solutions for a mean duration of 5.6 ± 6.2 (range, 1–31) days. Fifteen courses (20%) required discontinuation of premixed PN as a result of mild laboratory abnormalities. No changes in clinical status were observed in patients and all abnormalities were corrected after switching to individualized PN. In patients receiving PN for >48 hours, premixed PN solutions provided goal protein in 48/49 (98%) courses and goal calories in 33/49 (67%) courses. CONCLUSIONS: Premixed PN solutions were used in a wide range of pediatric patients and provide a potential option for PN support in pediatric patients when drug shortages limit PN product supply. Close monitoring for electrolyte abnormalities and protein and caloric intake is recommended when using premixed PN solutions in children. PMID:26472952

  9. Risk Factors for Subclavian Vein Thrombosis in Cancer Patients With Total Parenteral Nutrition

    PubMed Central

    Berea-Baltierra, Ricardo; Rivas-Ruiz, Rodolfo; Vela-Martinez, Elpidia; Sevilla-Gonzalez, Maria de la Luz; Talavera-Pina, Juan Osvaldo; Valencia-Jimenez, Elena; Perez-Franco, Irene; Escobedo-Hernandez, Laura

    2014-01-01

    Background There are few reports on total parenteral nutrition (TPN) and its possible prothrombotic effect. The purpose of this study was to identify risk factors for subclavian vein thrombosis (SVT) in patients receiving TPN. Method Cancer patients with indwelling subclavian catheters and TPN were followed in a cohort study. Doppler ultrasound examination was performed 8 and 30 days after catheter placement. Results One hundred twenty-one patients were included, with a mean of 61 (± 11.8) years of age. We detected 36 SVT events at day 8 (29.8%) and 47 (38.8%) at day 30 after central catheter placement. Mean length of subclavian catheterization was 17.2 (± 8.2) days. Fifty-three point three percent of patients receiving ≥ 3,050 mOsm TPN in 24 hours developed SVT (relative risk (RR) = 2.01, 95% CI, 1.14 - 3.57; P = 0.016) at day 8 and 60% (RR = 1.67, 95% CI, 1.30 - 2.71; P = 0.038) at day 30 post-catheter placement. Protein administration of > 97.5 g/day was shown to be a risk factor for early thrombosis with a mean of 16.88 days for the development of SVT (95% CI, 10 - 23.7) versus 27.8 days (95% CI, 25.8 - 29.9) in the group with nutritional protein content < 97.5 g/day (P = 0.000). Conclusion High-osmolarity and high-protein nutrition formulas were shown to be risk factors for SVT in cancer patients receiving TPN. PMID:25110538

  10. Parenteral iron therapy in obstetrics: 8 years experience with iron-sucrose complex.

    PubMed

    Perewusnyk, G; Huch, R; Huch, A; Breymann, C

    2002-07-01

    Fe is an essential component of haem in myoglobin and accounts for 70 % of haemoglobin. The balance of Fe, unlike that of other metals such as Na or Ca, is regulated solely by gastrointestinal absorption, which itself depends on the bioavailability of Fe in food, i.e. the chemical Fe species. Factors that maintain Fe homeostasis by modulating Fe transfer through the intestinal mucosa are found at the luminal, mucosal and systemic levels. Fe deficiency and its consequence, Fe-deficiency anaemia, form the commonest nutritional pathology in pregnant women. The current gold standard to detect Fe deficiency remains the serum ferritin value. Previously there was general consensus against parenteral Fe administration, i.e. parenteral Fe was only recommended for special conditions such as unresponsiveness to oral Fe, intolerance to oral Fe, severe anaemia, lack of time for therapy etc. However, especially in hospital settings, clinicians regularly face these conditions but are still worried about reactions that were described using Fe preparations such as Fe-dextrans. A widely used and safe alternative is the Fe-sucrose complex, which has become of major interest to prevent functional Fe deficiency after use of recombinant erythropoietin Numerous reports show the effectiveness and safety of the Fe-sucrose complex. Good tolerance to this Fe formulation is partly due to the low allergenic effect of the sucrose complex, partly due to slow release of elementary Fe from the complex. Accumulation of Fe-sucrose in parenchyma of organs is low compared with Fe-dextrans or Fe-gluconate, while incorporation into the bone marrow for erythropoiesis is considerably faster. Oral Fe is only started if haemoglobin levels are below 110 g/l. If levels fall below 100 g/l or are below 100 g/l at time of diagnosis, parenteral Fe-sucrose is used primarily. In cases of severe anaemia (haemoglobin <90 g/l) or non-response to parenteral Fe after 2 weeks, recombinant erythropoietin is considered in

  11. Fundamental understanding of drug absorption from a parenteral oil depot.

    PubMed

    Kalicharan, Raween W; Schot, Peter; Vromans, Herman

    2016-02-15

    Oil depots are parenteral drug formulations meant for sustained release of lipophilic compounds. Until now, a comprehensive understanding of the mechanism of drug absorption from oil depots is lacking. The aim of this paper was to fill this gap. A clinical study with healthy volunteers was conducted. An oil depot with nandrolone decanoate and benzyl alcohol was subcutaneously administered in the upper arm of female volunteers. Pharmacokinetic profiles of both substances were related to each other and to literature data. Benzyl alcohol absorbs much more rapidly than nandrolone. In detail, it appears that benzyl alcohol enters the central compartment directly, while nandrolone decanoate is recovered in serum after a lag time. This lag time is also seen in literature data, although not reported explicitly. The absorption of nandrolone is enhanced by the presence of benzyl alcohol. This is most likely an effect of altered oil viscosity and partition coefficient between the oil and aqueous phase. The absorption rate constant of compounds is found to be related to the logP of the solubilized prodrug. The absorption rate is however not only determined by the physico-chemical properties of the formulation but also by the tissue properties. Here, it is argued that lymphatic flow must be considered as a relevant parameter.

  12. The potential clinical relevance of visible particles in parenteral drugs.

    PubMed

    Doessegger, Lucette; Mahler, Hanns-Christian; Szczesny, Piotr; Rockstroh, Helmut; Kallmeyer, Georg; Langenkamp, Anja; Herrmann, Joerg; Famulare, Joseph

    2012-08-01

    Visible particulates (VP) are one subclass of defects seen during the final visual inspection of parenteral products and are currently one of the top ten reasons for recalls 1,2. The risk posed by particles is still unclear with limited experience reported in humans but remains an important consideration during the manufacture and use of parenteral products. From the experimental and clinical knowledge of the distribution of particulate matter in the body, clinical complications would include events occurring around parenteral administration e.g., as a result of mechanical pulmonary artery obstruction and injection site reaction, or sub-acute or chronic events e.g., granuloma. The challenge is to better understand the implication for patients of single vials with VP and align the risk with the probabilistic detection process used by manufacturers for accept/reject decisions of individual units of product.

  13. Glutamine: An Obligatory Parenteral Nutrition Substrate in Critical Care Therapy

    PubMed Central

    Stehle, Peter; Kuhn, Katharina S.

    2015-01-01

    Critical illness is characterized by glutamine depletion owing to increased metabolic demand. Glutamine is essential to maintain intestinal integrity and function, sustain immunologic response, and maintain antioxidative balance. Insufficient endogenous availability of glutamine may impair outcome in critically ill patients. Consequently, glutamine has been considered to be a conditionally essential amino acid and a necessary component to complete any parenteral nutrition regimen. Recently, this scientifically sound recommendation has been questioned, primarily based on controversial findings from a large multicentre study published in 2013 that evoked considerable uncertainty among clinicians. The present review was conceived to clarify the most important questions surrounding glutamine supplementation in critical care. This was achieved by addressing the role of glutamine in the pathophysiology of critical illness, summarizing recent clinical studies in patients receiving parenteral nutrition with intravenous glutamine, and describing practical concepts for providing parenteral glutamine in critical care. PMID:26495301

  14. Aluminum in Pediatric Parenteral Nutrition Products: Measured Versus Labeled Content

    PubMed Central

    Poole, Robert L.; Pieroni, Kevin P.; Gaskari, Shabnam; Dixon, Tessa K.; Park, KT; Kerner, John A.

    2011-01-01

    OBJECTIVE Aluminum is a contaminant in all parenteral nutrition solutions. Manufacturers currently label these products with the maximum aluminum content at the time of expiry, but there are no published data to establish the actual measured concentration of aluminum in parenteral nutrition solution products prior to being compounded in the clinical setting. This investigation assessed quantitative aluminum content of products commonly used in the formulation of parenteral nutrition solutions. The objective of this study is to determine the best products to be used when compounding parenteral nutrition solutions (i.e., those with the least amount of aluminum contamination). METHODS All products available in the United States from all manufacturers used in the production of parenteral nutrition solutions were identified and collected. Three lots were collected for each identified product. Samples were quantitatively analyzed by Mayo Laboratories. These measured concentrations were then compared to the manufacturers' labeled concentration. RESULTS Large lot-to-lot and manufacturer-to-manufacturer differences were noted for all products. Measured aluminum concentrations were less than manufacturer-labeled values for all products. CONCLUSIONS The actual aluminum concentrations of all the parenteral nutrition solutions were significantly less than the aluminum content based on manufacturers' labels. These findings indicate that 1) the manufacturers should label their products with actual aluminum content at the time of product release rather than at the time of expiry, 2) that there are manufacturers whose products provide significantly less aluminum contamination than others, and 3) pharmacists can select products with the lowest amounts of aluminum contamination and reduce the aluminum exposure in their patients. PMID:22477831

  15. [Pharmaconutrition with parenteral selenium in sepsis].

    PubMed

    Langlois, P L; de Oliveira Figliolino, L F; Hardy, G; Manzanares, W

    2014-04-01

    Critical illness is characterized by oxidative stress which leads to multiple organ failure, and sepsis-related organ dysfunction remains the most common cause of death in the intensive care unit. Over the last 2 decades, different antioxidant therapies have been developed to improve outcomes in septic patients. According to recent evidence, selenium therapy should be considered the cornerstone of the antioxidant strategies. Selenium given as selenious acid or sodium selenite should be considered as a drug or pharmaconutrient with prooxidant and cytotoxic effects when a loading dose in intravenous bolus form is administered, particularly in the early stage of severe sepsis/septic shock. To date, several phase ii trials have demonstrated that selenium therapy may be able to decrease mortality, improve organ dysfunction and reduce infections in critically ill septic patients. The effect of selenium therapy in sepsis syndrome must be confirmed by large, well designed phase iii clinical trials. The purpose of this review is to discuss current evidence on selenium pharmaconutrition in sepsis syndrome.

  16. Early marriage in Africa--trends, harmful effects and interventions.

    PubMed

    Walker, Judith-Ann

    2012-06-01

    This article explores the pattern of early marriage in Africa. It focuses on the sub-Saharan region as an area with the highest rates of early marriage in the world. The harmful effects of early marriage are explored in terms of impact on the health, education and economic well-being of young girls. The paper outlines a framework for analyzing global, regional and local initiatives to curb early marriage and examines the application of these interventions in sub-Saharan countries. Regional patterns are then examined and countries which have made progress in reducing age of marriage are compared to countries in which age of marriage amongst girls has reminded low. The paper concludes on the note that countries with the highest rates of early marriage are also the countries with the highest rates of poverty and highest population growth rates. The paper argues for a sub-regional strategy to address the problem of early marriage in the zone with the highest incidence.

  17. Fetal growth sustained by parenteral nutrition in pregnancy.

    PubMed

    Rivera-Alsina, M E; Saldana, L R; Stringer, C A

    1984-07-01

    Severe maternal nutritional deprivation has been associated with intrauterine growth retardation, premature labor, and increased perinatal mortality and morbidity. The authors present four cases in which total parenteral nutrition was used successfully to support fetal growth in such diverse complications as twin pregnancy with maternal jejunoileal bypass, regional enteritis, and acute pancreatitis. Maintenance of fetal growth as evidenced by serial sonographic examination allows achievement of fetal lung maturation before delivery. In all the cases presented there was no perinatal mortality or morbidity. The main clinical implication of the report is the possible application of total parenteral nutrition to maintain adequate growth in fetuses small for gestational age because of maternal nutritional deprivation.

  18. Standardised neonatal parenteral nutrition formulations - an Australasian group consensus 2012.

    PubMed

    Bolisetty, Srinivas; Osborn, David; Sinn, John; Lui, Kei

    2014-02-18

    Standardised parenteral nutrition formulations are routinely used in the neonatal intensive care units in Australia and New Zealand. In 2010, a multidisciplinary group was formed to achieve a consensus on the formulations acceptable to majority of the neonatal intensive care units. Literature review was undertaken for each nutrient and recommendations were developed in a series of meetings held between November 2010 and April 2011. Three standard and 2 optional amino acid/dextrose formulations and one lipid emulsion were agreed by majority participants in the consensus. This has a potential to standardise neonatal parenteral nutrition guidelines, reduce costs and prescription errors.

  19. [Parenteral iron therapy: problems and possible solutions].

    PubMed

    Hoigné, R; Breymann, C; Künzi, U P; Brunner, F

    1998-04-04

    To investigate whether there are differences in the frequency of ADRs (adverse drug reactions) to parenteral iron preparations, we compared the results of 4 different data collections which contain observations in particular on i.m. or i.v. iron dextran and i.v. iron hydroxide sucrose complex, primarily in relation to anaphylactic/anaphylactoid reactions and common exanthemas. 1. In 206 patients of the department of general internal medicine in a city/teaching hospital (in association with the Swiss Foundation for Comprehensive Hospital Drug Monitoring--CHDM), 4 probably allergic reactions to i.m. iron dextran were found, one with acute severe dyspnea, cyanosis and flush, 3 with slight generalized, probably allergic reactions. Data from the USA on i.v. iron dextran do not show marked differences in the frequency of ADRs as compared with our data with i.m. administration. 2. A group of 400 otherwise healthy patients of the obstetric department of Zurich University Hospital were treated with i.v. iron sucrose for anemia due to iron loss during pregnancy or following childbirth. Seven generalized skin reactions, 4 in the form of flush and 3 of common exanthema, occurred. 3. In a retrospective study on patients on maintenance hemodialysis with chronic renal insufficiency and anemia, a questionnaire was answered by the medical heads of 17 selected hemodialysis units in Switzerland. Response was 100%. During around 8100 patient-years with approximately 160,000 ampoules of iron sucrose (with 100 mg elementary iron), not a single life threatening reaction was observed; only 5-7 situations of rapidly reversible blood pressure fall occurred, some 10 with flush, and one each with urticaria and vomiting/diarrhea. 4. The relatively good tolerance of i.v. iron sucrose in patients with chronic renal failure may be due either to reduced immune competence in patients with chronic renal insufficiency and/or to the use of the preparation itself, or probably both. 5. In ADRs of

  20. Effects of Progress Monitoring Feedback on Early Literacy Student Achievement

    ERIC Educational Resources Information Center

    Lopuch, Jeremy Jon

    2016-01-01

    The purpose of this study was to examine the effects of diagnostic formative assessment feedback on early literacy skills. The participants were 12 first-grade general education teachers and 51 of their students who were assigned to the following treatments, diagnostic feedback and skills feedback (control) which lasted for 10 weeks. During the…

  1. The Effectiveness of Early Childhood Inclusion (Parents' Perspectives).

    ERIC Educational Resources Information Center

    Brown, Kyle T.

    This research examined the effectiveness of early childhood inclusion from the perspective of parents. Participating in the study were 18 parents (mothers and fathers) of 3- to 6-year-old children with a disability who had been placed in various educational settings. Half of the children were dually enrolled. Parents were interviewed separately.…

  2. ATRAZINE EFFECTS ON EARLY PREGNANCY AND IMPLANATION IN THE RAT

    EPA Science Inventory

    Atrazine Effects on Early Pregnancy and Implantation in the Rat.
    A.M. Cummings, B.E. Rhodes*, and R.L. Cooper*.
    Reproductive Toxicology Division, NHEERL, USEPA, Research Triangle Park, NC
    Atrazine (ATR), an herbicide, can induce mammary tumors in rats. ATR can also sup...

  3. A Cost-Effectiveness Analysis of Early Literacy Interventions

    ERIC Educational Resources Information Center

    Simon, Jessica

    2011-01-01

    Success in early literacy activities is associated with improved educational outcomes, including reduced dropout risk, in-grade retention, and special education referrals. When considering programs that will work for a particular school and context; cost-effectiveness analysis may provide useful information for decision makers. The study…

  4. HIV Infection: Transmission, Effects on Early Development, and Interventions.

    ERIC Educational Resources Information Center

    Lowenthal, Barbara

    1997-01-01

    Describes the modes of transmission of HIV and the course of the disease in infants and toddlers. Information is provided on its effects on early development, medical screening and treatments, therapies, psychosocial assistance, and interventions, including nutritional therapy, occupational and physical therapies, and speech and language therapy.…

  5. Spatial Working Memory Effects in Early Visual Cortex

    ERIC Educational Resources Information Center

    Munneke, Jaap; Heslenfeld, Dirk J.; Theeuwes, Jan

    2010-01-01

    The present study investigated how spatial working memory recruits early visual cortex. Participants were required to maintain a location in working memory while changes in blood oxygen level dependent (BOLD) signals were measured during the retention interval in which no visual stimulation was present. We show working memory effects during the…

  6. Early Childhood Traumatic Brain Injuries: Effects on Development and Interventions.

    ERIC Educational Resources Information Center

    Lowenthal, Barbara

    1998-01-01

    Describes the variety of possible effects of traumatic brain injuries (TBI) on early childhood development in the cognitive, language, social-emotional, motor, and adaptive domains. Suggests interventions which can assist young survivors and their families. Suggests that more long-term, intensive studies be conducted on the short- and long-term…

  7. Outpatient Parenteral Antibiotic Therapy in an Academic Practice in Rhode Island

    PubMed Central

    Touzard Romo, F; Resnick, B; Perez-Cioe, M; Flanigan, TP; Kojic, E; Beckwith, CG

    2015-01-01

    Outpatient parenteral antimicrobial therapy (OPAT) is an increasingly utilized treatment modality that has been proven to be safe and cost-effective for treating infections that require prolonged antimicrobial treatment. Adequate patient selection, a structured OPAT team with an effective communication system, and routine clinical monitoring are key elements to establish a successful OPAT program. The Infectious Diseases and Immunology Center at The Miriam Hospital offers a multidisciplinary OPAT model coordinated by infectious diseases specialists and serves as a major referral center in Rhode Island. PMID:25562060

  8. The thermodynamic effect of atmospheric mass on early Earth's temperature

    NASA Astrophysics Data System (ADS)

    Chemke, R.; Kaspi, Y.; Halevy, I.

    2016-11-01

    Observations suggest that Earth's early atmospheric mass differed from the present day. The effects of a different atmospheric mass on radiative forcing have been investigated in climate models of variable sophistication, but a mechanistic understanding of the thermodynamic component of the effect of atmospheric mass on early climate is missing. Using a 3-D idealized global circulation model (GCM), we systematically examine the thermodynamic effect of atmospheric mass on near-surface temperature. We find that higher atmospheric mass tends to increase the near-surface temperature mostly due to an increase in the heat capacity of the atmosphere, which decreases the net radiative cooling effect in the lower layers of the atmosphere. Additionally, the vertical advection of heat by eddies decreases with increasing atmospheric mass, resulting in further near-surface warming. As both net radiative cooling and vertical eddy heat fluxes are extratropical phenomena, higher atmospheric mass tends to flatten the meridional temperature gradient.

  9. [Suppression of cycling activity in sheep using parenteral progestagen treatment].

    PubMed

    Janett, F; Camponovo, L; Lanker, U; Hässig, M; Thun, R

    2004-03-01

    The objective of this study was to evaluate the effect of two synthetic progestagen preparations Chlormadinone acetate (CAP, Chronosyn, Veterinaria AG Zürich) and Medroxyprogesterone acetate (MPA, Nadigest, G Streuli & Co. Uznach) on cycling activity and fertility in sheep. A flock of 28 non pregnant white alpine sheep was randomly divided into three groups, A (n = 10), B (n = 9) and C (n = 9). During a period of 4 weeks the cycling activity was confirmed by blood progesterone analysis. Thereafter, the animals of group A were treated with 50 mg CAP, those of group B with 140 mg MPA and those of group C with physiological saline solution. All injections were given intramuscularly. Suppression of endogenous progesterone secretion lasted from 28 to 49 days (mean = 39 days) in group A and from 42 to 70 days (mean = 50 days) in group B. The synchronization effect of both preparations was unsatisfactory as the occurrence of first estrus was distributed over a period of 3 weeks in group A and 4 weeks in group B. These findings could also be confirmed by the lambing period which lasted 52 days in group A and 36 days in group B. Control animals lambed within 9 days due to the synchronizing effect of the ram. The first fertile estrus was observed 36 days (group A) and 45 days (group B) after the treatment. In group A all 10 animals and in groups B and C 8 of 9 ewes each became pregnant. Parenteral progestagen application with CAP and MPA is a simple, safe and reversible method of estrus suppression in the sheep. The minimal suppressive duration of 4 (CAP) and 5 weeks (MPA) is not sufficient when a period of 3 months (alpine pasture period) is desired.

  10. Examining the cost-effectiveness of early dental visits.

    PubMed

    Lee, Jessica Y; Bouwens, Thomas J; Savage, Matthew F; Vann, William F

    2006-01-01

    The subject of early dental visits as an integral dimension of anticipatory guidance and the related supporting scientific evidence for this concept is a critical and timely issue for the dental profession. The purpose of this paper was to review the scientific evidence and rationale for early dental visits. In theory, early dental visits can prevent disease and reduce costs. During the age 1 dental visit, there is strong emphasis on prevention and parents are given: (1) counseling on infant oral hygiene; (2) home and office-based fluoride therapies; (3) dietary counseling; and (4) information relative to oral habits and dental injury prevention. There is evidence that the early preventive visits can reduce the need for restorative and emergency care, therefore reducing dentally related costs among high-risk children. Preschool Medicaid children who had an early preventive dental visit by age 1 were more likely to use subsequent preventive services and experienced less dentally related costs. These finding have significant policy implications, and more research is needed to examine this effect in a low-risk population.

  11. Comparison between Total Parenteral Nutrition Vs. Partial Parenteral Nutrition on Serum Lipids Among Chronic Ventilator Dependent Patients; A Multi Center Study

    PubMed Central

    Radpay, Rojan; Radpay, Badiozaman

    2016-01-01

    Background: Malnutrition is very common among chronically hospitalized patients, especially those in the intensive care unit (ICU). Identifying the patients at risk and providing suitable nutritional support can prevent and/or overcome malnutrition in them. Total parenteral nutrition (TPN) and partial parenteral nutrition (PPN) are two common routes to deliver nutrition to hospitalized patients. We conducted a multicenter, prospective double blind randomized controlled trial to evaluate the benefits and compare their adverse effects of each method. Materials and Methods: 97 patients were enrolled and divided into two groups based on the inclusion criteria. Serum protein, serum albumin, serum transferrin, and total lymphocyte count were measured on days 7 and 14. Results: We did not find any statistically significant differences in clinical status or laboratory values between the two groups but there were significant improvements in measured lab values between days 7 and 14 (p<0.005) indicating improved nutritional status in each groups. Conclusion: This study shows that both TPN and PPN can be used safely in chronic ICU patients to provide nutritional support and prevent catabolic state among chronic critically ill patients. We need to develop precise selection criteria in order to choose the patients who would benefit the most from TPN and PPN. In addition, appropriate laboratory markers are needed to monitor the metabolic requirements of the patients and assess their progress. PMID:27403176

  12. Pseudomonas arthritis treated with parenteral and intra-articular ceftazidime.

    PubMed Central

    Walton, K; Hilton, R C; Sen, R A

    1985-01-01

    A 73-year-old diabetic presented with septic arthritis of the knee; Pseudomonas aeruginosa was isolated. She was successfully treated with a combination of parenteral and intra-articular ceftazidime, after failure to eradicate the organism with adequate serum levels of gentamicin and full doses of azlocillin. PMID:3896166

  13. Phytosterols, Lipid Administration, and Liver Disease During Parenteral Nutrition.

    PubMed

    Zaloga, Gary P

    2015-09-01

    Phytosterols are plant-derived sterols that are structurally and functionally analogous to cholesterol in vertebrate animals. Phytosterols are found in many foods and are part of the normal human diet. However, absorption of phytosterols from the diet is minimal. Most lipid emulsions used for parenteral nutrition are based on vegetable oils. As a result, phytosterol administration occurs during intravenous administration of lipid. Levels of phytosterols in the blood and tissues may reach high levels during parenteral lipid administration and may be toxic to cells. Phytosterols are not fully metabolized by the human body and must be excreted through the hepatobiliary system. Accumulating scientific evidence suggests that administration of high doses of intravenous lipids that are high in phytosterols contributes to the development of parenteral nutrition-associated liver disease. In this review, mechanisms by which lipids and phytosterols may cause cholestasis are discussed. Human studies of the association of phytosterols with liver disease are reviewed. In addition, clinical studies of lipid/phytosterol reduction for reversing and/or preventing parenteral nutrition associated liver disease are discussed.

  14. Micronutrients in Parenteral Nutrition: Boron, Silicon, and Fluoride

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Long-term parenteral nutrition (providing nutrients intravenously) is a life-saving treatment for patients with severe malabsorption of nutrients caused by intestinal failure, intestinal trauma (for example, gunshot or stab wounds), and intestinal removal. Metabolic bone disease characterized by min...

  15. Gluconeogenesis continues in premature infants receiving total parenteral nutrition

    Technology Transfer Automated Retrieval System (TEKTRAN)

    To determine the contribution of total gluconeogenesis, to glucose production in preterm infants receiving total parenteral nutrition (TPN) providing glucose exceeding normal infant glucose turnover rate, eight infants (0.955 +/- 0.066 kg, 26.5 - 0.5 wks, 4-1 d) were studied while receiving routine ...

  16. [Caloric substrates in postoperative parenteral nutrition].

    PubMed

    De Salvo, L; Romairone, E; Ansaldo, G L; Mattioli, G

    1991-05-31

    The paper describes the carbohydrate, lipidic and nitrogen metabolism of the postoperative period which is subdivided into an early and a late phase. Since the metabolism of caloric substrates in the early postoperative period is a stress metabolism with glucose intolerance and wide protein catabolism, the authors emphasise that an insufficient caloric intake is worse than the fasting state and suggest that alternative caloric sources, such as branched chain amino acids, fatty acids and, even, ketonic bodies, should be used.

  17. A study of parenteral iron regimens in hemodialysis patients.

    PubMed

    Besarab, A; Kaiser, J W; Frinak, S

    1999-07-01

    The administration of parenteral iron dextran to hemodialysis patients is typically intermittent. We sought to determine the most appropriate intervals for sampling iron parameters during intermittent need-based and continuous maintenance regimens and to quantify differences in efficacy between such regimens during long-term therapy. After a single course of 10 consecutive 100-mg iron doses administered to 14 patients on 16 occasions, transferrin saturation (TSAT) and ferritin were unreliable indices of iron status for the next 2 and 6 weeks, respectively. TSAT and ferritin levels at 1 week were virtually identical to those at 2 weeks after the administration of a single 50-mg or 100-mg iron dextran dose to 16 other patients. Twelve patients on maintenance iron therapy (25 to 100 mg/wk; TSAT, 30% to 50%) had a statistically significant decrease in the amount of recombinant human erythropoietin (rHuEPO) needed to maintain hemoglobin (Hb) levels between 10 and 11 g/dL compared with 12 patients receiving intermittent need-based dosing, an effect that persisted from week 16 to week 72 of the study. Maintenance iron was feasible even in a third group of eight patients targeted to sustain an Hb level of 14 g/dL. In both iron maintenance groups, iron indices could be measured at weekly intervals, and ferritin levels did not progressively increase over time. Continuous maintenance iron dextran used to maintain TSATs of 30% to 50% significantly reduced rHuEPO requirements and resulted in no adverse side effects in chronic hemodialysis patients. After weekly maintenance 25- to 100-mg iron dextran doses, iron indices can be measured after 1 week; a delay of 2 weeks is not necessary.

  18. Lipid emulsions – Guidelines on Parenteral Nutrition, Chapter 6

    PubMed Central

    Adolph, M.; Heller, A. R.; Koch, T.; Koletzko, B.; Kreymann, K. G.; Krohn, K.; Pscheidl, E.; Senkal, M.

    2009-01-01

    The infusion of lipid emulsions allows a high energy supply, facilitates the prevention of high glucose infusion rates and is indispensable for the supply with essential fatty acids. The administration of lipid emulsions is recommended within ≤7 days after starting PN (parenteral nutrition) to avoid deficiency of essential fatty acids. Low-fat PN with a high glucose intake increases the risk of hyperglycaemia. In parenterally fed patients with a tendency to hyperglycaemia, an increase in the lipid-glucose ratio should be considered. In critically ill patients the glucose infusion should not exceed 50% of energy intake. The use of lipid emulsions with a low phospholipid/triglyceride ratio is recommended and should be provided with the usual PN to prevent depletion of essential fatty acids, lower the risk of hyperglycaemia, and prevent hepatic steatosis. Biologically active vitamin E (α-tocopherol) should continuously be administered along with lipid emulsions to reduce lipid peroxidation. Parenteral lipids should provide about 25–40% of the parenteral non-protein energy supply. In certain situations (i.e. critically ill, respiratory insufficiency) a lipid intake of up to 50 or 60% of non-protein energy may be reasonable. The recommended daily dose for parenteral lipids in adults is 0.7–1.3 g triglycerides/kg body weight. Serum triglyceride concentrations should be monitored regularly with dosage reduction at levels >400 mg/dl (>4.6 mmol/l) and interruption of lipid infusion at levels >1000 mg/dl (>11.4 mmol/l). There is little evidence at this time that the choice of different available lipid emulsions affects clinical endpoints. PMID:20049078

  19. Earthquake Early Warning: User Education and Designing Effective Messages

    NASA Astrophysics Data System (ADS)

    Burkett, E. R.; Sellnow, D. D.; Jones, L.; Sellnow, T. L.

    2014-12-01

    The U.S. Geological Survey (USGS) and partners are transitioning from test-user trials of a demonstration earthquake early warning system (ShakeAlert) to deciding and preparing how to implement the release of earthquake early warning information, alert messages, and products to the public and other stakeholders. An earthquake early warning system uses seismic station networks to rapidly gather information about an occurring earthquake and send notifications to user devices ahead of the arrival of potentially damaging ground shaking at their locations. Earthquake early warning alerts can thereby allow time for actions to protect lives and property before arrival of damaging shaking, if users are properly educated on how to use and react to such notifications. A collaboration team of risk communications researchers and earth scientists is researching the effectiveness of a chosen subset of potential earthquake early warning interface designs and messages, which could be displayed on a device such as a smartphone. Preliminary results indicate, for instance, that users prefer alerts that include 1) a map to relate their location to the earthquake and 2) instructions for what to do in response to the expected level of shaking. A number of important factors must be considered to design a message that will promote appropriate self-protective behavior. While users prefer to see a map, how much information can be processed in limited time? Are graphical representations of wavefronts helpful or confusing? The most important factor to promote a helpful response is the predicted earthquake intensity, or how strong the expected shaking will be at the user's location. Unlike Japanese users of early warning, few Californians are familiar with the earthquake intensity scale, so we are exploring how differentiating instructions between intensity levels (e.g., "Be aware" for lower shaking levels and "Drop, cover, hold on" at high levels) can be paired with self-directed supplemental

  20. Parenteral organophosphorus poisoning in a rural emergency department: a case report

    PubMed Central

    2013-01-01

    Background Poisoning is a common presentation in the emergency department. Oral exposures to organophosphorus compounds are especially frequent in rural and agricultural regions of South Asia and throughout the developing world. Case presentation Here we report a case of deliberate self-harm with an organophosphorus pesticide via the relatively uncommon parenteral route. A young woman injected herself with chlorpyriphos. Although the cholinergic effects were mild, cellulitis and abscess development were noted as a result. Conclusion Resource limited agricultural countries like Nepal present health care workers with numerous challenges in poisoning management. This case represents a rare but potentially morbid method of agrochemical poison exposure. PMID:24321121

  1. Acetaldehyde involvement in ethanol's postabsortive effects during early ontogeny.

    PubMed

    March, Samanta M; Abate, P; Molina, Juan C

    2013-01-01

    Clinical and biomedical studies sustains the notion that early ontogeny is a vulnerable window to the impact of alcohol. Experiences with the drug during these stages increase latter disposition to prefer, use or abuse ethanol. This period of enhanced sensitivity to ethanol is accompanied by a high rate of activity in the central catalase system, which metabolizes ethanol in the brain. Acetaldehyde (ACD), the first oxidation product of ethanol, has been found to share many neurobehavioral effects with the drug. Cumulative evidence supports this notion in models employing adults. Nevertheless very few studies have been conducted to analyze the role of ACD in ethanol postabsorptive effects, in newborns or infant rats. In this work we review recent experimental literature that syndicates ACD as a mediator agent of reinforcing aspects of ethanol, during early ontogenetic stages. We also show a meta-analytical correlational approach that proposes how differences in the activity of brain catalase across ontogeny, could be modulating patterns of ethanol consumption.

  2. [Effect of zuoguiwan on early embryonic development of mice].

    PubMed

    Feng, Q J; Feng, M L; Wang, Y L

    1996-11-01

    Effects of Zuoguiwan (ZGW, a prescription for reinforcing Kidney Yin) on early embryonic development were observed by using embryonic developmental retardation model of mice formed by alcohol. Drug was given in three ways: add ZGW into cultural medium directly (group A), add the serum of mice received ZGW (group B) and cultured the embryo taken from ZGW treated mice (group C). The result was compared with that treated with Bazhen decoction (BZD, a prescription for supplementing Qi and blood). Results showed that the in vitro developmental rate of embryo from 2-cell stage to blastula stage in group B and C, which approached to normal control group, was higher than that in untreated model obviously. While in BZW group, it was higher than in normal control group only in certain stage. However, adding ZGW directly into culture medium didn't reveal marked effect on early embryonic development.

  3. An electrophysiological investigation of early effects of masked morphological priming

    PubMed Central

    Morris, Joanna; Grainger, Jonathan; Holcomb, Phillip J.

    2009-01-01

    This experiment examined event-related responses to targets preceded by semantically transparent morphologically related primes (e.g., farmer-farm), semantically opaque primes with an apparent morphological relation (cornercorn), and orthographically, but not morphologically, related primes (scandalscan) using the masked priming technique combined with a semantic categorisation task. In order to provide information about possible early effects of morphology we focused our analysis on the N250 ERP component. Priming effects for transparent and opaque items patterned together in the early phase of the N250 (200-250 ms), whereas the transparent and orthographic items patterned together in the latter phase of this component (250-300 ms). These results provide further evidence in support of the rapid extraction of morphemes from morphologically complex stimuli independently of the semantic relatedness of the whole and its parts. PMID:19779574

  4. Management of parenteral nutrition in critically ill patients

    PubMed Central

    Cotogni, Paolo

    2017-01-01

    Artificial nutrition (AN) is necessary to meet the nutritional requirements of critically ill patients at nutrition risk because undernutrition determines a poorer prognosis in these patients. There is debate over which route of delivery of AN provides better outcomes and lesser complications. This review describes the management of parenteral nutrition (PN) in critically ill patients. The first aim is to discuss what should be done in order that the PN is safe. The second aim is to dispel “myths” about PN-related complications and show how prevention and monitoring are able to reach the goal of “near zero” PN complications. Finally, in this review is discussed the controversial issue of the route for delivering AN in critically ill patients. The fighting against PN complications should consider: (1) an appropriate blood glucose control; (2) the use of olive oil- and fish oil-based lipid emulsions alternative to soybean oil-based ones; (3) the adoption of insertion and care bundles for central venous access devices; and (4) the implementation of a policy of targeting “near zero” catheter-related bloodstream infections. Adopting all these strategies, the goal of “near zero” PN complications is achievable. If accurately managed, PN can be safely provided for most critically ill patients without expecting a relevant incidence of PN-related complications. Moreover, the use of protocols for the management of nutritional support and the presence of nutrition support teams may decrease PN-related complications. In conclusion, the key messages about the management of PN in critically ill patients are two. First, the dangers of PN-related complications have been exaggerated because complications are uncommon; moreover, infectious complications, as mechanical complications, are more properly catheter-related and not PN-related complications. Second, when enteral nutrition is not feasible or tolerated, PN is as effective and safe as enteral nutrition. PMID

  5. Hypersensitivity reaction to components of parenteral nutrition in pediatrics.

    PubMed

    Hernández, Carlos Ruiz; Ponce, Esperanza Castejón; Busquets, Ferran Bossacoma; Hernández, Diana Sánchez; Oliva, Silvia Meavilla; Santacruz, Enrique Llerena; Pérez, Naymar; De Los Santos Pelegrini, Mariela; Flaque, Miquel Villaronga

    2016-01-01

    Very rare cases of hypersensitivity reactions to various constituents of parenteral nutrition (PN) have been reported in children. Adverse effects associated with PN administration have centered on metabolic, infectious, and mechanical complications. Here we describe three cases of hypersensitivity to components of PN. Case 1 is a 1-mo-old breastfed baby with a diagnosis of acute gastroenteritis associated with an infection with cytomegalovirus. On the second day of PN, 60 min after the initiation of the infusion, the patient had an allergic reaction with an overall diffused rash. On day 4 of PN, the multivitamin solution and the trace element mix were excluded, showing a good tolerance. Case 2 is a 4-y-old girl with a background of stage III neuroblastoma. On day 3 of PN, 15 min after the initiation of the infusion, the patient showed sudden facial edema. On day 5, suspecting the amino acid solution to be the etiology of her reaction, PN was infused with another amino acid preparation, and the patient showed good tolerance. Case 3 is a 10-y-old boy with a diagnosis of an acute peritonitis. Two h after the initiation of the infusion, the patient showed a general wheal rash. He referred a background of fish allergy. Considering that the lipid emulsion used had components from fish oil (SMOF Lipid), a new PN was infused on day 2. The new PN contained a lipid emulsion containing vegetable oil (ClinOleic). The patient showed good tolerance. In conclusion, we consider that, although the hypersensitivity to PN components is infrequent, there is an increase in reports of pediatric cases describing this allergic pathology.

  6. Outpatient parenteral antimicrobial therapy in osteoarticular infections in children.

    PubMed

    Maraqa, Nizar F; Gomez, Margarita M; Rathore, Mobeen H

    2002-01-01

    There are few data on the use of outpatient parenteral antimicrobial therapy (OPAT) in the management of osteoarticular infections (OAIs) in childhood. The objective of this study was to determine if OPAT is safe and effective in the management of OAIs. Using their OPAT database, the authors evaluated the use of OPAT in children younger than 18 years old treated for OAIs between January 1, 1995, and December 31, 1999. One hundred eighty-four OAIs were treated in 179 patients over 5 years. OPAT involved central venous lines (CVLs) in 110 (59.8%), peripherally inserted central catheters (PICCs) in 71 (38.6%), and peripheral cannulas in 3 (1.6%). One hundred eighteen (64%) OPAT courses were completed without interruption. Rehospitalization occurred in 48 (26.1%) courses and occurred earlier with PICC. OPAT complications were catheter-related in 58 (30%) courses, not catheter-related in 60 (32%), and unknown in 10 (5.3%). The mechanical complication rate was 6.3 per 1,000 catheter-days (CVL 4.2, PICC 10.6), and the rate of infectious complications was 2.7 per 1,000 catheter-days (CVL 2.8, PICC 2.4). One hundred sixty-eight (98%) of 172 evaluable OAIs were cured. Four (2.2%) patients failed treatment: one had recurrence and three had persistent infection. The authors conclude that OPAT can be safely used to manage OAIs in children without compromising outcome. Mechanical complications are more common with PICCs.

  7. Management of parenteral nutrition in critically ill patients.

    PubMed

    Cotogni, Paolo

    2017-02-04

    Artificial nutrition (AN) is necessary to meet the nutritional requirements of critically ill patients at nutrition risk because undernutrition determines a poorer prognosis in these patients. There is debate over which route of delivery of AN provides better outcomes and lesser complications. This review describes the management of parenteral nutrition (PN) in critically ill patients. The first aim is to discuss what should be done in order that the PN is safe. The second aim is to dispel "myths" about PN-related complications and show how prevention and monitoring are able to reach the goal of "near zero" PN complications. Finally, in this review is discussed the controversial issue of the route for delivering AN in critically ill patients. The fighting against PN complications should consider: (1) an appropriate blood glucose control; (2) the use of olive oil- and fish oil-based lipid emulsions alternative to soybean oil-based ones; (3) the adoption of insertion and care bundles for central venous access devices; and (4) the implementation of a policy of targeting "near zero" catheter-related bloodstream infections. Adopting all these strategies, the goal of "near zero" PN complications is achievable. If accurately managed, PN can be safely provided for most critically ill patients without expecting a relevant incidence of PN-related complications. Moreover, the use of protocols for the management of nutritional support and the presence of nutrition support teams may decrease PN-related complications. In conclusion, the key messages about the management of PN in critically ill patients are two. First, the dangers of PN-related complications have been exaggerated because complications are uncommon; moreover, infectious complications, as mechanical complications, are more properly catheter-related and not PN-related complications. Second, when enteral nutrition is not feasible or tolerated, PN is as effective and safe as enteral nutrition.

  8. Access technique and its problems in parenteral nutrition – Guidelines on Parenteral Nutrition, Chapter 9

    PubMed Central

    Jauch, K. W.; Schregel, W.; Stanga, Z.; Bischoff, S. C.; Braß, P.; Hartl, W.; Muehlebach, S.; Pscheidl, E.; Thul, P.; Volk, O.

    2009-01-01

    Catheter type, access technique, and the catheter position should be selected considering to the anticipated duration of PN aiming at the lowest complication risks (infectious and non-infectious). Long-term (>7–10 days) parenteral nutrition (PN) requires central venous access whereas for PN <3 weeks percutaneously inserted catheters and for PN >3 weeks subcutaneous tunnelled catheters or port systems are appropriate. CVC (central venous catheter) should be flushed with isotonic NaCl solution before and after PN application and during CVC occlusions. Strict indications are required for central venous access placement and the catheter should be removed as soon as possible if not required any more. Blood samples should not to be taken from the CVC. If catheter infection is suspected, peripheral blood-culture samples and culture samples from each catheter lumen should be taken simultaneously. Removal of the CVC should be carried out immediately if there are pronounced signs of local infection at the insertion site and/or clinical suspicion of catheter-induced sepsis. In case PN is indicated for a short period (max. 7–10 days), a peripheral venous access can be used if no hyperosmolar solutions (>800 mosm/L) or solutions with a high titration acidity or alkalinity are used. A peripheral venous catheter (PVC) can remain in situ for as long as it is clinically required unless there are signs of inflammation at the insertion site. PMID:20049083

  9. Effects of genistein on early-stage cutaneous wound healing

    SciTech Connect

    Park, Eunkyo; Lee, Seung Min; Jung, In-Kyung; Lim, Yunsook; Kim, Jung-Hyun

    2011-07-08

    Highlights: {yields} We examine the effect of genistein on cutaneous wound healing. {yields} Genistein enhanced wound closure during the early stage of wound healing. {yields} These genistein effects on wound closure were induced by reduction of oxidative stress through increasing antioxidant capacity and modulation of pro-inflammatory cytokine expression. -- Abstract: Wound healing occurs in three sequential phases: hemostasis and inflammation, proliferation, and remodeling. Inflammation, the earliest phase, is considered a critical period for wound healing because immune cells remove damaged tissues, foreign debris, and remaining dead tissue. Wound healing would be delayed without inflammation, and this phase is affected by antioxidation capacity. Therefore, we hypothesized that genistein, which has an antioxidant effect, might modulate the wound healing process by altering the inflammatory response. After three days of acclimation, mice were divided into three groups: control, 0.025% genistein, and 0.1% genistein. After two weeks of an experimental diet, skin wounds were induced. Wounded skin areas were imaged, and the healing rate calculated. To measure lipid peroxidation, antioxidant enzyme expression and activity, and pro-inflammatory cytokine expression, skin and liver tissues were harvested at 12, 24, 48, and 72 h. Genistein did not affect body weight. The rate of wound closure in mice fed genistein was significantly faster than in the control group during the early stage of wound healing, especially in first three days. Cu, Zn-SOD and Mn-SOD expression in wound skin tissue in the 0.1% genistein group was lower than in the control group. However, CAT expression did not differ among groups. We also found that genistein modulated NF-{kappa}B and TNF-{alpha} expression during the early stage of wound healing. The genistein group had significantly lower hepatic lipid peroxidation and higher SOD, CAT, and GPx activities than the control group. These results

  10. Parenteral lipid fatty acid composition directly determines the fatty acid composition of red blood cell and brain lipids in preterm pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Studies in enterally-fed infants have shown a positive effect of n-3 long-chain polyunsaturated fatty acid (LCPUFA) supplementatin on neurodevelopment. The effect of n-3 LCPUFA in fish oil-based parenteral (PN) lipid emulsions on neuronal tissues of PN-fed preterm infants is unknown. The objective ...

