JPEN. Journal of parenteral and enteral nutrition最新文献_第10页

The Fecal Microbiome in Pediatric Patients With Short Bowel Syndrome. 小儿短肠综合征患者的粪便微生物组。

IF 3.4

JPEN. Journal of parenteral and enteral nutrition Pub Date : 2016-11-01 Epub Date: 2015-06-09 DOI: 10.1177/0148607115591216

Zev H Davidovics, Beth A Carter, Ruth Ann Luna, Emily B Hollister, Robert J Shulman, James Versalovic

{"title":"The Fecal Microbiome in Pediatric Patients With Short Bowel Syndrome.","authors":"Zev H Davidovics, Beth A Carter, Ruth Ann Luna, Emily B Hollister, Robert J Shulman, James Versalovic","doi":"10.1177/0148607115591216","DOIUrl":"https://doi.org/10.1177/0148607115591216","url":null,"abstract":"Background: Changes in the intestinal microbiome of patients with short bowel syndrome (SBS) are thought to significantly affect clinical outcome. These changes may not only delay enteral diet advancement but may also predispose patients to bacterial translocation, bacteremia, and liver disease. Patients with SBS are thought to be more susceptible to changes in gut microbial communities due to intestinal dysmotility and/or lack of anatomic safeguards such as the ileocecal valve.Materials and methods: We analyzed the bacterial composition of 21 fecal specimens from 9 children with SBS and 8 healthy children ages 4 months to 8 years by 16S ribosomal RNA gene sequencing. The sequences were quality filtered and analyzed using QIIME, the Ribosomal Database Project Classifier, and the randomForest supervised learning algorithm.Results: The fecal microbiome of patients with SBS is different from that of healthy controls. Stool from patients with SBS had a significantly greater abundance of the bacterial classes Gammaproteobacteria and Bacilli. Stool from patients with SBS who experienced increased stool frequency tended to have increased abundance of Lactobacillus (P = .057) and decreased abundance of Ruminococcus.Conclusion: This study shows that the fecal microbiome of patients with SBS is significantly different from that of healthy controls when analyzed by 16S metagenomics. Differences in the composition and function of gut microbiomes in children with SBS may affect bowel physiology, and these findings may provide new opportunities for intestinal rehabilitation and clinical management.","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"1106-1113"},"PeriodicalIF":3.4,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0148607115591216","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33255373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 49

Physical Compatibility of Calcium Chloride and Sodium Glycerophosphate in Pediatric Parenteral Nutrition Solutions. 儿科肠外营养液中氯化钙和甘油磷酸钠的物理相容性。

IF 3.4

JPEN. Journal of parenteral and enteral nutrition Pub Date : 2016-11-01 Epub Date: 2015-06-25 DOI: 10.1177/0148607115592673

Collin Anderson, Mark MacKay

{"title":"Physical Compatibility of Calcium Chloride and Sodium Glycerophosphate in Pediatric Parenteral Nutrition Solutions.","authors":"Collin Anderson, Mark MacKay","doi":"10.1177/0148607115592673","DOIUrl":"https://doi.org/10.1177/0148607115592673","url":null,"abstract":"Background: Calcium and phosphate precipitation is an ongoing concern when compounding pediatric parenteral nutrition (PN) solutions. Considerable effort has been expended in producing graphs, tables, and equations to guide the practitioner in prescribing PN that will remain stable. Calcium gluconate is preferred over calcium chloride when compounding PN because of its superior compatibility with inorganic phosphates. PN solutions containing calcium gluconate carry a higher aluminum load than equivalent solutions compounded with calcium chloride, leading to increased potential for aluminum toxicity. This study tested the solubility of calcium chloride in PN solutions compounded with an organic phosphate component, sodium glycerophosphate (NaGP), in place of sodium phosphate.Methods: Five PN solutions were compounded by adding calcium chloride at 10, 20, 30, 40, and 50 mEq/L and corresponding concentrations of NaGP at 10, 20, 30, 40, and 50 mmol/L. Each of the 5 solutions was compounded using 1.5% and 4% amino acids, cysteine, and lipids. The physical stability was evaluated by visual inspection (precipitation, haze, and color change). Solutions were evaluated microscopically for any microcrystals using U.S. Pharmacopeia <788> standards.Results: Compatibility testing showed no changes in the PN solution in any of the concentrations tested. Calcium chloride was found to be physically compatible with NaGP in PN at the tested concentrations.Conclusion: Utilization of NaGP in PN solutions would eliminate the need for precipitation curves and allow for the use of calcium chloride. Compounding with NaGP and calcium chloride allows the practitioner a mechanism for reducing the aluminum load in PN.","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"1166-1169"},"PeriodicalIF":3.4,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0148607115592673","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33421228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 16

Response to "Teduglutide and Intestinal Permeability in Short Bowel Syndrome". 对“Teduglutide与肠通透性在短肠综合征中的作用”的反应。

IF 3.4

JPEN. Journal of parenteral and enteral nutrition Pub Date : 2016-11-01 DOI: 10.1177/0148607116637848

Johanna Iturrino, Michael Camilleri

引用次数: 0

Teduglutide for Safe Reduction of Parenteral Nutrient and/or Fluid Requirements in Adults: A Systematic Review. 替杜葡肽安全降低成人肠外营养和/或液体需要量：系统综述。

JPEN. Journal of parenteral and enteral nutrition Pub Date : 2016-11-01 Epub Date: 2015-04-16 DOI: 10.1177/0148607115582063