  11. Ampicillin-sulbactam: an update on the use of parenteral and oral forms in bacterial infections.

    PubMed

    Betrosian, Alex P; Douzinas, Emmanuel E

    2009-09-01

    Ampicillin-sulbactam has a wide range of antibacterial activity that includes Gram-positive and Gram-negative aerobic and anaerobic bacteria. However, the drug is not active against Pseudomonas aeruginosa and pathogens producing extended-spectrum beta-lactamases. The combination could be considered particularly active against Acinetobacter baumannii infections due to the intrinsic activity of sulbactam. The drug is indicated as empirical therapy for a broad range of community acquired infections supervened in adults or children and is effective in either parenteral (ampicillin-sulbactam) or oral (as a mutual prodrug sultamicillin) form. In clinical trials, sultamicillin has proved clinically and bacteriologically effective in adults and children against a variety of frequently encountered infections, including mild upper and lower respiratory tract infections, urinary tract infections, diabetic foot and skin and soft tissue infections. Furthermore, adverse effects rarely occur with the diarrhoea to represent the most commonly reported. The parenteral ampicillin-sulbactam is indicated for community infections of mild-to-moderate severity acquired infections such as intra-abdominal or gynecological. Moreover, it seems to represent the alternative of choice for the treatment of A. baumannii infections for carbapenem-resistant strains in the nosocomial setting. Thus, ampicillin-sulbactam remains a valuable agent in the physician's armamentarium in the management of adult and pediatric infections.

  12. Randomised placebo-controlled trial of teduglutide in reducing parenteral nutrition and/or intravenous fluid requirements in patients with short bowel syndrome

    PubMed Central

    Gilroy, R; Pertkiewicz, M; Allard, J P; Messing, B; O'Keefe, S J

    2011-01-01

    Background and aims Teduglutide, a GLP-2 analogue, may restore intestinal structural and functional integrity by promoting repair and growth of the mucosa and reducing gastric emptying and secretion, thereby increasing fluid and nutrient absorption in patients with short bowel syndrome (SBS). This 24-week placebo-controlled study evaluated the ability of teduglutide to reduce parenteral support in patients with SBS with intestinal failure. Methods In 83 patients randomised to receive subcutaneous teduglutide 0.10 mg/kg/day (n=32), 0.05 mg/kg/day (n=35) or placebo (n=16) once daily, parenteral fluids were reduced at 4-week intervals if intestinal fluid absorption (48 h urine volumes) increased ≥10%. Responders were subjects who demonstrated reductions of ≥20% in parenteral volumes from baseline at weeks 20 and 24. The primary efficacy end point, a graded response score (GRS), took into account higher levels and earlier onset of response, leading to longer duration of response. The intensity of the response was defined as a reduction from baseline in parenteral volume (from 20% to 100%), and the duration of the response was considered the response at weeks 16, 20 and 24. The results were tested according to a step-down procedure starting with the 0.10 mg/kg/day dose. Results Using the GRS criteria, teduglutide in a dose of 0.10 mg/kg/day did not have a statistically significant effect compared with placebo (8/32 vs 1/16, p=0.16), while teduglutide in a dose of 0.05 mg/kg/day had a significant effect (16/35, p=0.007). Since parenteral volume reductions were equal (353±475 and 354±334 ml/day), the trend towards higher baseline parenteral volume (1816±1008 vs 1374±639 ml/day, p=0.11) in the 0.10 mg/kg/day group compared with the 0.05 mg/kg/day group may have accounted for this discrepancy. Three teduglutide-treated patients were completely weaned off parenteral support. Serious adverse events were distributed similarly between active

  13. The Effective Early Learning Project: The Quality of Adult Engagement in Early Childhood Settings in the UK.

    ERIC Educational Resources Information Center

    Pascal, Christine; Bertram, Tony

    Based on the view that the quality of adult educative interactions with young children is critical in determining the effectiveness of educational provision and in improving early childhood settings, this paper examines the quality of adult engagement experienced by 3- and 4-year-olds in 9 types of early education and care settings from the…

  14. Frequency Effects or Context Effects in Second Language Word Learning: What Predicts Early Lexical Production?

    ERIC Educational Resources Information Center

    Crossley, Scott A.; Subtirelu, Nicholas; Salsbury, Tom

    2013-01-01

    This study examines frequency, contextual diversity, and contextual distinctiveness effects in predicting produced versus not-produced frequent nouns and verbs by early second language (L2) learners of English. The study analyzes whether word frequency is the strongest predictor of early L2 word production independent of contextual diversity and…

  15. Effects of early enteral nutrition on the gastrointestinal motility and intestinal mucosal barrier of patients with burn-induced invasive fungal infection

    PubMed Central

    Zhang, Yu; Gu, Fang; Wang, Fengxian; Zhang, Yuanda

    2016-01-01

    Objective: To evaluate the effects of early enteral nutrition on the gastrointestinal motility and intestinal mucosal barrier of patients with burn-induced invasive fungal infection. Methods: A total of 120 patients with burn-induced invasive fungal infection were randomly divided into an early enteral nutrition (EN) group and a parenteral nutrition (PN) group (n=60). The patients were given nutritional support intervention for 14 days, and the expression levels of serum transferrin, albumin, total protein, endotoxin, D-lactic acid and inflammatory cytokines were detected on the 1st, 7th and 14th days respectively. Results: As the treatment progressed, the levels of serum transferrin, albumin and total protein of the EN group were significantly higher than those of the PN group (P<0.05), while the levels of serum endotoxin and D-lactic acid of the form group were significantly lower (P<0.05). After treatment, the expression levels of IL-6 and TNF-α were decreased in the EN group, which were significantly different from those of the PN group (P<0.05). During treatment, the incidence rates of complications such as abdominal distension, diarrhea, sepsis, nausea, vomiting and gastric retention were similar. The mean healing time of wound surface was 9.34±0.78 days in the EN group and 12.46±2.19 days in the PN group, i.e. such time of the former was significantly shorter than that of the latter (P<0.05). Conclusion: Treating patients having burn-induced invasive fungal infection by early enteral nutrition support with arginine can safely alleviate malnutrition and stress reaction, strengthen cellular immune function and promote wound healing, thereby facilitating the recovery of gastrointestinal motility and the function of intestinal mucosal barrier. PMID:27375697

  16. [Enteral and/or parenteral nutrition in the critically ill : An algorithm as a possible basis for decision-making].

    PubMed

    Weimann, A

    2016-09-01

    Taking into account new data and recent clinical controversies regarding nutritional support within the first 7 days of critical illness, early enteral nutrition is recommended. A normocaloric goal of 25 kcal/kg body weight/day should be achieved. In case of inadequate enteral tolerance, parenteral supplementation starting between day 3 and 5 should be selectively restricted to primarily malnourished patients and those with high risk for complications and prolonged stay in the intensive care unit. This can be summarized in a clinical algorithm.

  17. Is there a role for parenteral feeding in clinical medicine?

    PubMed Central

    Phinney, S D; Siepler, J; Bach, H T

    1996-01-01

    Protein-calorie malnutrition as evidenced by loss of weight or of lean body mass is a commonly seen disorder. Although its cause is clearly multifactorial, objective measures of protein-calorie malnutrition have been repeatedly correlated with poor patient outcomes. Total parenteral nutrition was developed to halt or reverse this disorder, but its ability to improve the short- to intermediate-term outcome in patients with impaired nutrient intake has been highly inconsistent. Factors influencing this variable outcome include the degree of functional impairment in the treatment group, the underlying disease causing the impaired intake, and possibly the amount and composition of nonprotein calories delivered. In particular, considerable evidence points to intravenous soybean oil emulsion as a negative factor in the nutritional support of stressed patients. Taken in combination, current information suggests reserving the use of parenteral feeding for patients meeting objective criteria for protein-calorie malnutrition and making parsimonious use of lipid emulsion, especially in stressed patients. PMID:8775726

  18. Parenteral Nutrition–Associated Liver Injury and Increased GRP94 Expression Prevented by ω-3 Fish Oil–Based Lipid Emulsion Supplementation

    PubMed Central

    Zhu, Xueping; Xiao, Zhihui; Chen, Xiaoqian; Li, Yanhong; Zhang, Xiaomin; Xu, Yumin; Feng, Xing; Wang, Jian

    2014-01-01

    ABSTRACT Objective: Parenteral nutrition in infants with gastrointestinal disorders can be lifesaving, but it is also associated with parenteral nutrition–associated liver disease. We investigated the effects of incorporating ω-3 fish oil in a parenteral nutrition mixture on signs of parenteral nutrition–associated liver disease and explored the mechanism involved in this process. Methods: Seven-day-old New Zealand rabbits were divided into 3 groups of 8, and for 1 week they were infused via the right jugular vein with standard total parenteral nutrition with soybean oil (TPN-soy) or TPN with ω-3 fish oil–based lipid emulsion (TPN-FO), or naturally nursed with rabbit milk (control). Serum and liver tissues were analyzed for serological indicators and pathology, respectively. Reverse-transcriptase polymerase chain reaction was used to evaluate the messenger RNA levels of the endoplasmic reticulum stress chaperone protein glucose-regulated protein 94 (GRP94) in liver tissues and GRP94 protein levels were compared through immunohistochemistry and Western blot assays. Results: TPN-soy animals had significantly higher serum total bilirubin, direct bilirubin, and γ-glutamyl transpeptidase and lower serum albumin than the controls (P < 0.01, each) or the TPN-FO group, which were similar to the controls (P < 0.01 cf. TPN). Damage to liver tissues of the TPN-FO group was much less than that of the TPN-soy group. GRP94 messenger RNA and protein levels in liver tissues of TPN-soy animals were significantly higher than that of the controls or TPN-FO rabbits, which were similar to the controls. Conclusions: Incorporating ω-3 fish oil in parenteral nutrition emulsion greatly prevented liver dysfunction and liver tissue damage in week-old rabbit kits, possibly by preventing endoplasmic reticulum stress. PMID:25199039

  19. Limulus amoebocyte lysate assay for detection and quantitation of endotoxin in a small-volume parenteral product.

    PubMed Central

    Tsuji, K; Steindler, K A; Harrison, S J

    1980-01-01

    A Limulus amoebocyte lysate gel-clotting method for the determination of endotoxin in a small-volume parenteral product has been described. Sample dilution with 0.1 M potassium phosphate monobasic buffer (pH 8.0) effectively eliminated assay interference, whereas dilution with water did not. The threshold pyrogenic dose for Escherichia coli EC-2 and O127:B8 endotoxins was determined to be 1.0 ng of endotoxin per kg of body weight. Not more than 1.0 ng of endotoxin (the threshold pyrogenic dose) per the highest recommended human dose or the USP pyrogen test dose per kg of body weight, whichever dose is more stringent, is a logical limit for the quantity of bacterial endotoxin in small-volume parenteral products. Excellent correlation was attained when this criterion was used to compare the Limulus amoebocyte lysate assay with the USP pyrogen test. PMID:6448582

  20. Total parenteral nutrition-associated cholestasis in rats: comparison of different amino acid mixtures.

    PubMed

    Belli, D C; Fournier, L A; Lepage, G; Yousef, I; Weber, A M; Tuchweber, B; Roy, C C

    1987-01-01

    It has been suggested that the quantity of amino acids perfused is a pathogenetic factor in total parenteral nutrition (TPN)-associated hepatotoxicity. However, the effect of the qualitative pattern of amino acid solutions has not been studied. Rats on parenteral nutrition for 5 days received 10.2 g of dextrose and 3.4 g of amino acids daily. Bile flow (microliter/min/g liver protein) after administration of Vamin was 16.2 +/- 0.8, which was similar to that in controls given chow and dextrose iv, but it was significantly higher (p less than 0.001) than those on Travasol (12.3 +/- 0.8). The decrease in bile flow was not related to the large concentrations of alanine and glycine present in Travasol. However, the addition to Travasol of serine present only in Vamin increased bile flow significantly. Bile acid secretion rate, biliary lipid constituents, calcium, sodium, and glucose showed little change. In contrast, alpha-amino nitrogen was increased (p less than 0.05) in Vamin-perfused animals. Steatosis was noted in only a few animals in the Travasol group, and was not associated with an increase in the triglycerides content of the liver. Glycogen and protein content of the livers did not differ. The data show that the composition of amino acid solutions may be a determinant of TPN-induced cholestasis and suggest that the presence of methyl donor amino acids may have a protective effect.

  1. Influence of Preoperative Peripheral Parenteral Nutrition with Micronutrients after Colorectal Cancer Patients

    PubMed Central

    Tang, Hsiu-Chih; Hu, Shu-Hui; Yang, Hui-Lan

    2015-01-01

    Background. The inflammatory reactions are stronger after surgery of malnourished preoperative patients. Many studies have shown vitamin and trace element deficiencies appear to affect the functioning of immune cells. Enteral nutrition is often inadequate for malnourished patients. Therefore, total parenteral nutrition (TPN) is considered an effective method for providing preoperative nutritional support. TPN needs a central vein catheter, and there are more risks associated with TPN. However, peripheral parenteral nutrition (PPN) often does not provide enough energy or nutrients. Purpose. This study investigated the inflammatory response and prognosis for patients receiving a modified form of PPN with added fat emulsion infusion, multiple vitamins (MTV), and trace elements (TE) to assess the feasibility of preoperative nutritional support. Methods. A cross-sectional design was used to compare the influence of PPN with or without adding MTV and TE on malnourished abdominal surgery patients. Results. Both preoperative groups received equal calories and protein, but due to the lack of micronutrients, patients in preoperative Group B exhibited higher inflammation, lower serum albumin levels, and higher anastomotic leak rates and also required prolonged hospital stays. Conclusion. Malnourished patients who receive micronutrient supplementation preoperatively have lower postoperative inflammatory responses and better prognoses. PPN with added fat emulsion, MTV, and TE provides valid and effective preoperative nutritional support. PMID:26000296

  2. Delivery of vitamins E and C from parenteral alimentation solution.

    PubMed

    Shenai, J P; Borum, P R; Duke, E A

    1982-01-01

    We have previously shown that substantial losses of fat-soluble (FS) vitamin A from parenteral alimentation solution occur due to adsorption in the intravenous tubing and photodegradation in the bottle. This study assessed the delivery of other vitamins, viz, FS vitamin E and water-soluble (WS) vitamin C, from parenteral alimentation solution. The solution containing 2.0 ml/L of an aqueous multivitamin infusion was infused at a constant rate of 10 ml/h using a standard intravenous administration set. Multiple aliquots of the solution from the bottle and the effluent obtained sequentially in a 24-h period were analyzed for concentrations of vitamins E and C. Both vitamins remained relatively stable in the bottle. A significant amount (12%) of vitamin E was lost in the intravenous tubing. No losses of vitamin C were incurred in the intravenous tubing. The data suggest that delivery of FS vitamin E from parenteral alimentation solutions is less than optimum because of adsorptive losses. Similar losses are not encountered with WS vitamin C.

  3. Abnormalities of zinc and copper during total parenteral nutrition.

    PubMed Central

    Lowry, S F; Goodgame, J T; Smith, J C; Maher, M M; Makuch, R W; Henkin, R I; Brennan, M F

    1979-01-01

    Changes in serum zinc and copper levels were studied in 19 tumor bearing patients undergoing parenteral nutrition (TPN) for five to 42 days. Before initiation of intravenous feeding mean serum zinc and copper concentrations were within normal limits but during TPN levels decreased significantly below those measured prior to parenteral nutrition. During TPN nitrogen, zinc, and copper intake, urinary output and serum levels were studied prospectively in nine of these patients. These nine patients exhibited positive nitrogen retention based upon urinary nitrogen excretion, but elevated urinary zinc and copper excretion and lowered serum zinc and copper concentrations. Neither blood administration nor limited oral intake was consistently able to maintain normal serum levels of zinc or copper. Zinc and copper supplementation of hyperalimentation fluids in four patients studied for five to 16 days was successful in increasing serum zinc and copper levels in only two. The data obtained suggest that patients undergoing parenteral nutrition may require supplementation of zinc and copper to prevent deficiencies of these elements. PMID:103506

  4. Is early intervention for psychosis feasible and effective?

    PubMed Central

    Srihari, Vinod H.; Shah, Jai; Keshavan, Matcheri S.

    2012-01-01

    Synopsis Services that provide comprehensive, early intervention (EI) have shown promise in improving long-term outcomes in schizophrenia. This paper reviews the rationale and salient concepts relevant to understanding the growing EI literature. A selective review of studies evaluating the effectiveness of integrated EI is followed by a discussion of feasibility, especially in the U.S. context. Finally, the authors present a framework that seeks to integrate activities traditionally categorized and separated as discovery and implementation. This framework is offered as one way to advance both goals. PMID:22929869

  5. The effectiveness of early intervention: a critical review.

    PubMed

    Parry, T S

    1992-10-01

    The following principles are now clearly defined in the management of children with developmental delay: (1) Multidisciplinary teams are more effective than individual therapeutic approaches. (2) The whole development of the child needs to be considered rather than a single deficient area alone. (3) Home-based programmes are more effective in the young preschool child than centre-based programmes alone. (4) Parent involvement in partnership with professionals is essential for sustained progress. (5) Maximum effectiveness is achieved when parental skills are increased. (6) Programmes commencing earlier in preschool years are more effective than those that commence late. This concept has been recently challenged and evidence supports benefits for the disadvantaged rather than the disabled. White also contends that there is 'simply not enough information to be confident about the long-term impact of early intervention with handicapped children and evidence in support of many of the commonly held positions about mediating variables (e.g. parental involvement, age at start) is either non-existent or contradictory. Early intervention is clearly effective in offering parental support, fostering parent/child relationships and diminishing anxiety even for those programmes that have not at present been proven in altering the developmental disability. Programmes that involve high cost, disrupt total family functioning, deflect scarce resources away from more proven areas of effectiveness should be discouraged, and they should never cause guilt in either parent or professional when they seem ineffective. Future research should include investigation of outcomes other than cognitive and physical functioning alone. We should be warned from the somewhat crisp statement of Mark Twain: 'There is something fascinating about science. One gets such wholesale returns of conjecture out of such a trifling investment in fact'.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Supplemental Parenteral Nutrition Is the Key to Prevent Energy Deficits in Critically Ill Patients.

    PubMed

    Oshima, Taku; Heidegger, Claudia-Paula; Pichard, Claude

    2016-08-01

    This review emphasizes the role of a timely supplemental parenteral nutrition (PN) for critically ill patients. It contradicts the recommendations of current guidelines to avoid the use of PN, as it is associated with risk. Critical illness results in severe metabolic stress. During the early phase, inflammatory cytokines and mediators induce catabolism to meet the increased body energy demands by endogenous sources. This response is not suppressed by exogenous energy administration, and the early use of PN to reach the energy target leads to overfeeding. On the other hand, early and progressive enteral nutrition (EN) is less likely to cause overfeeding because of variable gastrointestinal tolerance, a factor frequently associated with significant energy deficit. Recent studies demonstrate that adequate feeding is beneficial during and after the intensive care unit (ICU) stay. Supplemental PN allows for timely adequate feeding, if sufficient precautions are taken to avoid overfeeding. Indirect calorimetry can precisely define the adequate energy prescription. Our pragmatic approach is to start early EN to progressively test the gut tolerance and add supplemental PN on day 3 or 4 after ICU admission, only if EN does not meet the measured energy target. We believe that supplemental PN plays a pivotal role in the achievement of adequate feeding in critically ill patients with intolerance to EN and does not cause harm if overfeeding is avoided by careful prescription, ideally based on energy expenditure measured by indirect calorimetry.

  7. [Electrolytes content in parenteral drugs authorised in Spain].

    PubMed

    Mirchandani Jagwani, J N; Arias Rico, R

    2013-01-01

    Introducción: La fluidoterapia es una de las prácticas más habituales en la práctica clínica diaria pero para un correcto manejo de electrolitos tanto en la sueroterapia como en la Nutrición Parenteral se deben conocer todos los aportes de electrolitos y fluidos y todas aquellas situaciones fisiopatológicos que conllevan alteraciones en la homeostasis de fluidos. Objetivos: Conocer el contenido y tipo de electrolitos de los medicamentos administrados por vía parenteral comercializados y autorizados en España hasta Febrero 2012. Métodos: Revisión de todas las fichas técnicas de todos aquellos medicamentos que estuvieran comercializados en España y con presentación comercial disponible por vía parenteral. Aquellos medicamentos con un contenido menor de 1 miliequivalente o 1 milimol por presentación comercial fueron excluidos. Resultados: De los 1800 principios activos estudiados, sólo 221 formaban parte de alguna presentación comercial por vía parenteral. De estos 221, 52 principios activos cumplían los criterios de inclusión del estudio y la mayoría (51-98,07%) tenían sodio en contenido mayor de un miliequivalente por presentación comercial, luego el potasio estaba presente en 3 y el calcio únicamente en uno. Discusión: La mayoría de medicamentos objeto del estudio contenían como principal electrolito el sodio, siendo la alteración de las concentraciones de este electrolito una de las más frecuentes en el entorno hospitalario y, en algunos casos, indicador de calidad en la atención del paciente. Por ello, para un mejor manejo de la reposición de electrolitos tanto en la sueroterapia como por Nutrición Parenteral es necesario tener en cuenta el aporte recibido por la medicación prescrita en los casos en que sea necesario.

  8. Construction and Characterization of Human Rotavirus Recombinant VP8* Subunit Parenteral Vaccine Candidates

    PubMed Central

    Wen, Xiaobo; Cao, Dianjun; Jones, Ronald W.; Li, Jianping; Szu, Shousun; Hoshino, Yasutaka

    2012-01-01

    Two currently licensed live oral rotavirus vaccines (Rotarix® and RotaTeq®) are highly efficacious against severe rotavirus diarrhea. However, the efficacy of such vaccines in selected low-income African and Asian countries is much lower than that in middle or high-income countries. Additionally, these two vaccines have recently been associated with rare case of intussusception in vaccinated infants. We developed a novel recombinant subunit parenteral rotavirus vaccine which may be more effective in low-income countries and also avert the potential problem of intussusception. Truncated recombinant VP8* (ΔVP8*) protein of human rotavirus strain Wa P[8], DS-1 P[4] or 1076 P[6] expressed in E. coli was highly soluble and was generated in high yield. Guinea pigs hyperimmunized intramuscularly with each of the ΔVP8* proteins (i.e., (P[8], P[4] or P[6]) developed high levels of homotypic as well as variable levels of heterotypic neutralizing antibodies. Moreover, the selected ΔVP8* proteins when administered to mice at a clinically relevant dosage, route and schedule, elicited high levels of serum anti-VP8* IgG and/or neutralizing antibodies. Our data indicated that the ΔVP8* proteins may be a plausible additional candidate as new parenteral rotavirus vaccines. PMID:22885016

  9. Construction and characterization of human rotavirus recombinant VP8* subunit parenteral vaccine candidates.

    PubMed

    Wen, Xiaobo; Cao, Dianjun; Jones, Ronald W; Li, Jianping; Szu, Shousun; Hoshino, Yasutaka

    2012-09-21

    Two currently licensed live oral rotavirus vaccines (Rotarix® and RotaTeq®) are highly efficacious against severe rotavirus diarrhea. However, the efficacy of such vaccines in selected low-income African and Asian countries is much lower than that in middle or high-income countries. Additionally, these two vaccines have recently been associated with rare case of intussusception in vaccinated infants. We developed a novel recombinant subunit parenteral rotavirus vaccine which may be more effective in low-income countries and also avert the potential problem of intussusception. Truncated recombinant VP8* (ΔVP8*) protein of human rotavirus strain Wa P[8], DS-1 P[4] or 1076 P[6] expressed in Escherichia coli was highly soluble and was generated in high yield. Guinea pigs hyperimmunized intramuscularly with each of the ΔVP8* proteins (i.e., P[8], P[4] or P[6]) developed high levels of homotypic as well as variable levels of heterotypic neutralizing antibodies. Moreover, the selected ΔVP8* proteins when administered to mice at a clinically relevant dosage, route and schedule, elicited high levels of serum anti-VP8* IgG and/or neutralizing antibodies. Our data indicated that the ΔVP8* proteins may be a plausible additional candidate as new parenteral rotavirus vaccines.

  10. Acetaldehyde involvement in ethanol's postabsortive effects during early ontogeny

    PubMed Central

    March, Samanta M.; Abate, P.; Molina, Juan C.

    2013-01-01

    Clinical and biomedical studies sustains the notion that early ontogeny is a vulnerable window to the impact of alcohol. Experiences with the drug during these stages increase latter disposition to prefer, use or abuse ethanol. This period of enhanced sensitivity to ethanol is accompanied by a high rate of activity in the central catalase system, which metabolizes ethanol in the brain. Acetaldehyde (ACD), the first oxidation product of ethanol, has been found to share many neurobehavioral effects with the drug. Cumulative evidence supports this notion in models employing adults. Nevertheless very few studies have been conducted to analyze the role of ACD in ethanol postabsorptive effects, in newborns or infant rats. In this work we review recent experimental literature that syndicates ACD as a mediator agent of reinforcing aspects of ethanol, during early ontogenetic stages. We also show a meta-analytical correlational approach that proposes how differences in the activity of brain catalase across ontogeny, could be modulating patterns of ethanol consumption. PMID:23801947

  11. Radiation-induced bystander effect: early process and rapid assessment.

    PubMed

    Wang, Hongzhi; Yu, K N; Hou, Jue; Liu, Qian; Han, Wei

    2015-01-01

    Radiation-induced bystander effect (RIBE) is a biological process that has received attention over the past two decades. RIBE refers to a plethora of biological effects in non-irradiated cells, including induction of genetic damages, gene expression, cell transformation, proliferation and cell death, which are initiated by receiving bystander signals released from irradiated cells. RIBE brings potential hazards to normal tissues in radiotherapy, and imparts a higher risk from low-dose radiation than we previously thought. Detection with proteins related to DNA damage and repair, cell cycle control, proliferation, etc. have enabled rapid assessment of RIBE in a number of research systems such as cultured cells, three-dimensional tissue models and animal models. Accumulated experimental data have suggested that RIBE may be initiated rapidly within a time frame as short as several minutes after radiation. These have led to the requirement of techniques capable of rapidly assessing RIBE itself as well as assessing the early processes involved.

  12. Quantifying the effectiveness of early warning systems for natural hazards

    NASA Astrophysics Data System (ADS)

    Sättele, M.; Bründl, M.; Straub, D.

    2016-01-01

    Early warning systems (EWSs) are increasingly applied as preventive measures within an integrated risk management approach for natural hazards. At present, common standards and detailed guidelines for the evaluation of their effectiveness are lacking. To support decision-makers in the identification of optimal risk mitigation measures, a three-step framework approach for the evaluation of EWSs is presented. The effectiveness is calculated in function of the technical and the inherent reliability of the EWS. The framework is applicable to automated and non-automated EWSs and combinations thereof. To address the specifics and needs of a wide variety of EWS designs, a classification of EWSs is provided, which focuses on the degree of automations encountered in varying EWSs. The framework and its implementation are illustrated through a series of example applications of EWS in an alpine environment.

  13. Quantifying the effectiveness of early warning systems for natural hazards

    NASA Astrophysics Data System (ADS)

    Sättele, M.; Bründl, M.; Straub, D.

    2015-07-01

    Early warning systems (EWS) are increasingly applied as preventive measures within an integrated risk management approach for natural hazards. At present, common standards and detailed guidelines for the evaluation of their effectiveness are lacking. To support decision-makers in the identification of optimal risk mitigation measures, a three-step framework approach for the evaluation of EWS is presented. The effectiveness is calculated in function of the technical and the inherent reliability of the EWS. The framework is applicable to automated and non-automated EWS and combinations thereof. To address the specifics and needs of a wide variety of EWS designs, a classification of EWS is provided, which focuses on the degree of automations encountered in varying EWS. The framework and its implementation are illustrated through a series of example applications of EWS in an alpine environment.

  14. Early effects of duloxetine on emotion recognition in healthy volunteers

    PubMed Central

    Bamford, Susan; Penton-Voak, Ian; Pinkney, Verity; Baldwin, David S; Munafò, Marcus R; Garner, Matthew

    2015-01-01

    The serotonin-noradrenaline reuptake inhibitor (SNRI) duloxetine is an effective treatment for major depression and generalised anxiety disorder. Neuropsychological models of antidepressant drug action suggest therapeutic effects might be mediated by the early correction of maladaptive biases in emotion processing, including the recognition of emotional expressions. Sub-chronic administration of duloxetine (for two weeks) produces adaptive changes in neural circuitry implicated in emotion processing; however, its effects on emotional expression recognition are unknown. Forty healthy participants were randomised to receive either 14 days of duloxetine (60 mg/day, titrated from 30 mg after three days) or matched placebo (with sham titration) in a double-blind, between-groups, repeated-measures design. On day 0 and day 14 participants completed a computerised emotional expression recognition task that measured sensitivity to the six primary emotions. Thirty-eight participants (19 per group) completed their course of tablets and were included in the analysis. Results provide evidence that duloxetine, compared to placebo, may reduce the accurate recognition of sadness. Drug effects were driven by changes in participants’ ability to correctly detect subtle expressions of sadness, with greater change observed in the placebo relative to the duloxetine group. These effects occurred in the absence of changes in mood. Our preliminary findings require replication, but complement recent evidence that sadness recognition is a therapeutic target in major depression, and a mechanism through which SNRIs could resolve negative biases in emotion processing to achieve therapeutic effects. PMID:25759400

  15. Protein and Calorie Requirements with Total Parenteral Nutrition

    PubMed Central

    Shizgal, Harry M.; Forse, R. Armour

    1980-01-01

    Body composition measurements, performed by multiple isotope dilution, were used to determine the protein and caloric requirements of patients receiving total parenteral nutrition (TPN). In addition the relative efficacy of lipid as opposed to carbohydrate calories were evaluated. Patients requiring TPN were randomly allocated to receive one of the following TPN solutions: a) 2.5% amino acid with 25% dextrose b) 5% amino acid with 25% dextrose c) 2.5% amino acid with 12.5% dextrose and a 5% lipid emulsion. The efficacy of each solution was evaluated by determining body composition at the onset,and at two week intervals during the course of TPN. In 204 patients who received TPN for 4447 days, 533 body composition studies were performed to evaluate 308 periods of TPN. In the normally nourished patient, as defined by the pre-TPN body composition, the body composition remained unchanged and normal with the three solutions. In the presence of preexisting malnutrition, two weeks of TPN resulted in a significant increase in body weight, arising primarily from an increase in the body cell mass. To evaluate the relative importance of the various factors responsible for the increase in the body cell mass, a multiple linear regression analysis was performed. The mean daily change in the body cell mass was correlated with the carbohydrate, protein and lipid calories infused and with the nutritional state. The resulting regression equation, which was statistically significant, indicated that the rate at which a depleted body cell mass was restored was related to the lipid and carbohydrate calories infused and to the nutritional state of the patient. Carbohydrate calories were more efficient than lipid calories. However increasing the amino acid concentration from 2.5 to 5% had no effect on the rate at which the body cell mass increased. The repletion rate was also directly related to the severity of malnutrition. Thus the correction of a malnourished individual with TPN is

  16. Parenteral adenoviral boost enhances BCG induced protection, but not long term survival in a murine model of bovine TB.

    PubMed

    Kaveh, Daryan A; Garcia-Pelayo, M Carmen; Webb, Paul R; Wooff, Esen E; Bachy, Véronique S; Hogarth, Philip J

    2016-07-25

    Boosting BCG using heterologous prime-boost represents a promising strategy for improved tuberculosis (TB) vaccines, and adenovirus (Ad) delivery is established as an efficacious boosting vehicle. Although studies demonstrate that intranasal administration of Ad boost to BCG offers optimal protection, this is not currently possible in cattle. Using Ad vaccine expressing the mycobacterial antigen TB10.4 (BCG/Ad-TB10.4), we demonstrate, parenteral boost of BCG immunised mice to induce specific CD8(+) IFN-γ producing T cells via synergistic priming of new epitopes. This induces significant improvement in pulmonary protection against Mycobacterium bovis over that provided by BCG when assessed in a standard 4week challenge model. However, in a stringent, year-long survival study, BCG/Ad-TB10.4 did not improve outcome over BCG, which we suggest may be due to the lack of additional memory cells (IL-2(+)) induced by boosting. These data indicate BCG-prime/parenteral-Ad-TB10.4-boost to be a promising candidate, but also highlight the need for further understanding of the mechanisms of T cell priming and associated memory using Ad delivery systems. That we were able to generate significant improvement in pulmonary protection above BCG with parenteral, rather than mucosal administration of boost vaccine is critical; suggesting that the generation of effective mucosal immunity is possible, without the risks and challenges of mucosal administration, but that further work to specifically enhance sustained protective immunity is required.

  17. Sex and Age Effects of Functional Connectivity in Early Adulthood.

    PubMed

    Zhang, Chao; Cahill, Nathan D; Arbabshirani, Mohammad R; White, Tonya; Baum, Stefi A; Michael, Andrew M

    2016-11-01

    Functional connectivity (FC) in resting-state functional magnetic resonance imaging (rs-fMRI) is widely used to find coactivating regions in the human brain. Despite its widespread use, the effects of sex and age on resting FC are not well characterized, especially during early adulthood. Here we apply regression and graph theoretical analyses to explore the effects of sex and age on FC between the 116 AAL atlas parcellations (a total of 6670 FC measures). rs-fMRI data of 494 healthy subjects (203 males and 291 females; age range: 22-36 years) from the Human Connectome Project were analyzed. We report the following findings. (1) Males exhibited greater FC than females in 1352 FC measures (1025 survived Bonferroni correction; [Formula: see text]). In 641 FC measures, females exhibited greater FC than males but none survived Bonferroni correction. Significant FC differences were mainly present in frontal, parietal, and temporal lobes. Although the average FC values for males and females were significantly different, FC values of males and females exhibited large overlap. (2) Age effects were present only in 29 FC measures and all significant age effects showed higher FC in younger subjects. Age and sex differences of FC remained significant after controlling for cognitive measures. (3) Although sex [Formula: see text] age interaction did not survive multiple comparison correction, FC in females exhibited a faster cross-sectional decline with age. (4) Male brains were more locally clustered in all lobes but the cerebellum; female brains had a higher clustering coefficient at the whole-brain level. Our results indicate that although both male and female brains show small-world network characteristics, male brains were more segregated and female brains were more integrated. Findings of this study further our understanding of FC in early adulthood and provide evidence to support that age and sex should be controlled for in FC studies of young adults.

  18. Dual effects of fluoxetine on mouse early embryonic development

    SciTech Connect

    Kim, Chang-Woon; Choe, Changyong; Kim, Eun-Jin; Lee, Jae-Ik; Yoon, Sook-Young; Cho, Young-Woo; Han, Sunkyu; Tak, Hyun-Min; Han, Jaehee; Kang, Dawon

    2012-11-15

    Fluoxetine, a selective serotonin reuptake inhibitor, regulates a variety of physiological processes, such as cell proliferation and apoptosis, in mammalian cells. Little is known about the role of fluoxetine in early embryonic development. This study was undertaken to investigate the effect of fluoxetine during mouse early embryonic development. Late two-cell stage embryos (2-cells) were cultured in the presence of various concentrations of fluoxetine (1 to 50 μM) for different durations. When late 2-cells were incubated with 5 μM fluoxetine for 6 h, the percentage that developed into blastocysts increased compared to the control value. However, late 2-cells exposed to fluoxetine (5 μM) over 24 h showed a reduction in blastocyst formation. The addition of fluoxetine (5 μM) together with KN93 or KN62 (calcium/calmodulin-dependent protein kinase II (CaMKII) inhibitors) failed to increase blastocyst formation. Fluoxetine treatment inhibited TREK-1 and TREK-2, members of the two-pore domain K{sup +} channel family expressed in mouse embryos, activities, indicating that fluoxetine-induced membrane depolarization in late 2-cells might have resulted from TREK inhibition. In addition, long-term exposure to fluoxetine altered the TREK mRNA expression levels. Furthermore, injection of siRNA targeting TREKs significantly decreased blastocyst formation by ∼ 30% compared to injection of scrambled siRNA. Long-term exposure of fluoxetine had no effect on blastocyst formation of TREK deficient embryos. These results indicate that low-dose and short-term exposures of late 2-cells to fluoxetine probably increase blastocyst formation through activation of CaMKII-dependent signal transduction pathways, whereas long-term exposure decreases mouse early embryonic development through inhibition of TREK channel gating. Highlights: ► Short-term exposure of 2-cells to fluoxetine enhances mouse blastocyst formation. ► The enhancive effect of fluoxetine is resulted from Ca

  19. Effects of genistein on early-stage cutaneous wound healing.

    PubMed

    Park, Eunkyo; Lee, Seung Min; Jung, In-Kyung; Lim, Yunsook; Kim, Jung-Hyun

    2011-07-08

    Wound healing occurs in three sequential phases: hemostasis and inflammation, proliferation, and remodeling. Inflammation, the earliest phase, is considered a critical period for wound healing because immune cells remove damaged tissues, foreign debris, and remaining dead tissue. Wound healing would be delayed without inflammation, and this phase is affected by antioxidation capacity. Therefore, we hypothesized that genistein, which has an antioxidant effect, might modulate the wound healing process by altering the inflammatory response. After three days of acclimation, mice were divided into three groups: control, 0.025% genistein, and 0.1% genistein. After two weeks of an experimental diet, skin wounds were induced. Wounded skin areas were imaged, and the healing rate calculated. To measure lipid peroxidation, antioxidant enzyme expression and activity, and pro-inflammatory cytokine expression, skin and liver tissues were harvested at 12, 24, 48, and 72 h. Genistein did not affect body weight. The rate of wound closure in mice fed genistein was significantly faster than in the control group during the early stage of wound healing, especially in first three days. Cu, Zn-SOD and Mn-SOD expression in wound skin tissue in the 0.1% genistein group was lower than in the control group. However, CAT expression did not differ among groups. We also found that genistein modulated NF-κB and TNF-α expression during the early stage of wound healing. The genistein group had significantly lower hepatic lipid peroxidation and higher SOD, CAT, and GPx activities than the control group. These results suggest that genistein supplementation reduces oxidative stress by increasing antioxidant capacity and modulating proinflammatory cytokine expression during the early stage of wound healing.

  20. Prenatal cocaine effects on brain structure in early infancy.

    PubMed

    Grewen, Karen; Burchinal, Margaret; Vachet, Clement; Gouttard, Sylvain; Gilmore, John H; Lin, Weili; Johns, Josephine; Elam, Mala; Gerig, Guido

    2014-11-01

    Prenatal cocaine exposure (PCE) is related to subtle deficits in cognitive and behavioral function in infancy, childhood and adolescence. Very little is known about the effects of in utero PCE on early brain development that may contribute to these impairments. The purpose of this study was to examine brain structural differences in infants with and without PCE. We conducted MRI scans of newborns (mean age = 5 weeks) to determine cocaine's impact on early brain structural development. Subjects were three groups of infants: 33 with PCE co-morbid with other drugs, 46 drug-free controls and 40 with prenatal exposure to other drugs (nicotine, alcohol, marijuana, opiates, SSRIs) but without cocaine. Infants with PCE exhibited lesser total gray matter (GM) volume and greater total cerebral spinal fluid (CSF) volume compared with controls and infants with non-cocaine drug exposure. Analysis of regional volumes revealed that whole brain GM differences were driven primarily by lesser GM in prefrontal and frontal brain regions in infants with PCE, while more posterior regions (parietal, occipital) did not differ across groups. Greater CSF volumes in PCE infants were present in prefrontal, frontal and parietal but not occipital regions. Greatest differences (GM reduction, CSF enlargement) in PCE infants were observed in dorsal prefrontal cortex. Results suggest that PCE is associated with structural deficits in neonatal cortical gray matter, specifically in prefrontal and frontal regions involved in executive function and inhibitory control. Longitudinal study is required to determine whether these early differences persist and contribute to deficits in cognitive functions and enhanced risk for drug abuse seen at school age and in later life.

  1. Effects of the audiovisual conflict on auditory early processes.

    PubMed

    Scannella, Sébastien; Causse, Mickaël; Chauveau, Nicolas; Pastor, Josette; Dehais, Frédéric

    2013-07-01

    Auditory alarm misperception is one of the critical events that lead aircraft pilots to an erroneous flying decision. The rarity of these alarms associated with their possible unreliability may play a role in this misperception. In order to investigate this hypothesis, we manipulated both audiovisual conflict and sound rarity in a simplified landing task. Behavioral data and event related potentials (ERPs) of thirteen healthy participants were analyzed. We found that the presentation of a rare auditory signal (i.e., an alarm), incongruent with visual information, led to a smaller amplitude of the auditory N100 (i.e., less negative) compared to the condition in which both signals were congruent. Moreover, the incongruity between the visual information and the rare sound did not significantly affect reaction times, suggesting that the rare sound was neglected. We propose that the lower N100 amplitude reflects an early visual-to-auditory gating that depends on the rarity of the sound. In complex aircraft environments, this early effect might be partly responsible for auditory alarm insensitivity. Our results provide a new basis for future aeronautic studies and the development of countermeasures.

  2. Role of parenteral antibiotherapy in gastrointestinal tract flora suppression. A study in children treated with high-dose chemotherapy and autologous bone marrow transplantation.

    PubMed

    Chastagner, P; Hartmann, O; Tancrede, C; Kalifa, C; Patte, C; Flamant, F; Lemerle, J

    1989-07-01

    In order to determine the effect of parenteral antibiotherapy on the fecal flora in patients with profound and prolonged granulocytopenia, we initiated a prospective study of 62 cases of autologous bone marrow transplantation following high-dose chemotherapy. All patients were children from 2 to 18 years old, isolated in a protective environment, receiving a diet low in viable microbial content but no oral non-absorbable prophylactic antibiotics to decontaminate the gastrointestinal tract. Bacteriological analysis of fecal flora was conducted at least once a week before and during parenteral antibiotherapy, administered at the first greater than 38 degrees C febrile episode in these granulocytopenic patients (granulocyte count less than 0.5 X 10(9)/l). The 58 evaluable patients fell into three groups with regard to the systemic antibiotherapy: group A (n = 16): moxalactam + mezlocillin; group B (n = 15): moxalactam + tobramycin; and group C (n = 27): cefotaxime plus gentamicin. Fecal flora suppression was observed in 51/58 cases (88%) (group A: 15/16, group B: 13/15, group C: 23/27). It always occurred within 5 days of initiating parenteral antibiotherapy and persisted in 88% of the 51 patients over the whole period of systemic antibiotherapy. During the latter, fecal recolonization was observed in seven cases (12%), always by Enterobacteriaceae sensitive to the prescribed systemic antibiotherapy, never responsible for septicemia. Since parenteral antibiotherapy alone was able to suppress the gastrointestinal tract flora, the effects of this treatment should be considered in all trials of digestive tract decontamination.

  3. Longitudinal Effects on Early Adolescent Language: A Twin Study

    PubMed Central

    DeThorne, Laura Segebart; Smith, Jamie Mahurin; Betancourt, Mariana Aparicio; Petrill, Stephen A.

    2016-01-01

    Purpose We evaluated genetic and environmental contributions to individual differences in language skills during early adolescence, measured by both language sampling and standardized tests, and examined the extent to which these genetic and environmental effects are stable across time. Method We used structural equation modeling on latent factors to estimate additive genetic, shared environmental, and nonshared environmental effects on variance in standardized language skills (i.e., Formal Language) and productive language-sample measures (i.e., Productive Language) in a sample of 527 twins across 3 time points (mean ages 10–12 years). Results Individual differences in the Formal Language factor were influenced primarily by genetic factors at each age, whereas individual differences in the Productive Language factor were primarily due to nonshared environmental influences. For the Formal Language factor, the stability of genetic effects was high across all 3 time points. For the Productive Language factor, nonshared environmental effects showed low but statistically significant stability across adjacent time points. Conclusions The etiology of language outcomes may differ substantially depending on assessment context. In addition, the potential mechanisms for nonshared environmental influences on language development warrant further investigation. PMID:27732720

  4. Early learner perceptions of the attributes of effective preceptors.

    PubMed

    Huggett, Kathryn N; Warrier, Rugmini; Maio, Anna

    2008-12-01

    Medical education in the US has adapted to the shift of patient care from hospital to ambulatory settings by developing educational opportunities in outpatient settings. Faculty development efforts must acknowledge learners' perspectives to be effective in improving teaching and learning. Clinics provide important and unique learning opportunities, but also present different challenges for preceptors (i.e., physician teachers) and learners. Multiple studies have identified characteristics of effective preceptors of ambulatory care medicine. However, most of these studies were conducted among residents or students with clinical experience. To investigate preclinical, second-year medical students' perceptions of preceptor quality, we conducted an exploratory qualitative study using analysis of student learning journals. The purposive sample included 120 medical students in a private, Midwestern medical school in the United States. Learning journals of 110 students for two semesters were reviewed. Five attributes of an effective preceptor emerged: (1) Demonstrates professional expertise (2) Actively engages students in learning (3) Creates a positive environment for teaching and learning (4) Demonstrates collegiality and professionalism (5) Discusses career-related topics and concerns. Our findings suggest preclinical learners often begin initial clinical experiences with sophisticated definitions of professional expertise, and hold specific expectations for professionalism. These are based on previous coursework and personal experience. These expectations influence their perceptions of effective preceptors and learning experiences. Early clinical experiences can also influence perceptions about career and specialty choice. Improving our understanding of preclinical learners' perceptions of preceptor quality will improve the efficacy of faculty development efforts and learning experiences.

  5. Characterizing the Severe Reactions of Parenteral Vitamin K1.

    PubMed

    Britt, Rachel B; Brown, Jamie N

    2016-01-01

    Parenteral vitamin K1 (phytonadione) is used for anticoagulant reversal, and a boxed warning exists with intravenous and intramuscular administration due to the possibility of severe reactions, including fatalities. These reactions resemble hypersensitivity or anaphylaxis, including anaphylactoid reaction, and have led to shock and cardiac and/or respiratory arrest. The objective of this review is to summarize the available literature detailing the anaphylactic/anaphylactoid reactions with parenteral vitamin K1 in order to better characterize the reaction and provide a more in-depth understanding of its importance. A comprehensive literature search of MEDLINE (1946 to June 2016) and EMBASE (1947 to June 2016) was conducted using the terms vitamin K1, phytonadione, phytomenadione, vitamin K group, anaphylaxis, polyoxyethylated castor oil, and cremophor. A total of 2 retrospective surveillance studies, 2 retrospective cohort studies, and 17 case reports were identified for inclusion and assessment. Based on a review of the literature, use of parenteral vitamin K1 may result in severe hypotension, bradycardia or tachycardia, dyspnea, bronchospasm, cardiac arrest, and death. These reactions are most consistent with a nonimmune-mediated anaphylactoid mechanism. It appears that intravenous administration is more frequently associated with these reactions and occurs at an incidence of 3 per 10 000 doses of intravenous vitamin K1. The solubilizer may also increase the risk of adverse reactions, which occurred in patients with and without previous exposure to vitamin K1. Although there are known factors that increase the risk of an adverse drug event occurring, reactions have been reported despite all precautions being properly followed.

  6. Drugs Used for Parenteral Sedation in Dental Practice

    PubMed Central

    Dionne, Raymond A.; Gift, Helen C.

    1988-01-01

    The relative efficacy and safety of drugs and combinations used clinically in dentistry as premedicants to alleviate patient apprehension are largely unsubstantiated. To evaluate the efficacy and safety of agents used for parenteral sedation through controlled clinical trials, it is first necessary to identify which drugs, doses, and routes of administration are actually used in practice. A survey instrument was developed to characterize the drugs used clinically for anesthesia and sedation by dentists with advanced training in pain control. A random sample of 500 dentists who frequently use anesthesia and sedation in practice was selected from the Fellows of the American Dental Society of Anesthesiology. The first mailing was followed by a second mailing to nonrespondents after 30 days. The respondents report a variety of parenteral sedation techniques in combination with local anesthesia (the response categories are not mutually exclusive): nitrous oxide (64%), intravenous conscious sedation (59%), intravenous “deep” sedation (47%), and outpatient general anesthesia (27%). Drugs most commonly reported for intravenous sedation include diazepam, methohexital, midazolam, and combinations of these drugs with narcotics. A total of 82 distinct drugs and combinations was reported for intravenous sedation and anesthesia. Oral premedication and intramuscular sedation are rarely used by this group. Most general anesthesia reported is done on an outpatient basis in private practice. These results indicate that a wide variety of drugs is employed for parenteral sedation in dental practice, but the most common practice among dentists with advanced training in anesthesia is local anesthesia supplemented with intravenous sedation consisting of a benzodiazepine and an opioid or a barbiturate. PMID:3250279

  7. Is parenteral phosphate replacement in the intensive care unit safe?

    PubMed

    Agarwal, Banwari; Walecka, Agnieszka; Shaw, Steve; Davenport, Andrew

    2014-02-01

    Hypophosphatemia is well recognized in the intensive care setting, associated with refeeding and continuous forms of renal replacement therapy (CCRT). However, it is unclear as to when and how to administer intravenous phosphate supplementation in the general intensive care setting. There have been recent concerns regarding phosphate administration and development of acute kidney injury. We therefore audited our practice of parenteral phosphate administration. We prospectively audited parenteral phosphate administration (20 mmol) in 58 adult patients in a general intensive care unit in a University tertiary referral center. Fifty-eight patients were audited; mean age 57.2 ± 2.0 years, 70.7% male. The median duration of the infusion was 310 min (228-417), and 50% of the patients were on CRRT. 63.8% of patients were hypophosphatemic (<0.87 mmol/L) prior to the phosphate infusion, and serum phosphate increased from 0.79 ± 0.02 to 1.07 ± 0.03 mmol/L, P < 0.001. Two patients became hyperphosphatemic (>1.45 mmol/L). There was no correlation between the change in serum phosphate and the pre-infusion phosphate. Although there were no significant changes in serum urea, creatinine or other electrolytes, arterial ionized calcium fell from 1.15 ± 0.01 to 1.13 ± 0.01 mmol/L, P < 0.01. Although infusion of 20 mmol phosphate did not appear to adversely affect renal function and corrected hypophosphatemia in 67.7% of cases, we found that around 33% of patients who were given parenteral phosphate were not hypophosphatemic, and that the fall in ionized calcium raises the possibility of the formation of calcium-phosphate complexes and potential for soft tissue calcium deposition.

  8. Early universe cosmology, effective supergravity, and invariants of algebraic forms

    NASA Astrophysics Data System (ADS)

    Sinha, Kuver

    2015-09-01

    The presence of light scalars can have profound effects on early universe cosmology, influencing its thermal history as well as paradigms like inflation and baryogenesis. Effective supergravity provides a framework to make quantifiable, model-independent studies of these effects. The Riemannian curvature of the Kähler manifold spanned by scalars belonging to chiral superfields, evaluated along supersymmetry breaking directions, provides an order parameter (in the sense that it must necessarily take certain values) for phenomena as diverse as slow roll modular inflation, nonthermal cosmological histories, and the viability of Affleck-Dine baryogenesis. Within certain classes of UV completions, the order parameter for theories with n scalar moduli is conjectured to be related to invariants of n -ary cubic forms (for example, for models with three moduli, the order parameter is given by a function on the ring of invariants spanned by the Aronhold invariants). Within these completions, and under the caveats spelled out, this may provide an avenue to obtain necessary conditions for the above phenomena that are in principle calculable given nothing but the intersection numbers of a Calabi-Yau compactification geometry. As an additional result, abstract relations between holomorphic sectional and bisectional curvatures are utilized to constrain Affleck-Dine baryogenesis on a wide class of Kähler geometries.

  9. Early dioxin exposure causes toxic effects in adult zebrafish.

    PubMed

    Baker, Tracie R; Peterson, Richard E; Heideman, Warren

    2013-09-01

    The acute effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) exposure have been well documented in many vertebrate species. However, less is known about the consequences in adulthood from sublethal exposure during development. To address this, we exposed zebrafish to sublethal levels of TCDD (1h; 50 pg/ml), either in early embryogenesis (day 0) or during sexual determination (3 and 7 weeks), and assessed the effects later in adulthood. We found that exposure during embryogenesis produced few effects on the adults themselves but did affect the offspring of these fish: Malformations and increased mortality were observed in the subsequent generation. Zebrafish exposed during sexual development showed defects in the cranial and axial skeleton as adults. This was most clearly manifested as scoliosis caused by malformation of individual vertebrae. These fish also showed defects in reproduction, producing fewer eggs with lower fertilization success. Both males and females were affected, with males contributing to the decrease in egg release from the females and exposed females contributing to fertilization failure. TCDD exposure at 3 and 7 weeks produced feminization of the population. Surprisingly, part of this was due to the appearance of fish with clearly female bodies, yet carrying testes in place of ovaries. Our results show that exposures that produce little if any impact during development can cause severe consequences during adulthood and present a model for studying this process.

  10. Testing Gravity Against Early Time Integrated Sachs-Wolfe Effect

    SciTech Connect

    Zhang, Pengjie; /Shanghai, Astron. Observ. /Fermilab

    2005-11-01

    A generic prediction of general relativity is that the cosmological linear density growth factor D is scale independent. But in general, modified gravities do not preserve this signature. A scale dependent D can cause time variation in gravitational potential at high redshifts and provides a new cosmological test of gravity, through early time integrated Sachs-Wolfe (ISW) effect-large scale structure (LSS) cross correlation. We demonstrate the power of this test for a class of f(R) gravity, with the form f(R) = {lambda}{sub 1}H{sub 0}{sup 2} exp(-R/{lambda}{sub 2}H{sub 0}{sup 2}). Such f(R) gravity, even with degenerate expansion history to {Lambda}CDM, can produce detectable ISW effect at z {approx}> 3 and l {approx}> 20. Null-detection of such effect would constrain {lambda}{sub 2} to be {lambda}{sub 2} > 1000 at > 95% confidence level. On the other hand, robust detection of ISW-LSS cross correlation at high z will severely challenge general relativity.

  11. Dose and Effect Thresholds for Early Key Events in a Mode of PPARa-Mediated Action

    EPA Science Inventory

    ABSTRACT Strategies for predicting adverse health outcomes of environmental chemicals are centered on early key events in toxicity pathways. However, quantitative relationships between early molecular changes in a given pathway and later health effects are often poorly defined. T...

  12. [Parenteral feeding in child surgery. Results of balance studies].

    PubMed

    Schärli, A F; Rumlova, E

    1975-02-01

    After operations in infancy considerable negative nitrogen balances are regularly observed. Balance examinations have demonstrated that there is a minimal requirement of 300 to 350 mg N in the form of a crystalline amino acid solution for the normalization of the catabolic condition of metabolism. The administration of nitrogen, however, is only reasonable, if simultaneously 60 cal/kg of combustible energy is supplied. In severe surgical diseases and in neonates the metabolic requirements can be twice as high. In such cases, if correctly applied and accompanied by controls of the metabolic condition, parenteral nutrition can be useful and may, therefore, be regarded as one of the greatest progresses of modern medicine.

  13. Metabolic bone diseases during long-term total parenteral nutrition.

    PubMed

    Acca, M; Ragno, A; Francucci, C M; D'Erasmo, E

    2007-01-01

    Long-term total parenteral nutrition (TPN) is a procedure commonly applied to patients with advanced forms of intestinal malabsorption. Among TPN complications, bone metabolic diseases, such as osteoporosis and osteomalacia, are a common finding. Initially considered to be a manifestation of aluminium toxicity which followed massive contamination with the element of the solutions used in TPN, metabolic osteopathy during TPN is currently considered a multiform syndrome, with a multifactorial pathogenesis, which may manifest itself with vague or clear clinical pictures. In this review, we analyse clinical, pathogenetic, and therapeutic aspects of the most common bone metabolic diseases in patients undergoing long-term TPN.

  14. Malassezia Pneumonia: A Rare Complication of Parenteral Nutrition Therapy.

    PubMed

    Baker, Richelle M; Stegink, Ryan J; Manaloor, John J; Schmitt, Bryan H; Stevens, John C; Christenson, John C

    2016-11-01

    Malassezia species (formerly known as Pityrosporum) are part of normal human skin flora and have been associated with benign dermatologic conditions, such as seborrheic dermatitis and tinea versicolor. In rare cases, however, Malassezia has been associated with systemic disease in immunocompromised patients and infants in the neonatal intensive care unit. Malassezia species require long-chain fatty acids for growth and therefore have a known predilection for individuals receiving lipid containing intravenous parenteral nutrition (PN). Systemic infections are characterized by prolonged fevers and illness but can include nonspecific signs and symptoms. We present the diagnosis and management of a rare case of an immunocompetent, nonneonatal, PN-dependent child with Malassezia furfur pneumonia.

  15. Malassezia furfur meningitis associated with total parenteral nutrition subdural effusion.

    PubMed

    Rosales, Cecilia M; Jackson, Mary Anne; Zwick, David

    2004-01-01

    We present a case of Malassezia furfur meningitis arising in a very low birth weight infant with chronic lung disease, necrotizing enterocolitis, and intraventricular hemorrhage. M. furfur meningitis was probably acquired late following successful treatment for earlier systemic central line-associated M. furfur infection. M. furfur meningitis has only once been previously reported. Unlike the previous case where meningitis was secondary to widespread blood-borne dissemination, infection was limited to the leptomeninges and arose in association with extravasation of total parenteral nutrition (TPN) and intralipid fluid into subarachnoid space via peripheral scalp catheter.

  16. Sex and Age Effects of Functional Connectivity in Early Adulthood

    PubMed Central

    Zhang, Chao; Cahill, Nathan D.; Arbabshirani, Mohammad R.; White, Tonya; Baum, Stefi A.

    2016-01-01

    Abstract Functional connectivity (FC) in resting-state functional magnetic resonance imaging (rs-fMRI) is widely used to find coactivating regions in the human brain. Despite its widespread use, the effects of sex and age on resting FC are not well characterized, especially during early adulthood. Here we apply regression and graph theoretical analyses to explore the effects of sex and age on FC between the 116 AAL atlas parcellations (a total of 6670 FC measures). rs-fMRI data of 494 healthy subjects (203 males and 291 females; age range: 22–36 years) from the Human Connectome Project were analyzed. We report the following findings. (1) Males exhibited greater FC than females in 1352 FC measures (1025 survived Bonferroni correction; \\documentclass{aastex}\\usepackage{amsbsy}\\usepackage{amsfonts}\\usepackage{amssymb}\\usepackage{bm}\\usepackage{mathrsfs}\\usepackage{pifont}\\usepackage{stmaryrd}\\usepackage{textcomp}\\usepackage{portland, xspace}\\usepackage{amsmath, amsxtra}\\pagestyle{empty}\\DeclareMathSizes{10}{9}{7}{6}\\begin{document} $$p < 7.49{ \\rm{E}} - 6$$ \\end{document}). In 641 FC measures, females exhibited greater FC than males but none survived Bonferroni correction. Significant FC differences were mainly present in frontal, parietal, and temporal lobes. Although the average FC values for males and females were significantly different, FC values of males and females exhibited large overlap. (2) Age effects were present only in 29 FC measures and all significant age effects showed higher FC in younger subjects. Age and sex differences of FC remained significant after controlling for cognitive measures. (3) Although sex \\documentclass{aastex}\\usepackage{amsbsy}\\usepackage{amsfonts}\\usepackage{amssymb}\\usepackage{bm}\\usepackage{mathrsfs}\\usepackage{pifont}\\usepackage{stmaryrd}\\usepackage{textcomp}\\usepackage{portland, xspace}\\usepackage{amsmath, amsxtra}\\pagestyle{empty}\\DeclareMathSizes{10}{9}{7}{6}\\begin{document} $$\\times

  17. Total parenteral nutrition in a methylcholanthrene-induced rat sarcoma model.

    PubMed

    Popp, M B; Morrison, S D; Brennan, M F

    1981-01-01

    Problems with currently available studies of the effects of total parenteral nutrition (TPN) on rat tumor models include: inadequate definition of the natural history of the tumor model; use of nutritional techniques and solutions which have not been proven effective; failure to allow animals to recover from stress of catheterization before starting nutritional manipulation; short-term studies; failure to use sham-operated orally fed control animals; and inadequate evaluation of nutritional result. We have instituted TPN after a 4-day postcatheterization recovery period in a defined methylcholanthrene-induced rat sarcoma model. Preliminary results suggest that TPN increases tumor weight without changing tumor composition of water, nitrogen, or fat. TPN also increases carcass fat and water content, but not carcass protein. In tumor-bearing animals, the percentage of energy expended on activity decreases with increasing tumor burden in both TPN and orally fed controls. TPN in these studies appears to support fat stores and stimulate tumor growth.

  18. Enteral obeticholic acid prevents hepatic cholestasis in total parenteral nutrition-fed neonatal pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Total parenteral nutrition (TPN) is a vital support for neonatal infants with congenital or acquired gastrointestinal (GI) disorders and requiring small bowel resection. An adverse outcome associated with prolonged TPN use is parenteral nutrition associated cholestasis (PNAC). We previously showed t...

  19. Finding new solutions in pediatric parenteral admixtures: how to improve quality and to deal with shortages.

    PubMed

    Watrobska-Swietlikowska, Dorota; Kwidzynska, Anna; Szlagatys-Sidorkiewicz, Agnieszka; Sznitowska, Malgorzata; Klek, Stanislaw

    2014-07-01

    INTRODUCCIÓN: La nutrición parenteral pediátrica permite un crecimiento normal incluso en lactantes pretérmino. Sin embargo, estos niños requieren una nutrición parenteral a medida y la formulación de tal nutrición puede suponer un reto por el riesgo de inestabilidad y el desabastecimiento.

  20. Evaluation of Outpatient Parenteral Antimicrobial Therapy at a Veterans Affairs Hospital.

    PubMed

    Spivak, Emily Sydnor; Kendall, Brian; Orlando, Patricia; Perez, Christian; De Amorim, Marina; Samore, Matthew; Pavia, Andrew T; Hersh, Adam L

    2015-09-01

    We reviewed outpatient parenteral antimicrobial therapy at a Veterans Affairs Medical Center to identify opportunities for antimicrobial stewardship intervention. A definite or possible modification would have been recommended in 60% of courses. Forty-one percent of outpatient parenteral antimicrobial therapy courses were potentially avoidable, including 22% involving infectious diseases consultation.

  1. Mechanisms of disease: update on the molecular etiology and fundamentals of parenteral nutrition associated cholestasis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Since its introduction into clinical practice in the 1970s, parenteral nutrition has revolutionized the care of premature neonates. Serum transaminase and bilirubin levels are commonly elevated in infants on parenteral nutrition, but their normalization is typical in the setting of short-term admini...

  2. Hepatic transcriptomic profiles of preterm piglets nourished by enteral and parenteral nutrition

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Parenteral nutrition is a life-saving nutritional support for more than half a million premature and hospitalized infants in the U.S. annually. Lipids in parenteral nutrition provide essential fatty acids and are a major source of energy. Intralipid (IL) is the only approved lipid emulsion in the U....

  3. The effects of early grade retention: Effect modification by prior achievement and age.

    PubMed

    Vandecandelaere, Machteld; Vansteelandt, Stijn; De Fraine, Bieke; Van Damme, Jan

    2016-02-01

    This study examines the effects of early grade retention and different effects according to prior achievement and age. Within a population of children at risk of early retention, we compared the development throughout primary school in mathematics achievement after kindergarten retention, first-grade retention, and continuous promotion. Analyzing data from a large-scale longitudinal study using covariate balancing propensity score weighting, the findings revealed that early grade repeaters would score higher in mathematics if they were promoted each year instead. However, the effects diminished or even disappeared in the long term. Compared to kindergarten retention, first-grade retention was found to be more harmful for the mathematics development of younger children specifically.

  4. Effects of a Computer-Based Early Reading Program on the Early Reading and Oral Language Skills of At-Risk Preschool Children

    ERIC Educational Resources Information Center

    Huffstetter, Mary; King, James R.; Onwuegbuzie, Anthony J.; Schneider, Jenifer J.; Powell-Smith, Kelly A.

    2010-01-01

    This study examined the effects of a computer-based early reading program (Headsprout Early Reading) on the oral language and early reading skills of at-risk preschool children. In a pretest-posttest control group design, 62 children were randomly assigned to receive supplemental instruction with Headsprout Early Reading (experimental group) or…

  5. Effects of early endometriosis on IVF-ET outcomes.

    PubMed

    Mekaru, Keiko; Yagi, Chiaki; Asato, Kozue; Masamoto, Hitoshi; Sakumoto, Kaoru; Aoki, Yoichi

    2013-01-01

    There have been very few reports on the outcomes of in vitro fertilization and embryo transfer (IVF-ET) in women with stage I/II endometriosis. The objective of this study was to investigate IVF-ET outcomes in women with early-stage endometriosis. We enrolled 35 women less than 40 years with unexplained infertility who underwent IVF-ET into the study. We compared 18 women with stage I/II endometriosis according to the revised American Society for Reproductive Medicine classification for endometriosis, who underwent 39 IVF-ET cycles (En (+) group) with 17 women without endometriosis who underwent 41 IVF-ET cycles (En (-) group). Higher requirements of total gonadotropin, a lower percentage of high-quality embryos of all fertilized eggs (9.0% vs. 16.3%), a relatively lower pregnancy rate (33.3% vs. 41.5%), and a lower live birth rate (25.6% vs. 34.1%) were observed in the En (+) group. Although no significant effect on IVF-ET outcome was observed, ovarian response may be decreased in women with stage I/II endometriosis. Considering the decreased number of high-quality embryos in the En (+) group, stage I/II endometriosis may have detrimental effects on embryo quality.

  6. Effect of early allograft dysfunction on outcomes following liver transplantation.

    PubMed

    Hudcova, Jana; Scopa, Caitlin; Rashid, Jawad; Waqas, Ahsan; Ruthazer, Robin; Schumann, Roman

    2017-02-01

    Early allograft dysfunction (EAD) following liver transplantation (LT) remains a challenge for patients and clinicians. We retrospectively analyzed the effect of pre-defined EAD on outcomes in a 10-year cohort of deceased-donor LT recipients with clearly defined exclusion criteria. EAD was defined by at least one of the following: AST or ALT >2000 IU/L within first-week post-LT, total bilirubin ≥10 mg/dL, and/or INR ≥1.6 on post-operative day 7. Ten patients developed primary graft failure and were analyzed separately. EAD occurred in 86 (36%) recipients in a final cohort of 239 patients. In univariate and multivariate analyses, EAD was significantly associated with mechanical ventilation ≥2 days or death on days 0, 1, PACU/SICU stay >2 days or death on days 0-2 and renal failure (RF) at time of hospital discharge (all P<.05). EAD was also significantly associated with higher one-year graft loss in both uni- and multivariate Cox hazard analyses (P=.0203 and .0248, respectively). There was no difference in patient mortality between groups in either of the Cox proportional hazard models. In conclusion, we observed significant effects of EAD on short-term post-LT outcomes and lower graft survival.

  7. Early effects of the antineoplastic agent salinomycin on mitochondrial function.

    PubMed

    Managò, A; Leanza, L; Carraretto, L; Sassi, N; Grancara, S; Quintana-Cabrera, R; Trimarco, V; Toninello, A; Scorrano, L; Trentin, L; Semenzato, G; Gulbins, E; Zoratti, M; Szabò, I

    2015-10-22

    Salinomycin, isolated from Streptomyces albus, displays antimicrobial activity. Recently, a large-scale screening approach identified salinomycin and nigericin as selective apoptosis inducers of cancer stem cells. Growing evidence suggests that salinomycin is able to kill different types of non-stem tumor cells that usually display resistance to common therapeutic approaches, but the mechanism of action of this molecule is still poorly understood. Since salinomycin has been suggested to act as a K(+) ionophore, we explored its impact on mitochondrial bioenergetic performance at an early time point following drug application. In contrast to the K(+) ionophore valinomycin, salinomycin induced a rapid hyperpolarization. In addition, mitochondrial matrix acidification and a significant decrease of respiration were observed in intact mouse embryonic fibroblasts (MEFs) and in cancer stem cell-like HMLE cells within tens of minutes, while increased production of reactive oxygen species was not detected. By comparing the chemical structures and cellular effects of this drug with those of valinomycin (K(+) ionophore) and nigericin (K(+)/H(+) exchanger), we conclude that salinomycin mediates K(+)/H(+) exchange across the inner mitochondrial membrane. Compatible with its direct modulation of mitochondrial function, salinomycin was able to induce cell death also in Bax/Bak-less double-knockout MEF cells. Since at the concentration range used in most studies (around 10 μM) salinomycin exerts its effect at the level of mitochondria and alters bioenergetic performance, the specificity of its action on pathologic B cells isolated from patients with chronic lymphocytic leukemia (CLL) versus B cells from healthy subjects was investigated. Mesenchymal stromal cells (MSCs), proposed to mimic the tumor environment, attenuated the apoptotic effect of salinomycin on B-CLL cells. Apoptosis occurred to a significant extent in healthy B cells as well as in MSCs and human primary

  8. Parenteral Administration of l-Arginine Prevents Fetal Growth Restriction in Undernourished Ewes12

    PubMed Central

    Lassala, Arantzatzu; Bazer, Fuller W.; Cudd, Timothy A.; Datta, Sujay; Keisler, Duane H.; Satterfield, M. Carey; Spencer, Thomas E.; Wu, Guoyao

    2010-01-01

    Intrauterine growth restriction (IUGR) is a major health problem worldwide that currently lacks an effective therapeutic solution. This study was conducted with an ovine IUGR model to test the hypothesis that parenteral administration of l-arginine (Arg) is effective in enhancing fetal growth. Beginning on d 28 of gestation, ewes were fed a diet providing 100% (control-fed) or 50% (underfed) of NRC-recommended nutrient requirements. Between d 60 of gestation and parturition, underfed ewes received i.v. infusions of saline or 155 μmol Arg-HCl/kg body weight 3 times daily, whereas control-fed ewes received only saline. The birth weights of lambs from saline-infused underfed ewes were 23% lower (P < 0.01) than those of lambs from control-fed dams. Administration of Arg to underfed ewes increased (P < 0.01) concentrations of Arg (69%), ornithine (55%), proline (29%), methionine (37%), leucine (36%), isoleucine (35%), cysteine (19%), and FFA (43%) in maternal serum, decreased maternal circulating levels of ammonia (18%) and triglycerides (32%), and enhanced birth weights of lambs by 21% compared with saline-infused underfed ewes. There was no difference in birth weights of lambs between the control-fed and the Arg-infused underfed ewes. These novel results indicate that parenteral administration of Arg to underfed ewes prevented fetal growth restriction and provide support for its clinical use to ameliorate IUGR in humans. The findings also lay a new framework for studying cellular and molecular mechanisms responsible for the beneficial effects of Arg in regulating conceptus growth and development. PMID:20505020

  9. Plasma lipid levels in preterm neonates receiving parenteral fat emulsions.

    PubMed Central

    Hilliard, J L; Shannon, D L; Hunter, M A; Brans, Y W

    1983-01-01

    Concentrations of various plasma lipid fractions were determined during 96 hours of continuous parenteral infusions of lipid emulsions in 10 normally-grown neonates whose birth-weights ranged from 960 to 1760 g and whose gestational ages ranged from 26 to 32 weeks. Total lipid, triglyceride, free glycerol, and free fatty acid concentrations were measured. During lipid infusions, mean plasma concentrations of all lipid fractions increased above the mean preinfusion values if 2 g/kg a day or more of lipid emulsion was used. There were no further significant increases in mean plasma lipid levels if the infused dosage was increased to 3 or 4 g/kg a day. At these higher infusion rates however, there were considerable individual variations. The only neonate less than 27 weeks of gestation had plasma lipid levels severalfold higher than any of his peers, his plasma was frankly creamy on visual inspection, and the study had to be stopped. Further investigations are needed to determine the optimal modalities of parenteral nutrition with fat emulsions. PMID:6402989

  10. Nitrogen sparing by 2-ketoisocaproate in parenterally fed rats

    SciTech Connect

    Yagi, M.; Matthews, D.E.; Walser, M. )

    1990-11-01

    In rats receiving total parenteral nutrition with or without sodium 2-ketoisocaproate (KIC; 2.48 g.kg-1.day-1), L-(1-{sup 13}C)leucine and (1-{sup 14}C)KIC were constantly infused for 6 h. CO{sub 2} production, {sup 14}CO{sub 2} production, {sup 13}CO{sub 2} enrichment, urinary urea nitrogen (N) plus ammonia N and total urinary N were measured. Whole body protein synthesis (S) was calculated in non-KIC-infused rats and also in unfed rats infused with (1-{sup 14}C)leucine from fractional oxidation of labeled leucine (1-F), where F is fractional utilization for protein synthesis, and urea N plus ammonia N excretion (C) as S = C x F/(1-F). Addition of KIC caused a significant reduction in N excretion and a significant improvement in N balance. Fractional oxidation of labeled KIC increased, whereas fractional utilization of labeled KIC for protein synthesis decreased, but the extent of incorporation of infused KIC into newly synthesized protein (as leucine) amounted to at least 40% of the total rate of leucine incorporation into newly synthesized whole body protein. We conclude that addition of KIC spares N in parenterally fed rats and becomes a major source of leucine for protein synthesis.

  11. Controversies in the Mechanism of Total Parenteral Nutrition Induced Pathology

    PubMed Central

    Kumar, Jain Ajay; Teckman, Jeffery H.

    2015-01-01

    Over 30,000 patients are permanently dependent on Total Parenteral Nutrition (TPN) for survival with several folds higher requiring TPN for a prolonged duration. Unfortunately, it can cause potentially fatal complications. TPN infusion results in impairment of gut mucosal integrity, enhanced inflammation, increased cytokine expression and trans-mucosal bacterial permeation. It also causes endotoxin associated down regulation of bile acid transporters and Parenteral Nutrition Associated Liver Disease (PNALD), which includes steatosis, disrupted glucose metabolism, disrupted lipid metabolism, cholestasis and liver failure. Despite multiple theories, its etiology and pathophysiology remains elusive and is likely multifactorial. An important cause for TPN related pathologies appears to be a disruption in the normal enterohepatic circulation due to a lack of feeding during such therapy. This is further validated by the fact that in clinical settings, once cholestasis sets in, its reversal occurs when a patient is receiving a major portion of calories enterally. There are several other postulated mechanisms including gut bacterial permeation predisposing to endotoxin associated down regulation of bile acid transporters. An additional potential mechanism includes toxicity of the TPN solution itself, such as lipid mediated hepatic toxicity. Prematurity, leading to a poor development of bile acid regulating nuclear receptors and transporters has also been implicated as a causative factor. This review presents the current controversies and research into mechanisms of TPN associated injury. PMID:27417369

  12. Cardiac tamponade as a complication of parenteral nutrition

    PubMed Central

    Garcia, Diego Paim Carvalho; Neto, Clarissa Santos; Hubner, Pablo Nelson Valle; Furtado, Thiago de Almeida; Petroianu, Andy; Alberti, Luiz Ronaldo

    2015-01-01

    Introduction Complications arising from the use of central venous catheters are numerous, but cardiac tamponade is a complication well defined, very rare and often fatal. The mortality rate is 47–77% in the literature. Presentation of case We report a case of successful diagnosis and treatment of cardiac tamponade by parenteral nutrition in a 31-year-old female. Discussion There are only few cases of cardiac tamponade reported in the world literature since 1958. The true incidence is unclear and the most cases occur in children. Despite the rarity of this condition, it has a high mortality rate. The clinical findings are pain and discomfort in the epigastrium and chest region, nausea, dyspnea, tachycardia, distended jugular veins, paradoxical pulse, hypotension, electrocardiographic tracing signals with low voltage and enlargement of cardiac area. The immediate diagnosis and the treatment of cardiac tamponade are capital for patient survival. Conclusion Cardiac tamponade should be suspected among patients with sudden onset of shock in use of parenteral nutrition, and therefore immediately treated. PMID:25681814

  13. Selenite metabolism in total parenteral nutrition (TPN)

    SciTech Connect

    Sitrin, M.D.; Ting, B.T.G.; Hazell, T.; Janghorbani, M. )

    1989-02-01

    Patients on long-term TPN commonly receive selenite to prevent selenium (Se) deficiency. Little information is available concerning the effect of chronic selenite supplementation on Se metabolism. In this study, we have used {sup 74}Se to examine selenite metabolism in 2 home TPN patents, one on selenite and one on no supplementation. Afte rcollection of baseline blood and urine samples, 80 {mu}g of selenite enriched with {sup 74}Se was added to the TPN formula, and infused over 12 hrs. Daily urine output was collected for 10 d. Inductively coupled plasma mass spectrometry was used to determine the isotope ratios of {sup 74}Se to {sup 77}Se, and {sup 74}Se to {sup 82}Se (added in vitro and an internal standard) in urine. Cumulative {sup 74}Se retention and an apparent selenite exchangeable pool size were calculated using standard isotope dilution equations. The unsupplemented TPN patient had biochemical Se deficiency, with decreased plasma Se (1 ng/ml) urine Se (1 ug/d) and red cell and plasma glutathione peroxidase activity (GSH-Px). Retention of {sup 74}Se was very high, 93% at 10 d, and the pool size was extremely low, 566 ug at 10 d. The supplemented patent had normal plasma and urine Se levels and plasma and red cell GSH-Px. {sup 74}Se retention was very poor, only 42% at 1 d and 38% at 10 d. The Se pool size increased rapidly over time, reaching 12000 ug at 10 d. In contrast, our previous studies in normal subjects consuming dietary orgaic Se showed a selenite retention of 85-90% at 1 d and 70-80% at 10 d, and a pool size of 6000-8000 ug at 10 day. Conclusions: 1. Using {sup 74}Se, differences in Se retention and pool size can easily be detected in Se deficient vs replete TPN patients 2. Chronic supplementation with selenite appears to result in decreased {sup 74}Se retention and an expanded selenite exchangeable pool in comparison with normals consuming dietary Se.

  14. Effects of Early Head Start Prior to Kindergarten Entry: The Importance of Early Experience

    ERIC Educational Resources Information Center

    Love, John M.

    2010-01-01

    The Early Head Start evaluation included 17 sites drawn from the first two waves of programs started more than a decade ago. By design, the Administration on Children, Youth and Families (ACYF) selected programs that would reflect the range of service options and context of all extant program rather than choosing a representative sample. The sites…

  15. Effects of differentiation on the geodynamics of the early Earth

    NASA Astrophysics Data System (ADS)

    Piccolo, Andrea; Kaus, Boris; White, Richard; Johnson, Tim

    2016-04-01

    Archean geodynamic processes are not well understood, but there is general agreement that the mantle potential temperature was higher than present, and that as a consequence significant amounts of melt were produced both in the mantle and any overlying crust. This has likely resulted in crustal differentiation. An early attempt to model the geodynamic effects of differentiation was made by Johnson et al. (2014), who used numerical modeling to investigate the crust production and recycling in conjunction with representative phase diagrams (based on the inferred chemical composition of the primary melt in accordance with the Archean temperature field). The results of the simulations show that the base of the over-thickened primary basaltic crust becomes gravitational unstable due to the mineral assemblage changes. This instability leads to the dripping of dense material into the mantle, which causes an asthenospheric return flow, local partial melting and new primary crust generation that is rapidly recycled in to mantle. Whereas they gave important insights, the previous simulations were simplified in a number of aspects: 1) the rheology employed was viscous, and both elasticity and pressure-dependent plasticity were not considered; 2) extracted mantle melts were 100% transformed into volcanic rocks, whereas on the present day Earth only about 20-30% are volcanic and the remainder is plutonic; 3) the effect of a free surface was not studied in a systematic manner. In order to better understand how these simplifications affect the geodynamic models, we here present additional simulations to study the effects of each of these parameters. Johnson, T.E., Brown, M., Kaus, B., and VanTongeren, J.A., 2014, Delamination and recycling of Archaean crust caused by gravitational instabilities: Nature Geoscience, v. 7, no. 1, p. 47-52, doi: 10.1038/NGEO2019.

  16. Classroom Effects of an Early Childhood Educator Professional Development Partnership

    ERIC Educational Resources Information Center

    Algozzine, Bob; Babb, Julie; Algozzine, Kate; Mraz, Maryann; Kissel, Brian; Spano, Sedra; Foxworth, Kimberly

    2011-01-01

    We evaluated an Early Childhood Educator Professional Development (ECEPD) project that provided high-quality, sustained, and intensive professional development designed to support developmentally appropriate instruction for preschool-age children based on the best available research on early childhood pedagogy, child development, and preschool…

  17. Effective Leadership and Management in the Early Years

    ERIC Educational Resources Information Center

    Moyles, Janet

    2006-01-01

    There has recently been an unprecedented focus on early years care and education, particularly on the impact of the various adults who work and play with children in the birth to five/six-years age range. Staff in early years settings have had to adapt to many changes and demands, locally and nationally, from local authorities and national…

  18. Preparing Therapists as Effective Practitioners in Early Intervention

    ERIC Educational Resources Information Center

    Campbell, Philippa H.; Chiarello, Lisa; Wilcox, M. Jeanne; Milbourne, Suzanne

    2009-01-01

    Occupational and physical therapists and speech language pathologists provide services for almost half of the children enrolled in early intervention programs nationally. Each professional association has adopted documents defining practice in early intervention that advocate for family-centered practices and interventions embedded in family…

  19. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications).

    PubMed

    Pittiruti, Mauro; Hamilton, Helen; Biffi, Roberto; MacFie, John; Pertkiewicz, Marek

    2009-08-01

    When planning parenteral nutrition (PN), the proper choice, insertion, and nursing of the venous access are of paramount importance. In hospitalized patients, PN can be delivered through short-term, non-tunneled central venous catheters, through peripherally inserted central catheters (PICC), or - for limited period of time and with limitation in the osmolarity and composition of the solution - through peripheral venous access devices (short cannulas and midline catheters). Home PN usually requires PICCs or - if planned for an extended or unlimited time - long-term venous access devices (tunneled catheters and totally implantable ports). The most appropriate site for central venous access will take into account many factors, including the patient's conditions and the relative risk of infective and non-infective complications associated with each site. Ultrasound-guided venepuncture is strongly recommended for access to all central veins. For parenteral nutrition, the ideal position of the catheter tip is between the lower third of the superior cava vein and the upper third of the right atrium; this should preferably be checked during the procedure. Catheter-related bloodstream infection is an important and still too common complication of parenteral nutrition. The risk of infection can be reduced by adopting cost-effective, evidence-based interventions such as proper education and specific training of the staff, an adequate hand washing policy, proper choices of the type of device and the site of insertion, use of maximal barrier protection during insertion, use of chlorhexidine as antiseptic prior to insertion and for disinfecting the exit site thereafter, appropriate policies for the dressing of the exit site, routine changes of administration sets, and removal of central lines as soon as they are no longer necessary. Most non-infective complications of central venous access devices can also be prevented by appropriate, standardized protocols for line insertion

  20. [Glucose or sugar substitutes in parenteral infusions? The choice of carbohydrates in postoperative infusion therapy].

    PubMed

    Leutenegger, A F

    1980-12-18

    The aim of parenteral nutrition should be to optimise fluid, energy and nitrogen balance. In the post-traumatic or post-operative phase a stress induced glucose intolerance may occur and it may become difficult to meet the patient's energy requirements with glucose alone. For these reasons the use of sugar substitutes (fructose, sorbitol and xylitol) in combination with glucose is recommended as an alternative. Patients receiving a mixed sugar solution of glucose, fructose and xylitol at a ratio of 1:2:1 require less exogenous insulin and yet maintain a lower blood glucose concentration. Used in limited quantities, we encountered no side effects either in patients undergoing elective surgery or requiring intensive care.

  1. [TOTAL PARENTERAL NUTRITION IN A PREGNANT PATIENT WITH ACUTE PANCREATITIS AND LIPOPROTEIN LIPASE DEFICIENCY].

    PubMed

    Contreras-Bolívar, Victoria; González-Molero, Inmaculada; Valdivieso, Pedro; Olveira, Gabriel

    2015-10-01

    We present a case of severe acute pancreatitis induced by hypertriglyceridemia secondary to lipoprotein lipase (LPL) deficiency in a pregnant patient with gestational diabetes, initially maneged with diet but it was later necessary to carry out artificial nutricional support measures: total parenteral nutrition. LPL deficiency might cause severe hypertriglyceridemia, repetition acute pancreatitis which is an unwieldy and severe situation during pregnancy. Acute familial hypertriglyceridemia pancreatitis accounts for 5% of cases, including LPL deficiency. The goal of treatment is to reach triglycerides levels below 500 mg/dl, being very low fat diet the treatment of choice, drugs or plasmapheresis techniques can also be associated. TPN enriched in ω3 fatty acids and glutamine was safe and effective in our patient with significant decrease in triglyceride levels.

  2. The effects of early postoperative radiation on vascularized bone grafts

    SciTech Connect

    Evans, H.B.; Brown, S.; Hurst, L.N. )

    1991-06-01

    The effects of early postoperative radiation were assessed in free nonvascularized and free vascularized rib grafts in the canine model. The mandibles of one-half of the dogs were exposed to a cobalt 60 radiation dose of 4080 cGy over a 4-week period, starting 2 weeks postoperatively. The patency of vascularized grafts was confirmed with bone scintigraphy. Histological studies, including ultraviolet microscopy with trifluorochrome labeling, and histomorphometric analyses were performed. Osteocytes persist within the cortex of the vascularized nonradiated grafts to a much greater extent than in nonvascularized, nonradiated grafts. Cortical osteocytes do not persist in either vascularized or nonvascularized grafts subjected to radiation. New bone formation is significantly retarded in radiated grafts compared with nonradiated grafts. Periosteum and endosteum remained viable in the radiated vascularized grafts, producing both bone union and increased bone turnover, neither of which were evident to any significant extent in nonvascularized grafts. Bone union was achieved in vascularized and non-vascularized nonradiated bone. In the radiated group of dogs, union was only seen in the vascularized bone grafts.

  3. The effects of microgravity on gametogenesis, fertilization, and early embryogenesis

    NASA Astrophysics Data System (ADS)

    Tan, X.

    Gametogenesis fertilization and early embryogenesis are crucial periods for normal development afterwards In past three decades many experiments have been conducted in space and in simulated weightlessness induced by clinostats to elucidate the issue Different animal species including Drosophila wasp shrimp fish amphibian mouse rats etc have been used for the study Oogenesis and spermatogenesis are affected by microgravity in different ways Some researches found that microgravity condition perturbed the process of oogenesis in many species A significant increased frequency of chromosomal non-disjunction was found in Drosophila females resulting the loss of chromosomes during meiosis and inhibition of cell division Studies on wasp showed a decreased hatchability and accumulation of unhatched eggs when the insects were exposed to spaceflight at different stages of oogenesis For experiments conducted on vertebrate animal models the results are somehow different however Microgravity has no significant effect for fish Medaka etc amphibian South African clawed toad Xenopus laevis or mammals mouse Spermatogenesis on the other hand is more significantly affected by microgravity condition Some researches indicated sperm are sensitive to changes in gravitational force and this sensitivity affects the ability of sperm to fertilize eggs Sperm swim with higher velocity in microgravity which is coupled with altered protein phosphorylation level in sperm under microgravity condition Microgravity also induced activation of the

  4. Outpatient parenteral antimicrobial therapy for orthopedic infections - a successful public healthcare experience in Brazil.

    PubMed

    Oliveira, Priscila Rosalba; Felix, Cassia da Silva; Carvalho, Vladimir Cordeiro de; Giovani, Arlete Mazzini; Reis, Rosangela Suarti Dos; Beraldo, Marisa; Albuquerque, Edmir Peralta; Ferreira, Walter Cintra; Silva, Jorge Dos Santos; Lima, Ana Lucia Lei

    2016-01-01

    Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions

  5. Aminosyn PF or trophamine: which provides more protection from cholestasis associated with total parenteral nutrition?

    PubMed

    Forchielli, M L; Gura, K M; Sandler, R; Lo, C

    1995-11-01

    Cholestasis often occurs in infants on total parenteral nutrition (TPN) for long periods. Amino acid formulations developed specifically for infants, namely Aminosyn PF and Trophamine, may protect against cholestasis associated with total parenteral nutrition (CATPN). The development of cholestasis may also be caused by other risk factors such as prematurity, surgery, sepsis, and extracorporeal membrane oxygenation (ECMO). To evaluate the relative effectiveness of the pediatric amino acid formulations in reducing CATPN, the courses of 70 infants < 1 year of age who received TPN for at least 14 days were reviewed. Cholestasis was defined as a conjugated serum bilirubin > or = 2 mg/dl subsequent to the initiation of TPN; CATPN was considered present when other factors related to cholestasis were ruled out. Liver function tests were recorded 24 h before starting TPN and at day 7, 15, and 21 during TPN infusion. Thirty infants (42.8%) developed cholestasis. CATPN was judged to have occurred in 15 (21.4%) of 70 infants, while 15 (21.4%) developed cholestasis secondary to other factors. Of the 15 CATPN patients, 7 had received Trophamine, 6 had received Aminosyn PF, and 2 had received both solutions. Aminosyn PF and Trophamine, along with other potential risk factors for CATPN such as antecedent surgery, sepsis, ECMO, prematurity, and nitrogen/calorie intake were analyzed by regression-analysis methods. None was statistically significant except the length of TPN (p = 0.0063). In conclusion, we cannot support the view that Trophamine is more effective than Aminosyn PF in the prevention of CATPN.

  6. Early detection of ocean acidification effects on marine calcification

    SciTech Connect

    Ilyina, T.; Zeebe, R. E.; E. Maier-Reimer; C. Heinze

    2009-02-19

    Ocean acidification is likely to impact calcification rates in many pelagic organisms, which may in turn cause significant changes in marine ecosystem structure. We examine effects of changes in marine CaCO3 production on total alkalinity (TA) in the ocean using the global biogeochemical ocean model HAMOCC. We test a variety of future calcification scenarios because experimental studies with different organisms have revealed a wide range of calcification sensitivities to CaCO3 saturation state. The model integrations start at a preindustrial steady state in the year 1800 and run until the year 2300 forced with anthropogenic CO2 emissions. Calculated trends in TA are evaluated taking into account the natural variability in ocean carbonate chemistry, as derived from repeat hydrographic transects. We conclude that the data currently available does not allow discerning significant trends in TA due to changes in pelagic calcification caused by ocean acidification. Given different calcification scenarios, our model calculations indicate that the TA increase over time will start being detectable by the year 2040, increasing by 5–30 umol/kg compared to the present-day values. In a scenario of extreme reductions in calcification, large TA changes relative to preindustrial conditions would have occurred at present, which we consider very unlikely. However, the time interval of reliable TA observations is too short to disregard this scenario. The largest increase in surface ocean TA is predicted for the tropical and subtropical regions. In order to monitor and quantify possible early signs of acidification effects, we suggest to specifically target those regions during future ocean chemistry surveys.

  7. Effects of maternal geohelminth infections on allergy in early childhood

    PubMed Central

    Cooper, Philip J.; Chico, Martha E.; Amorim, Leila D.; Sandoval, Carlos; Vaca, Maritza; Strina, Agostino; Campos, Ana Clara; Rodrigues, Laura C.; Barreto, Mauricio L.; Strachan, David P.

    2016-01-01

    Background Maternal geohelminth infections during pregnancy may protect against allergy development in childhood. Objective We sought to investigate the effect of maternal geohelminths on the development of eczema, wheeze, and atopy during the first 3 years of life. Methods A cohort of 2404 neonates was followed to 3 years of age in a rural district in coastal Ecuador. Data on wheeze and eczema were collected by means of questionnaire and physical examination at 13, 24, and 36 months of age. Atopy was measured based on skin prick test (SPT) reactivity to 9 allergens at 36 months. Maternal stool samples were examined for geohelminths by microscopy. Data on potential confounders was collected after birth by questionnaire. Results Geohelminths were observed in 45.9% of mothers. Eczema and wheeze were reported for 17.7% and 25.9%, respectively, of 2069 (86.1%) children with complete follow-up to 3 years, and allergen SPT reactivity to any allergen was present in 17.2% and to house dust mite in 8.7%. Maternal geohelminth infections were not significantly associated with eczema (adjusted odds ratio [OR], 1.26; 95% CI, 0.98-1.61), wheeze (adjusted OR, 1.02; 95% CI, 0.82-1.27), and SPT reactivity to any allergen (adjusted OR, 0.79; 95% CI, 0.61-1.01). In subgroup analyses maternal geohelminths were associated with a significantly reduced risk of SPT reactivity to mite and other perennial allergens, and maternal ascariasis was associated with an increased risk of eczema and reduced risk of SPT reactivity to all allergens. Conclusion Our data do not support a protective effect of maternal infections with geohelminth parasites during pregnancy against the development of eczema and wheeze in early childhood, although there was evidence in subgroup analyses for a reduction in SPT reactivity to house dust mites and perennial allergens. PMID:26395817

  8. Parenteral monofluorophosphate (MFP) is a more potent inducer of enamel fluorotic defects in neonatal hamster molars than sodium fluoride.

    PubMed

    Lyaruu, Donacian M; Schoonderwoerd, Mark; Tio, Dane; Tse, Chukan; Bervoets, Theodore J; DenBesten, Pamela; Bronckers, Antonius L J J

    2014-07-01

    Supra-optimal intake of sodium fluoride (NaF) during early childhood results in formation of irreversible enamel defects. Monofluorophosphate (MFP) was considered as less toxic than NaF but equally cariostatic. We compared the potency of MFP and NaF to induce pre-eruptive sub-ameloblastic cysts and post-eruptive white spots and pits in developing hamster enamel. Hamster pups were injected subcutaneously with either NaF or MFP in equimolar doses of either 9 mg or 18 mg F/kg body weight. At 9 mg F/kg, MFP induced more but smaller sub-ameloblastic cysts with a collective cyst volume twice as large as that induced by NaF. Eight days after F injection, all F-injected groups had formed 4-6 white spots per molar, with an additional 2 pits per molar in the low MFP group. Twenty-eight days after injection, most white spots had turned into pits (5-6 per molar) and only the high MFP group still contained 2 white spots per molar. We conclude that parenterally applied MFP is more potent in inducing enamel defects than NaF. Most white spots formed turn into pits by functional use of the dentition. The higher potency of parenteral MFP may be associated with sustained elevated F levels in the enamel organ by enzymatic hydrolysis of MFP by alkaline phosphatase activity.

  9. [Management of parenteral nutrition in intensive care units in Spain].

    PubMed

    Vaquerizo Alonso, Clara; Mesejo, Alfonso; Acosta Escribano, José; Ruiz Santana, Sergio

    2013-01-01

    Introducción y objetivos: No se sabe con exactitud aspectos de relevancia en nutrición parenteral como aportes calórico-proteicos, volumen total, control de glucemia, tipo de emulsión lipídica o comparación de diferentes fórmulas, en las UCIs españolas. Planteamos como objetivo conocer los patrones de práctica clínica habitual en la terapéutica con nutrición artificial, fundamentalmente parenteral, en dichas UCIs. Material y métodos: Participaron doce UCIs representativas, de enero a marzo de dos mil doce, para la realización de una encuesta nutricional. La encuesta se dividió en dos apartados : A) Manejo del soporte nutricional artificial en el paciente grave y B) Valoración de una nueva fórmula de nutrición parenteral adaptada al paciente grave. Se recogió: porcentaje de pacientes con nutrición artificial; disponibilidad de fórmulas enterales; tipos de emulsiones lipídicas; calorías, aminoácidos y lípidos aportados; adición de glutamina, vitaminas y oligoelementos; manejo del volumen y de la hiperglucemia y datos comparativos de pacientes con la nueva formulación frente a fórmulas de uso habitual: control glucémico, afectación hepática y complicaciones infecciosas, así como aportes de calorías totales, proteínas, volumen e insulina administrada. Resultados: La media de camas hospitalarias es de 780 y de UCI de 25, con una media de ingresos de 950 pacientes/año. Un 49% son pacientes médicos, 31% quirúrgicos y 20% traumatológicos. El 59,75% precisaron nutrición artificial (NA). De ellos, 58,7% nutrición enteral (NE), 16% nutrición parenteral total (NPT) y 25,3% nutrición parenteral complementaria (NPC). Ante NE contraindicada, el 83,3% inicia NPT precoz (24 horas) y ante NE insuficiente el 66,7% inicia NPC en 48 horas. En relación con la práctica habitual de los prescriptores, un 50% intenta reducción de volumen y el 100% dispone de protocolo de infusión de insulina. Un 39% recomiendan NPT hiperproteica, baja en volumen

  10. Supplementation of parenteral nutrition with fish oil attenuates acute lung injury in a rat model

    PubMed Central

    Kohama, Keisuke; Nakao, Atsunori; Terashima, Mariko; Aoyama-Ishikawa, Michiko; Shimizu, Takayuki; Harada, Daisuke; Nakayama, Mitsuo; Yamashita, Hayato; Fujiwara, Mayu; Kotani, Joji

    2014-01-01

    Fish oil rich in n-3 polyunsaturated fatty acids has diverse immunomodulatory properties and attenuates acute lung injury when administered in enternal nutrition. However, enteral nutrition is not always feasible. Therefore, we investigated the ability of parenteral nutrition supplemented with fish oil to ameliorate acute lung injury. Rats were infused with parenteral nutrition solutions (without lipids, with soybean oil, or with soybean oil and fish oil) for three days. Lipopolysaccharide (15 mg/kg) was then administered intratracheally to induce acute lung injury, characterized by impaired lung function, polymorphonuclear leukocyte recruitment, parenchymal tissue damage, and upregulation of mRNAs for inflammatory mediators. Administration of parenteral nutrition supplemented with fish oil prior to lung insult improved gas exchange and inhibited neutrophil recruitment and upregulation of mRNAs for inflammatory mediators. Parenteral nutrition supplemented with fish oil also prolonged survival. To investigate the underlying mechanisms, leukotriene B4 and leukotriene B5 secretion was measured in neutrophils from the peritoneal cavity. The neutrophils from rats treated with fish oil-rich parenteral nutrition released significantly more leukotriene B5, an anti-inflammatory eicosanoid, than neutrophils isolated from rats given standard parenteral nutrition. Parenteral nutrition with fish oil significantly reduced lipopolysaccharide-induced lung injury in rats in part by promoting the synthesis of anti-inflammatory eicosanoids. PMID:24688221

  11. Observational effects of the early episodically dominating dark energy

    NASA Astrophysics Data System (ADS)

    Park, Chan-Gyung; Lee, Jae-heon; Hwang, Jai-chan; Noh, Hyerim

    2014-10-01

    We investigate the observational consequences of the early episodically dominating dark energy on the evolution of cosmological structures. For this aim, we introduce the minimally coupled scalar-field dark energy model with the Albrecht-Skordis potential, which allows a sudden ephemeral domination of a dark energy component during the radiation or early matter era. The conventional cosmological parameters in the presence of such an early dark energy are constrained with WMAP and Planck cosmic microwave background radiation data including other external data sets. It is shown that in the presence of such an early dark energy, the estimated cosmological parameters can deviate substantially from the currently known Λ cold dark matter (Λ CDM )-based parameters, with best-fit values differing by several percent for WMAP and by a percent level for Planck data. For the latter case, only a limited amount of dark energy with episodic nature is allowed since the Planck data strongly favor the Λ CDM model. Compared with the conventional dark energy model, the early dark energy dominating near the radiation-matter equality or at the early matter era results in the shorter cosmic age or the presence of tensor-type perturbation, respectively. Our analysis demonstrates that the alternative cosmological parameter estimation is allowed based on the same observations even in Einstein's gravity.

  12. PROTEIN NEEDS OF CRITICALLY ILL PATIENTS RECEIVING PARENTERAL NUTRITION.

    PubMed

    Germano Borges de Oliveira Nascimento Freitas, Renata; Negrão Nogueira, Roberto José; Hessel, Gabriel

    2015-07-01

    Introducción: evaluar si las recomendaciones de ingesta de proteínas actuales pueden mejorar los parámetros bioquímicos de los pacientes críticos que reciben nutrición parenteral. Métodos: estudio longitudinal con tres evaluaciones realizadas (durante las primeras 72 horas, en el séptimo y los días decimocuarto de nutrición parenteral). Se aplicaron las siguientes pruebas: albúmina, proteína C reac ti va, prealbúmina, colesterol total, HDL, triglicéridos, linfocitos y glutatión peroxidasa. La gravedad se determinó por SOFA. El análisis estadístico incluyó las pruebas de Spearman y Mann-Whitney, así como ANOVA (análisis de varianza). Resultados: de los 53 pacientes evaluados, 20 (37,74%) fallecieron. La caloría media fue de 24,68 ± 9,78 kcal/kg (comienzo de PN), 26,49 ± 8,89 kcal/kg (tercero-séptimo días de PN), y 30,9 ± 12,19 kcal/kg (séptimo-décimo cuarto días de PN). La proteína media fue de 1,19 ± 0,44 g/ kcal/kg (primeras 72 horas de PN), 1,29 ± 0,44 g/kcal/kg (tercero-séptimo días de PN) y 1,49 ± 0,69 g/kcal/kg (séptimo- decimocuarto días de PN). La prealbúmina, la albúmina, el colesterol total y la HDL estaban por debajo de los valores de referencia, mientras que los niveles de PCR eran altos. A lo largo de los tres tiempos de evaluación, no hay una mejora significativa en los niveles de los exámenes de laboratorio. Una correlación fuerte y negativa entre SOFA y prealbúmina (r = -0,64, p = 0,05). Conclusiones: la oferta de proteínas, de acuerdo con las recomendaciones tradicionales, no fue suficiente para mejorar los parámetros bioquímicos de los pacientes críticos sometidos a nutrición parenteral.

  13. Meta-analysis of structured triglyceride versus other lipid emulsions for parenteral nutrition.

    PubMed

    Zhu, Mengbai; Li, Xueliang

    2013-06-01

    Structured triglyceride (STG) is a new emulsion synthesized from long-chain fatty acids and medium-chain fatty acids bound to the same glycerol backbone. We performed a meta-analysis to examine the safety, efficacy, and tolerability of STG for parenteral nutrition. We searched MEDLINE, EMBASE, and the Chinese Biomedicine Database, with the last search done in May 2012. Only randomized controlled trials in humans published in Chinese or English were included. Search terms included structured triglyceride and structural lipid. Methodologic quality was evaluated using the Jadad Scale. Meta-analysis was conducted using Review Manager 5.0.24 to calculate the weighted mean difference (WMD) and standardized mean difference (SMD) with 95% confidence intervals. Twenty-one studies (833 participants) published in English or Chinese were included in the analysis. STG significantly affected plasma triglycerides (WMD = -0.15; 95% confidence interval [CI], -0.29 to -0.01; P = 0.04), plasma glycerol (WMD = 0.21; 95% CI, 0.01-0.41; P = 0.04), free fatty acids (WMD = 0.21; 95% CI, 0.03-0.39; P = 0.02), nitrogen balance (SMD = 1.13; 95% CI, 0.26-1.99; P = 0.01), AST (WMD = -5.97; 95% CI, -7.17 to -4.76; P < 0.00001), and glucose (WMD = -0.18; 95% CI, -0.30 to -0.06; P = 004), but not respiratory quotient, resting energy expenditure, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, bilirubin, cholesterol, serum creatinine, or vital signs. STG is rapidly metabolized without harming the liver, and positively affects nitrogen balance. STG is at least as safe and effective for parenteral nutrition as other triglycerides.

  14. Aluminium exposure from parenteral nutrition in preterm infants and later health outcomes during childhood and adolescence.

    PubMed

    Fewtrell, Mary S; Edmonds, Caroline J; Isaacs, Elizabeth; Bishop, Nick J; Lucas, Alan

    2011-08-01

    Aluminium is the most common metallic element, but has no known biological role. It accumulates in the body when protective gastrointestinal mechanisms are bypassed, renal function is impaired, or exposure is high - all of which apply frequently to preterm infants. Recognised clinical manifestations of aluminium toxicity include dementia, anaemia and bone disease. Parenteral nutrition (PN) solutions are liable to contamination with aluminium, particularly from acidic solutions in glass vials, notably calcium gluconate. When fed parenterally, infants retain >75% of the aluminium, with high serum, urine and tissue levels. Later health effects of neonatal intravenous aluminium exposure were investigated in a randomised trial comparing standard PN solutions with solutions specially sourced for low aluminium content. Preterm infants exposed for >10 d to standard solutions had impaired neurologic development at 18 months. At 13-15 years, subjects randomised to standard PN had lower lumbar spine bone mass; and, in non-randomised analyses, those with neonatal aluminium intake above the median had lower hip bone mass. Given the sizeable number of infants undergoing intensive care and still exposed to aluminium via PN, these findings have contemporary relevance. Until recently, little progress had been made on reducing aluminium exposure, and meeting Food and Drug Administration recommendations (<5 μg/kg per d) has been impossible in patients <50 kg using available products. Recent advice from the UK Medicines and Healthcare regulatory Authority that calcium gluconate in small volume glass containers should not be used for repeated treatment in children <18 years, including preparation of PN, is an important step towards addressing this problem.

  15. Nitrite and Nitrate Concentrations and Metabolism in Breast Milk, Infant Formula, and Parenteral Nutrition

    PubMed Central

    Jones, Jesica A.; Ninnis, Janet R.; Hopper, Andrew O.; Ibrahim, Yomna; Merritt, T. Allen; Wan, Kim-Wah; Power, Gordon G.; Blood, Arlin B.

    2015-01-01

    Dietary nitrate and nitrite are sources of gastric NO, which modulates blood flow, mucus production, and microbial flora. However, the intake and importance of these anions in infants is largely unknown. Nitrate and nitrite levels were measured in breast milk of mothers of preterm and term infants, infant formulas, and parenteral nutrition. Nitrite metabolism in breast milk was measured after freeze-thawing, at different temperatures, varying oxygen tensions, and after inhibition of potential nitrite-metabolizing enzymes. Nitrite concentrations averaged 0.07 ± 0.01 μM in milk of mothers of preterm infants, less than that of term infants (0.13 ± 0.02 μM) (P < .01). Nitrate concentrations averaged 13.6 ± 3.7 μM and 12.7 ± 4.9 μM, respectively. Nitrite and nitrate concentrations in infant formulas varied from undetectable to many-fold more than breast milk. Concentrations in parenteral nutrition were equivalent to or lower than those of breast milk. Freeze-thawing decreased nitrite concentration ∼64%, falling with a half-life of 32 minutes at 37°C. The disappearance of nitrite was oxygen-dependent and prevented by ferricyanide and 3 inhibitors of lactoperoxidase. Nitrite concentrations in breast milk decrease with storage and freeze-thawing, a decline likely mediated by lactoperoxidase. Compared to adults, infants ingest relatively little nitrite and nitrate, which may be of importance in the modulation of blood flow and the bacterial flora of the infant GI tract, especially given the protective effects of swallowed nitrite. PMID:23894175

  16. Nitrite and nitrate concentrations and metabolism in breast milk, infant formula, and parenteral nutrition.

    PubMed

    Jones, Jesica A; Ninnis, Janet R; Hopper, Andrew O; Ibrahim, Yomna; Merritt, T Allen; Wan, Kim-Wah; Power, Gordon G; Blood, Arlin B

    2014-09-01

    Dietary nitrate and nitrite are sources of gastric NO, which modulates blood flow, mucus production, and microbial flora. However, the intake and importance of these anions in infants is largely unknown. Nitrate and nitrite levels were measured in breast milk of mothers of preterm and term infants, infant formulas, and parenteral nutrition. Nitrite metabolism in breast milk was measured after freeze-thawing, at different temperatures, varying oxygen tensions, and after inhibition of potential nitrite-metabolizing enzymes. Nitrite concentrations averaged 0.07 ± 0.01 μM in milk of mothers of preterm infants, less than that of term infants (0.13 ± 0.02 μM) (P < .01). Nitrate concentrations averaged 13.6 ± 3.7 μM and 12.7 ± 4.9 μM, respectively. Nitrite and nitrate concentrations in infant formulas varied from undetectable to many-fold more than breast milk. Concentrations in parenteral nutrition were equivalent to or lower than those of breast milk. Freeze-thawing decreased nitrite concentration ~64%, falling with a half-life of 32 minutes at 37°C. The disappearance of nitrite was oxygen-dependent and prevented by ferricyanide and 3 inhibitors of lactoperoxidase. Nitrite concentrations in breast milk decrease with storage and freeze-thawing, a decline likely mediated by lactoperoxidase. Compared to adults, infants ingest relatively little nitrite and nitrate, which may be of importance in the modulation of blood flow and the bacterial flora of the infant GI tract, especially given the protective effects of swallowed nitrite.

  17. Safety and role of ketogenic parenteral nutrition for intractable childhood epilepsy.

    PubMed

    Jung, Da Eun; Kang, Hoon-Chul; Lee, Joon Soo; Lee, Eun Joo; Kim, Heung Dong

    2012-09-01

    To retrospectively evaluate the safety and role of ketogenic parenteral nutrition in patients with intractable childhood epilepsy. The ketogenic parenteral nutrition was given to 10 patients who were unable to absorb nutrients through the intestinal tract because of various gastrointestinal disorders and required complete bowel rest. This nutrition consisted of conventional intravenous fat emulsion (20% Lipision) plus dextrose and amino acid (6% Trophamine) hyperalimentation in a 4:1 (or 3:1) lipid to non-lipid ratio, infused during the bowel rest. If the ketogenic parenteral nutrition allowed normal daily functioning or resolved the underlying problems, we soon changed it to the enteral ketogenic diet (KD). The mean (±SD) duration of the ketogenic parenteral nutrition was 4.1 (±1.5) days. Although a brief span of several days, all patients could maintain ketosis and the efficacy of the previous enteral KD during the ketogenic parenteral nutrition. Complications included elevated aspartate aminotransferase and/or alanine aminotransferase in one patient. Amylase and lipase increased in one patient. Serum triglyceride level increased to the level of 1885 mg/dl in one patient, but normalized in one week after discontinuation of the ketogenic parenteral nutrition and resuming of the enteral KD. Nine patients (90%) remained on the enteral KD after the ketogenic parenteral nutrition (the mean follow-up period was 9 months), including 2 patients who successfully completed the diet with seizure free state. Only one patient discontinued the ketogenic parenteral nutrition because of persistent increase of the amylase and lipase levels. The ketogenic parenteral nutrition proved to be a relatively safe short-term method of continuing KD to maintain ketosis for seizure control, while patients were unable to absorb nutrients through their intestinal tract.

  18. Parenteral drug products containing aluminum as an ingredient or a contaminant: Response to Food and Drug Administration notice of intent and request for information. ASCN/A. S. P. E. N. Working Group on Standards for Aluminum Content of Parenteral Nutrition Solutions

    SciTech Connect

    Not Available

    1991-03-01

    Aluminum remains a significant contaminant of total parenteral nutrition (TPN) solutions and may be elevated in bone, urine, and plasma of infants receiving TPN. Aluminum accumulation in tissues of uremic patients and adult TPN patients has been associated with low-turnover bone disease. Furthermore, aluminum has also been linked with encephalopathy and anemia in uremic patients and with hepatic cholestasis in experimental animals. Because of the toxic effects of aluminum, the Food and Drug Administration (FDA) recently published a notice of intent to set an upper limit of 25 micrograms/L for aluminum in large-volume parenterals and to require manufacturers of small-volume parenterals, such as calcium and phosphate salts, to measure aluminum content and note this content on the package label. The ASCN/A.S.P.E.N. Working Group on Standards for Aluminum Content of Parenteral Nutrition Solutions supports these intentions and further urges the FDA to require that cumulative aluminum intake in terms of safe, unsafe, and toxic quantities of aluminum per kilogram be made known to physicians and pharmacists preparing the TPN solutions, to ensure that manufacturers use appropriate control procedures in aluminum measurements, and to employ a standard unit of aluminum measurement.

  19. The metabolic consequences of infusing emulsions containing medium chain triglycerides for parenteral nutrition: a comparative study with conventional lipid.

    PubMed Central

    Dennison, A. R.; Ball, M.; Crowe, P. J.; White, K.; Hands, L.; Watkins, R. M.; Kettlewell, M.

    1986-01-01

    In order to test the hypothesis that medium chain triglycerides (MCT's) are a safe and potentially superior energy source during parenteral nutrition 13 patients were entered into a randomised cross over trial. They received either a long chain triglyceride emulsion (LCT) or a 50% medium chain (MCT)/50% LCT mixture as part of their energy supply. Nitrogen balance was significantly better when MCT/LCT was infused and the greater levels of plasma ketones and lower plasma triglyceride levels suggested that MCT was more readily metabolised in these patients. Routine haematology, biochemistry and liver function tests gave no indication of harmful side effects from MCT. PMID:3089123

  20. A Rare Case of Central Pontine Myelinolysis in Overcorrection of Hyponatremia with Total Parenteral Nutrition in Pregnancy

    PubMed Central

    Janga, Kalyana C.; Khan, Tazleem; Khorolsky, Ciril; Greenberg, Sheldon; Persaud, Priscilla

    2015-01-01

    A 42-year-old high risk pregnant female presented with hyponatremia from multiple causes and was treated with total parenteral nutrition. She developed acute hypernatremia due to the stage of pregnancy and other comorbidities. All the mechanisms of hyponatremia and hypernatremia were summarized here in our case report. This case has picture (graph) representation of parameters that led to changes in serum sodium and radiological findings of central pontine myelinolysis on MRI. In conclusion we present a complicated case serum sodium changes during pregnancy and pathophysiological effects on serum sodium changes during pregnancy. PMID:26798530

  1. The Use of Parenteral Iron Therapy for the Treatment of Postpartum Anemia.

    PubMed

    Nash, Christopher M; Allen, Victoria M

    2015-05-01

    Rates of postpartum hemorrhage have been increasing in Canada over the last 10 years, with postpartum iron deficiency anemia as the most common consequence. Postpartum anemia is treated with oral iron supplementation and/or blood transfusion. Recent studies have evaluated the use of parenteral iron as a better tolerated treatment modality. Compared with oral iron supplements, parenteral iron is associated with a more rapid rise in serum ferritin and hemoglobin and improved maternal fatigue scores in the postpartum period. It may also decrease rates of blood transfusion. Parenteral iron may be considered in select clinical situations for the treatment of postpartum anemia.

  2. A review of parenteral sustained-release naltrexone systems

    SciTech Connect

    Olsen, J.L.; Kincl, F.A.

    1981-01-01

    The ideal naltrexone sustained-release delivery system should be easy to inject or implant, not cause adverse tissue reaction, release the drug at a relatively constant rate for at least 30 days, and biodegrade within a short time afterwards. Mechanisms which can be used for sustaining drug release include reducing solubility and surface area, coating, encapsulation and microencapsulation, complexation, binding and hydrophilic gelation. Drug release from such systems is controlled by diffusion through a barrier/film, diffusion from a monolithic device, erosion of the surface, hydrolysis, ion exchange, biodegradation, or a combination of these. Injectable systems would seem to be ultimately preferred because of the ease of administration and handling, while the implantable devices may find first use in man since they are easily removable, should that be necessary. Maintaining particulate-free products and sterilization methods are two problems with all parenteral dosage forms. Production must be particularly well controlled and validated.

  3. [Hypersensibility reaction to parenteral nutrition approach; a case report].

    PubMed

    Sanchez Acera, Elián; Arenas Villafranca, Jose Javier; Abilés, Jimena; Faus Felipe, Vicente

    2014-03-01

    Parenteral nutrition (PN) is essential in the treatment of many hospitalized patients. However, administration of PN is not without potential complications and patients are exposed to related possible adverse reactions such as hypersensitivity. For that reason and because of the complexity of this treatment, PNs are considered by the ISMP (Institute for Safe Medication Practice) a high risk medication. Following is introduced the case of an oncologic patient with severe malnutrition, who after receiving PN for several days, developed a hypersensitivity reaction that could have being associated with intravenous mixture administration. Our aim is to analize the difficulties related with pre-surgery nutrition and to clarify the main possible causes of the reaction.

  4. Selected ultratrace elements in total parenteral nutrition solutions

    SciTech Connect

    Berner, Y.N.; Shuler, T.R.; Nielsen, F.H.; Flombaum, C.; Farkouh, S.A.; Shike, M. )

    1989-11-01

    Ultratrace elements are potentially essential (eg. boron, molybdenum, nickel, and vanadium) or toxic (eg, aluminum and cadmium) in humans. Long-term total parenteral nutrition (TPN) patients can inadvertently receive significant amounts of ultratrace elements present as contaminants in TPN solutions. We determined the intake of selected ultratrace elements from a standard TPN solution and compared it with the amount reported to be absorbed from food in normal subjects. Contamination of TPN solutions with ultratrace elements was widespread and variable. The daily intakes of Mo, Ni, V. and Cd from this contamination were comparable to the amounts reported to be absorbed through the gastrointestinal tract in normal subjects. Al intake was high; B intake was low, approximately 10% of the amount absorbed by normal subjects. Thus, TPN solutions are contaminated with significant amounts of ultratrace elements. The biological significance of the intravenous infusion of these ultratrace elements is unclear and requires further investigation, particularly in home TPN patients.

  5. A re-evaluation of energy expenditure during parenteral nutrition.

    PubMed Central

    Quebbeman, E J; Ausman, R K; Schneider, T C

    1982-01-01

    Nutritional support regimens are currently based on estimates of energy expenditure, and these estimates are then increased substantially in patients with severe trauma or sepsis because of a presumed hypermetabolic state. Forty-four patients on parenteral nutrition were evaluated using indirect calorimetry to measure actual energy expenditure, and an attempt was made to correlate metabolic rate with clinical diagnosis. We found no statistical difference in metabolic rates between groups of patients classified as malnourished, stressed, or catabolic, If high levels of nonprotein energy substrates are to be administered to a catabolic or "hypermetabolic" patient group, the justification must be on a basis other than a significant increase in actual rate of energy expenditure. PMID:6800313

  6. Precipitation of trace elements in parenteral nutrition mixtures.

    PubMed

    Allwood, M C; Martin, H; Greenwood, M; Maunder, M

    1998-10-01

    Trace elements are an essential additive to parenteral nutrition (PN) mixtures. Previous studies have indicated that certain trace elements, in particular copper and iron, may interact with complete PN mixtures leading to precipitate formation. The causes of these incompatibilities have not been fully elucidated. The purpose of this study was to determine factors responsible for common trace element incompatibilities, using X-ray energy dispersive spectroscopy to examine the elemental content of precipitates isolated from stored PN mixtures with added trace elements. Results indicated that copper sulphide precipitated most rapidly in PN mixtures containing Vamin 9 and in mixtures stored in multilayered bags. Copper sulphide precipitation was delayed in PN mixtures containing Vamin 14 and was not observed in PN mixtures stored in EVA bags. Iron phosphate precipitates were observed in Synthamin-containing PN mixtures after storage, but this was prevented in mixtures containing vitamins stored in multilayered bags.

  7. Gastrointestinal immune and microbiome changes during parenteral nutrition.

    PubMed

    Pierre, Joseph F

    2017-03-01

    Parenteral nutrition (PN) is a lifesaving therapy that provides intravenous nutrition support to patients who cannot, or should not, feed via the gastrointestinal (GI) tract. Unfortunately, PN also carries certain risks related to infection and metabolic complications compared with enteral nutrition. In this review, an overview of PN and GI immune and microbiome changes is provided. PN impacts the gut-associated lymphoid tissue functions, especially adaptive immune cells, changes the intestinal epithelium and chemical secretions, and significantly alters the intestinal microbiome. Collectively, these changes functionally result in increased susceptibility to infectious and injurious challenge. Since PN remains necessary in large numbers of patients, the search to improve outcomes by stimulating GI immune function during PN remains of interest. This review closes by describing recent advances in using enteric nervous system neuropeptides or microbially derived products during PN, which may improve GI parameters by maintaining immunity and physiology.

  8. Lipid composition and structure of commercial parenteral emulsions.

    PubMed

    Férézou, J; Nguyen, T L; Leray, C; Hajri, T; Frey, A; Cabaret, Y; Courtieu, J; Lutton, C; Bach, A C

    1994-07-14

    In order to study the influence of the phospholipid/triacylglycerol (PL/TG) ratio of parenteral emulsions on the distribution and the physico-chemical properties of their fat particles, commercial 10, 20 or 30% fat formulas were fractionated by centrifugation into an upper lipid cake (resuspended in aqueous glycerol) and a subnatant or mesophase, from which a PL-rich subfraction (d = 1.010-1.030 g/l) was purified by density gradient ultracentrifugation. Chemical and 31P-NMR analyses of these fractions indicated that at least two types of fat particles coexist in parenteral emulsions: (i) TG-rich particles (mean diameter: 330, 400, 470 nm in the 10, 20, 30% emulsion) which contain practically all the TG and esterified phytosterols of native emulsions, but only a fraction of their PL, unesterified cholesterol and phytosterols, and other minor lipids; (ii) PL-bilayer particles or liposomes (mean diameter: 80-100 nm) which are constituted with the remaining PL and relatively very small amounts of TG and other lipids. The higher the oil content of the emulsion, the lower the amount of these PL-rich particles, which represent the major particle population of the mesophase. Indeed, minute amounts of TG-rich particles (probably the smallest ones) are also present in the mesophase, even in the PL-rich subfraction which contains the bulk of liposomal PL. Since the PL-rich particles of the infused emulsion generate lipoprotein X-like particles, only the large TG-rich particles can be considered as true chylomicron counterparts.

  9. Decreased cysteine and proline synthesis in parenterally fed, premature infants.

    PubMed

    Miller, R G; Jahoor, F; Jaksic, T

    1995-07-01

    Little is known about the amino acid (AA) biosynthetic capacity and requirements of premature infants. This study assessed the synthesis of seven biochemically nonessential AA from a universal precursor, glucose, in stable, parenterally fed, premature neonates. Seven infants (six boys, one girl) were studied at a mean age of 6.3 +/- 0.6 (SEM) days; mean gestational age was 29.7 +/- 1.3 (SEM) weeks, and mean birth weight was 1,222.8 +/- 176.5 (SEM) grams. All infants were parenterally fed a mixture of 7.5% to 12.5% dextrose and 2.2% Trophamine, with or without lipid. Mean caloric intake was 93 +/- 8.4 (SEM) kcal/kg/d, and total AA intake was standardized at 2.86 g/kg/d AA, plus supplemental cysteine (30 mg/g AA/d). Each infant received a 4-hour continuous, unprimed intravenous infusion of a stable isotope tracer of D(-)[U13C] glucose (200 mg/kg). Blood samples were obtained before and at the end of the infusion. Conversion of the glucose tracer into seven biochemically nonessential AA (cysteine [Cys], proline [Pro], aspartate [Asp], serine [Ser], glutamate [Glu], alanine [Ala], and glycine [Gly]) was assessed by measuring their isotopic enrichment in plasma, using gas chromatography/mass spectrometry (GC/MS), and expressed as mole percent excess (MPE) (mean +/- SEM). The isotopic enrichment of plasma glucose was also measured using GC/MS. Free plasma AA concentrations (mean +/- SD) were measured using an automated amino acid analyzer. Mean MPE for M + 1, M + 2 and M + 3 Cys, and for M + 1 and M + 3 Pro were not significantly different from 0; M + 2 Pro barely achieved statistical significance (P = .048).(ABSTRACT TRUNCATED AT 250 WORDS)

  10. The lifelong effects of early childhood adversity and toxic stress.

    PubMed

    Boyce, W Thomas

    2014-01-01

    A rapidly expanding body of research indicates that early social environments characterized by adversity, subordination and stress, along with individual differences in susceptibility to such environments, create risks for lifelong chronic diseases, including declines in oral health. Emerging findings suggest that gene-environment interplay, resulting in epigenetically regulated differences in gene expression, underlie many such declines in health. The origins of these processes in early life reveal how many of the chronic morbidities of adulthood should be viewed as developmental disorders, with etiologic roots in childhood.

  11. The Parable of the Sower and the Long-Term Effects of Early Reading

    ERIC Educational Resources Information Center

    Suggate, Sebastian P.

    2015-01-01

    Previous work on the long-term effects of early reading focuses on whether children can read early (i.e. capability) not on whether this is beneficial (i.e. optimality). The Luke Effect is introduced to predict long-term reading development as a function of when children learn to read. A review of correlational, intervention, and comparative…

  12. Modification of a micellar system for amino acid separation by MEKC--application for amino acid profiling in formulations for parenteral use.

    PubMed

    Jaworska, Małgorzata; Szulińska, Zofia; Wilk, Małgorzata; Anuszewska, Elżbieta

    2010-12-15

    The paper proposes a new method for amino acid determination which can be applied for amino acid profiling in solutions for parenteral nutrition. The MEKC method based on a mixed micellar system was developed for the separation of 6-aminoquinolyl-N-hydroxysuccinimidyl carbamate (AQC) derivatized amino acids. Background electrolyte was based on tris-borate buffer with high alkaline pH. Sodium dodecyl sulfate micelles were modified using 1,2-hexanediol as a co-surfactant. The effect of the modifier on amino acid migration was studied with respect to hydrophobicity of the analytes. The modifier appeared to be suitable to improve the separation of AQC-tagged amino acids without an adverse effect on buffer ionic strength or EOF velocity. The method was successfully validated and applied for amino acid profiling in medicinal preparations for parenteral nutrition. The results obtained were compared with a reference chromatographic method (amino acid analyser).

  13. Development and Implementation of an Effective Early Childhood Handicapped Program.

    ERIC Educational Resources Information Center

    Condon, Kathryn; Dahlstrom, Mark

    The paper describes the Early Childhood Handicapped Program of Kenosha (WI). The program focuses on receptive and expressive language, fine and gross motor skills, self-help skills, cognitive skills, perceptual skills, and social/emotional skills development. For admission into the program, children must exhibit significant delays in two or more…

  14. Early Intervention and Its Effects on Maternal and Child Development.

    ERIC Educational Resources Information Center

    Slaughter, Diana T.

    1983-01-01

    The longitudinal study reported used an intervention strategy to test the thesis that sociocultural background, mediated by maternal attitudes and behaviors, influences Black children's early development in educationally significant ways. Two models of parent education were contrasted: the Levenstein toy demonstration program and the…

  15. Effects of Early Intervention and Stimulation on the Preterm Infant.

    ERIC Educational Resources Information Center

    Leib, Susan A.; And Others

    1980-01-01

    To test the hypothesis that early intervention can enhance the development of high risk preterm infants, a prescribed multimodal sensory enrichment program, within a regional neonatal intensive care unit, was designed and implemented with 28 preterm infants. Journal Availability: American Academy of Pediatrics, P.O. Box 1034, Evanston, IL 60204…

  16. Effects of Early Seizures on Later Behavior and Epileptogenicity

    ERIC Educational Resources Information Center

    Holmes, Gregory L.

    2004-01-01

    Both clinical and laboratory studies demonstrate that seizures early in life can result in permanent behavioral abnormalities and enhance epileptogenicity. Understanding the critical periods of vulnerability of the developing nervous system to seizure-induced changes may provide insights into parallel or divergent processes in the development of…

  17. Genetic Variation and the Effectiveness of Early Generation Selection

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Selection of wheat (Triticum aestivum L.) milling and baking quality in single-environment, non-replicated early-generation head-rows would increase the efficiency of most soft winter wheat (SWW) breeding programs. This study (i) estimated the heritability of SWW quality and gluten strength in a cr...

  18. Effects of Early Childhood Education on Kindergarten Readiness Scores

    ERIC Educational Resources Information Center

    Modeste, Janis Monrose

    2016-01-01

    The purpose of this correlational study, which took place in a Central Florida school district, was to investigate the relationship between the quality of the early childhood education (ECE) programs and students' kindergarten readiness scores. Vygotsky's sociocultural theory, which states that a child's environment, culture, and language are…

  19. The Peter Effect in Early Experimental Education Research

    ERIC Educational Resources Information Center

    Little, Joseph

    2003-01-01

    One of the signatures of scientific writing is its ability to present the claims of science as if they were "untouched by human hands." In the early years of experimental education, researchers achieved this by adopting a citational practice that led to the sedimentation of their cardinal method, the analysis of variance, and their standard for…

  20. Early environmental effects on epigenetic regulation in humans

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We all know our environment affects our risk of disease. But importantly, the health consequences of environmental exposures depend not only on their severity, but also on their timing relative to developmental milestones. The developmental origins hypothesis is based on the fact that certain early ...

  1. Effects of Video Interaction Guidance on Early Childhood Teachers

    ERIC Educational Resources Information Center

    Fukkink, Ruben G.; Tavecchio, Louis W. C.

    2010-01-01

    An experimental study showed that a video feedback intervention improved the interaction skills of early childhood education and care teachers. The teachers who had received the Video Interaction Guidance training appeared more stimulating in their behavior, were more sensitive and more verbally stimulating than teachers from the control group.…

  2. Enteral but not parenteral antibiotics enhance gut function and prevent necrotizing enterocolitis in formula-fed newborn preterm pigs.

    PubMed

    Birck, Malene M; Nguyen, Duc Ninh; Cilieborg, Malene S; Kamal, Shamrulazhar S; Nielsen, Dennis S; Damborg, Peter; Olsen, John E; Lauridsen, Charlotte; Sangild, Per T; Thymann, Thomas

    2016-03-01

    Preterm infants are susceptible to infection and necrotizing enterocolitis (NEC) and are often treated with antibiotics. Simultaneous administration of enteral and parenteral antibiotics during the first days after preterm birth prevents formula-induced NEC lesions in pigs, but it is unknown which administration route is most effective. We hypothesized that only enteral antibiotics suppress gut bacterial colonization and NEC progression in formula-fed preterm pigs. Caesarean-delivered preterm pigs (90-92% of gestation) were fed increasing amounts of infant formula from birth to day 5 and given saline (CON) or antibiotics (ampicillin, gentamicin, and metronidazole) via the enteral (ENT) or parenteral (PAR) route (n = 16-17). NEC lesions, intestinal morphology, function, microbiology, and inflammatory mediators were evaluated. NEC lesions were completely prevented in ENT pigs, whereas there were high incidences of mild NEC lesions (59-63%) in CON and PAR pigs (P < 0.001). ENT pigs had elevated intestinal weight, villus height/crypt depth ratio, and goblet cell density and reduced gut permeability, mucosal adherence of bacteria, IL-8 levels, colonic lactic acid levels, and density of Gram-positive bacteria, relative to CON pigs (P < 0.05). Values in PAR pigs were intermediate with few affected parameters (reduced lactic acid levels and density and adherence of Gram-positive bacteria, relative to CON pigs, P < 0.05). There was no evidence of increased antimicrobial resistance following the treatments. We conclude that enteral, but not parenteral, administration of antibiotics reduces gut bacterial colonization, inflammation, and NEC lesions in newborn, formula-fed preterm pigs. Delayed colonization may support intestinal structure, function, and immunity in the immediate postnatal period of formula-fed preterm neonates.

  3. Impact of new-generation lipid emulsions on cellular mechanisms of parenteral nutrition-associated liver disease.

    PubMed

    Burrin, Douglas G; Ng, Ken; Stoll, Barbara; Sáenz De Pipaón, Miguel

    2014-01-01

    Parenteral nutrition (PN) is a life-saving nutritional support for a large population of hospitalized infants, and lipids make a substantial contribution to their energy and essential fatty acid (FA) needs. A challenge in the care of these infants is that their metabolic needs require prolonged PN support that increases the risk of PN-associated liver disease (PNALD). In recent years, the emergence of new parenteral lipid emulsions containing different source lipids and FA profiles has created nutritional alternatives to the first-generation, soybean oil-based lipid emulsion Intralipid. The limited U.S. introduction of the new-generation fish-oil emulsion Omegaven has generated promising results in infants with PNALD and spawned a renewed interest in how PN and lipid emulsions, in particular, contribute to this disease. Studies suggest that the lipid load and constituents, such as specific FAs, ratio of n-3 (ω-3) to n-6 (ω-6) long-chain polyunsaturated FAs, phytosterols, and vitamin E content, may be involved. There is an existing literature describing the molecular mechanisms whereby these specific nutrients affect hepatic metabolism and function via lipid and bile acid sensing nuclear receptors, such as peroxisome proliferator-activated receptor α, liver X receptor, and farnesoid X receptor, yet virtually no information as to how they interact and modulate liver function in the context of PN in pediatric patients or animal models. This article will review the recent development of parenteral lipid emulsions and their influence on PNALD and highlight some of the emerging molecular mechanisms that may explain the effects on liver function and disease.

  4. Organisation, regulations, preparation and logistics of parenteral nutrition in hospitals and homes; the role of the nutrition support team - Guidelines on Parenteral Nutrition, Chapter 8.

    PubMed

    Bischoff, S C; Kester, L; Meier, R; Radziwill, R; Schwab, D; Thul, P

    2009-11-18

    PN (parenteral nutrition) should be standardised to ensure quality and to reduce complications, and it should be carried out in consultation with a specialised nutrition support team whenever possible. Interdisciplinary nutrition support teams should be established in all hospitals because effectiveness and efficiency in the implementation of PN are increased. The tasks of the team include improvements of quality of care as well as enhancing the benefit to cost ratio. Therapeutic decisions must be taken by attending physicians, who should collaborate with the nutrition support team. "All-in-One" bags are generally preferred for PN in hospitals and may be industrially manufactured, industrially manufactured with the necessity to add micronutrients, or be prepared "on-demand" within or outside the hospital according to a standardised or individual composition and under consideration of sterile and aseptic conditions. A standardised procedure should be established for introduction and advancement of enteral or oral nutrition. Home PN may be indicated if the expected duration of when PN exceeds 4 weeks. Home PN is a well established method for providing long-term PN, which should be indicated by the attending physician and be reviewed by the nutrition support team. The care of home PN patients should be standardised whenever possible. The indication for home PN should be regularly reviewed during the course of PN.

  5. PIPIDA scintigraphy for cholecystitis: false positives in alcoholism and total parenteral nutrition

    SciTech Connect

    Shuman, W.P.; Gibbs, P.; Rudd, T.G.; Mack, L.A.

    1982-01-01

    A review of gallbladder scintigraphy in patients with potentially compromised hepatobiliary function revealed two groups in whom cholecystitis might be mistakenly diagnosed. In 200 consecutive hospitalized patients studied with technetium-99m-PIPIDA for acute cholecystitis or cholestasis, there were 41 alcoholics and 17 patients on total parenteral nutrition. In 60% of the alcoholics and 92% of those on parenteral nutrition, absent or delayed visualization of the gallbladder occurred without physical or clinical evidence of cholecystitis. A cholecystagogue, sincalide, did not prevent the false-positive features which presumably are due to altered bile flow kinetics related to alcoholism and parenteral nutrition. Four patients on parenteral nutrition undergoing cholecystectomy for suspected cholecystitis had normal gallbladders filled with jellylike viscous thick bile. A positive (nonvisualized or delayed visualized) gallbladder PIPIDA scintigram in these two populations should not be interpreted as indicating a need for cholecystectomy.

  6. Validating hyperbilirubinemia and gut mucosal atrophy with a novel ultramobile ambulatory total parenteral nutrition piglet model

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Total parenteral nutrition (TPN) provides all nutrition intravenously. Although TPN therapy has grown enormously, it causes significant complications, including gut and hepatic dysfunction. Current models use animal tethering which is unlike ambulatory human TPN delivery and is cost prohibitive. We ...

  7. Parenteral nutrition product shortages: the A.S.P.E.N. strategy.

    PubMed

    Mirtallo, Jay M; Holcombe, Beverly; Kochevar, Marty; Guenter, Peggi

    2012-06-01

    Product (drug) shortages have had a significant impact on the healthcare system, particularly on patients and clinicians. This has been especially true with patients requiring parenteral nutrition (PN). The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) has dealt with PN product shortages in the past on behalf of its members and their patients. However, the shortage severity and duration have made dealing with the PN product shortages in 2010-2012 extremely challenging.

  8. Parenteral buprenorphine-naloxone abuse is a major cause of fatal buprenorphine-related poisoning.

    PubMed

    Häkkinen, Margareeta; Heikman, Pertti; Ojanperä, Ilkka

    2013-10-10

    Buprenorphine (BPN) medication for opioid maintenance treatment in Finland consists predominantly of buprenorphine-naloxone (BNX). Both BPN and BNX are associated with diversion, abuse and non-medically supervised use worldwide. Our purpose was to estimate the proportion of BNX to all BPN-related fatalities. The material consisted of 225 deceased drug abusers in Finland from January 2010 to June 2011 with a positive BPN and/or norbuprenorphine (NOR) and/or naloxone (NX) finding in urine. The data were divided into three groups based on the urine NX and BPN concentrations. The "Parenteral BNX" group (>100 μg/l NX) was presumed to consist of injecting or snorting BNX abusers and the "Parenteral BPN" group (>50 μg/l BPN, 0 μg/l NX) of injecting or snorting BPN abusers, while the "Other BNX or BPN" group (≤100 μg/l NX, or ≤50 μg/l BPN combined with 0 μg/l NX) was presumed to consist of mainly sublingual BNX or BPN users. In 12.4% of cases the NX urine concentration was higher than the threshold 100 μg/l. In fatal BPN poisonings, the proportion of parenteral BNX was 28.4%. In the "Parenteral BNX", "Parenteral BPN" and "Other BNX or BPN" groups, the proportion of fatal BPN poisonings was 67.9, 31.0 and 22.6%, respectively. BNX abuse can be fatal. Among the 225 BPN-related fatalities, parenteral abuse of BNX was shown to be common (12.4%) and BNX poisoning was the underlying cause of death in 8.4%. Parenteral BNX caused fatal BPN poisoning proportionally more often than parenteral BPN.

  9. Home parenteral nutrition in management of patients with severe radiation enteritis

    SciTech Connect

    Lavery, I.C.; Steiger, E.; Fazio, V.W.

    1980-03-01

    Five patients who would have been unable to survive because of intestinal complications of radiation therapy were able to lead an otherwise normal life with the use of parenteral nutrition administered at home. One patient died of recurrent carcinoma of the cervix after 14 months. Another patient died as the result of a totally avoidable pharmaceutical error after 2 1/2 years. The remaining three are still disease free without morbidity relating to the parenteral nutrition.

  10. An advanced protocol-driven transition from parenteral prostanoids to inhaled trepostinil in pulmonary arterial hypertension

    PubMed Central

    Agarwal, Manyoo; Rischard, Franz; De Marco, Teresa

    2016-01-01

    Abstract Patients with pulmonary arterial hypertension (PAH) often require parenteral prostanoids to improve symptoms and signs of PAH. Complications of parenteral prostanoids—such as catheter-related infections and intolerable adverse effects—may develop, prompting transition to inhaled prostanoids. We report a prospective, protocol-driven transition from parenteral prostanoids to inhaled prostanoids with monitoring of exercise gas exchange and acute hemodynamics. Three PAH centers recruited patients transitioning from parenteral prostanoids to inhaled trepostinil. Rigid inclusion criteria were used, including parenteral prostanoid dose < 30 ng/kg/min, New York Heart Association functional class (FC) < 3, and pulmonary vascular resistance (PVR) < 6 Wood units. Of the 9 patients meeting initial inclusion criteria, 3 were excluded. In the remaining patients, the parenteral prostanoid was reduced and the inhaled prostanoid was increased over 24–36 hours with continuous hemodynamic monitoring. Exercise capacity and FC were measured at baseline and weeks 1, 4, and 12. All patients were successfully weaned from parenteral prostanoids. An acute PVR decrease was seen with most inhaled prostanoid doses, but PVR varied throughout the transition. Patients tolerated inhaled prostanoids for 9–12 breaths 4 times a day with no treatment-limiting adverse events. At week 12, FC was unchanged, and all patients continued to receive inhaled prostanoids without serious adverse events or additional PAH therapy. In 5 of 6 patients, 6-minute walk distance and peak V˙O2 were within 10% of baseline. Using a strict transition protocol and rigid patient selection criteria, the parenteral prostanoid to inhaled prostanoid transition appeared safe and well tolerated and did not result in clinical deterioration over 12 weeks. Hemodynamic variability noted acutely during transition in our study did not adversely affect successful transition. (Trial registration: Clinical

  11. Selected pharmacokinetic issues of the use of antiepileptic drugs and parenteral nutrition in critically ill patients

    PubMed Central

    2010-01-01

    Objectives To conduct a systematic review for the evidence supporting or disproving the reality of parenteral nutrition- antiepileptic drugs interaction, especially with respect to the plasma protein-binding of the drug. Methods The articles related to the topic were identified through Medline and PubMed search (1968-Feburary 2010) for English language on the interaction between parenteral nutrition and antiepileptic drugs; the search terms used were anti-epileptic drugs, parenteral nutrition, and/or interaction, and/or in vitro. The search looked for prospective randomized and nonrandomized controlled studies; prospective nonrandomized uncontrolled studies; retrospective studies; case reports; and in vitro studies. Full text of the articles were then traced from the Universiti Sains Malaysia (USM) library subscribed databases, including Wiley-Blackwell Library, Cochrane Library, EBSCOHost, OVID, ScienceDirect, SAGE Premier, Scopus, SpringerLINK, and Wiley InterScience. The articles from journals not listed by USM library were traced through inter library loan. Results There were interactions between parenteral nutrition and drugs, including antiepileptics. Several guidelines were designed for the management of illnesses such as traumatic brain injuries or cancer patients, involving the use of parenteral nutrition and antiepileptics. Moreover, many studies demonstrated the in vitro and in vivo parenteral nutrition -drugs interactions, especially with antiepileptics. Conclusions There was no evidence supporting the existence of parenteral nutrition-antiepileptic drugs interaction. The issue has not been studied in formal researches, but several case reports and anecdotes demonstrate this drug-nutrition interaction. However, alteration in the drug-free fraction result from parenteral nutrition-drug (i.e. antiepileptics) interactions may necessitate scrupulous reassessment of drug dosages in patients receiving these therapies. This reassessment may be particularly

  12. Early Adult Outcomes of Male Arrest Trajectories: Propensity versus Causation Effects

    PubMed Central

    Wiesner, Margit; Capaldi, Deborah M.; Kim, Hyoun K.

    2013-01-01

    This study examined early adult outcomes of differing arrest trajectories across childhood through early adulthood that were identified in prior work for 197 at-risk young men. Early adult outcomes were assessed at ages 27-28 to 29-30 years. Predictive effects of arrest trajectory membership on outcomes were examined after controlling for various factors, including prior levels and early antisocial propensity. As early adults, both chronic offender groups showed poorer adjustment in terms of deviant peer affiliation, education, and work domains than did the Rare Offenders; High-Level Chronic Offenders stood out from all other groups in terms of mental health problems and physical aggression toward a partner. These effects represent plausible causal effects of developmental pathways of offending on the outcomes. Evidence for propensity effects on the outcomes was more limited. Theoretical and prevention implications are discussed. PMID:23730147

  13. Dropping stones in magma oceans - Effects of early lunar cratering

    NASA Technical Reports Server (NTRS)

    Hartmann, W. K.

    1980-01-01

    A new methodology is used to calculate the accumulation rate of megaregolith materials for two models of early lunar cratering, both with and without episodes of late cataclysmic cratering. Results show that the pulverization of early rock layers was an important process competing with the formation of a coherent rock lithosphere at the surface of the hypothetical lunar magma ocean. If a magma ocean existed, then its initial cooling was marked by a period of pre-lithospheric chaos in which impacts punched through the initially thin rocky skin, mixing rock fragments with splashed magma. Furthermore, the results show that intense brecciation and pulverization of rock materials must have occurred to a depth of at least tens of kilometers in the first few hundred years of lunar history regardless of whether a 'terminal lunar cataclysm' occurred around 4.0 G.y. ago. The predicted pattern of brecciation and the ages of surviving rock fragments is similar to that actually observed among lunar samples. More reliable dating of basin-forming events and models of rock exhumation and survival are needed in order to understand better the relation between the early intense bombardment of the moon and the samples collected on the moon today.

  14. Parenteral iron therapy: a single institution's experience over a 5-year period.

    PubMed

    Laman, Christopher A; Silverstein, Scott B; Rodgers, George M

    2005-11-01

    Many patients require parenteral iron therapy for optimal correction of anemia, including cancer patients who require erythropoietic drugs. Available parenteral iron therapy options include iron dextran, iron gluconate, and iron sucrose. The purpose of this study is to summarize our institution's experience with parenteral iron therapy over a 5-year period, with a focus on comparative safety profiles. All patients receiving parenteral iron therapy over this period were included in the analysis. Chi-squared test and Fisher's exact test were used to compare the adverse event rates of each product. A total of 121 patients received 444 infusions of parenteral iron over this period. Iron dextran was the most commonly used product (85 patients) and iron sucrose was the least used (2 patients). Iron gluconate was used by 34 patients. Overall adverse event rates per patient with iron dextran and iron gluconate were 16.5% and 5.8%, respectively (P = .024). Premedication with diphenhydramine and acetaminophen before infusions of iron dextran reduced adverse event rates per infusion from 12.3% to 4.4% (P = .054). Test doses of iron dextran were used 88% of the time for initial infusions of iron dextran. All adverse events for all parenteral iron products were mild or moderate. There were no serious adverse events and no anaphylaxis was observed. Our results suggest that, if test doses and premedications are used, iron dextran is an acceptable product to treat iron deficiency.

  15. Glutamine Supplementation of Parenteral Nutrition Does Not Improve Intestinal Permeability, Nitrogen Balance, or Outcome in Newborns and Infants Undergoing Digestive-Tract Surgery

    PubMed Central

    Albers, Marcel J. I. J.; Steyerberg, Ewout W.; Hazebroek, Frans W. J.; Mourik, Marjan; Borsboom, Gerard J. J. M.; Rietveld, Trinet; Huijmans, Jan G. M.; Tibboel, Dick

    2005-01-01

    Objective: To assess the effect of isocaloric isonitrogenous parenteral glutamine supplementation on intestinal permeability and nitrogen loss in newborns and infants after major digestive-tract surgery. Summary Background Data: Glutamine supplementation in critically ill and surgical adults may normalize intestinal permeability, attenuate nitrogen loss, improve survival, and lower the incidence of nosocomial infections. Previous studies in critically ill children were limited to very-low-birthweight infants and had equivocal results. Methods: Eighty newborns and infants were included in a double-blind, randomized trial comparing standard parenteral nutrition (sPN; n = 39) to glutamine-supplemented parenteral nutrition (GlnPN; glutamine target intake, 0.4 g kg−1 day−1; n = 41), starting on day 2 after major digestive-tract surgery. Primary endpoints were intestinal permeability, as assessed by the urinary excretion ratio of lactulose and rhamnose (weeks 1 through 4); nitrogen balance (days 4 through 6), and urinary 3-methylhistidine excretion (day 5). Secondary endpoints were mortality, length of stay in the ICU and the hospital, number of septic episodes, and usage of antibiotics and ICU resources. Results: Glutamine intake plateaued at 90% of the target on day 4. No differences were found between patients assigned sPN and patients assigned GlnPN regarding any of the endpoints. Glutamine supplementation was not associated with adverse effects. Conclusions: In newborns and infants after major digestive-tract surgery, we did not identify beneficial effects of isonitrogenous, isocaloric glutamine supplementation of parenteral nutrition. Glutamine supplementation in these patients therefore is not warranted until further research proves otherwise. PMID:15798461

  16. [Nutritive provision of children during intensive therapy in the early post-aggressive period].

    PubMed

    Uglitskikh, A K

    2007-01-01

    The purpose of the study conducted at the intensive care units (ICI) of a Tushino children's city hospital (CCH), Moscow, in 2000-2005, was to enhance the efficiency of treatment in children with brain injuries, severe pneumonias, or appendicitis-induced peritonitis in the early postaggression period, by optimizing their feeding. Examination of 224 patients aged 1 month to 15 years, treated at the ICI of the Tushino CCH for brain injuries, severe pneumonias, or appendicitis-induced peritonitis in 2000-2005, indicated that mixed (parenteral and enteral) feeding was more effective in children in the early postaggression period than enteral feeding. Consideration of the size of protein losses and the amount of dietary protein and energy and estimation of nitrogen balance revealed that, by increasing the amount of dietary protein and energy, lowering protein losses, and thus producing positive changes in nitrogen balance, higher blood glucose decrease rates, and in a number of anthropometric and somatometric indices, mixed (parenteral and enteral) feeding is an effective method of nutritive provision in children at an intensive care unit.

  17. Sedating the apprehensive debilitated patients for dental procedures by combining parenteral sedation and hypnosis with supplemental acupuncture therapy.

    PubMed

    Lu, Dominic P; Wu, Ping-Shi; Lu, Winston I

    2012-01-01

    Treating apprehensive debilitated patients (i.e. geriatric patients, patients with cardiac, pulmonary, kidney, or liver diseases, and those with other severe systemic conditions) for dental procedures can cause unexpected medical complications such as cardiac arrest, stroke, asthma or shock, etc. Due to diminishing functional capacities of their organs, sedating those patients with sedative drugs in normal regular dosage could increase the risk of adverse events for this group of patients and can also increase the risk of liability for the clinician. The authors treated 34 apprehensive dental patients with a combination technique using parenteral sedation and hypnosis together with acupuncture. We used Bi-Digital O-Ring Test (BDORT) to select the compatible sedative drugs and to individualize the dosage suitable to the patient's medical condition. Oftentimes, BDORT predetermined dosage amounts to a fraction of regular dosage that is normally recommended by manufacturer for regular healthy patients. Such a reduced dosage, though benign to patient, may be insufficient to render a patient to the sedation level for dental treatment. Nevertheless, hypnosis with acupuncture can be applied to potentiate the therapeutic effect of parenteral sedation, thereby reducing the amount of sedative agents required to alleviate patient anxiety. The results indicated that hypnosis with acupuncture and BDORT could effectively allow the reduction of the sedative dosage and may beneficially provide a safe and comfortable situation for the debilitated patients to receive the necessary treatment.

  18. Aggressive parenteral nutrition and growth velocity in preterm infants.

    PubMed

    Ribed Sánchez, Almudena; Romero Jiménez, Rosa Ma; Sánchez Gómez de Orgaz, Ma Carmen; Sánchez Luna, Manuel; Sanjurjo Sáez, María

    2013-11-01

    Introducción: La administración parenteral de nutrientes para mantener el crecimiento en recién nacidos representa un importante reto terapéutico. Objetivo: Describir las prácticas de nutrición parenteral (NP) en un hospital de tercer nivel y evaluar el crecimiento postnatal en recién nacidos prematuros. Material y métodos: Estudio observacional retrospectivo de 3 meses de duración. Se incluyeron niños ingresados en el Servicio de Neonatología que iniciaron NP. Se recogieron datos demográficos, antropométricos, calorías diarias, ingesta de proteínas y componentes de la NP. La velocidad de crecimiento se midió mediante la media de la ganancia diaria de peso y se comparó con el crecimiento intrauterino. Resultados: 68 niños prematuros iniciaron NP durante el período de estudio. La mayoría de los niños (65%) nacieron por cesárea y la media de edad gestacional fue de 33 semanas. El 25% de los recién nacidos no recuperó el peso de nacimiento. El 75% restante recuperó el peso de nacimiento en el tercer día de NP y la media de la ganancia diaria de peso fue de 16 g/kg/d, con un rango de 12 a 22g/kg/d. A pesar de que la ganancia de peso se acercó a la tasa intrauterina, la mayoría de los niños nacidos con menos de 30 semanas de gestación no lograron la media de la población de referencia. La NP precoz e intensiva se administró con una media de 3, 11 y 3g/Kg/d de proteínas, hidratos de carbono y lípidos, respectivamente, alcanzando un máximo en el cuarto día de 4, 18, 4 g/kg/d, respectivamente. Discusión: La NP intensiva se utiliza en el ámbito hospitalario. Los recién nacidos prematuros alcanzaron antes el peso de nacimiento y presentaron una velocidad de crecimiento mayor que en otros estudios y similar al crecimiento intrauterino.

  19. Effects of Early Surgical Exploration in Suspected Barotraumatic Perilymph Fistulas

    PubMed Central

    Park, Ga Young; Byun, HaYoung; Moon, Il Joon; Hong, Sung Hwa; Cho, Yang-Sun

    2012-01-01

    Objectives Treatment of traumatic perilymph fistula (PLF) remains controversial between surgical repair and conservative therapy. The aim of this study is to analyze the outcomes of early surgical exploration in suspected barotraumatic PLF. Methods Nine patients (10 cases) who developed sudden sensorineural hearing loss and dizziness following barotrauma and underwent surgical exploration with the clinical impression of PLF were enrolled. Types of antecedent trauma, operative findings, control of dizziness after surgery, postoperative hearing outcomes, and relations to the time interval between traumatic event and surgery were assessed retrospectively. Results All patients had sudden or progressive hearing loss and dizziness following trauma. Types of barotrauma were classified by the origin of the trauma: 4 external (car accident, slap injury) and 6 internal traumas (lifting, nasal blowing, straining). Surgical exploration was performed whenever PLF was suspected with the time interval of 2 to 47 days after the trauma. The possible evidence of PLF was found during surgery in 9 cases: a fibrous web around the oval window (n=3), fluid collection in the round window (RW; n=6) and bulging of the RW pseudomembrane (n=1). In every patient, vestibular symptoms disappeared immediately after surgery. The hearing was improved with a mean gain of 27.0±14.9 dB. When the surgical exploration was performed as early as less than 10 days after the trauma, serviceable hearing (≤40 dB) was obtained in 4 out of 7 cases (57.1%). Conclusion Sudden or progressive sensorineural hearing loss accompanied by dizziness following barotrauma should prompt consideration of PLF. Early surgical exploration is recommended to improve hearing and vestibular symptoms. PMID:22737287

  20. The lifelong effects of early childhood adversity and toxic stress.

    PubMed

    Shonkoff, Jack P; Garner, Andrew S

    2012-01-01

    Advances in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our understanding of health and disease across the lifespan. This converging, multidisciplinary science of human development has profound implications for our ability to enhance the life prospects of children and to strengthen the social and economic fabric of society. Drawing on these multiple streams of investigation, this report presents an ecobiodevelopmental framework that illustrates how early experiences and environmental influences can leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term health. The report also examines extensive evidence of the disruptive impacts of toxic stress, offering intriguing insights into causal mechanisms that link early adversity to later impairments in learning, behavior, and both physical and mental well-being. The implications of this framework for the practice of medicine, in general, and pediatrics, specifically, are potentially transformational. They suggest that many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood. An ecobiodevelopmental framework also underscores the need for new thinking about the focus and boundaries of pediatric practice. It calls for pediatricians to serve as both front-line guardians of healthy child development and strategically positioned, community leaders to inform new science-based strategies that build strong foundations for educational achievement, economic productivity, responsible citizenship, and lifelong health.

  1. Potential neural mechanisms underlying the effectiveness of early intervention for children with autism spectrum disorder.

    PubMed

    Sullivan, Katherine; Stone, Wendy L; Dawson, Geraldine

    2014-11-01

    Although evidence supports the efficacy of early intervention for improving outcomes for children with autism spectrum disorder (ASD), the mechanisms underlying their effectiveness remain poorly understood. This paper reviews the research literature on the neural bases of the early core deficits in ASD and proposes three key features of early intervention related to the neural mechanisms that may contribute to its effectiveness in improving deficit areas. These features include (1) the early onset of intensive intervention which capitalizes on the experience-expectant plasticity of the immature brain, (2) the use of treatment strategies that address core deficits in social motivation through an emphasis on positive social engagement and arousal modulation, and (3) promotion of complex neural networks and connectivity through thematic, multi-sensory and multi-domain teaching approaches. Understanding the mechanisms of effective early intervention will enable us to identify common or foundational active ingredients for promoting optimal outcomes in children with ASD.

  2. Potential neural mechanisms underlying the effectiveness of early intervention for children with autism spectrum disorder

    PubMed Central

    Sullivan, Katherine; Stone, Wendy L.; Dawson, Geraldine

    2014-01-01

    Although evidence supports the efficacy of early intervention for improving outcomes for children with autism spectrum disorder (ASD), the mechanisms underlying their effectiveness remain poorly understood. This paper reviews the research literature on the neural bases of the early core deficits in ASD and proposes three key features of early intervention related to the neural mechanisms that may contribute to its effectiveness in improving deficit areas. These features include (1) the early onset of intensive intervention which capitalizes on the experience-expectant plasticity of the immature brain, (2) the use of treatment strategies that address core deficits in social motivation through an emphasis on positive social engagement and arousal modulation, and (3) promotion of complex neural networks and connectivity through thematic, multi-sensory and multi-domain teaching approaches. Understanding the mechanisms of effective early intervention will enable us to identify common or foundational active ingredients for promoting optimal outcomes in children with ASD. PMID:25108609

  3. An outcomes analysis of outpatient parenteral antibiotic therapy (OPAT) in a large Asian cohort.

    PubMed

    Seetoh, Theresa; Lye, David C; Cook, Alex R; Archuleta, Sophia; Chan, Monica; Sulaiman, Zuraidah; Zhong, Lihua; Llorin, Ryan M; Balm, Michelle; Fisher, Dale

    2013-06-01

    Outpatient parenteral antibiotic therapy (OPAT) facilitates early discharge, easing demands on inpatient resources and allowing patients the opportunity to restore home life. In Singapore, two large hospitals established a common prospective database in 2006. This study presents an analysis of all enrolled cases over 6 years to consider factors potentially causing adverse outcomes. In this prospective observational study, patients' first OPAT episodes, from initiation to completion, re-admission or early cessation, were recorded and analysed using Cox regression to identify factors associated with clinical deterioration leading to unplanned hospital re-admission. Of 2229 first episodes, 1874 (84.1%) completed treatment in OPAT as planned; 201 episodes (9.0%) were complicated by clinical deterioration and re-admitted. Other patients who failed to complete treatment were either re-admitted for elective procedures, experienced adverse drug reactions or peripherally inserted central catheter-related complications, or had other reasons for not completing treatment. Increased risk of clinical deterioration was associated with homecare OPAT (aHR=2.5, 95% CI 1.7-3.8; P<0.001), age >70 years (aHR=1.6, 95% CI 1.1-2.2; P=0.008) and non-private care (aHR=1.8, 95% CI 1.0-3.0; P=0.033). Diagnosis and type of antibiotic treatment were not significant risk factors for re-admission. OPAT provides intravenous antibiotics to those who would otherwise remain as hospital inpatients. In this large Asian cohort, clinical factors did not relate to the ability of patients to complete their treatment in OPAT. Criteria identified as significant warrant ongoing consideration as patients are assessed for acceptance into OPAT programmes.

  4. Can Parents' Involvement in Children's Education Offset the Effects of Early Insensitivity on Academic Functioning?

    ERIC Educational Resources Information Center

    Monti, Jennifer D.; Pomerantz, Eva M.; Roisman, Glenn I.

    2014-01-01

    Data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,312) were analyzed to examine whether the adverse effects of early insensitive parenting on children's academic functioning can be offset by parents' later involvement in children's education. Observations of mothers' early…

  5. The Effectiveness of Family Involvement in Early Childhood Programmes: Perceptions of Kindergarten Principals and Teachers

    ERIC Educational Resources Information Center

    Ihmeideh, Fathi; Oliemat, Enass

    2015-01-01

    Family involvement can no longer be considered a luxury but is rather a main component of early childhood programmes. The purpose of this study is to explore the effectiveness of family involvement in early childhood programmes in Jordan. In total, 84 kindergarten principals and 276 teachers participated in the study. To achieve the study…

  6. The Effect of Professional Learning on Early Algebra Teachers' Content Knowledge in Nigeria

    ERIC Educational Resources Information Center

    Ladele, Omolola; Ormond, Christine; Hackling, Mark

    2014-01-01

    Teachers' knowledge of the early algebra content that is to be taught is crucial for effective pedagogy and ensuring that the students' understanding of early algebra is not flawed. This article reports the findings of two of the activities that a group of in-service teachers participated in during a professional learning intervention program that…

  7. "Te Whariki", the New Zealand Early Childhood Curriculum: Is It Effective?

    ERIC Educational Resources Information Center

    Blaiklock, Ken

    2010-01-01

    "Te Whariki", the New Zealand early childhood curriculum, has received much praise since its introduction in 1996. There is, however, little research evidence about the implementation or effectiveness of the curriculum in early childhood centres. This article raises questions about the structure and content of "Te Whariki". The…

  8. Early Number Skills: Examining the Effects of Class-Wide Interventions on Kindergarten Performance

    ERIC Educational Resources Information Center

    Codding, Robin S.; Chan-Iannetta, Lisa; George, Shauna; Ferreira, Kristine; Volpe, Robert

    2011-01-01

    The purpose of this study was to use multilevel modeling to compare the effects of KPALS alone and combined with goal setting and reinforcement to a control condition on early numeracy performance of 96 kindergarteners. Demographic variables were examined as moderators. Results differed according to early numeracy measure, with both versions of…

  9. Using the Teaching and Guidance Policy Essentials Checklist to Build and Support Effective Early Childhood Systems

    ERIC Educational Resources Information Center

    Garrity, Sarah M.; Longstreth, Sascha L.; Salcedo-Potter, Nina S.; Staub, April

    2016-01-01

    The prevalence of preschool expulsion, coupled with racial disparities in expulsion rates and the potential long term negative effects of challenging behaviors in the early years, has created an urgent need to build early childhood systems to address these issues. The teaching and guidance policy essentials checklist (TAG-PEC) has been developed…

  10. Effects of hydroelectric turbine passage on fish early life stages

    SciTech Connect

    Cada, G.F.

    1991-01-01

    Turbine-passage mortality has been studied extensively for juveniles and adults of migratory fish species, but few studies have directly quantified mortality of fish eggs and larvae. An analysis of literature relating to component stresses of turbine passage (i.e., pressure changes, blade contact, and shear) indicates that mortality of early life stages of fish would be relatively low at low-head, bulb turbine installations. The shear forces and pressure regimes normally experienced are insufficient to cause high mortality rates. The probability of contact with turbine blades is related to the size of the fish; less than 5% of entrained ichthyoplankton would be killed by the blades in a bulb turbine. Other sources of mortality (e.g., cavitation and entrainment of fish acclimated to deep water) are controlled by operation of the facility and thus are mitigable. Because turbine-passage mortality among fish early life stages can be very difficult to estimate directly, it may be more fruitful to base the need for mitigation at any given site on detailed knowledge of turbine characteristics and the susceptibility of the fish community to entrainment. 7 refs., 1 fig.

  11. Childhood to Early-Midlife Systolic Blood Pressure Trajectories: Early-Life Predictors, Effect Modifiers, and Adult Cardiovascular Outcomes.

    PubMed

    Theodore, Reremoana F; Broadbent, Jonathan; Nagin, Daniel; Ambler, Antony; Hogan, Sean; Ramrakha, Sandhya; Cutfield, Wayne; Williams, Michael J A; Harrington, HonaLee; Moffitt, Terrie E; Caspi, Avshalom; Milne, Barry; Poulton, Richie

    2015-12-01

    Previous studies examining blood pressure change over time have modeled an average population trajectory. Recent research among older adults suggests there may be subgroups with different blood pressure trajectories. Identifying subgroups at risk of developing adult hypertension early in life can inform effective risk reduction efforts. We sought to identify different systolic blood pressure trajectories from childhood, their correlated risk factors, and early-midlife cardiovascular outcomes. Blood pressure data at ages 7, 11, 18, 26, 32, and 38 years from a longitudinal, representative birth cohort study (n=975) were used to identify 4 distinct trajectory groups via group-based trajectory modeling: normal (21.8%), high-normal (43.3%), prehypertensive (31.6%), and hypertensive (4.2%). The categories refer to blood pressure beginning at the age of 7 years and most recently measured at the age of 38 years. Family history of high blood pressure (odds ratio [OR], 43.23; 95% confidence interval [CI], 5.27-354.65), male sex (OR, 109.48; 95% CI, 26.82-446.96), being first born (OR, 2.5; 95% CI, 1.00-8.69) and low birth weight (OR, 2.79; 95% CI, 2.49-3.09) were associated with hypertensive group membership (compared with the normal group). Higher body mass index and cigarette smoking resulted in increasing blood pressure across trajectories, particularly for the higher blood pressure groups. Prehypertensive and hypertensive trajectory groups had worse cardiovascular outcomes by early midlife. Harmful blood pressure trajectories are identifiable in childhood, associated with both antecedent and modifiable risk factors over time, and predict adult cardiovascular disease risk. Early detection and subsequent targeted prevention and intervention may reduce the lifecourse burden associated with higher blood pressure.

  12. CHILDHOOD TO EARLY MID-LIFE SYSTOLIC BLOOD PRESSURE TRAJECTORIES: EARLY LIFE PREDICTORS, EFFECT MODIFIERS, AND ADULT CARDIOVASCULAR OUTCOMES

    PubMed Central

    Theodore, Reremoana F; Broadbent, Jonathan; Nagin, Daniel; Ambler, Antony; Hogan, Sean; Ramrakha, Sandhya; Cutfield, Wayne; Williams, Michael J A; Harrington, HonaLee; Moffitt, Terrie E; Caspi, Avshalom; Milne, Barry; Poulton, Richie

    2015-01-01

    Previous studies examining blood pressure change over time have modelled an “average” population trajectory. Recent research among older adults suggests there may be subgroups with different blood pressure trajectories. Identifying subgroups at risk of developing adult hypertension early in life can inform effective risk reduction efforts. We sought to identify different systolic blood pressure trajectories from childhood, their correlated risk factors and early midlife cardiovascular outcomes. Blood pressure data at ages 7, 11, 18, 26, 32 and 38 years from a longitudinal, representative birth cohort study (n=975) were used to identify four distinct trajectory groups via group-based trajectory modeling: ‘normal’ (21.8%), ‘high-normal’ (43.3%), ‘prehypertensive’ (31.6%), and ‘hypertensive’ (4.2%). The categories refer to blood pressure beginning at age 7 and most recently measured at age 38. Family history of high blood pressure (OR=43.23, 95% CI 5.27, 354.65), male gender (OR=109.48, 95% CI=26.82, 446.96), being first born (OR=2.5 95% CI=1.00, 8.69) and low birthweight (OR=2.79, 95% CI 2.49, 3.09) were associated with hypertensive group membership (compared to the normal group). Higher body mass index and cigarette smoking resulted in increasing blood pressure across trajectories, particularly for the higher blood pressure groups. Prehypertensive and hypertensive trajectory groups had worse cardiovascular outcomes by early midlife. Harmful blood pressure trajectories are identifiable in childhood, associated with both antecedent and modifiable risk factors over time, and predict adult cardiovascular disease risk. Early detection, subsequent targeted prevention and/or intervention may reduce the lifecourse burden associated with higher blood pressure. PMID:26558818

  13. Medicare program; replacement of reasonable charge methodology by fee schedules for parenteral and enteral nutrients, equipment, and supplies. Final rule.

    PubMed

    2001-08-28

    This final rule implements fee schedules for payment of parenteral and enteral nutrition (PEN) items and services furnished under the prosthetic device benefit, defined in section 1861(s)(8) of the Social Security Act. The authority for establishing these fee schedules is provided by the Balanced Budget Act of 1997, which amended the Social Security Act at section 1842(s). Section 1842(s) of the Social Security Act specifies that statewide or other area wide fee schedules may be implemented for the following items and services still subject to the reasonable charge payment methodology: medical supplies; home dialysis supplies and equipment; therapeutic shoes; parenteral and enteral nutrients, equipment, and supplies; electromyogram devices; salivation devices; blood products; and transfusion medicine. This final rule describes changes made to the proposed fee schedule payment methodology for these items and services and provides that the fee schedules for PEN items and services are effective for all covered items and services furnished on or after January 1, 2002. Fee schedules will not be implemented for electromyogram devices and salivation devices at this time since these items are not covered by Medicare. In addition, fee schedules will not be implemented for medical supplies, home dialysis supplies and equipment, therapeutic shoes, blood products, and transfusion medicine at this time since the data required to establish these fee schedules are inadequate.

  14. Home Parenteral Nutrition: Fat Emulsions and Potential Complications.

    PubMed

    Mundi, Manpreet S; Salonen, Bradley R; Bonnes, Sara

    2016-10-01

    Since the first intravenous nutrition support attempt with olive oil in the 17th century, intravenous fat emulsions (IVFEs) have evolved to become an integral component in the management of patients receiving home parenteral nutrition (HPN). IVFEs serve as a calorie source and provide essential fatty acids (linoleic acid and α-linolenic acid) in patients unable to achieve adequate intake of these fatty acids through alternative means. However, IVFE use is also associated with multiple complications, including increased infection risk, liver disease, and systemic proinflammatory states. In the United States, most IVFEs are composed of 100% soybean oil; internationally multiple alternative IVFEs (using fish oil, olive oil, and long- and medium-chain triglycerides) are available or being developed. The hope is that these IVFEs will prevent, or decrease the risk of, some of the HPN-associated complications. The goal of this article is to review how IVFEs came into use, their composition and metabolism, options for IVFE delivery in HPN, benefits and risks of IVFE use, and strategies to minimize the risks associated with IVFE use in HPN patients.

  15. Should pediatric parenteral nutrition be individualized?☆

    PubMed Central

    Freitas, Renata Germano Borges de Oliveira Nascimento; Nogueira, Roberto José Negrão; Saron, Margareth Lopes Galvão; Lima, Alexandre Esteves Souza; Hessel, Gabriel

    2014-01-01

    INTRODUCTION: Parenteral nutrition (PN) formulations are commonly individualized, since their standardization appears inadequate for the pediatric population. This study aimed to evaluate the nutritional state and the reasons for PN individualization in pediatric patients using PN, hospitalized in a tertiary hospital in Campinas, São Paulo. METHODS: This longitudinal study comprised patients using PN followed by up to 67 days. Nutritional status was classified according to the criteria established by the World Health Organization (WHO) (2006) and WHO (2007). The levels of the following elements in blood were analyzed: sodium, potassium, ionized calcium, chloride, magnesium, inorganic phosphorus, and triglycerides (TGL). Among the criteria for individualization, the following were considered undeniable: significant reduction in blood levels of potassium (<3mEq/L), sodium (<125mEq/L), magnesium (<1mEq/L), phosphorus (<1.5mEq/L), ionic calcium (<1mmol), and chloride (<90mEq/L), or any value above the references. RESULTS: Twelve pediatric patients aged 1 month to 15 years were studied (49 individualizations). Most patients were classified as malnourished. It was observed that 74/254 (29.2%) of examinations demanded individualized PN for indubitable reasons. CONCLUSION: The nutritional state of patients was considered critical in most cases. Thus, the individualization performed in the beginning of PN for energy protein adequacy was indispensable. In addition, the individualized PN was indispensable in at least 29.2% of PN for correction of alterations found in biochemical parameters. PMID:25510996

  16. Nutritional intake of gut failure patients on home parenteral nutrition

    SciTech Connect

    DiCecco, S.; Nelson, J.; Burnes, J.; Fleming, C.R.

    1987-11-01

    Nutrient intake patterns were analyzed in 23 patients with gut failure who were receiving home parenteral nutrition (HPN). All patients had stable weights without changes in intravenous calories or protein for 3 consecutive months. Our objectives were to assess oral intake of calories, carbohydrates, fat, and protein, to examine relationships between oral nutrient intakes and disease categories, and to compare oral and intravenous intakes to calculated resting energy expenditure (REE). Two patterns of oral nutrient intake were identified among the patients. Patients with short bowel syndrome, regardless of the underlying disease, consumed calories by mouth that clearly exceeded calculated resting energy expenditure (short bowel, non-Crohn's, 170% of REE; short bowel, Crohn's, 200 of REE); however, calories approximating the REE had to be given via HPN, suggesting that efficiency of absorption was at a very low level. Patients with diffuse gut diseases (radiation enteritis or pseudo-obstruction syndromes) had very low intakes of oral nutrients. The distribution of oral calories among carbohydrate, protein, and fat did not differ among the disease categories.

  17. Parenteral iron therapy in the anaemia of rheumatoid arthritis.

    PubMed

    Bentley, D P; Williams, P

    1982-05-01

    Thirty anaemic patients with active rheumatoid arthritis were each given 800 mg of iron , as iron dextran, intramuscularly over an interval of four weeks. The haemoglobin concentration rose significantly within two months in 26 of the patients but this was followed by a significant fall to the pre-treatment level nine months after treatment. The response to iron therapy was not related to the initial haemoglobin concentration, serum iron concentration, transferrin saturation nor to the amount of storage iron, whether assessed by bone marrow stainable iron or the serum ferritin concentration. There was an unexpected fall in the serum ferritin concentration within the first two months after treatment in half of the patients and this was followed by a rise towards the pre-treatment level during the following seven months, such that there was no apparent addition to the amount of storage iron over the period of the study. The possible mechanisms for these findings are discussed. A response to parenteral iron therapy in patients with active rheumatoid arthritis should not be regarded as evidence of iron deficiency and only by correction of the underlying inflammatory process will lasting improvement in the anaemia be obtained.

  18. Hematologic disorders in trauma patients during parenteral alimentation with lipids.

    PubMed

    Faintuch, J; Machado, F K; Freire, A N; Reis, J R; Machado, M; Pinto, L P; Ramos, S M; Loebens, M; Jovchelevich, V; Pinotti, H W

    1996-01-01

    Total parenteral nutrition with lipids is a well-accepted modality of metabolic support in seriously ill trauma patients. Intolerance to lipid administration is unusual when dosage limits are not exceeded, and few hematologic disturbances have been recorded with modern fat emulsions. In the course of intravenous alimentation of six adults admitted for traumatic lesions, eosinophilia with or without leukocytopenia was noticed after periods of four days to five weeks. Principal clinical events and hematologic derangements were documented in this population. Sepsis was not always present in the patients by the time of the complication, and in those that did require antibiotics and other drugs, the prescription remained unchanged along the episode. Discontinuation of the nutritional regimen with lipids was followed by normalization of the hematologic profile, suggesting that an acute or sub-acute allergic reaction was responsible. The appearance of skin rash in two occasions reinforces this hypothesis, and the possibility of hemophagocytosis merits consideration in two of the cases who displayed reversible acute leukocytopenia. It is concluded that blood cell aberrations are possible during intravenous feeding with lipids in trauma subjects, but tend to respond to suppression of the lipid-containing nutritional prescription.

  19. Fatty Acids as Therapeutic Auxiliaries for Oral and Parenteral Formulations

    PubMed Central

    Hackett, Michael J.; Zaro, Jennica L.; Shen, Wei-Chiang; Guley, Patrick C.; Cho, Moo J.

    2012-01-01

    Many drugs have decreased therapeutic activity due to issues with absorption, distribution, metabolism and excretion. The co-formulation or covalent attachment of drugs with fatty acids has demonstrated some capacity to overcome these issues by improving intestinal permeability, slowing clearance and binding serum proteins for selective tissue uptake and metabolism. For orally administered drugs, albeit at low level of availability, the presence of fatty acids and triglycerides in the intestinal lumen may promote intestinal uptake of small hydrophilic molecules. Small lipophilic drugs or acylated hydrophilic drugs also show increased lymphatic uptake and enhanced passive diffusional uptake. Fatty acid conjugation of small and large proteins or peptides have exhibited protracted plasma half-lives, site-specific delivery and sustained release upon parenteral administration. These improvements are most likely due to associations with lipid-binding serum proteins, namely albumin, LDL and HDL. These molecular interactions, although not fully characterized, could provide the ability of using the endogenous carrier systems for improving therapeutic outcomes. PMID:22921839

  20. Religio-Ethnic Effects on Attainments in the Early Career.

    ERIC Educational Resources Information Center

    Stryker, Robin

    1981-01-01

    Explores the effects of religion/ethnicity on educational and occupational attainments of White males. Suggests that future research should focus on the structural contexts in which these effects occur. (ST)

  1. Probing the Early Universe with the SZ Effect

    NASA Technical Reports Server (NTRS)

    Joy, M. K.; Carlstrom, J. E.; Rose, M. Franklin (Technical Monitor)

    2001-01-01

    The Cosmic Microwave Background Radiation (CMBR) which we observe today is relic radiation which last interacted with matter more than 10 billion years ago, when the expanding universe cooled to the point that free electrons and ionized nuclei recombined to form atoms. Prior to recombination, scattering between photons and free electrons was a very frequent occurrence, and the distance light could penetrate was small; afterwards, with free electrons out of circulation, the universe became largely transparent to light. Thus, the CMBR photons we observe today give us a clear view of the state of the early universe. Measured deviations in the intensity of the CMBR trace the small perturbations in the primordial matter density, which have been amplified by gravitational forces to form the magnificent, complex structures which comprise the present-day universe.

  2. Non-surgical oncology – Guidelines on Parenteral Nutrition, Chapter 19

    PubMed Central

    Arends, J.; Zuercher, G.; Dossett, A.; Fietkau, R.; Hug, M.; Schmid, I.; Shang, E.; Zander, A.

    2009-01-01

    Reduced nutritional state is associated with unfavourable outcomes and a lower quality of life in patients with malignancies. Patients with active tumour disease frequently have insufficient food intake. The resting energy expenditure in cancer patients can be increased, decreased, or remain unchanged compared to predicted values. Tumours may result in varying degrees of systemic pro-inflammatory processes with secondary effects on all significant metabolic pathways. Therapeutic objectives are to stabilise nutritional state with oral/enteral nutrition and parenteral nutrition (PN) and thus to prevent or reduce progressive weight loss. The maintenance or improvement of quality of life, and the increase in the effectiveness and a reduction in the side-effects of antitumor therapy are further objectives. Indications for PN in tumour patients are essentially identical to those in patients with benign illnesses, with preference given to oral or enteral nutrition when feasible. A combined nutritional concept is preferred if oral or enteral nutrition are possible but not sufficient. There are generally no accepted standards for ideal energy and nutrient intakes in oncological patients, particularly when exclusive artificial nutrition is administered. The use of PN as a general accompaniment to radiotherapy or chemotherapy is not indicated, but PN is indicated in chronic severe radiogenic enteritis or after allogenic transplantation with pronounced mucositis or GvH-related gastrointestinal damage for prolonged periods, with particular attention to increased risk of bleeding and infection. No PN is necessary in the terminal phase. PMID:20049066

  3. Role of carbonic anhydrase in bone - Partial inhibition of disuse atrophy of bone by parenteral acetazolamide

    NASA Technical Reports Server (NTRS)

    Kenny, A. D.

    1985-01-01

    The effectiveness of orally and subcutaneously administered acetazolamide sodium in preventing denervation-induced bone loss in rats is examined. Male Sprague-Dawley rats were treated with acetazolamide either orally by incorporation of 0.2, 0.5, or 1.5 percent concentrations in their diet for 15 days, or subcutaneously by either injection of 0.5 ml/rat of a solution containing either 20 or 100 mg/ml of the drug twice daily for 15 days or by continuous infusion of 5, 50, 500, or 1000 mg/ml of acetazolamide sodium for 8 days using an osmotic minipump. The effects of acetazolamide on body weight, food consumption, and plasma calcium content are evaluated. It is observed that parenteral administration is equally effective as oral administration in partially preventing denervation-induced bone mass changes. The data reveal that approximately 50 percent protection occurs with daily doses of 1094, 129, and 8 mg/kg body weight for the oral, subcutaneous injection, and subcutaneous infusion methods, respectively.

  4. Parenteral iron compounds: potent oxidants but mainstays of anemia management in chronic renal disease.

    PubMed

    Zager, Richard A

    2006-09-01

    Ferric iron (Fe)-carbohydrate complexes are widely used for treating Fe deficiency in patients who are unable to meet their Fe requirements with oral supplements. Intravenous Fe generally is well tolerated and effective in correcting Fe-deficient states. However, the complexing of Fe to carbohydrate polymers does not block its potent pro-oxidant effects; systemic free radical generation and, possibly, tissue damage may result. The purpose of this review is to (1) underscore the capacity of currently used parenteral Fe formulations to induce oxidative stress, (2) compare the severity of these oxidant reactions with those that result from unshielded Fe salts and with each other, and (3) speculate as to the potential of these agents to induce acute renal cell injury and augment systemic inflammatory responses. The experimental data that are reviewed should not be extrapolated to the clinical setting or be used for clinical decision making. Rather, it is hoped that the information provided herein may have utility for clinical hypothesis generation and, hence, future clinical studies. By so doing, a better understanding of Fe's potential protean effects on patients with renal disease may result.

  5. Evaluation of parenteral drugs for anesthesia in the blue crab (Callinectes sapidus).

    PubMed

    Quesada, Rolando J; Smith, Christopher D; Heard, Darryl J

    2011-06-01

    The objective of this study was to evaluate the efficacy and safety of several parenteral anesthetics in blue crabs (Callinectes sapidus). Thirty-one animals were administered one or more of the following drugs by injection into the hemolymph (i.v.) through an arthrodial membrane: etomidate, ketamine, lidocaine, pentobarbital, propofol, tiletamine-zolazepam, xylazine, and ketamine-xylazine. A subset of crabs received intracardiac ketamine. Etomidate had no effect. Lidocaine effects were ultrashort (<3 min). Pentobarbital had prolonged inductions (2 min) and often caused violent excitement and poor anesthesia. Propofol induced light anesthesia accompanied by distress and limb autotomy. Inductions with ketamine, xylazine, tiletamine-zolazepam, and ketamine-xylazine were usually fast (<60 sec). Their anesthetic effects were generally very short (5-10 min) but predictable, smooth, and with good muscle relaxation. The latter two protocols induced a deep plane of anesthesia more consistently but also more significant bradycardia. Intracardiac ketamine injection was fatal in four of five crabs. In conclusion, the anesthetic protocols were considered unsuitable for prolonged anesthesia. However, if very short-term anesthesia is desired, then tiletamine-zolazepam or ketamine-xylazine is recommended. Further studies are indicated to identify a safe anesthetic protocol of longer duration in C. sapidus as well as in other crab species.

  6. Environmental Effects on the Metallicities of Early-Type Galaxies

    NASA Technical Reports Server (NTRS)

    Jones, Christine; Oliversen, Ronald (Technical Monitor)

    2004-01-01

    We completed and published two papers in the Astrophysical Journal based on research from grant. In the first paper we analyzed nine X-ray-bright Virgo early-type galaxies observed by both ASCA and ROSAT. Through spatially resolved spectroscopy, we determined the radial temperature profiles and abundances of Mg, Si, and Fe for six galaxies. The temperature profiles are consistent with isothermal temperatures outside of cooler regions at the galaxies' centers. We present new evidence for iron abundance gradients in NGC 4472 and NGC 4649 and confirm the previous results on NGC 4636. Mg and Si abundance gradients on average are flatter than those of iron and correspond to an underabundance of α-process elements at high Fe values, while at low iron the element ratios favor enrichment by Type II supernovae (SNe). We explain the observed trend using the metallicity dependence of SN Ia metal production and present constraints on the available theoretical modeling for low-metallicity inhibition of SNe Ia. In the second paper We analyzed nine X-ray-bright Virgo early-type galaxies observed by both ASCA and ROSAT. Through spatially resolved spectroscopy, we determined the radial temperature profiles and abundances of Mg, Si, and Fe for six galaxies. The temperature profiles are consistent with isothermal temperatures outside of cooler regions at the galaxies' centers. We present new evidence for iron abundance gradients in NGC 4472 and NGC 4649 and confirm the previous results on NGC 4636. Mg and Si abundance gradients on average are flatter than those of iron and correspond to an underabundance of α-process elements at high Fe values, while at low iron the element ratios favor enrichment by Type I1 supernovae (SNe). We explain the observed trend using the metallicity dependence of SN Ia metal production and present constraints on the available theoretical modeling for low-metallicity inhibition of SNe Ia.

  7. The Effect of Impacts on the Early Martian Climate

    NASA Technical Reports Server (NTRS)

    Colaprete, A.; Haberle, R. M.; Segura, T. L.; Toon, O. B.; Zahnle, K.

    2004-01-01

    The first images returned by the Mariner 7 spacecraft of the Martian surface showed a landscape heavily scared by impacts. Mariner 9 imaging revealed geomorphic features including valley networks and outflow channels that suggest liquid water once flowed at the surface of Mars. Further evidence for water erosion and surface modification has come from the Viking Spacecraft, Mars Pathfinder, Mars Global Surveyor's (MGS) Mars Orbiter Camera (MOC), and Mars Odyssey's THEMIS instrument. In addition to network channels, this evidence includes apparent paleolake beds, fluvial fans and sedimentary layers. The estimated erosion rates necessary to explain the observed surface morphologies present a conundrum. The rates of erosion appear to be highest when the early sun was fainter and only 75% as luminous as it is today. All of this evidence points to a very different climate than what exists on Mars today. The most popular paradigm for the formation of the valley networks is that Mars had at one time a warm (T average > 273), wetter and stable climate. Possible warming mechanisms have included increased surface pressures, carbon dioxide clouds and trace greenhouse gasses. Yet to date climate models have not been able to produce a continuously warm and wet early Mars. The rates of erosion appear to correlate with the rate at which Mars was impacted thus an alternate possibility is transient warm and wet conditions initiated by large impacts. It is widely accepted that even relatively small impacts (approx. 10 km) have altered the past climate of Earth to such an extent as to cause mass extinctions. Mars has been impacted with a similar distribution of objects. The impact record at Mars is preserved in the abundance of observable craters on it surface. Impact induced climate change must have occurred on Mars.

  8. Vitamin E in new-generation lipid emulsions protects against parenteral nutrition-associated liver disease in parenteral nutrition-fed preterm pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Parenteral nutrition (PN) in preterm infants leads to PN-associated liver disease (PNALD). PNALD has been linked to serum accumulation of phytosterols that are abundant in plant oil but absent in fish oil emulsions. Whether modifying the phytosterol and vitamin E composition of soy and fish oil lipi...

  9. n-3 Polyunsaturated Fatty Acids Improve Inflammation via Inhibiting Sphingosine Kinase 1 in a Rat Model of Parenteral Nutrition and CLP-Induced Sepsis.

    PubMed

    Tian, Tao; Zhao, Yunzhao; Huang, Qian; Li, Jieshou

    2016-03-01

    The sphingosine kinase 1 (SphK1)/sphingosine-1-phosphate (S1P) pathway plays a key role in inflammation. Parenteral nutrition containing n-3 polyunsaturated fatty acids (n-3 PUFA) may regulate inflammatory reactions. The aim of this study is to determine whether n-3 PUFA may improve inflammatory responses by neutralizing SphK1 signaling. Rat models of parenteral nutrition, cecal ligation and puncture (CLP)-induced sepsis were generated. Male Sprague-Dawley rats were operated for CLP on day 2 after venous catheterization. The rats were randomized to receive normal saline (NS; n = 20), parenteral nutrition (PN; n = 20), or PN + fish oil (FO; n = 20) for 5 days. The daily intake of fish oil (1.25-2.82 g EPA and 1.44-3.09 g DHA per 100 ml) in the FO group was approximately 1.8 g/kg body weight/day. Rats in the control group (n = 10) were subjected to sham operation and received a chow diet. Spleen tissues were collected for SphK1 and S1P receptor expression analysis. Our data showed that n-3 PUFA ameliorated the survival rate. SphK1 expression and its enzymatic activity were significantly upregulated in sepsis rats. Furthermore, mRNA and protein levels of S1PR3, but not S1PR1, were also facilitated after CLP. However, PN + FO dramatically decreased SphK1 mRNA level and its enzymatic activity. S1PR3 expression was also attenuated by FO addition. In conclusion, the anti-inflammatory effect of n-3 PUFA may be linked to the inhibition of the SphK1/S1P pathway in a rat model of parenteral nutrition and CLP-induced sepsis.

  10. Hydrogen peroxide generation in a model paediatric parenteral amino acid solution.

    PubMed

    Brawley, V; Bhatia, J; Karp, W B

    1993-12-01

    1. Parenteral amino acid solutions undergo photooxidation, which may be an important factor in total parenteral nutrition-associated hepatic dysfunction. Light-exposed parenteral solutions containing amino acids, in addition to vitamins and trace minerals, generate free radicals, which, in turn, may contribute to this type of injury. This study examined the characteristics of H2O2 production in a parenteral amino acid solution modelled on a commercially available paediatric parenteral amino acid solution. 2. The solution was exposed to light in the presence of riboflavin-5'-monophosphate (riboflavin), and peroxide formation in the presence and absence of catalase (H2O2 formation) was assayed using potassium iodide/molybdate. 3. Peak H2O2 production occurred at a light intensity of 8 microW cm-2 nm-1 in the 425-475 nm waveband and was linear to 2 h of light exposure. H2O2 production reached 500 mumol/l at 24 h. 4. H2O2 was directly related to a riboflavin concentration of up to 20 mumol/l and was maximal at 30 mumol/l. 5. H2O2 production was greatest in the amino acid/riboflavin solution at a pH of between 5 and 6. 6. Under the conditions of light exposure intensity, light exposure time, riboflavin concentration and pH found during the administration of parenteral nutrition in neonatal intensive care units, net H2O2 production occurs in solutions modelled on a paediatric parenteral amino acid preparation.

  11. Multiple Staffing and Teacher Actions: The Effect of Team Teaching In Early Childhood Education.

    ERIC Educational Resources Information Center

    McNairy, Marion R.

    1988-01-01

    Studies the effects of multiple staffing in an early childhood classroom through the use of participant and classroom observation. Interpersonal relationships, territorial ownership, and differential status characteristics contributed to differential behavior of an educator. (RJC)

  12. Parenteral nutrition support: Beyond gut feeling? Quality control study of parenteral nutrition practices in a Tertiary Care Hospital

    PubMed Central

    Ramakrishnan, Nagarajan; Shankar, Bhuvaneshwari; Ranganathan, Lakshmi; Daphnee, D. K.; Bharadwaj, Adithya; Venkataraman, Ramesh

    2016-01-01

    Background: Enteral nutrition (EN) is preferred over parenteral nutrition (PN) in hospitalized patients based on International consensus guidelines. Practice patterns of PN in developing countries have not been documented. Objectives: To assess practice pattern and quality of PN support in a tertiary hospital setting in Chennai, India. Methods: Retrospective record review of patients admitted between February 2010 and February 2012. Results: About 351,008 patients were admitted to the hospital in the study period of whom 29,484 (8.4%) required nutritional support. About 70 patients (0.24%) received PN, of whom 54 (0.18%) received PN for at least three days. Common indications for PN were major gastrointestinal surgery (55.6%), intolerance to EN (25.9%), pancreatitis (5.6%), and gastrointestinal obstruction (3.7%). Conclusions: The proportion of patients receiving PN was very low. Quality issues were identified relating to appropriateness of indication and calories and proteins delivered. This study helps to introspect and improve the quality of nutrition support. PMID:26955215

  13. Identifying Effective Behavior Management in the Early Childhood Classroom

    ERIC Educational Resources Information Center

    Victor, Kelly Rae

    2005-01-01

    Every educator has a dream to maintain a classroom free from disruptions; one in which each child is being molded, shaped, and corrected in a loving and caring environment that inspires appropriate behavior. The purpose of this research project was to determine how to create an effective behavior management plan and effectively teach classroom…

  14. Teacher Effects in Early Grades: Evidence from a Randomized Study

    ERIC Educational Resources Information Center

    Konstantopoulos, Spyros

    2011-01-01

    Background/Context: One important question to educational research is whether teachers can influence student achievement over time. This question is related to the durability of teacher effects on student achievement in successive grades. The research evidence about teacher effects on student achievement has been somewhat mixed. Some education…

  15. Parenteral administration of factor Xa/IIa inhibitors limits experimental aortic aneurysm and atherosclerosis

    PubMed Central

    Moran, Corey S.; Seto, Sai-Wang; Krishna, Smriti M.; Sharma, Surabhi; Jose, Roby J.; Biros, Erik; Wang, Yutang; Morton, Susan K.; Golledge, Jonathan

    2017-01-01

    Intraluminal thrombus is a consistent feature of human abdominal aortic aneurysm (AAA). Coagulation factor Xa (FXa) catalyses FII to thrombin (FIIa). We examined the effect of FXa/FIIa inhibition on experimental aortic aneurysm in apolipoprotein E-deficient (ApoE−/−) mice infused with angiotensin II (AngII). The concentration of FXa within the supra-renal aorta (SRA) correlated positively with SRA diameter. Parenteral administration of enoxaparin (FXa/IIa inhibitor) and fondaparinux (FXa inhibitor) over 14 days reduced to severity of aortic aneurysm and atherosclerosis in AngII-infused ApoE−/− mice. Enteral administration of the FIIa inhibitor dabigatran had no significant effect. Aortic protease-activated receptor (PAR)-2 expression increased in response to AngII infusion. Fondaparinux reduced SRA levels of FXa, FIIa, PAR-2, matrix metalloproteinase (MMP)2, Smad2/3 phosphorylation, and MOMA-2 positive cells in the mouse model. FXa stimulated Smad2/3 phosphorylation and MMP2 expression in aortic vascular smooth muscle cells (VSMC) in vitro. Expression of MMP2 in FXa-stimulated VSMC was downregulated in the presence of a PAR-2 but not a PAR-1 inhibitor. These findings suggest that FXa/FIIa inhibition limits aortic aneurysm and atherosclerosis severity due to down-regulation of vascular PAR-2-mediated Smad2/3 signalling and MMP2 expression. Inhibition of FXa/FIIa may be a potential therapy for limiting aortic aneurysm. PMID:28220880

  16. [Solid-state stability and preformulation study of a new parenteral cephalosporin antibiotics (E1040)].

    PubMed

    Ashizawa, K; Uchikawa, K; Hattori, T; Ishibashi, Y; Miyake, Y; Sato, T

    1990-03-01

    In designing the dosage form, one major factor controlling their physicochemical properties is solid forms of the drug powder. The method for improving the physicochemical stability of unstable beta-lactam antibiotics is very important. E1040 is a novel parenteral 3-betaine type cephalosporin which has a broad antibacterial spectrum and potent activities against Citrobacter, freundii, Enterobacter cloacase, and glucose-non-fermentative bacteria, including P. aeruginosa. The present study was intended to provide the solid-state chemical stability of perenteral steril dry dosage form of E1040. The chemical stability differences among the various solid forms, dry amorphous, additive freeze dried amorphous solid and crystalline powder, were evaluated as a function of temperature by thermo stress tests. Freeze dried anhydrous amorphous form was the first steril dry dosage form investigated during the preformulation study. However, this compound is chemically unstable, in the titer of them, reduction are observed in the freeze dried amorphous solid. In order to select the most suitable solid form of E1040, two methods were used. One was crystalline solid and the other was NaCl additive freeze-dried formulation. Through our experiments, the solid-state chemical stabilization can be achieved by these two methods (effect of crystal structure and effect of NaCl additive).

  17. Parenteral administration of factor Xa/IIa inhibitors limits experimental aortic aneurysm and atherosclerosis.

    PubMed

    Moran, Corey S; Seto, Sai-Wang; Krishna, Smriti M; Sharma, Surabhi; Jose, Roby J; Biros, Erik; Wang, Yutang; Morton, Susan K; Golledge, Jonathan

    2017-02-21

    Intraluminal thrombus is a consistent feature of human abdominal aortic aneurysm (AAA). Coagulation factor Xa (FXa) catalyses FII to thrombin (FIIa). We examined the effect of FXa/FIIa inhibition on experimental aortic aneurysm in apolipoprotein E-deficient (ApoE(-/-)) mice infused with angiotensin II (AngII). The concentration of FXa within the supra-renal aorta (SRA) correlated positively with SRA diameter. Parenteral administration of enoxaparin (FXa/IIa inhibitor) and fondaparinux (FXa inhibitor) over 14 days reduced to severity of aortic aneurysm and atherosclerosis in AngII-infused ApoE(-/-) mice. Enteral administration of the FIIa inhibitor dabigatran had no significant effect. Aortic protease-activated receptor (PAR)-2 expression increased in response to AngII infusion. Fondaparinux reduced SRA levels of FXa, FIIa, PAR-2, matrix metalloproteinase (MMP)2, Smad2/3 phosphorylation, and MOMA-2 positive cells in the mouse model. FXa stimulated Smad2/3 phosphorylation and MMP2 expression in aortic vascular smooth muscle cells (VSMC) in vitro. Expression of MMP2 in FXa-stimulated VSMC was downregulated in the presence of a PAR-2 but not a PAR-1 inhibitor. These findings suggest that FXa/FIIa inhibition limits aortic aneurysm and atherosclerosis severity due to down-regulation of vascular PAR-2-mediated Smad2/3 signalling and MMP2 expression. Inhibition of FXa/FIIa may be a potential therapy for limiting aortic aneurysm.

  18. Value and Clinical Impact of an Infectious Disease-Supervised Outpatient Parenteral Antibiotic Therapy Program

    PubMed Central

    Petrak, Russell M.; Skorodin, Nathan C.; Fliegelman, Robert M.; Hines, David W.; Chundi, Vishnu V.; Harting, Brian P.

    2016-01-01

    Background. Outpatient parenteral antibiotic therapy (OPAT) is a safe and effective modality for treating serious infections. This study was undertaken to define the value of OPAT in a multicentered infectious disease (ID) private practice setting. Methods. Over a period of 32 months, 6120 patients were treated using 19 outpatient ID offices in 6 states. Analysis included patient demographics, indications of OPAT, diagnoses, therapeutic agent, duration of therapy, and site of therapy initiation. Outcomes were stratified by therapeutic success, clinical relapse, therapeutic complications, and hospitalizations after initiating therapy. Statistical analysis included an ordinal logistic regression analysis. Results. Forty-three percent of patients initiated therapy in an outpatient office, and 57% began therapy in a hospital. Most common diagnoses treated were bone and joint (32.2%), abscesses (18.8%), cellulitis (18.5%), and urinary tract infection (10.8%). Ninety-four percent of patients were successfully treated, and only 3% were hospitalized after beginning therapy. Most common cause of treatment failure was a relapse of primary infection (60%), progression of primary infection (21%), and therapeutic complication (19%). Conclusions. An ID-supervised OPAT program is safe, efficient, and clinically effective. By maximizing the delivery of outpatient care, OPAT provides a tangible value to hospitals, payers, and patients. This program is a distinctive competency available to ID physicians who offer this service to patients. PMID:27807591

  19. Homeostasis alteration within small intestinal mucosa after acute enteral refeeding in total parenteral nutrition mouse model

    PubMed Central

    Feng, Yongjia; Barrett, Meredith; Hou, Yue; Yoon, Hong Keun; Ochi, Takanori

    2015-01-01

    Feeding strategies to care for patients who transition from enteral nutrient deprivation while on total parenteral nutrition (TPN) to enteral feedings generally proceed to full enteral nutrition once the gastrointestinal tract recovers; however, an increasing body of literature suggests that a subgroup of patients may actually develop an increased incidence of adverse events, including death. To examine this further, we studied the effects of acute refeeding in a mouse model of TPN. Interestingly, refeeding led to some beneficial effects, including prevention in the decline in intestinal epithelial cell (IEC) proliferation. However, refeeding led to a significant increase in mucosal expression of proinflammatory cytokines, including tumor necrosis factor-α (TNF-α), as well as an upregulation in Toll-like receptor 4 (TLR-4). Refeeding also failed to prevent TPN-associated increases in IEC apoptosis, loss of epithelial barrier function, and failure of the leucine-rich repeat-containing G protein-coupled receptor 5-positive stem cell expression. Transitioning from TPN to enteral feedings led to a partial restoration of the small bowel microbial population. In conclusion, while acute refeeding led to some restoration of normal gastrointestinal physiology, enteral refeeding led to a significant increase in mucosal inflammatory markers and may suggest alternative strategies to enteral refeeding should be considered. PMID:26635320

  20. Practical handling of AIO admixtures – Guidelines on Parenteral Nutrition, Chapter 10

    PubMed Central

    Mühlebach, S.; Franken, C.; Stanga, Z.

    2009-01-01

    All-in-one admixtures (AIO-admixtures) provide safe, effective and low-risk PN (parenteral nutrition) for practically all indications and applications. Water, energy (carbohydrates and lipids), amino acids, vitamins and trace elements are infused together with PN either as industrially-manufactured AIO admixtures provided as two- or three-chamber bags (shelf life usually more than 12 months) completed with electrolytes and micronutrients where appropriate or as individually compounded ready-to-use AIO admixtures (compounding, usually prepared by a pharmacy on either a daily or weekly basis and stored at 2–8°C). Physico-chemical and microbial stability of an AIO admixture is essential for the safety and effectiveness of patient-specific PN, and its assurance requires specialist pharmaceutical knowledge. The stability should be documented for an application period of 24 (–48) hours. It is advisable to offer a limited selection of different PN regimes in each hospital. For reasons of drug and medication safety, PN admixtures prepared for individual patients must be correctly labelled and specifications for storage conditions must also be followed during transport. Monitoring is required where applicable. Micronutrients are usually administered separately to AIO admixtures. In case compatibility and stability have been well documented trace elements and/or combination preparations including water-soluble or water-soluble/fat soluble vitamin supplements can be added to PN admixtures under strict aseptic conditions. AIO admixtures are usually not used as vehicles for drugs (incompatibilities). PMID:20049073

  1. Role of parenteral iron in transfusion requirements after total hip replacement. A pilot study.

    PubMed

    Muñoz, M; Naveira, E; Seara, J; Palmer, J H; Cuenca, J; García-Erce, J A

    2006-04-01

    An important percentage of patients undergoing total hip replacement (THR) receive allogeneic blood transfusion (ABT) to avoid the risks of acute anaemia. However, concerns about the risks of ABT have led to the search for alternatives, such as stimulation of erythropoiesis. We prospectively investigated the effect of postoperative administration of 300 mg of intravenous iron sucrose on ABT requirements in THR patients (group 2; n = 24). A previous series of 22 THR patients served as the control group (group 1). All patients were operated on by the same surgeon, using the same implant, and a set of clinical data was gathered. No adverse reactions to iron administration were observed. The group-given iron showed a trend to a lower transfusion rate (46 vs. 73%; P = 0.067) and lower transfusion index (0.96 vs. 1.68 units/patient; P = 0.038). Moreover, amongst the non-transfused patients, admission haemoglobin levels were lower in those coming from the iron group than those from the control group (12.7 +/- 0.9 vs. 14.0 +/- 1.2 g dL(-1), respectively; P = 0.017). Postoperative parenteral iron administration could be a safe and effective way to reduce ABT requirements in the THR patients. A large, randomized controlled trial to confirm these results is warranted.

  2. Optimising patient safety when using elastomeric pumps to administer outpatient parenteral antibiotic therapy.

    PubMed

    Oliver, Gemma

    2016-10-27

    Outpatient parenteral antibiotic therapy (OPAT) is a growing area of practice that has numerous benefits for both patients and the healthcare system. In order for OPAT services to be successful, strategies need to be in place to maximise efficiency while providing safe, high-quality care. The use of elastomeric pumps to deliver intravenous (IV) antibiotics can have many benefits for OPAT services; they are cost-effective, easy to use and allow the patient to be fully ambulant. However, plans need to be put in place to make sure their use is safe and effective. This article discusses the use of elastomeric pumps by a UK-based OPAT team and the governance processes the team put in place to optimise patient safety when using elastomeric pumps to deliver IV antibiotics. Furthermore, with experience of using elastomeric pumps for more than 4 years the OPAT team was asked to evaluate an elastomeric pump new to the UK market: the Accufuser pump (Vygon (UK) Limited). By collecting data on its use it was found to be safe and easy to use. The team felt that the Accufuser pump ran to time in 96% of completed evaluations and considered it to be clinically acceptable in all responses.

  3. [Parenteral iron therapy in chronic kidney disease or chronic heart failure].

    PubMed

    Eisenga, Michele F; Diepenbroek, Adry; Swinkels, Dorine W; Bakker, Stephan J L; van der Meer, Peter; Gaillard, Carlo A J M

    2015-01-01

    Iron deficiency and anaemia occur frequently in patients with chronic kidney disease (CKD) or chronic heart failure (CHF) and are associated with lower quality of life and higher mortality. Treating anaemia with erythropoietic growth factors produces no improvement. In recent years, the focus has therefore shifted to correction of iron deficiency. Chronic inflammation in CKD increases the production of hepcidin, which blocks iron absorption from the intestine and leads to less efficient re-use of iron from the macrophages. In absolute iron deficiency the body's iron stores are depleted, whereas in functional iron deficiency the supply of iron is not sufficient to meet demand from the bone marrow. Normal or high ferritin levels do not exclude iron deficiency at tissue level. The iron saturation fraction is a more useful indicator. Parenteral iron therapy ameliorates in CHF the symptoms of iron deficiency, irrespective of the effect on haemoglobin levels. The long-term effects of intravenous iron on mortality and morbidity are still unknown.

  4. Transient effects of microgravity on early embryos of Xenopus laevis.

    PubMed

    De Mazière, A; Gonzalez-Jurado, J; Reijnen, M; Narraway, J; Ubbels, G A

    1996-01-01

    In order to study the role of gravity on the early development of the clawed toad Xenopus laevis, we performed an experiment on the Maser-6 sounding rocket launched from Kiruna (Sweden) on 4 Nov 1993. The aim was to find out whether a short period of microgravity during fertilization and the first few minutes of development does indeed result in abnormal axis formation as was suggested by a pilot experiment on the Maser 3 in 1989. On the Maser 6 we used two new technical additions in the Fokker CIS unit, viz. a 1-g control centrifuge and a video recording unit which both worked successfully. The 1-g control centrifuge was used to discriminate between the influences of flight perturbations and microgravity. After fertilization shortly before launch, one of the first indications of successful egg activation, the cortical contraction, was registered in microgravity and on earth. Analysis of the video tapes revealed that the cortical contraction in microgravity starts earlier than at 1 g on earth. After recovery of the eggs fertilized in microgravity and culture of the embryos on earth, the morphology of the blastocoel has some consistent differences from blastulae from eggs fertilized in the 1-g centrifuge of the rocket. However from the gastrula stage onward, the microgravity embryos apparently recover and resume normal development: the XBra gene is normally expressed, and histological examination shows normal axis formation.

  5. Early effects of cranial irradiation on hypothalamic-pituitary function

    SciTech Connect

    Lam, K.S.; Tse, V.K.; Wang, C.; Yeung, R.T.; Ma, J.T.; Ho, J.H.

    1987-03-01

    Hypothalamic-pituitary function was studied in 31 patients before and after cranial irradiation for nasopharyngeal carcinoma. The estimated radiotherapy (RT) doses to the hypothalamus and pituitary were 3979 +/- 78 (+/- SD) and 6167 +/- 122 centiGrays, respectively. All patients had normal pituitary function before RT. One year after RT, there was a significant decrease in the integrated serum GH response to insulin-induced hypoglycemia. In the male patients, basal serum FSH significantly increased, while basal serum LH and testosterone did not change. Moreover, in response to LHRH, the integrated FSH response was increased while that of LH was decreased. Such discordant changes in FSH and LH may be explained by a defect in LHRH pulsatile release involving predominantly a decrease in pulse frequency. The peak serum TSH response to TRH became delayed in 28 patients, suggesting a defect in TRH release. Twenty-one patients were reassessed 2 yr after RT. Their mean basal serum T4 and plasma cortisol levels had significantly decreased. Hyperprolactinemia associated with oligomenorrhoea was found in 3 women. Further impairment in the secretion of GH, FSH, LH, TSH, and ACTH had occurred, and 4 patients had hypopituitarism. Thus, progressive impairment in hypothalamic-pituitary function occurs after cranial irradiation and can be demonstrated as early as 1 yr after RT.

  6. Pathway to a Phenocopy: Heat Stress Effects in Early Embryogenesis

    PubMed Central

    Crews, Sarah M.; McCleery, W. Tyler; Hutson, M. Shane

    2015-01-01

    Background Heat shocks applied at the onset of gastrulation in early Drosophila embryos frequently lead to phenocopies of U-shaped mutants – having characteristic failures in the late morphogenetic processes of germband retraction and dorsal closure. The pathway from non-specific heat stress to phenocopied abnormalities is unknown. Results Drosophila embryos subjected to 30-min, 38-°C heat shocks at gastrulation appear to recover and restart morphogenesis. Post-heat-shock development appears normal, albeit slower, until a large fraction of embryos develop amnioserosa holes (diameters > 100 μm). These holes are positively correlated with terminal U-shaped phenocopies. They initiate between amnioserosa cells and open over tens of minutes by evading normal wound healing responses. They are not caused by tissue-wide increases in mechanical stress or decreases in cell-cell adhesion, but instead appear to initiate from isolated apoptosis of amnioserosa cells. Conclusions The pathway from heat shock to U-shaped phenocopies involves the opening of one or more large holes in the amnioserosa that compromise its structural integrity and lead to failures in morphogenetic processes that rely on amnioserosa-generated tensile forces. The proposed mechanism by which heat shock leads to hole initiation and expansion is heterochonicity – i.e., disruption of morphogenetic coordination between embryonic and extra-embryonic cell types. PMID:26498920

  7. Response of layer and broiler strain chickens to parenteral administration of a live Salmonella Typhimurium vaccine.

    PubMed

    Groves, Peter J; Sharpe, Sue M; Cox, Julian M

    2015-07-01

    Responses to the parenteral administration of a live aroA deletion Salmonella serovar Typhimurium vaccine given to three brown egg layer strains and two broiler strains were studied. Twenty-five birds of each strain were reared together in floor pens to 6 weeks of age and then moved as individual strains to new floor pens and injected with 10(8) colony forming units (CFU) per bird of the vaccine bacteria intramuscularly or subcutaneously, 10(6) CFU per bird subcutaneously, or phosphate buffered saline (PBS) subcutaneously as a vaccination control. Three birds of one layer strain were injected intramuscularly with 0.5mg/ bird S. Typhimurium lipopolysaccharide (LPS) to evaluate whether response was similar for vaccine and endotoxin. Birds were weighed, and rectal temperatures recorded at the time of injection, then observed over 24 hours. Rectal temperatures were measured and blood samples collected for serum IL-6 assay at 3 hours post injection (PI). At 12 hours PI blood samples were drawn for analyses for plasma phosphorus (P), glucose (Glu), cholesterol (Cho), aspartate transaminase (AST), total protein (Ptn) and creatinine kinase (CK). Blood was sampled 14 days PI and tested for serum antibody to S. Typhimurium. Vaccination resulted in significant seroconversion by 14 days PI in all strains compared to the controls. The three layer strains exhibited a clinical malaise, evident within 90 minutes of injection, lasting for 12 hours, with complete recovery by 24 hours PI. Only the 10(8) CFU dose given subcutaneously produced an increase in rectal temperature 3 hours PI. Vaccination had no effect on IL-6 or Ptn. All vaccine doses increased P and the higher dose by either route decreased Cho in all bird strains. The 10(8) vaccine dose increased Glu and intramuscular injection markedly elevated CK only in the layer strains. The response was not completely congruous with that to LPS alone. The results highlight the need for consideration of differences in response of

  8. Aggressive nutrition in extremely low birth weight infants: impact on parenteral nutrition associated cholestasis and growth

    PubMed Central

    Lochmann, Ruth; Unterasinger, Lukas; Weber, Michael; Berger, Angelika; Haiden, Nadja

    2016-01-01

    Background Parenteral nutrition associated cholestasis (PNAC) is a frequently observed pathology in extremely low birth weight (ELBW) infants. Its pathogenesis is determined by the composition and duration of parenteral nutrition (PN) as well as the tolerance of enteral feeds (EF). “Aggressive” nutrition is increasingly used in ELBW infants to improve postnatal growth. Little is known about the effect of “aggressive” nutrition on the incidence of PNAC. We analyzed the influence of implementing an “aggressive” nutritional regimen on the incidence of PNAC and growth in a cohort of ELBW infants. Methods ELBW infants were nourished using a “conservative” (2005–6; n = 77) or “aggressive” (2007–9; n = 85) nutritional regimen that differed in the composition of PN after birth as well as the composition and timing of advancement of EFs. We analyzed the incidence of PNAC (conjugated bilirubin > 1.5 mg/dl (25 µmol/l)) corrected for confounders of cholestasis (i.e., NEC and/or gastrointestinal surgery, sepsis, birth weight, Z-score of birth weight, time on PN and male sex), growth until discharge (as the most important secondary outcome) and neonatal morbidities. Results The incidence of PNAC was significantly lower during the period of “aggressive” vs. “conservative “nutrition (27% vs. 46%, P < 0.05; adjusted OR 0.275 [0.116–0.651], P < 0.01). Body weight (+411g), head circumference (+1 cm) and length (+1 cm) at discharge were significantly higher. Extra-uterine growth failure (defined as a Z-score difference from birth to discharge lower than −1) was significantly reduced for body weight (85% vs. 35%), head circumference (77% vs. 45%) and length (85% vs. 65%) (P < 0.05). The body mass index (BMI) at discharge was significantly higher (11.1 vs. 12.4) using “aggressive” nutrition and growth became more proportionate with significantly less infants being discharged below the 10th BMI percentile (44% vs. 9%), while the percentage of

  9. Developmental effects of methyl benzimidazolecarbamate following exposure during early pregnancy

    EPA Science Inventory

    Methyl 2-benzimidazolecarbamate (MBC) and its parent compound benomyl are used as agricultural fungicides. Both chemicals are embryotoxic if administered during organogenesis, and benomyl is teratogenic. Based on a previous study indicating a lack of maternal effects of MBC follo...

  10. Gastroenterology – Guidelines on Parenteral Nutrition, Chapter 15

    PubMed Central

    Schulz, R. J.; Bischoff, S. C.; Koletzko, B.

    2009-01-01

    In patients with Crohn's disease and ulcerative colitis parenteral nutrition (PN) is indicated when enteral nutrition is not possible or should be avoided for medical reasons. In Crohn's patients PN is indicated when there are signs/symptoms of ileus or subileus in the small intestine, scars or intestinal fistulae. PN requires no specific compounding for chronic inflammatory bowel diseases. In both diseases it should be composed of 55–60% carbohydrates, 25–30% lipids and 10–15% amino acids. PN helps in the correction of malnutrition, particularly the intake of energy, minerals, trace elements, deficiency of calcium, vitamin D, folic acid, vitamin B12, and zinc. Enteral nutrition is clearly superior to PN in severe, acute pancreatitis. An intolerance to enteral nutrition results in an indication for total PN in complications such as pseudocysts, intestinal and pancreatic fistulae, and pancreatic abscesses or pancreatic ascites. If enteral nutrition is not possible, PN is recommended, at the earliest, 5 days after admission to the hospital. TPN should not be routinely administered in mild acute pancreatitis or nil by moth status <7 days, due to high costs and an increased risk of infection. The energy requirements are between 25 and 35 kcal/kg body weight/day. A standard solution including lipids (monitoring triglyceride levels!) can be administered in acute pancreatitis. Glucose (max. 4–5 g/kg body weight/day) and amino acids (about 1.2–1.5 g/kg body weight/day) should be administered and the additional enrichment of TPN with glutamine should be considered in severe, progressive forms of pancreatitis. PMID:20049077

  11. 100 patient-years of ambulatory home total parenteral nutrition.

    PubMed Central

    Dudrick, S J; O'Donnell, J J; Englert, D M; Matheny, R G; Blume, E R; Nutt, R E; Hickey, M S; Barroso, A O

    1984-01-01

    More than 100 patient-years' experience has been acquired in the treatment of 133 patients with ambulatory home total parenteral nutrition (TPN) between May 1974 and December 1983. Indications for chronic or permanent home TPN include short bowel syndrome, malabsorption, scleroderma, and vasoactive intestinal polypeptide syndrome. Indications for acute or temporary home TPN include Crohn's disease, malignancies, gastrointestinal fistulas, ulcerative colitis, anorexia nervosa, and numerous other disorders. Eighty-two patients in the acute group were treated primarily with percutaneously placed standard subclavian catheters and 51 patients in the chronic group have been treated thus far with implanted silicone rubber, Dacron-cuffed catheters for a cumulative total of 38,939 patient days. Of the 125 implanted catheters, 115 were placed in the superior vena cava and ten in the inferior vena cava for an average duration of 250 catheter-days, the longest single catheter remaining in situ for more than 8 1/2 years. Catheter-related sepsis occurred 33 times with the implanted catheters, or once every 2.6 catheter-years. One hundred and fourteen temporary catheters were placed percutaneously in the superior vena cava via a subclavian vein for an average duration of 68 days, the longest single catheter remaining in situ for 213 days. Catheter-related sepsis occurred seven times, equivalent to one episode per 3 catheter-years. Total catheter-related complications were quite infrequent and were directly related to duration of catheterization. They included venous thrombosis (12), clotted catheter (11), catheter failure or rupture (8), catheter compression (5) and inadvertent catheter removal (4). Twenty-six catheters were repaired or spliced in situ when the external segment was accidentally damaged or deteriorated secondary to long-term material fatigue. One remarkable patient has been maintained exclusively by TPN originally as an inpatient and subsequently as an outpatient

  12. [Parenteral administration medicines: recommendations of preparation, administration and stability].

    PubMed

    Gaspar Carreño, M; Torrico Martín, F; Novajarque Sala, L; Batista Cruz, M; Ribeiro Gonçalves, P; Porta Oltra, B; Sánchez Santos, J C

    2014-11-03

    Objetivo: Elaborar unas recomendaciones de preparacion de medicamentos de administracion parenteral (MAP) para valorar la posibilidad de transferir su preparacion, desde las unidades de enfermeria en planta de hospitalizacion al servicio de farmacia (SF). Método: Se procede a elaborar una tabla de estabilidades de los medicamentos incluidos en la guia farmacoterapeutica del Hospital, aplicando la Guia USP (Pharmaceutical compounding Sterile Preparations) y la Guia de de buenas practicas de preparacion de medicamentos en los servicios de farmacia hospitalaria. Se recopilo informacion sobre las MAP: metodo de preparacion, compatibilidad, conservacion, periodo de validez, modo de administracion y tipo de envase. Los datos se obtuvieron mediante consulta de las fichas tecnicas, laboratorios, revision bibliografica y otras bases de datos. Resultados: Tras revisar 209 farmacos se elaboro un listado de recomendaciones. Segun los datos obtenidos, las MAP se prepararan de la siguiente forma: 89 seran preparadas desde el SF, 62 en unidad de enfermeria en planta de hospitalizacion pues son medicamentos que requieren administracion inmediata y 58 ya van acondicionados para su administracion por la industria. De los 62 farmacos que se prepararan por enfermeria, en 14 de ellos las dosis siguientes se prepararan desde el SF. Por lo tanto de los 209 farmacos solo 48 se prepararan exclusivamente en la unidad de enfermeria. Conclusiones: Desde el SF se ha establecido un metodo normalizado de preparacion, conservacion, administracion y periodo de validez de MAP. La preparacion de MAP en SF ampliaria su tiempo de conservacion, al tener en cuenta la estabilidad fisicoquimica, el nivel de riesgo y la vulnerabilidad del preparado a la contaminacion microbiologica. La informacion aportada contribuira a una disminucion de errores asociados al proceso de preparacion y administracion de MAP.

  13. [Validation of cold chain during distribution of parenteral nutrition].

    PubMed

    Tuan, Federico; Perone, Virginia; Verdini, Rocio; Pell, Maria Betina; Traverso, Maria Luz

    2015-09-01

    Objetivo: el presente estudio tiene la finalidad de demostrar la aptitud del proceso empleado para acondicionar las mezclas de nutrición parenteral extemporáneas para su distribución, considerando el objetivo de conservar la cadena de frío durante el traslado hasta que llega al paciente, necesario para asegurar la estabilidad, efectividad y seguridad de estas mezclas. Método: validación concurrente; diseño e implementación de un protocolo de evaluación del proceso de acondicionamiento y distribución de MNPE elaboradas por un laboratorio farmacéutico. Ejecución de test, según criterios de aceptación predefinidos. Se efectúa en dos oportunidades, en verano y en las rutas que requieren un tiempo de traslado más prolongado. Evaluación de la conservación de la temperatura mediante supervisión de los valores de temperatura interna de cada tipo de empaquetado, registrados por equipos data loggers calibrados. Resultados: los diferentes test cumplen con los criterios preestablecidos. Los valores obtenidos permiten asegurar el mantenimiento de la cadena de frío durante un tiempo superior al traslado hasta los puntos más distantes. Conclusiones: este estudio permite mostrar la aptitud del proceso de acondicionamiento de MNPE para su distribución, manteniendo la cadena de frío durante todo el traslado desde el Laboratorio farmacéutico hasta el paciente. Considerando que la rotura de la cadena de frío puede ocasionar alteraciones de la compatibilidad y estabilidad de las nutriciones parenterales, así como fallas en el soporte nutricional, este estudio contribuye a la seguridad del paciente, una de las dimensiones relevantes de la calidad de la atención de la salud.

  14. Gut Lymphocyte Phenotype Changes after Parenteral Nutrition and Neuropeptide Administration

    PubMed Central

    Jonker, Mark A; Heneghan, Aaron F; Fechner, John H; Pierre, Joseph F; Sano, Yoshifumi; Lan, Jinggang; Kudsk, Kenneth A

    2016-01-01

    STRUCTURED ABSTRACT Objective Define gut associated lymphocyte phenotype (GALT) changes with parenteral nutrition (PN) and PN with bombesin (BBS). Summary Background Data PN reduces respiratory tract (RT) & GALT Peyer’s patch and lamina propria (LP) lymphocytes, lowers gut and RT IgA levels and destroys established RT antiviral & antibacterial immunity. BBS, an enteric nervous system (ENS) neuropeptide, reverses PN-induced IgA and RT immune defects. Methods Exp 1: IV-cannulated ICR mice received Chow, PN or PN + BBS injections for 5 days. LSR-II flow cytometer analyzed PP and LP isolated lymphocytes for homing phenotypes (L-selectin+ & LPAM-1+) and state of activation (CD25+, CD44+) in T (CD3+) cell subsets (CD4+ & CD8+) along with homing phenotype (L-selectin+ & LPAM-1+) in naive B (IgD+) and antigen-activated (IgD− or IgM+) B (CD45R/B220+) cells. Exp 2: Following initial experiment 1 protocol, LP T regulatory (Treg) cell phenotype was evaluated by Foxp3 expression. Results Exp 1: PN significantly reduced LP 1) CD4+CD25+ (activated) and 2) CD4+CD25+LPAM-1+ (activated cells homed to LP) T cells while PN-BBS assimilated Chow levels. PN significantly reduced LP 1) IgD+ (naïve), 2) IgD-LPAM+ (antigen-activated homed to LP) and CD44+ memory B cells while PN-BBS assimilated Chow levels. Exp 2: PN significantly reduced LP CD4+CD25+Foxp3+ Treg cells compared to Chow mice while PN+BBS assimilated Chow levels. Conclusions PN reduces LP activated and regulatory T cells as well as naïve and memory B cells. BBS addition to PN maintains these cell phenotypes, demonstrating the intimate involvement of the ENS in mucosal immunity. PMID:25563877

  15. Dysregulation of bile acid homeostasis in parenteral nutrition mouse model

    PubMed Central

    Zhan, Le; Yang, Ill; Shen, Jianliang; Gorczyca, Ludwik; Memon, Naureen; Buckley, Brian T.

    2015-01-01

    Long-term parenteral nutrition (PN) administration can lead to PN-associated liver diseases (PNALD). Although multiple risk factors have been identified for PNALD, to date, the roles of bile acids (BAs) and the pathways involved in BA homeostasis in the development and progression of PNALD are still unclear. We have established a mouse PN model with IV infusion of PN solution containing soybean oil-based lipid emulsion (SOLE). Our results showed that PN altered the expression of genes involved in a variety of liver functions at the mRNA levels. PN increased liver gene expression of Cyp7a1 and markedly decreased that of Cyp8b1, Cyp7b1, Bsep, and Shp. CYP7A1 and CYP8B1 are important for synthesizing the total amount of BAs and regulating the hydrophobicity of BAs, respectively. Consistently, both the levels and the percentages of primary BAs as well as total non-12α-OH BAs increased significantly in the serum of PN mice compared with saline controls, whereas liver BA profiles were largely similar. The expression of several key liver-X receptor-α (LXRα) target genes involved in lipid synthesis was also increased in PN mouse livers. Retinoid acid-related orphan receptor-α (RORα) has been shown to induce the expression of Cyp8b1 and Cyp7b1, as well as to suppress LXRα function. Western blot showed significantly reduced nuclear migration of RORα protein in PN mouse livers. This study shows that continuous PN infusion with SOLE in mice leads to dysregulation of BA homeostasis. Alterations of liver RORα signaling in PN mice may be one of the mechanisms implicated in the pathogenesis of PNALD. PMID:26564717

  16. Glycemic Variation in Tumor Patients with Total Parenteral Nutrition

    PubMed Central

    Yang, Jin-Cheng; Dai, Yuan-Yuan; Wang, Li-Ming; Xie, Yi-Bin; Zhou, Hai-Yan; Li, Guo-Hui

    2015-01-01

    Background: Hyperglycemia is associated with poor clinical outcomes and mortality in several patients. However, studies evaluating hyperglycemia variation in tumor patients receiving total parenteral nutrition (TPN) are scarce. The aim of this study was to assess the relationship between glycemia and tumor kinds with TPN by monitoring glycemic variation in tumor patients. Methods: This retrospective clinical trial selected 312 patients with various cancer types, whose unique nutrition treatment was TPN during the monitoring period. All patients had blood glucose (BG) values assessed at least six times daily during the TPN infusion. The glycemic variation before and after TPN was set as the indicator to evaluate the factors influencing BG. Results: The clinical trial lasted 7.5 ± 3.0 days adjusted for age, gender, family cancer history and blood types. There were six cancer types: Hepatic carcinoma (HC, 21.8%), rectal carcinoma (17.3%), colon carcinoma (CC, 14.7%), gastric carcinoma (29.8%), pancreatic carcinoma (11.5%), and duodenal carcinoma (DC, 4.8%). The patients were divided into diabetes and nondiabetes groups. No statistical differences in TPN glucose content between diabetes and nondiabetes groups were found; however, the tumor types affected by BG values were obvious. With increasing BG values, DC, HC and CC were more represented than other tumor types in this sequence in diabetic individuals, as well as in the nondiabetic group. BG was inclined to be more easily influenced in the nondiabetes group. Other factors did not impact BG values, including gender, body mass index, and TPN infusion duration time. Conclusions: When tumor patients are treated with TPN, BG levels should be monitored according to different types of tumors, besides differentiating diabetes or nondiabetes patients. Special BG control is needed for DC, HC and CC in both diabetic and nondiabetic patients. If BG overtly increases, positive measurements are needed to control BG values. The

  17. Terrestrial Effects of Nearby Supernovae in the Early Pleistocene

    NASA Astrophysics Data System (ADS)

    Thomas, B. C.; Engler, E. E.; Kachelrieß, M.; Melott, A. L.; Overholt, A. C.; Semikoz, D. V.

    2016-07-01

    Recent results have strongly confirmed that multiple supernovae happened at distances of ˜100 pc, consisting of two main events: one at 1.7-3.2 million years ago, and the other at 6.5-8.7 million years ago. These events are said to be responsible for excavating the Local Bubble in the interstellar medium and depositing 60Fe on Earth and the Moon. Other events are indicated by effects in the local cosmic ray (CR) spectrum. Given this updated and refined picture, we ask whether such supernovae are expected to have had substantial effects on the terrestrial atmosphere and biota. In a first look at the most probable cases, combining photon and CR effects, we find that a supernova at 100 pc can have only a small effect on terrestrial organisms from visible light and that chemical changes such as ozone depletion are weak. However, tropospheric ionization right down to the ground, due to the penetration of ≥TeV CRs, will increase by nearly an order of magnitude for thousands of years, and irradiation by muons on the ground and in the upper ocean will increase twentyfold, which will approximately triple the overall radiation load on terrestrial organisms. Such irradiation has been linked to possible changes in climate and increased cancer and mutation rates. This may be related to a minor mass extinction around the Pliocene-Pleistocene boundary, and further research on the effects is needed.

  18. Cascaded Effects of Spatial Adaptation in the Early Visual System

    PubMed Central

    Dhruv, Neel T.; Carandini, Matteo

    2014-01-01

    Summary Virtually all stages of the visual system exhibit adaptation: neurons adjust their responses based on the recent stimulus history. While some of these adjustments occur at specific stages, others may be inherited from earlier stages. How do adaptation effects cascade along the visual system? We measured spatially selective adaptation at two successive stages in the mouse visual system: visual thalamus (LGN) and primary visual cortex (V1). This form of adaptation affected both stages but in drastically different ways: in LGN it only changed response gain, while in V1 it also shifted spatial tuning away from the adaptor. These effects, however, are reconciled by a simple model whereby V1 neurons summate LGN inputs with a fixed, unadaptable weighting profile. These results indicate that adaptation effects cascade through the visual system, that this cascading can shape selectivity, and that the rules of integration from one stage to the next are not themselves adaptable. PMID:24507190

  19. Profile effects in early bilingual language and literacy

    PubMed Central

    OLLER, D. KIMBROUGH; PEARSON, BARBARA Z.; COBO-LEWIS, ALAN B.

    2012-01-01

    Bilingual children’s language and literacy is stronger in some domains than others. Reanalysis of data from a broad-scale study of monolingual English and bilingual Spanish–English learners in Miami provided a clear demonstration of “profile effects,” where bilingual children perform at varying levels compared to monolinguals across different test types. The profile effects were strong and consistent across conditions of socioeconomic status, language in the home, and school setting (two way or English immersion). The profile effects indicated comparable performance of bilingual and monolingual children in basic reading tasks, but lower vocabulary scores for the bilinguals in both languages. Other test types showed intermediate scores in bilinguals, again with substantial consistency across groups. These profiles are interpreted as primarily due to the “distributed characteristic” of bilingual lexical knowledge, the tendency for bilingual individuals to know some words in one language but not the other and vice versa. PMID:22639477

  20. Cascaded effects of spatial adaptation in the early visual system.

    PubMed

    Dhruv, Neel T; Carandini, Matteo

    2014-02-05

    Virtually all stages of the visual system exhibit adaptation: neurons adjust their responses based on the recent stimulus history. While some of these adjustments occur at specific stages, others may be inherited from earlier stages. How do adaptation effects cascade along the visual system? We measured spatially selective adaptation at two successive stages in the mouse visual system: visual thalamus (LGN) and primary visual cortex (V1). This form of adaptation affected both stages but in drastically different ways: in LGN it only changed response gain, while in V1 it also shifted spatial tuning away from the adaptor. These effects, however, are reconciled by a simple model whereby V1 neurons summate LGN inputs with a fixed, unadaptable weighting profile. These results indicate that adaptation effects cascade through the visual system, that this cascading can shape selectivity, and that the rules of integration from one stage to the next are not themselves adaptable.

  1. Costs of Multidisciplinary Parenteral Nutrition Care Provided at a Distance via Mobile Tablets

    PubMed Central

    Kim, Heejung; Spaulding, Ryan; Werkowitch, Marilyn; Yadrich, Donna; Piamjariyakul, Ubolrat; Gilroy, Richard; Smith, Carol E.

    2014-01-01

    Background Determining the costs of healthcare delivery is a key step for providing efficient nutrition-based care. This analysis tabulates the costs of delivering home parenteral nutrition (HPN) interventions and clinical assessments through encrypted mobile technologies to increase patients’ access to healthcare providers, reduce their travel expenses, and allow early detection of infection and other complications. Methods A traditional cost-accounting method was used to tabulate all expenses related to mobile distance HPN clinic appointments, including (1) personnel time of multidisciplinary healthcare professionals, (2) supply of HPN intervention materials, and (3) equipment, connection, and delivery expenses. Results A total of 20 mobile distance clinic appointments were conducted for an average of 56 minutes each with 45 patients who required HPN infusion care. The initial setup costs included mobile tablet devices, 4G data plans, and personnel's time as well as intervention materials. The initial costs were on average $916.64 per patient, while the follow-up clinic appointments required $361.63 a month, with these costs continuing to decline as the equipment was used by multiple patients more frequently over time. Patients reported high levels of satisfaction with cost savings in travel expenses and rated the quality of care comparable to traditional in-person examinations. Conclusion This study provides important aspects of the initial cost tabulation for visual assessment for HPN appointments. These findings will be used to generate a decision algorithm for scheduling mobile distance clinic appointments intermittent with in-person visits to determine how to lower costs of nutrition assessments. To maximize the cost benefits, clinical trials must continue to collect clinical outcomes. PMID:25245253

  2. Tissue tropism of Toxoplasma gondii in turkeys (Meleagris gallopavo) after parenteral infection.

    PubMed

    Zöller, B; Koethe, M; Ludewig, M; Pott, S; Daugschies, A; Straubinger, R K; Fehlhaber, K; Bangoura, B

    2013-05-01

    Turkeys are known to be natural hosts for the zoonotic protozoan parasite Toxoplasma gondii. The objective of the present study was to gain further knowledge of possible predilection sites of T. gondii infection in this species after parenteral application of tachyzoites. A total of 38 turkeys were infected with different doses of T. gondii tachyzoites. Birds were killed either 6 to 8 or 10 to 12 weeks after the experimental infection. Fourteen different tissues per bird were investigated by a nested polymerase chain reaction (PCR) for the presence of the parasites' DNA. T. gondii DNA was found in any type of tissue analysed; in 86.1 % of all infected birds, at least one sample was tested positive. Over all intravenously infected birds, 15.4 % of all analysed samples contained T. gondii DNA. Most frequently affected tissues were liver (43.3 % positive samples), breast muscle (26.7 % positive samples) and heart (20.0 % positive samples), while the brain was less frequently positive (6.7 %). The number of positive tissues varied from zero to seven tissues per animal with at least one T. gondii-positive edible tissue sample in 80 % of all intravenously infected birds. Still, the results did not indicate defined target tissues or a cyst distribution pattern. Nonetheless, edible organs were most frequently parasitised. The number of positive findings did not differ between the early and the late examination time points. Therefore, a persistence of the tissue stages until the end of the study (12 weeks after infection) is concluded.

  3. Dual Language Learners: Effective Instruction in Early Childhood

    ERIC Educational Resources Information Center

    Goldenberg, Claude; Hicks, Judy; Lit, Ira

    2013-01-01

    Preschool teachers can best educate youngsters learning their home language and English by using children's primary language where possible, adopting effective practices for building English language skills, and involving families in supporting children's learning. This article surveys the growing body of research on improving preschool…

  4. Ingestion, cytotoxicity, and early morphological effects of asbestos on Tetrahymena.

    PubMed

    Hjelm, K K

    1988-01-01

    Crocidolite asbestos fibers are rapidly ingested in large amounts by Tetrahymena. This varies little with incubation time of fibers in the culture medium or with dilution of the medium. The ingested fibers form large, oblong bundles in the cell rather than the normal spherical food vacuoles. In addition, crocidolite results in a rapid dose dependent induction of various minor morphological abnormalities. At 0.1-3 mg/ml these are observed in approximately one third of the population. Crocidolite is, however, not cytotoxic to Tetrahymena even in these high concentrations as measured by cell death and population doubling time. Phagocytosis and cytotoxicity are thus not related in this cell. Preliminary studies indicate that all the U.I.C.C. standard reference asbestos samples have largely similar effects but that their ability to induce abnormalities depends on the species of Tetrahymena used. For studies of the effects of asbestos Tetrahymena should be a suitable model system because the massive ingestion of fibers and its short generation time should facilitate rapid detection of adverse effects. Among such effects is the induction of heterogenous cell lines. This may involve modification of non-nucleic acid carried hereditary (cytotactic) information.

  5. Early Learner Perceptions of the Attributes of Effective Preceptors

    ERIC Educational Resources Information Center

    Huggett, Kathryn N.; Warrier, Rugmini; Maio, Anna

    2008-01-01

    Medical education in the US has adapted to the shift of patient care from hospital to ambulatory settings by developing educational opportunities in outpatient settings. Faculty development efforts must acknowledge learners' perspectives to be effective in improving teaching and learning. Clinics provide important and unique learning…

  6. The Effects of Early Patient Contact: The Student's Perspective.

    ERIC Educational Resources Information Center

    Briggs-Style, Carolyn; And Others

    1990-01-01

    Medical students' (N=18) were interviewed as part of the evaluation of an innovative Longitudinal Introduction of Clinical Medicine program. Three themes emerged: the importance of experiences with patients; the differences in the effect of patient contact in the first versus the second year; and the educational structure that makes patient…

  7. A Meta-Analysis of Enteral Nutrition and Total Parenteral Nutrition in Patients with Acute Pancreatitis

    PubMed Central

    Quan, Heming; Wang, Xingpeng; Guo, Chuanyong

    2011-01-01

    Objective. To analyze the effect of total parenteral nutrition (TPN) and enteral nutrition (EN) in patients with acute pancreatitis. Methods. Randomized controlled trials of TPN and EN in patients with acute pancreatitis were searched in NCBI and CBM databases and The Cochrane Controlled Trials Register. Six studies were enrolled into the analysis, and the details about the trial designs, characters of the subjects, results of the studies were reviewed by two independent authors and analyzed by STATA 11.0 software. Results. Compared with TPN, EN was associated with a significantly lower incidence of pancreatic infection complications (RR = 0.556, 95% CI 0.436∼0.709, P = .000), MOF (RR = 0.395, 95% CI 0.272∼0.573, P = .003), surgical interventions (RR = 0.556, 95% CI 0.436∼0.709, P = .000), and mortality (RR = 0.426, 95% CI 0.238∼0.764, P = .167). There was no statistic significance in non-pancreatitis-related complications (RR = 0.853, 95% CI 0.490∼1.483, P = .017). However, EN had a significantly higher incidence of non-infection-related complications (RR = 2.697, 95% CI 1.947∼3.735, P = .994). Conclusion. EN could be the preferred nutrition feeding method in patients with acute pancreatitis. PMID:21687619

  8. Oral and parenteral immunization of chickens (Gallus gallus) against West Nile virus with recombinant envelope protein

    USGS Publications Warehouse

    Fassbinder-Orth, C. A.; Hofmeister, E.K.; Weeks-Levy, C.; Karasov, W.H.

    2009-01-01

    West Nile virus (WNV) causes morbidity and mortality in humans, horses, and in more than 315 bird species in North America. Currently approved WNV vaccines are designed for parenteral administration and, as yet, no effective oral WNV vaccines have been developed. WNV envelope (E) protein is a highly antigenic protein that elicits the majority of virus-neutralizing antibodies during a WNV immune response. Leghorn chickens were given three vaccinations (each 2 wk apart) of E protein orally (20 ??g or 100 ??g/dose), of E protein intramuscularly (IM, 20 ??g/dose), or of adjuvant only (control group) followed by a WNV challenge. Viremias were measured post-WNV infection, and three new enzyme-linked immunosorbent assays were developed for quantifying IgM, IgY, and IgA-mediated immune response of birds following WNV infection. WNV viremia levels were significantly lower in the IM group than in both oral groups and the control group. Total WNV E protein-specific IgY production was significantly greater, and WNV nonstructural 1-specific IgY was significantly less, in the IM group compared to all other treatment groups. The results of this study indicate that IM vaccination of chickens with E protein is protective against WNV infection and results in a significantly different antibody production profile as compared to both orally vaccinated and nonvaccinated birds. ?? 2009 American Association of Avian Pathologists.

  9. Pharmacokinetic study of an injectable long-acting parenteral formulation of doxycycline hyclate in calves.

    PubMed

    Vargas-Estrada, D; Gracia-Mora, J; Sumano, H

    2008-06-01

    Doxycycline hyclate (DOX-h) can be regarded as a time-dependant antibacterial. Hence, a parenteral long-acting formulation may be regarded as more pharmacologically sound. A poloxamer-based matrix was used to produce a long-acting injectable preparation (DOX-h-LA) and its serum concentrations vs. time profile investigated after its s.c. injection to calves. Serum concentrations profiles for such a prepartion were compared to the corresponding profiles obtained with an aqueous formulation of DOX-h injected either i.m. or i.v. in 10 calves in a crossover study at dose of 10mg/kg, with washout periods. DOX-h-LA showed the greatest values for bioavailability (602%); maximum serum concentration (C(max)) value was 1.99microg/mL with a time to reach C(max) (T(max)) of 25h and an elimination half-life of 40.81h. Considering minimum effective serum concentration of 0.5microg/mL a dose-interval of 80h can be achieved for DOX-h-LA, and only 9.7h and 17h after the i.v. or i.m. administration of DOX-h, respectively.

  10. Proteomic analysis of plasma from rats following total parenteral nutrition-induced liver injury.

    PubMed

    Tsai, Jai-Jen; Kuo, Hsing-Chun; Lee, Kam-Fai; Tsai, Tung-Hu

    2015-11-01

    Total parenteral nutrition (TPN) is provided as the primary nitrogen source to manage patients with intestinal failure who were not able to sustain themselves on enteral feeds. The most common complication of long-term TPN use is hepatitis. A proteomic approach was used to identify proteins that are differentially expressed in the plasma of rats following TPN-related acute liver injury. Six male rats were randomly assigned to either the saline infusion control group or the TPN infusion group. Our results demonstrate that TPN infusion in rats resulted in hepatic dysfunction and hepatocyte apoptosis. Five proteins that were differentially expressed between TPN infusion and normal rats were determined and validated in vivo. Fascinatingly, the proteomic differential displays, downregulated proteins included peroxiredoxin 2 (PRDX2), alpha-1-antiproteinase (A1AT), and fibrinogen gamma chain (FIBG), which were involved in oxidative stress, inflammatory respondence and cells apoptosis. After TPN infusion, two protein spots showed increased expression, namely, the glucagon receptor (GLR) protein and apolipoprotein A-1 (APOA1), which may mediate the effects of TPN administration on glycogen and lipid metabolism. In this study, proteomic analysis suggested TPN-related acute liver injury could be involved in limiting cellular protection mechanisms against oxidative stress-induced apoptosis. On the basis of the results, we also give molecular evidences replying TPN-related hepatitis.

  11. [In vitro activities of sulopenem, a new parenteral penem, against anaerobes].

    PubMed

    Watanabe, K; Kato, N; Tanaka-Bandoh, K; Tanaka, Y; Kato, H; Ueno, K

    1996-04-01

    In vitro activities of sulopenem, a novel parenteral penem, was compared with those of imipenem, flomoxef, cefuzonam, cefoperazone and sulbactam/ampicillin against 66 reference strains (19 genera, 61 species) and 392 recent clinical isolates of anaerobic bacteria and fastidious aerobic bacteria. Sulopenem had a very broad spectrum against anaerobic bacteria. In general, this compound was active against anaerobic reference strains with MICs of < or = 0.78 micrograms/ml, while being the least active against Bifidobacterium spp. and less active than imipenem against Lactobacillus spp. Sulopenem was more active against Bacteroides fragilis isolates than imipenem and had the highest activities against Bacteroides thetaiotaomicron, Prevotella intermedia, Porphyromonas gingivalis, Fusobacterium spp. and Peptostreptococcus spp. among the antibiotics tested. Sulopenem was not hydrolyzed by oxyiminocephalosporinase type 1 produced by B. fragilis GAI-0558, GAI-7955 and GAI-10150 and its stability was comparable to imipenem. Its susceptibilities to hydrolysis by a metallo-beta-lactamase from B. fragilis GAI-30144 was less than imipenem. Sulopenem (120 mg/kg, 3 times a day for 4 days) was as effective as imipenem/cilastatin against a mixed intraabdominal mice infection due to E. coli and B. fragilis. Sulopenem (20 mg/kg twice a day for 5 days) did not induce an overgrowth of Clostridium difficile in the caecum of mice.

  12. Organic solvents for pharmaceutical parenterals and embolic liquids: a review of toxicity data.

    PubMed

    Mottu, F; Laurent, A; Rufenacht, D A; Doelker, E

    2000-01-01

    Non-aqueous solvents have long been used in subcutaneous or intramuscular pharmaceutical formulations to dissolve water-insoluble drugs. In recent years, the need for these vehicles was increased since the drug discovery process has yielded many poorly water-soluble drugs. Besides, preparations containing embolic materials dissolved in undiluted non-aqueous water-miscible solvents have been proposed for the intravascular treatment of aneurysms, arteriovenous malformations, or tumors. These organic solvents, regarded as chemically and biologically inert, may show pharmacological and toxicological effects. Therefore, knowledge of tolerance and activity of non-aqueous solvents is essential before they can be administered, especially when given undiluted. This paper focuses on thirteen organic solvents reported as possible vehicles for injectable products and details toxicological data when they have been administered intravascularly. These solvents can be subdivided into three groups according to their description in the literature either for intravenous pharmaceutical parenterals or for intravascular embolic liquids: well-documented organic solvents (propylene glycol, polyethylene glycols, ethanol), solvents described in specific applications (dimethyl sulfoxide, N-methyl-2-pyrrolidone, glycofurol, Solketal, glycerol formal, acetone), and solvents not reported in intravascular applications but potentially useful (tetrahydrofurfuryl alcohol, diglyme, dimethyl isosorbide, ethyl lactate). This review of the literature shows that toxicity data on intravascular organic solvents are insufficient because they concern solvents diluted with water and because of the lack of comparative evaluation using the same methodologies.

  13. Amino acid dosing in parenteral nutrition for very low birth weight preterm neonates: an outcome assessment.

    PubMed

    Kamarudin, Nor Aini; Manan, Mohamed Mansor; Zulkifly, Hanis Hanum; Neoh, Chin Fen; Ali, Salmiah Mohd; Ming, Long Chiau

    2016-01-01

    This study aimed to investigate the effects of parenteral nutrition (PN) administration of amino acids (AA) on physical changes among very low birth weight infants in a local hospital setting in Malaysia. A retrospective study was carried out at a hospital in Malaysia. Records of neonates prescribed PN in the neonatal unit in 2012 were screened for eligibility. A total of 199 premature neonates received PN support in the year 2012 and, of these, 100 fulfilled the inclusion criteria. The median value of AA intake on the first day of PN was 2.00 (<28 weeks group); 1.00 (28-31 weeks group) and 0.75 (>31 weeks group). Neonates in the <28 weeks group were more likely to receive AA at an earlier time and higher initial dose compared with the other age groups. The study also found that there was no statistically significant difference in the dose of AA on the first day of PN administration and that the significant variations in nutritional parameters among the subjects did not lead to differences in physical outcomes. This study identified that when PN is provided in the local hospital setting, it is likely that the current nutritional practices are inadequate to achieve the standard growth recommendations. Our findings call for a need to optimize AA and calorie intake since growth restriction is a morbidity which will affect the infants' growth and development. Current prescriptions for PN in this hospital need to be reviewed in order to improve patient outcomes.

  14. Competence and psychopathology: cascade effects in the NICHD Study of Early Child Care and Youth Development.

    PubMed

    Burt, Keith B; Roisman, Glenn I

    2010-08-01

    Existing longitudinal research on the interplay between externalizing problems, internalizing problems, and academic and social competence has documented "cascading" effects from early aggressive/disruptive behavior through impairments in competence, leading to symptoms of depression and anxiety. The primary aim of the current study was to replicate such work using the NICHD Study of Early Child Care and Youth Development while also extending the developmental window of investigation of cascades back into early childhood. Participating families (N = 1,160) completed questionnaire measures of externalizing, internalizing, and social competence (maternal report), as well as individual assessment of academic achievement, spanning five time points from age 54 months through age 15 years. A series of nested structural equation models tested predicted links across various domains of competence and psychopathology. Results were consistent with prior research, demonstrating cross-domain effects from early externalizing problems through effects on both academic and social competence into later internalizing problems. Effects held across gender and were largely unaffected by inclusion of socioeconomic status, early caregiving, and early cognitive ability as covariates in the model.

  15. Early-Life Effects on Adult Physical Activity: Concepts, Relevance, and Experimental Approaches.

    PubMed

    Garland, Theodore; Cadney, Marcell D; Waterland, Robert A

    Locomotion is a defining characteristic of animal life and plays a crucial role in most behaviors. Locomotion involves physical activity, which can have far-reaching effects on physiology and neurobiology, both acutely and chronically. In human populations and in laboratory rodents, higher levels of physical activity are generally associated with positive health outcomes, although excessive exercise can have adverse consequences. Whether and how such relationships occur in wild animals is unknown. Behavioral variation among individuals arises from genetic and environmental factors and their interactions as well as from developmental programming (persistent effects of early-life environment). Although tremendous progress has been made in identifying genetic and environmental influences on individual differences in behavior, early-life effects are not well understood. Early-life effects can in some cases persist across multiple generations following a single exposure and, in principle, may constrain or facilitate the rate of evolution at multiple levels of biological organization. Understanding the mechanisms of such transgenerational effects (e.g., exposure to stress hormones in utero, inherited epigenetic alterations) may prove crucial to explaining unexpected and/or sex-specific responses to selection as well as limits to adaptation. One area receiving increased attention is early-life effects on adult physical activity. Correlational data from epidemiological studies suggest that early-life nutritional stress can (adversely) affect adult human activity levels and associated physiological traits (e.g., body composition, metabolic health). The few existing studies of laboratory rodents demonstrate that both maternal and early-life exercise can affect adult levels of physical activity and related phenotypes. Going forward, rodents offer many opportunities for experimental studies of (multigenerational) early-life effects, including studies that use maternal

  16. The possible long-term effects of early-life circadian rhythm disturbance on social behavior.

    PubMed

    Kohyama, Jun

    2014-07-01

    Sleep loss impairs brain function. As late sleep onset can reduce sleep, this sleep/circadian rhythm disturbance may cause brain impairment. Specific data on the long-term effects of sleep/circadian rhythm disturbance on subsequent brain function are lacking. Japan, a sleep-deprived society from infancy to adulthood, provides an ideal platform to investigate the association of these disturbances in early life with subsequent functioning. In this article, several current problematic behaviors among youth in Japan (dropping out from high school, school absenteeism, early resignation from employment, and suicide) are discussed in relation to early life sleep/circadian rhythm patterns. We hypothesize that daily habits of modern society during early stages of life produce unfavorable effects on brain function resulting in problematic behaviors in subsequent years.

  17. Non-Parenteral Medications for Procedural Sedation in Children- A Narrative: Review Article.

    PubMed

    Fallah, Razieh; Ferdosian, Farzad; Shajari, Ahmad

    2015-01-01

    Procedural sedation may be needed in many diagnostic and therapeutic procedures in children. To make pediatric procedural sedation as safe as possible, protocols should be developed by institutions. Response to sedation in children is highly variable, while some become deeply sedated after minimal doses, others may need much higher doses. Child developmental status, clinical circumstances and condition of patient should be considered and then pharmacologic and non-pharmacologic interventions for sedation be selected. Drug of choice and administration route depend on the condition of the child, type of procedure, and predicted pain degree. The drugs might be administered parenteral (intravenous or intramuscular) or non parenteral including oral, rectal, sublingual, aerosolized buccal and intranasal. The use of intravenous medication such propofol, ketamine, dexmedetomidine, or etomidate may be restricted in use by pediatric anesthesiologist or pediatric critical care specialists or pediatric emergency medicine specialists. In this review article we discuss on non-parenteral medications that can be used by non- anesthesiologist.

  18. Non-Parenteral Medications for Procedural Sedation in Children- A Narrative: Review Article

    PubMed Central

    FALLAH, Razieh; FERDOSIAN, Farzad; SHAJARI, Ahmad

    2015-01-01

    Procedural sedation may be needed in many diagnostic and therapeutic procedures in children. To make pediatric procedural sedation as safe as possible, protocols should be developed by institutions. Response to sedation in children is highly variable, while some become deeply sedated after minimal doses, others may need much higher doses. Child developmental status, clinical circumstances and condition of patient should be considered and then pharmacologic and non-pharmacologic interventions for sedation be selected. Drug of choice and administration route depend on the condition of the child, type of procedure, and predicted pain degree. The drugs might be administered parenteral (intravenous or intramuscular) or non parenteral including oral, rectal, sublingual, aerosolized buccal and intranasal. The use of intravenous medication such propofol, ketamine, dexmedetomidine, or etomidate may be restricted in use by pediatric anesthesiologist or pediatric critical care specialists or pediatric emergency medicine specialists. In this review article we discuss on non-parenteral medications that can be used by non- anesthesiologist. PMID:26401146

  19. Case of congenital short small intestine: survival with use of long-term parenteral feeding.

    PubMed

    Dorney, S F; Byrne, W J; Ament, M E

    1986-03-01

    Isolated congenital short small intestine is a rare anomaly. Of six (one male, five females) previously reported cases, four died in infancy from intractable diarrhea. We report the case of 7-year-old boy with this syndrome in whom a 2-year period of parenteral feeding at home allowed normal weight gain, growth, and development while intestinal adaptation occurred. Parenteral feeding was discontinued at age 2 1/3 years, and for the past 5 years his weight has remained between the tenth and 25th percentiles and his stature between the 25th and 50th percentiles. His development has been normal and he functions at or above grade level at school. Coefficient of fat absorption has increased from 54% to 81%. Vitamin B12 absorption has improved but has not normalized. He remains lactose intolerant. We believe his survival, growth, and development would have been compromised if he had not received a prolonged period of parenteral feeding.

  20. Use of erythropoietin and parenteral iron dextran in a severely anemic Jehovah's Witness with colon cancer.

    PubMed

    Madura, J A

    1993-10-01

    A Jehovah's Witness presented with colon cancer and profound anemia. On admission, her hemoglobin level was 30 g/L (3.0 g/dL). She refused all transfusions and failed to respond to oral iron therapy. She was ultimately prepared for surgery using recombinant human erythropoietin, iron dextran, and total parenteral nutrition. It took nearly 1 month to increase her hemoglobin level to an acceptable preoperative level of 110 g/L (11.0 g/dL). During the postoperative period, erythropoietin and parenteral iron therapy were briefly continued and a follow-up hemoglobin level of greater than 120 g/L (12.0 g/dL) was observed. Recombinant human erythropoietin, along with parenteral iron and adequate nutrition, may be useful in patients who refuse transfusion or cannot be transfused because of difficult cross-reacting antibodies.

  1. Enteral bile acid treatment improves parenteral nutrition-related liver disease and intestinal mucosal atrophy in neonatal pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Total parenteral nutrition (TPN) is essential for patients with impaired gut function but leads to parenteral nutrition-associated liver disease (PNALD). TPN disrupts the normal enterohepatic circulation of bile acids, and we hypothesized that it would decrease intestinal expression of the newly des...

  2. Community-based parenteral anti-infective therapy (CoPAT). Pharmacokinetic and monitoring issues.

    PubMed

    Williams, D N; Raymond, J L

    1998-07-01

    Community-based parenteral anti-infective therapy (CoPAT) has, over the past 20 years, increased rapidly in many parts of the world including North America, Europe, South America and Australia. CoPAT is a multidisciplinary activity demanding close cooperation between nurses, pharmacists and physicians, as well as with the patient. The selection of an anti-infective drug for use outside the hospital setting must take into account not only the therapeutic effectiveness, cost effectiveness and safety of the drug, but also pharmacological factors such as the dosage schedule and the stability of the drug. Dosage schedules vary with pharmacokinetic factors (e.g. the use of drugs with long half-lives are favoured by CoPAT programmes) and pharmacodynamic features (e.g. once daily gentamicin therapy is attractive and practical because of concentration-dependent bactericidal killing and prolonged post-antibiotic effect). With selected drugs, the renal and, to a lesser degree, liver function of the patient will influence the dosage schedule. The mode of intravenous (i.v.) drugs administration will vary with volume considerations (limiting the use of syringe-infusion therapy for some drugs), stability issues (prevents drugs that are stable at room temperature for less than 24 hours from being used in multidose computerised delivery systems), as well as patient factors (ability to self administer an i.v. drug). Monitoring serum anti-microbial concentrations is undertaken to assure effectiveness and avoid toxicity, and is indicated for drugs with a narrow therapeutic window, such as the aminoglycosides. With the advent of the single daily dose administration of aminoglycosides, checking serum concentrations at the mid-point, i.e. 6 to 14 hours following administration of the first dose, is one approach. Because the toxic effects of vancomycin have been overstated, serum concentrations should only be obtained for defined indications primarily to assure therapeutic effectiveness.

  3. Early metabolic effects and mechanism of ammonium transport in yeast

    SciTech Connect

    Pena, A.; Pardo, J.P.; Ramirez, J.

    1987-03-01

    Studies were performed to define the effects and mechanism of NH+4 transport in yeast. The following results were obtained. Glucose was a better facilitator than ethanol-H/sub 2/O/sub 2/ for ammonium transport; low concentrations of uncouplers or respiratory inhibitors could inhibit the transport with ethanol as the substrate. With glucose, respiratory inhibitors showed only small inhibitory effects, and only high concentrations of azide or trifluoromethoxy carbonylcyanide phenylhydrazone could inhibit ammonium transport. Ammonium in the free state could be concentrated approximately 200-fold by the cells. Also, the addition of ammonium produced stimulation of both respiration and fermentation; an increased rate of H+ extrusion and an alkalinization of the interior of the cell; a decrease of the membrane potential, as monitored by fluorescent cyanine; an immediate decrease of the levels of ATP and an increase of ADP, which may account for the stimulation of both fermentation and respiration; and an increase of the levels of inorganic phosphate. Ammonium was found to inhibit 86Rb+ transport much less than K+. Also, while K+ produced a competitive type of inhibition, that produced by NH4+ was of the noncompetitive type. From the distribution ratio of ammonium and the pH gradient, an electrochemical potential gradient of around -180 mV was calculated. The results indicate that ammonium is transported in yeast by a mechanism similar to that of monovalent alkaline cations, driven by a membrane potential. The immediate metabolic effects of this cation seem to be due to an increased (H+)ATPase, to which its transport is coupled. However, the carriers seem to be different. The transport system studied in this work was that of low affinity.

  4. Aluminum contamination of parenteral nutrition additives, amino acid solutions, and lipid emulsions.

    PubMed

    Popińska, K; Kierkuś, J; Lyszkowska, M; Socha, J; Pietraszek, E; Kmiotek, W; Ksiazyk, J

    1999-09-01

    Contamination of parenteral nutrition solutions with aluminum may result in accumulation of this element in bones and, in premature infants, may inhibit bone calcium uptake and induce cholestasis. We measured the aluminum concentration of small-volume parenterals, amino acid solutions, lipid emulsions, and special solutions containing glucose, amino acids, electrolytes, and trace elements (standard I for children with a body weight of 3-5 kg, standard II for children with a body weight of 5-10 kg). The method used was graphite furnace atomic absorption spectrometry GTA-AAS (SpectrAA-400 Plus, Varian, PtY Ltd., Mulgrave, Australia). Quality control was run with the use of control serum (Seronorm, Nycomed, Oslo, Norway). The aluminum contents of parenterally administered solutions were: pediatric trace elements, 130 micrograms/L, and pediatric trace elements, 3000 micrograms/L; phosphorus salts: K-phosphates, 9800 micrograms/L, and Na/K phosphates, 13,000 micrograms/L; 10% calcium gluconate, 4400 micrograms/L; 6.5% amino acids, 30 micrograms/L; 10% amino acids, 120 micrograms/L; 12.5% amino acids, 121 micrograms/L; 20% lipid emulsion, 30 micrograms/L; 20% lipid emulsion, 180 micrograms/L; water-soluble vitamins, 12 micrograms/L; lipid soluble vitamins, 360 micrograms/L; standard I, 55 micrograms/L; standard II, 90 micrograms/L; The aluminum intake from parenteral nutrition was 6.6-10.8 micrograms.kg-1.d-1--a dose exceeding the safety limit of 2 micrograms.kg-1.d-1. The possible association of aluminum not only with metabolic bone disease, but also with encephalopathy, dictates caution when dealing with the pediatric population on long-term parenteral nutrition. In the absence of reliable label information, it seems proper to monitor the aluminum concentration in parenteral nutrition products and to report it in professional journals.

  5. Evaluation of Bacillus oleronius as a Biological Indicator for Terminal Sterilization of Large-Volume Parenterals.

    PubMed

    Izumi, Masamitsu; Fujifuru, Masato; Okada, Aki; Takai, Katsuya; Takahashi, Kazuhiro; Udagawa, Takeshi; Miyake, Makoto; Naruyama, Shintaro; Tokuda, Hiroshi; Nishioka, Goro; Yoden, Hikaru; Aoki, Mitsuo

    2016-01-01

    In the production of large-volume parenterals in Japan, equipment and devices such as tanks, pipework, and filters used in production processes are exhaustively cleaned and sterilized, and the cleanliness of water for injection, drug materials, packaging materials, and manufacturing areas is well controlled. In this environment, the bioburden is relatively low, and less heat resistant compared with microorganisms frequently used as biological indicators such as Geobacillus stearothermophilus (ATCC 7953) and Bacillus subtilis 5230 (ATCC 35021). Consequently, the majority of large-volume parenteral solutions in Japan are manufactured under low-heat sterilization conditions of F0 <2 min, so that loss of clarity of solutions and formation of degradation products of constituents are minimized. Bacillus oleronius (ATCC 700005) is listed as a biological indicator in "Guidance on the Manufacture of Sterile Pharmaceutical Products Produced by Terminal Sterilization" (guidance in Japan, issued in 2012). In this study, we investigated whether B. oleronius is an appropriate biological indicator of the efficacy of low-heat, moist-heat sterilization of large-volume parenterals. Specifically, we investigated the spore-forming ability of this microorganism in various cultivation media and measured the D-values and z-values as parameters of heat resistance. The D-values and z-values changed depending on the constituents of large-volume parenteral products. Also, the spores from B. oleronius showed a moist-heat resistance that was similar to or greater than many of the spore-forming organisms isolated from Japanese parenteral manufacturing processes. Taken together, these results indicate that B. oleronius is suitable as a biological indicator for sterility assurance of large-volume parenteral solutions subjected to low-heat, moist-heat terminal sterilization.

  6. Effects of saline drinking water on early gosling development

    USGS Publications Warehouse

    Stolley, D.S.; Bissonette, J.A.; Kadlec, J.A.; Coster, D.

    1999-01-01

    Relatively high levels of saline drinking water may adversely affect the growth, development, and survival of young waterfowl. Saline drinking water was suspect in the low survival rate of Canada goose (Branta canadensis) goslings at Fish Springs National Wildlife Refuge (FSNWR) in western Utah. Hence, we investigated the effects of saline drinking water on the survival and growth of captive, wild-strain goslings from day 1-28 following hatch. We compared survival and growth (as measured by body mass, wing length, and culmen length) between a control group on tap water with a mean specific conductivity of 650 ??S/cm, and 2 saline water treatments: (1) intermediate level (12,000 ??S/cm), and (2) high level (18,000 ??S/cm). Gosling mortality occurred only in the 18,000 ??S/cm treatment group (33%; n = 9). Slopes of regressions of mean body mass, wing length, and culmen length on age were different from each other (P < 0.05), except for culmen length for the intermediate and high treatment levels. We predict that free-ranging wild goslings will experience mortality at even lower salinity levels than captive goslings because of the combined effects of depressed growth and environmental stresses, including hot desert temperatures and variable food quality over summer.

  7. Early and late endocrine effects in pediatric central nervous system diseases.

    PubMed

    Aslan, Ivy R; Cheung, Clement C

    2014-01-01

    Endocrinopathies are frequently linked to central nervous system disease, both as early effects prior to the disease diagnosis and/or late effects after the disease has been treated. In particular, tumors and infiltrative diseases of the brain and pituitary, such as craniopharyngioma, optic pathway and hypothalamic gliomas, intracranial germ cell tumor, and Langerhans cell histiocytosis, can present with abnormal endocrine manifestations that precede the development of neurological symptoms. Early endocrine effects include diabetes insipidus, growth failure, obesity, and precocious or delayed puberty. With improving prognosis and treatment of childhood brain tumors, many survivors experience late endocrine effects related to medical and surgical interventions. Chemotherapeutic agents and radiation therapy can affect the hypothalamic-pituitary axes governing growth, thyroid, gonadal, and adrenal function. In addition, obesity and metabolic alterations are frequent late manifestations. Diagnosing and treating both early and late endocrine manifestations can dramatically improve the growth, well-being, and quality of life of patients with childhood central nervous system diseases.

  8. The Effects of Two Influential Early Childhood Interventions on Health and Healthy Behaviour

    PubMed Central

    Conti, Gabriella; Heckman, James; Pinto, Rodrigo

    2015-01-01

    This paper examines the long-term impacts on health and healthy behaviors of two of the oldest and most widely cited U.S. early childhood interventions evaluated by the method of randomization with long-term follow-up: the Perry Preschool Project (PPP) and the Carolina Abecedarian Project (ABC). There are pronounced gender effects strongly favoring boys, although there are also effects for girls. Dynamic mediation analyses show a significant role played by improved childhood traits, above and beyond the effects of experimentally enhanced adult socioeconomic status. These results show the potential of early life interventions for promoting health. PMID:28260805

  9. ROLE OF PARENTERAL NUTRITION IN ONCOLOGIC PATIENTS WITH INTESTINAL OCCLUSION AND PERITONEAL CARCINOMATOSIS.

    PubMed

    Aría Guerra, Eva; Cortés-Salgado, Alfonso; Mateo-Lobo, Raquel; Nattero, Lía; Riveiro, Javier; Vega-Piñero, Belén; Valbuena, Beatriz; Carabaña, Fátima; Carrero, Carmen; Grande, Enrique; Carrato, Alfredo; Botella-Carretero, José Ignacio

    2015-09-01

    Introducción y objetivos: el papel preciso de la nutrición parenteral en el manejo de los pacientes oncológicos con obstrucción intestinal no está bien definido todavía. El objetivo del presente trabajo es evaluar los efectos de la nutrición parenteral en este tipo de pacientes en cuanto al pronóstico. Material y métodos: fueron incluidos 55 pacientes con obstrucción intestinal y carcinomatosis peritoneal. La nutrición parenteral proporcionó 20-35 kcal/Kg/día y 1.0 g/kg/día de aminoácidos. El peso, el IMC, el tipo de tumor, el tipo de quimioterapia recibida y el ECOG, entre otras variables, fueron recogidas y analizadas. Resultados: un 69,1% de los pacientes presentaban tumors gastrointestinales, un 18,2% ginecológicos y otros tumores el 12,7% restante. La edad media fue de 60 ± 13 años, con un ECOG basal de 1,5 ± 0,5 y un IMC de 21,6 ± 4,3. La presencia de malnutrición fue de un 85%. La supervivencia desde el inicio de la nutrición parenteral no fue significativamente distinta entre los pacientes al considerar su ECOG basal (log rank = 0,593, p = 0,743), las líneas previas de quimioterapia recibida (log rank = 2,117, p = 0,548), el IMC basal (log rank = 2,686, p = 0,261), o el tipo de tumor (log rank = 2,066, p = 0,356). La supervivencia en los pacientes en que fue posible el alta hospitalaria con nutrición parenteral fue superior (log rank = 7,090, p = 0,008). La supervivencia en los pacientes en que se inició la quimioterapia durante o tras iniciar la nutrición parenteral fue también superior (log rank = 17,316, p < 0,001). Un total de 3,6% de los pacientes presentaron infección relacionada con el catéter sin afectar la supervivencia (log rank = 0,061, p = 0,804). Conclusión: la nutrición parenteral en los pacientes oncológicos con obstrucción intestinal y carcinomatosis peritoneal es segura y, en aquellos que responden a qui mioterapia, el uso de la nutrición parenteral domiciliaria, junto con en tratamiento antitumoral activo

  10. Hemosiderosis secondary to chronic parenteral iron therapy in maintenance hemodialysis patients.

    PubMed

    Pitts, T O; Barbour, G L

    1978-01-01

    Autopsy data on 24 chronic maintenance hemodialysis patients who had received varying doses of parenteral iron as the iron-dextran complex were reviewed for evidence of iron overload (hemosiderosis) and tissue fibrosis or organ dysfunction (hemochromatosis). Hemosiderosis was frequent in patients who received high total doses of iron but absent in those who received little or no iron. The degree of tissue iron did not increase with increased iron administration above a total of 2.5 g. Hemochromatosis or organ dysfunction secondary to tissue iron deposition was not noted in any patient. Chronic parenteral iron administration may improve anemia and result in tissue iron deposition but does not lead to hemochromatosis.

  11. Feasibility of parenteral iron therapy as a field approach for management of pregnancy anaemia.

    PubMed

    Raman, L; Vasumathi, N; Rawal, A; Rajalakshmi, K

    1989-08-01

    The feasibility of parenteral iron administration for treatment of pregnancy anaemia, in field conditions was investigated. High reaction rates were observed (30-40%) with either intramuscular (im) or intravenous (iv) iron-dextran complex (test dose). Mothers with lower body weight had higher reaction rates with both im or iv iron-dextran complex. In pregnancy induced hypertension (PIH) the reaction rate was significantly lower. Our study indicates that under the existing situations of the health care system in India and the poor body weight and weight gain of Indian women during pregnancy, parenteral iron therapy for controlling anaemia may not be a feasible approach, at the field level.

  12. Neonatal parenteral nutrition hypersensitivity: a case report implicating bisulfite sensitivity in a newborn infant.

    PubMed

    Huston, Robert K; Baxter, Louise M; Larrabee, Paige B

    2009-01-01

    This report describes a case of parenteral nutrition hypersensitivity in a 37 weeks' gestation infant with congenital diaphragmatic hernia complicated by bowel necrosis and functional short bowel syndrome. The patient developed a rash with subsequent urticaria beginning on the 50th day of life. The reactions were confirmed with a positive rechallenge. After the amino acid solution was replaced with a non-bisulfite-containing product, the infant was able to continue to receive nutrition support through parenteral nutrition without recurrence of symptoms. It is speculated that the bisulfite additive in the amino acid solution may have interacted with the lipid emulsion to sensitize the patient.

  13. Neuroimaging identifies increased manganese deposition in infants receiving parenteral nutrition12

    PubMed Central

    Aschner, Judy L; Anderson, Adam; Slaughter, James Christopher; Aschner, Michael; Steele, Steven; Beller, Amy; Mouvery, Amanda; Furlong, Heather M; Maitre, Nathalie L

    2015-01-01

    Background: Manganese, an essential metal for normal growth and development, is neurotoxic on excessive exposure. Standard trace element–supplemented neonatal parenteral nutrition (PN) has a high manganese content and bypasses normal gastrointestinal absorptive control mechanisms, which places infants at risk of manganese neurotoxicity. Magnetic resonance (MR) relaxometry demonstrating short T1 relaxation time (T1R) in the basal ganglia reflects excessive brain manganese accumulation. Objective: This study tested the hypothesis that infants with greater parenteral manganese exposure have higher brain manganese accumulation, as measured by MR imaging, than do infants with lower parenteral manganese exposure. Design: Infants exposed to parenteral manganese were enrolled in a prospective cohort study. Infants classified as having high manganese exposure received >75% of their nutrition in the preceding 4 wk as PN. All others were classified as having low exposure. Daily parenteral and enteral manganese intakes were calculated. Whole-blood manganese was measured by high-resolution inductively coupled plasma mass spectrometry. Brain MR relaxometry was interpreted by a masked reviewer. Linear regression models, adjusted for gestational age (GA) at birth, estimated the association of relaxometry indexes with total and parenteral manganese exposures. Results: Seventy-three infants were enrolled. High-quality MR images were available for 58 infants, 39 with high and 19 with low manganese exposure. Four infants with a high exposure had blood manganese concentrations >30 μg/L. After controlling for GA, higher parenteral and total manganese intakes were associated with a lower T1R (P = 0.01) in the globus pallidus and putamen but were not associated with whole-blood manganese (range: 3.6–56.6 μg/L). Elevated conjugated bilirubin magnified the association between parenteral manganese and decreasing T1R. Conclusion: A short T1R for GA identifies infants at risk of

  14. Ivermectin plus diethylcarbamazine: an additive effect on early microfilarial clearance.

    PubMed

    Moulia-Pelat, J P; Nguyen, L N; Glaziou, P; Chanteau, S; Ottesen, E A; Cardines, R; Martin, P M; Cartel, J L

    1994-02-01

    The effects of ivermectin, diethylcarbamazine (DEC), and the combination of both drugs on levels of microfilaremia (mf) were studied in 30 male Polynesian Wuchereria bancrofti carriers. Microfilarial densities were measured 30 min (H1/2), 1 hr (H1), and 2, 4, 8, 24, and 96 hr (H2, H4, H8, H24, and H96) after supervised single doses of ivermectin plus DEC (400 micrograms/kg plus 1 mg/kg, respectively, 400 micrograms/kg plus 3 mg/kg, respectively, and 400 micrograms/kg plus 6 mg/kg, respectively), DEC (6 mg/kg) alone, and ivermectin (400 micrograms/kg and 100 micrograms/kg, respectively) alone given to six groups of five patients each. The results showed that 1) DEC alone or combined with ivermectin induced a rapid clearance of mf after drug intake; at H1/2, the number of circulating microfilariae was reduced to 16%, 8%, 28%, and 31%, respectively, of pretreatment values in the groups receiving ivermectin plus DEC (400 micrograms/kg plus 1 mg/kg, 400 micrograms/kg plus 3 mg/kg, and 400 micrograms/kg plus 6 mg/kg) and DEC (6 mg/kg) alone; 2) ivermectin alone induced a rapid increase of mf densities during the first 2 hr, followed by a sharp decrease from H4 to H96; and 3) between H8 and H96, mf clearance was almost complete with the combination of ivermectin and DEC. A comparison among groups did not show any synergistic interaction between ivermectin and DEC on the clearance of microfilaria, with the effect of each drug being additive to each another.

  15. Parenteral iron use in the management of anemia in end-stage renal disease patients.

    PubMed

    Bailie, G R; Johnson, C A; Mason, N A

    2000-01-01

    Intravenous iron is required by most dialysis patients receiving erythropoietin (EPO) to maintain an adequate hematocrit. In the United States, there are currently two parenteral iron preparations, iron dextran and iron gluconate, approved for such use, and a third product, iron sucrose, is under development. This article reviews each of these products. Each of the iron products increases the efficacy of EPO use in anemia management. There is considerable experience in the United States and elsewhere with the use of iron dextran. Although it is clinically effective, iron dextran is also associated with significant morbidity from both dose-dependent and -independent side effects. The slow release of iron from this complex necessitates a delay in monitoring iron indices after the administration of large doses of iron dextran. Recommended doses of iron sucrose appear very safe with little risk of anaphylactic reactions. Adverse effects are uncommon and not life threatening. If approved for use in the United States, iron sucrose may be a safe and effective alternative to iron dextran. Iron dissociates from iron gluconate quite rapidly and may increase the production of ionized free iron. Iron gluconate may be a safe alternative to iron dextran for patients with severe reactions, including anaphylaxis. The risk of allergic reactions to iron gluconate is very low. The exact place in therapy for the newer iron complexes remains unclear. Currently available data suggest that iron sucrose and iron gluconate may have diminished adverse effect profiles when compared with iron dextran. Additional clinical experience will establish the role for these new iron products.

  16. Cost effectiveness of responsive stimulation and nutrition interventions on early child development outcomes in Pakistan.

    PubMed

    Gowani, Saima; Yousafzai, Aisha K; Armstrong, Robert; Bhutta, Zulfiqar A

    2014-01-01

    Early childhood programs are heralded as a way to improve children's health and educational outcomes. However, few studies in developing countries calculate the effectiveness of quality early childhood interventions. Even fewer estimate the associated costs of such interventions. The study here looks at the costs and effectiveness of a cluster-randomized effectiveness trial on children from birth to 24 months in rural Sindh, Pakistan. Responsive stimulation and/or enhanced nutrition interventions were integrated in the Lady Health Worker program in Pakistan. Outcomes suggest that children who receive responsive stimulation had significantly better development outcomes at 24 months than those who only received enhanced nutrition intervention. A cost-effectiveness analysis of the results verifies that early childhood interventions that include responsive stimulation are more cost effective than a nutrition intervention alone in promoting children's early development. Costs of a responsive stimulation intervention integrated in an existing community-based service providing basic health and nutrition care is approximately US$4 per month per child. We discuss these findings and make recommendations about scaling up and costs for future early child development programs.

  17. Cost-Effectiveness Analysis of Early Reading Programs: A Demonstration with Recommendations for Future Research

    ERIC Educational Resources Information Center

    Hollands, Fiona M.; Kieffer, Michael J.; Shand, Robert; Pan, Yilin; Cheng, Henan; Levin, Henry M.

    2016-01-01

    We review the value of cost-effectiveness analysis for evaluation and decision making with respect to educational programs and discuss its application to early reading interventions. We describe the conditions for a rigorous cost-effectiveness analysis and illustrate the challenges of applying the method in practice, providing examples of programs…

  18. Exercise Effects on Fitness and Bone Mineral Density in Early Postmenopausal Women: 1-Year EFOPS Results.

    ERIC Educational Resources Information Center

    Kemmler, Wolfgang; Engelke, Klaus; Lauber, Dirk; Weineck, Juergen; Hensen, Johannes; Kalender, Willi A.

    2002-01-01

    Investigated the effect of intense exercise training on physical fitness, coronary heart disease, bone mineral density (BMD), and parameters related to quality of life in early postmenopausal women with osteopenia. Data on woman in control and exercise training groups indicated that the intense exercise training program was effective in improving…

  19. Persistent effects of a soy diet in early development on bone in female rats

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We have previously reported that feeding soy protein isolate (SPI) diet to pre-pubertal animals had a beneficial effect on bone accretion. However, it currently remains unclear whether the positive effects of SPI diet on bone in early life will persist to adulthood. In the present study, we fed post...

  20. Effects of Foliar Fertilizer and Mepiquat Penteborate on Early Planted Cotton Growth and Lint Production

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Multiple growth regulators and foliar fertilizers are currently marketed for use in cotton (Gossypium hirsutum L.) with varying effectiveness in promoting yield improvement. This research addressed the effectiveness of these products in a cotton early planting production system with its higher yiel...

  1. Effect of early skin-to-skin contact on breast-feeding.

    PubMed

    Suzuki, S

    2013-10-01

    We examined the effect of early skin-to-skin contact (SSC) on breast-feeding at 1 month after delivery, in Japanese women. We reviewed the obstetric records of healthy nulliparous women with vaginal singleton delivery at 37-41 weeks' gestation, at the Japanese Red Cross Katsushika Maternity Hospital and between 1 February and 30 November 2011, there was a total of 403 women who planned to breast-feed their babies at birth. Of these, 272 women (67.5%) initiated early SSC in the delivery room and 131 women (32.5%) did not initiate early SSC. There were no significant differences in the obstetric characteristics and birth outcomes between the two groups of women with and without initiating early SSC. However, the rate of exclusive breast-feeding at 1 month after delivery in the group of women following early SSC (59.6%, 162/272) was significantly higher than that in the group of women without early SSC (45.8%, 60/131; crude OR 1.74, 95% CI 1.1-2.7, p = 0.009). The current results may support the benefit of early SSC in Japanese women after vaginal delivery.

  2. Early Effects of the San Francisco Paid Sick Leave Policy

    PubMed Central

    Colla, Carrie H.; Dow, William H.; Dube, Arindrajit; Lovell, Vicky

    2014-01-01

    Objectives. We examined employers’ responses to San Francisco, California’s 2007 Paid Sick Leave Ordinance. Methods. We used the 2009 Bay Area Employer Health Benefits Survey to describe sick leave policy changes and the policy’s effects on firm (n = 699) operations. Results. The proportion of firms offering paid sick leave in San Francisco grew from 73% in 2006 to 91% in 2009, with large firms (99%) more likely to offer sick leave than are small firms (86%) in 2009. Most firms (57%) did not make any changes to their sick leave policy, although 17% made a major change to sick leave policy to comply with the law. Firms beginning to offer sick leave reported reductions in other benefits (39%), worse profitability (32%), and increases in prices (18%) but better employee morale (17%) and high support for the policy (71%). Many employers (58%) reported some difficulty understanding legal requirements, complying administratively, or reassigning work responsibilities. Conclusions. There was a substantial increase in paid sick leave coverage after the mandate. Employers reported some difficulties in complying with the law but supported the policy overall. PMID:24432927

  3. Composition optimization and stability testing of a parenteral antifungal solution based on a ternary solvent system.

    PubMed

    Kovács, Kristóf; Antal, István; Stampf, György; Klebovich, Imre; Ludányi, Krisztina

    2010-03-01

    An intravenous solution is a dosage forms intended for administration into the bloodstream. This route is the most rapid and the most bioavailable method of getting drugs into systemic circulation, and therefore it is also the most liable to cause adverse effects. In order to reduce the possibility of side effects and to ensure adequate clinical dosage of the formulation, the primarily formulated composition should be optimized. It is also important that the composition should retain its therapeutic effectiveness and safety throughout the shelf-life of the product. This paper focuses on the optimization and stability testing of a parenteral solution containing miconazole and ketoconazole solubilized with a ternary solvent system as model drugs. Optimization of the solvent system was performed based on assessing the risk/benefit ratio of the composition and its properties upon dilution. Stability tests were conducted based on the EMEA (European Medicines Agency) "guideline on stability testing: stability testing of existing active substances and related finished products". Experiments show that both the amount of co-solvent and surface active agent of the solvent system could substantially be reduced, while still maintaining adequate solubilizing power. It is also shown that the choice of various containers affects the stability of the compositions. It was concluded that by assessing the risk/benefit ratio of solubilizing power versus toxicity, the concentration of excipients could be considerably decreased while still showing a powerful solubilizing effect. It was also shown that a pharmaceutically acceptable shelf-life could be assigned to the composition, indicating good long-term stability.

  4. Cardioprotective effects of early and late aerobic exercise training in experimental pulmonary arterial hypertension.

    PubMed

    Moreira-Gonçalves, Daniel; Ferreira, Rita; Fonseca, Hélder; Padrão, Ana Isabel; Moreno, Nuno; Silva, Ana Filipa; Vasques-Nóvoa, Francisco; Gonçalves, Nádia; Vieira, Sara; Santos, Mário; Amado, Francisco; Duarte, José Alberto; Leite-Moreira, Adelino F; Henriques-Coelho, Tiago

    2015-11-01

    Clinical studies suggest that aerobic exercise can exert beneficial effects in pulmonary arterial hypertension (PAH), but the underlying mechanisms are largely unknown. We compared the impact of early or late aerobic exercise training on right ventricular function, remodeling and survival in experimental PAH. Male Wistar rats were submitted to normal cage activity (SED), exercise training in early (EarlyEX) and in late stage (LateEX) of PAH induced by monocrotaline (MCT, 60 mg/kg). Both exercise interventions resulted in improved cardiac function despite persistent right pressure-overload, increased exercise tolerance and survival, with greater benefits in EarlyEX+MCT. This was accompanied by improvements in the markers of cardiac remodeling (SERCA2a), neurohumoral activation (lower endothelin-1, brain natriuretic peptide and preserved vascular endothelial growth factor mRNA), metabolism and mitochondrial oxidative stress in both exercise interventions. EarlyEX+MCT provided additional improvements in fibrosis, tumor necrosis factor-alpha/interleukin-10 and brain natriuretic peptide mRNA, and beta/alpha myosin heavy chain protein expression. The present study demonstrates important cardioprotective effects of aerobic exercise in experimental PAH, with greater benefits obtained when exercise training is initiated at an early stage of the disease.

  5. Effects of early feeding and exogenous putrescine on growth and small intestinal development in posthatch ducks.

    PubMed

    Peng, P; Xu, J; Chen, W; Tangara, M; Qi, Z L; Peng, J

    2010-02-01

    1. Effects of early feeding with a diet containing added putrescine on duck intestinal development and growth performance were examined by a 2 x 2 factorial arrangement with two different feeding times (6 and 48 h) and two levels of putrescine (0 and 025%). 2. A significant main effect of early feeding on increasing body weight (BW) was observed from hatch to 35 d, whereas dietary putrescine had no significant effect on BW. 3. In the first week posthatch, enhanced small intestinal weight and intestinal density (weight of intestinal tissue/unit length of intestine), increased villus length and reduced crypt depth were observed in the early feeding group, while no effect was observed when putrescine was added to the diet. 4. Maltase and sucrase activity and protein/DNA ratio in jejunum were increased by early feeding in the first week, while decreased by putrescine supplementation. 5. In conclusion, early feeding methods have great potential for small intestine development and thereafter enhanced the growth performance of ducks, but dietary putrescine used during this period should be used cautiously to avoid toxicity.

  6. The effect of early environmental manipulation on locomotor sensitivity and methamphetamine conditioned place preference reward.

    PubMed

    Hensleigh, E; Pritchard, L M

    2014-07-15

    Early life stress leads to several effects on neurological development, affecting health and well-being later in life. Instances of child abuse and neglect are associated with higher rates of depression, risk taking behavior, and an increased risk of drug abuse later in life. This study used repeated neonatal separation of rat pups as a model of early life stress. Rat pups were either handled and weighed as controls or separated for 180 min per day during postnatal days 2-8. In adulthood, male and female rats were tested for methamphetamine conditioned place preference reward and methamphetamine induced locomotor activity. Tissue samples were collected and mRNA was quantified for the norepinephrine transporter in the prefrontal cortex and the dopamine transporter in the nucleus accumbens. Results indicated rats given methamphetamine formed a conditioned place preference, but there was no effect of early separation or sex. Separated males showed heightened methamphetamine-induced locomotor activity, but there was no effect of early separation for females. Overall females were more active than males in response to both saline and methamphetamine. No differences in mRNA levels were observed across any conditions. These results suggest early neonatal separation affects methamphetamine-induced locomotor activity in a sex-dependent manner but has no effects on methamphetamine conditioned place preference.

  7. Effects of early adolescent environmental enrichment on cognitive dysfunction, prefrontal cortex development, and inflammatory cytokines after early life stress.

    PubMed

    do Prado, Carine H; Narahari, Tanya; Holland, Freedom H; Lee, Ha-Neul; Murthy, Shashi K; Brenhouse, Heather C

    2016-05-01

    Early postnatal stress such as maternal separation causes cognitive dysfunction later in life, including working memory deficits that are largely mediated by the prefrontal cortex. Maternal separation in male rats also yields a loss of parvalbumin-containing prefrontal cortex interneurons in adolescence, which may occur via inflammatory or oxidative stress mechanisms. Environmental enrichment can prevent several effects of maternal separation; however, effects of enrichment on prefrontal cortex development are not well understood. Here, we report that enrichment prevented cognitive dysfunction in maternally separated males and females, and prevented elevated circulating pro-inflammatory cytokines that was evident in maternally separated males, but not females. However, enrichment did not prevent parvalbumin loss or adolescent measures of oxidative stress. Significant correlations indicated that adolescents with higher oxidative damage and less prefrontal cortex parvalbumin in adolescence committed more errors on the win-shift task; therefore, maternal separation may affect cognitive dysfunction via aberrant interneuron development. © 2015 Wiley Periodicals, Inc. Dev Psychobiol 58: 482-491, 2016.

  8. An examination of sex differences in the effects of early-life opiate and alcohol exposure.

    PubMed

    Terasaki, Laurne S; Gomez, Julie; Schwarz, Jaclyn M

    2016-02-19

    Early-life exposure to drugs and alcohol is one of the most preventable causes of developmental, behavioural and learning disorders in children. Thus a significant amount of basic, animal and human research has focused on understanding the behavioural consequences and the associated neural effects of exposure to drugs and alcohol during early brain development. Despite this, much of the previous research that has been done on this topic has used predominantly male subjects or rodents. While many of the findings from these male-specific studies may ultimately apply to females, the purpose of this review is to highlight the research that has also examined sex as a factor and found striking differences between the sexes in their response to early-life opiate and alcohol exposure. Finally, we will also provide a framework for scientists interested in examining sex as a factor in future experiments that specifically examine the consequences of early-life drug and alcohol exposure.

  9. An examination of sex differences in the effects of early-life opiate and alcohol exposure

    PubMed Central

    Terasaki, Laurne S.; Gomez, Julie; Schwarz, Jaclyn M.

    2016-01-01

    Early-life exposure to drugs and alcohol is one of the most preventable causes of developmental, behavioural and learning disorders in children. Thus a significant amount of basic, animal and human research has focused on understanding the behavioural consequences and the associated neural effects of exposure to drugs and alcohol during early brain development. Despite this, much of the previous research that has been done on this topic has used predominantly male subjects or rodents. While many of the findings from these male-specific studies may ultimately apply to females, the purpose of this review is to highlight the research that has also examined sex as a factor and found striking differences between the sexes in their response to early-life opiate and alcohol exposure. Finally, we will also provide a framework for scientists interested in examining sex as a factor in future experiments that specifically examine the consequences of early-life drug and alcohol exposure. PMID:26833841

  10. Effects of early menarche on physical and psychosocial health problems in adolescent girls and adult women.

    PubMed

    Yoo, Jae-Ho

    2016-09-01

    The menarcheal age of Korean women has been rapidly decreasing for the last 50 years, and the average menarcheal age of women born in the 1990s is approaching 12.6 years. In addition, interest in early puberty has been increasing recently owing to the rapid increase in precocious puberty. Generally, out of concern for short stature and early menarche, idiopathic central precocious puberty in female adolescents is treated with gonadotropin-releasing hormone analogs. Studies to date have described the association between early menarche and psychosocial problems such as delinquency and risky sexual behavior, as well as physical health problems such as obesity, diabetes, cardiovascular diseases, and breast cancer throughout the lifespan of women. However, the pathophysiological mechanism underlying this association has not been clarified thus far. In this article, we review and discuss the existing literature to describe the current understanding of the effects of early menarche on the physical and psychosocial health of adolescent girls and adult women.

  11. The effects of bromocriptine treatment during early pregnancy on postpartum maternal behaviors in rats.

    PubMed

    Price, Anya K; Bridges, Robert S

    2014-09-01

    Prolactin, a hormone of the anterior pituitary, is involved in initiating maternal behavior, alleviating postpartum anxiety, and stimulating lactogenesis. Bromocriptine, a dopamine D2 receptor agonist, inhibits prolactin secretion. Bromocriptine administration represses postpartum maternal behaviors (pup retrieval) in mice, and causes elevated anxiety in the elevated plus maze [Larsen & Grattan (2010). Endocrinology 151(8): 3805-3814]. Whether similar effects exist in other species is unknown. The present study examined the possible involvement of prolactin during early gestation on maternal behavior and anxiety in rats. Bromocriptine given on days 2-4 of pregnancy resulted in impaired postpartum maternal behaviors in a novel environment during early lactation. However, compared to controls, bromocriptine-treated subjects did not exhibit increased postpartum anxiety in the elevated plus maze. These findings support work in mice that bromocriptine treatment during early gestation impedes postpartum maternal care, and indicate that early gestational hormonal status affects postpartum behavior more broadly in other mammals.

  12. In vitro antibacterial activity of TOC-50, a new parenteral cephalosporin against methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis.

    PubMed

    Nomura, S; Hanaki, H; Unemi, N

    1996-01-01

    The in vitro activity of TOC-50, a new parenteral cephalosporin, was assessed against methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE). TOC-50 showed excellent activity, which was stronger than that of methicillin, cloxacillin, the cephalosporins tested, imipenem, gentamycin, minocycline, ofloxacin and ciprofloxacin against MRSA and had a minimum inhibitory concentration (MIC) comparable to that of vancomycin (the MICs of TOC-50 and vancomycin for growth inhibition of 90% of the strains tested were 3.13 and 1.56 micrograms/ml, respectively). Against MRSE, TOC-50 exhibited excellent activity, which was stronger than that of methicillin, ampicillin, the cephalosporins tested and imipenem, and was twice as active as vancomycin. In terms of the bactericidal effect against MRSA, TOC-50 was superior to vancomycin.

  13. [Efficiency of a pharmaceutical care program for long-acting parenteral antipsychotics in the health area of Santiago de Compostela].

    PubMed

    Vázquez-Mourelle, Raquel; Parrondo, Carmen Durán; López-Pardo Pardo, Estrella; Carracedo-Martínez, Eduardo

    2016-01-01

    In the healthcare area of Santiago de Compostela (Spain), the therapeutic subgroup "other antipsychotics" represented the fifth largest outpatient expenditure in 2013. More than half of this expenditure corresponded to long-acting parenteral forms of paliperidone and risperidone. Over a 12-month period, the implementation of a pharmaceutical care program based on process management and coordination of actions between health professionals in both levels of care represented savings of € 636,391.01 for the organization and a direct saving of € 16,767.36 and 9,008 trips to the pharmacy for patients. This study shows the efficiency of the program, which was facilitated by its situation in an area of integrated management and the use the unified medical records and electronic prescription, elements that will enable the future implementation of similar programmes. The new registries and healthcare interventions will allow reliable evaluation of their effectiveness in terms of treatment adherence, relapses and hospitalisations.

  14. A combination of corticosteroid, sirolimus, and intradialytic parenteral nutrition in encapsulating peritoneal sclerosis: Case report and literature review.

    PubMed

    Minetto Brabo, Alexandre; Soares Do Carmo Reis, Nayrana; Barretti, Pasqual; Ponce, Daniela

    2016-10-09

    Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis that carries a high morbidity and mortality. Although its pathogenesis is still not clear, the "two hit theory" suggests that long term deterioration of the peritoneum combined with intraperitoneal inflammation is needed in the pathogenesis of EPS. To date, there is no proven effective therapy with an absence of randomized controlled trials. Individual case reports and small case series have reported on the use of tamoxifen and corticosteroids for medical management of EPS. Here, we present the first case of EPS treated successfully with a combination of sirolimus, low dose corticosteroid and intradialytic parenteral nutrition. A critical review of the relevant literature on this subject is also presented to determine the best approach.

  15. Short communication: in vivo evaluation of microemulsion system for oral and parenteral delivery of rutaecarpine to rats.

    PubMed

    Yong, Chul-Soon; Park, Byung-Joo; Kim, Dong-Hyun; Yoo, Bong-Kyu; Woo, Jong Soo; Bhamdari, Krisna; Jahng, Yurngdong; Choi, Han-Gon; Lee, Mann Hyung

    2007-05-01

    Rutaecarpine-loaded microemulsion composed of 10.8% polyethylene glycol 400, 7.2% Tween 80, 20% caster oil, and 62% water were previously reported to be physically and chemically stable for at least 6 months. For the development of a Rutaecarpine-loaded microemulsion, here we studied the pharmacokinetic profiles of rutaecarpine after oral and intravenous administration of rutaecarpine-loaded microemulsion compared to suspension. The AUC of rutaecarpine from microemulsion after oral and intravenous administration increased about three-fold compared with that from suspension. Furthermore, the rutaecarpine-loaded microemulsion gave significantly higher AUC and Cmax than did suspension, suggesting that the oral bioavailability of rutaecarpine in this microemulsion system could be enhanced due to the enhanced solubility of rutaecarpine by microemulsion. Thus, our results indicated that the microemulsion system composed of castor oil, polyethylene glycol 400, Tween 80, and water could be a more effective oral and parenteral dosage form for rutaecarpine.

  16. Maternal and early life stress effects on immune function: relevance to immunotoxicology.

    PubMed

    Bellinger, Denise L; Lubahn, Cheri; Lorton, Dianne

    2008-10-01

    Stress is triggered by a variety of unexpected environmental stimuli, such as aggressive behavior, fear, forced physical activity, sudden environmental changes, social isolation or pathological conditions. Stressful experiences during very early life (particularly, maternal stress during fetal ontogeny) can permanently alter the responsiveness of the nervous system, an effect called programming or imprinting. Programming affects the hypothalamic-pituitary-adrenocortical (HPA) axis, brain neurotransmitter systems, sympathetic nervous system (SNS), and the cognitive abilities of the offspring, which can alter neural regulation of immune function. Prenatal or early life stress may contribute to the maladaptive immune responses to stress that occur later in life. This review focuses on the effect of maternal and early life stress on immune function in the offspring across life span. It highlights potential mechanisms by which prenatal stress impacts immune functions over life span. The literature discussed in this review suggests that psychosocial stress during pre- and early postnatal life may increase the vulnerability of infants to the effects of immunotoxicants or immune-mediated diseases, with long-term consequences. Neural-immune interactions may provide an indirect route through which immunotoxicants affect the developing immune system. A developmental approach to understanding how immunotoxicants interact with maternal and early life stress-induced changes in immunity is needed, because as the body changes physiologically across life span so do the effects of stress and immunotoxicants. In early and late life, the immune system is more vulnerable to the effects of stress. Stress can mimic the effects of aging and exacerbate age-related changes in immune function. This is important because immune dysregulation in the elderly is more frequently and seriously associated with clinical impairment and death. Aging, exposure to teratogens, and psychological stress

  17. Natural experiments to study the effects of early experience: progress and limitations.

    PubMed

    O'Connor, Thomas G

    2003-01-01

    Questions concerning the long-term effects of early experience on psychological development in humans continue to stir up controversy. There are, at present, great diversity and contradictions among extant conceptual models and inadequate data to resolve these differences. Limited opportunities to use experimental approaches and the inherent restrictions of observational approaches in research on humans implies that alternative research designs are needed. This article examines the use of "natural experiments" as a method for testing hypotheses concerning the effects of early experience on psychological development. The benefits and limitations of using natural experiments are reviewed and several case illustrations are considered.

  18. Anti-Inflammatory and Anti-Fibrotic Profile of Fish Oil Emulsions Used in Parenteral Nutrition-Associated Liver Disease

    PubMed Central

    Pastor-Clerigues, Alfonso; Marti-Bonmati, Ezequiel; Milara, Javier; Almudever, Patricia; Cortijo, Julio

    2014-01-01

    Home parenteral nutrition (PN) is associated with many complications including severe hepatobiliary dysfunction. Commercial ω-6 fatty acid-soybean based-lipid emulsions in PN may mediate long term PN associate liver disease (PNALD) whereas ω-3-fish oil parenteral emulsions have shown to reverse PNALD in children. However, its clinical effectiveness in adults has been scarcely reported. In this work, we study the role of soybean and fish oil lipid commercial emulsions on inflammatory and profibrotic liver markers in adults with long term PNALD and in in vitro cellular models. Inflammatory and profibrotic markers were measured in serum of ten adults with long term PNALD and in culture supernatants of monocytes. Liver epithelial to mesenchymal transition (EMT) was induced by transforming growth factor beta 1 (TGFβ1) to evaluate in vitro liver fibrosis. Omegaven®, a 100% fish oil commercial emulsion, was infused during four months in two patients with severe long term PNALD reversing, at the first month, the inflammatory, profibrotic and clinical parameters of PNALD. The effect was maintained during the treatment course but impaired when conventional lipid emulsions were reintroduced. The other patients under chronic soybean oil-based PN showed elevated inflammatory and profibrotic parameters. In vitro human monocytes stimulated with lipopolysaccharide induced a strong inflammatory response that was suppressed by Omegaven®, but increased by soybean emulsions. In other experiments, TGFβ1 induced EMT that was suppressed by Omegaven® and enhanced by soybean oil lipid emulsions. Omegaven® improves clinical, anti-inflammatory and anti-fibrotic parameters in adults with long-term home PNALD. PMID:25502575

  19. Effects of early-onset voluntary exercise on adult physical activity and associated phenotypes in mice.

    PubMed

    Acosta, Wendy; Meek, Thomas H; Schutz, Heidi; Dlugosz, Elizabeth M; Vu, Kim T; Garland, Theodore

    2015-10-01

    The purpose of this study was to evaluate the effects of early-life exercise on adult physical activity (wheel running, home-cage activity), body mass, food consumption, and circulating leptin levels in males from four replicate lines of mice selectively bred for high voluntary wheel running (High Runner or HR) and their four non-selected control (C) lines. Half of the mice were given wheel access shortly after weaning for three consecutive weeks. Wheel access was then removed for 52 days, followed by two weeks of adult wheel access for all mice. A blood sample taken prior to adult wheel testing was analyzed for circulating leptin concentration. Early-life wheel access significantly increased adult voluntary exercise on wheels during the first week of the second period of wheel access, for both HR and C mice, and HR ran more than C mice. During this same time period, activity in the home cages was not affected by early-age wheel access, and did not differ statistically between HR and C mice. Throughout the study, all mice with early wheel access had lower body masses than their sedentary counterparts, and HR mice had lower body masses than C mice. With wheel access, HR mice also ate significantly more than C mice. Early-life wheel access increased plasma leptin levels (adjusted statistically for fat-pad mass as a covariate) in C mice, but decreased them in HR mice. At sacrifice, early-life exercise had no statistically significant effects on visceral fat pad, heart (ventricle), liver or spleen masses (all adjusted statistically for variation in body mass). Results support the hypothesis that early-age exercise in mice can have at least transitory positive effects on adult levels of voluntary exercise, in addition to reducing body mass, and may be relevant for the public policy debates concerning the importance of physical education for children.

  20. Investigation on the remineralization effect of arginine toothpaste for early enamel caries: nanotribological and nanomechanical properties

    NASA Astrophysics Data System (ADS)

    Yu, Ping; Arola, Dwayne D.; Min, Jie; Yu, Dandan; Xu, Zhou; Li, Zhi; Gao, Shanshan

    2016-11-01

    Remineralization is confirmed as a feasible method to restore early enamel caries. While there is evidence that the 8% arginine toothpaste has a good remineralization effect by increasing surface microhardness, the repair effect on wear-resistance and nanomechanical properties still remains unclear. Therefore, this research was conducted to reveal the nanotribological and nanomechanical properties changes of early caries enamel after remineralized with arginine toothpaste. Early enamel caries were created in bovine enamel blocks, and divided into three groups according to the treatment solutions: distilled and deionized water (DDW group), arginine toothpaste slurry (arginine group) and fluoride toothpaste slurry (fluoride group). All of the samples were subjected to pH cycling for 12 d. The nanotribological and nanomechanical properties were evaluated via the nanoscratch and nanoindentation tests. The wear depth and scratch morphology were observed respectively by scanning probe microscopic (SPM) and scanning electron microscopy (SEM). Finally, x-ray photoelectron spectroscopy (XPS) was used for element analysis of remineralized surfaces. Results showed that the wear depth of early caries enamel decreased after remineralization treatment and both the nanohardness and elastic modulus increased. Compared with the fluoride group, the arginine group exhibited higher nanohardness and elastic modulus with higher levels of calcium, fluoride, nitrogen and phosphorus; this group also underwent less wear and related damage. Overall, the synergistic effect of arginine and fluoride in arginine toothpaste achieves better nanotribological and nanomechanical properties than the single fluoride toothpaste, which could have significant impact on fight against early enamel caries.