Jane K Naberhuis, Kelly A Tappenden

{"title":"Teduglutide for Safe Reduction of Parenteral Nutrient and/or Fluid Requirements in Adults: A Systematic Review.","authors":"Jane K Naberhuis, Kelly A Tappenden","doi":"10.1177/0148607115582063","DOIUrl":"10.1177/0148607115582063","url":null,"abstract":"Background: Teduglutide (Gattex; NPS Pharma, Bedminster, NJ), a recombinant analogue of human glucagon-like peptide 2 (GLP-2), is the first long-term medical therapy approved for the treatment of adults dependent on parenteral nutrition (PN).Objective: To assess the efficacy and safety of teduglutide in reducing PN (parenteral nutrient and/or fluid) requirements in PN-dependent adults.Methods: Studies were identified using predefined search criteria and multiple databases, including Medline and Embase. The search was completed to November 30, 2014, in the absence of date or study design restrictions. Citation inclusion criteria and methodological quality were assessed by 2 independent reviewers. Outcomes of interest were changes in parenteral nutrient or fluid requirements and adverse event incidence. From 2693 unique citations, 76 abstracts were reviewed. Fourteen reports met the inclusion criteria, including data from 2 phase III, double-blind, placebo-controlled clinical trials and their respective extension studies. Data extraction was performed by 2 reviewers using a standardized form.Results: Teduglutide reduced PN requirements compared with placebo, whereas adverse event incidence was similar.Limitations: Number of subjects studied and length of follow-up.Conclusions: Teduglutide appears to be a safe and well-tolerated means to reduce PN dependence in adults, regardless of PN dependence duration.","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"1096-1105"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33100322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Relationship of vitamin D deficiency to clinical outcomes in critically ill patients. 重症患者维生素D缺乏与临床预后的关系

IF 3.4

JPEN. Journal of parenteral and enteral nutrition Pub Date : 2012-11-01 Epub Date: 2012-04-20 DOI: 10.1177/0148607112444449

David M Higgins, Paul E Wischmeyer, Kelly M Queensland, Stefan H Sillau, Alexandra J Sufit, Daren K Heyland

{"title":"Relationship of vitamin D deficiency to clinical outcomes in critically ill patients.","authors":"David M Higgins, Paul E Wischmeyer, Kelly M Queensland, Stefan H Sillau, Alexandra J Sufit, Daren K Heyland","doi":"10.1177/0148607112444449","DOIUrl":"https://doi.org/10.1177/0148607112444449","url":null,"abstract":"Background: Despite the numerous disease conditions associated with vitamin D deficiency in the general population, the relationship of this deficiency to outcome in critically ill patients remains unclear. The objective of this study is to determine the burden of vitamin D deficiency in intensive care unit (ICU) patients and determine if it is associated with poor patient outcomes.Methods: The authors conducted an analysis of samples collected from a prospective study of 196 patients admitted to a medical/surgical ICU in a tertiary care hospital. They measured serum 25-hydroxyvitamin D at admission and up to 10 days following admission and followed patients prospectively for 28-day outcomes.Results: Of analyzable patients, 50 (26%) were deficient (≤30 nmol/L) and 109 (56%) were insufficient (>30 and ≤60 nmol/L). Baseline 25(OH)D levels decreased significantly in all patients after 3 days in the ICU and remained significantly lower through 10 days (P < .001). 25(OH)D status was not significantly associated with 28-day all-cause mortality (hazard ratio [HR], 0.89; 95% confidence interval, [CI] 0.37-2.24). Higher levels of 25(OH)D were associated with a shorter time-to-alive ICU discharge (HR, 2.11; 95% CI, 1.27-3.51). 25(OH)D-deficient patients showed a nonstatistically significant trend toward a higher infection rate (odds ratio [OR], 3.20; 95% CI, 0.784-13.07; P = .11) compared with patients with sufficient levels of 25(OH)D.Conclusions: This study demonstrates significant decreases in vitamin D status over the duration of the patient's ICU stay. Low levels of vitamin D are associated with longer time to ICU discharge alive and a trend toward increased risk of ICU-acquired infection.","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"713-20"},"PeriodicalIF":3.4,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0148607112444449","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40173006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 126

Resting energy expenditure after Fontan surgery in children with single-ventricle heart defects. 单心室心脏缺陷患儿Fontan手术后静息能量消耗。

IF 3.4

JPEN. Journal of parenteral and enteral nutrition Pub Date : 2012-11-01 Epub Date: 2012-04-26 DOI: 10.1177/0148607112445581

Nilesh M Mehta, John M Costello, Lori J Bechard, Victor M Johnson, David Zurakowski, Francis X McGowan, Peter C Laussen, Christopher P Duggan

{"title":"Resting energy expenditure after Fontan surgery in children with single-ventricle heart defects.","authors":"Nilesh M Mehta, John M Costello, Lori J Bechard, Victor M Johnson, David Zurakowski, Francis X McGowan, Peter C Laussen, Christopher P Duggan","doi":"10.1177/0148607112445581","DOIUrl":"https://doi.org/10.1177/0148607112445581","url":null,"abstract":"Background: Data on resting energy expenditure (REE) and oxygen consumption (VO(2)) after pediatric cardiopulmonary bypass (CPB) will facilitate optimal nutrient prescription.Methods: The authors measured continuous REE and VO(2), using an in-line indirect calorimetery (IC) in 30 consecutive children with single-ventricle physiology immediately after Fontan surgery. REE during steady state at 8 hours after surgery was compared with standard equation-estimated energy expenditure (EEE). Patients were classified into 3 groups: hypermetabolic (measured REE [MREE]/EEE ratio >1.2), hypometabolic (MREE/EEE ratio <0.8), and normometabolic (MREE/EEE ratio 0.8-1.2). Demographic, anthropometric, and perioperative clinical characteristics were examined for their correlation with metabolic status.Results: In 26 of 30 patients with completed IC, mean REE at 8 hours after surgery was 57 ± 20 kcal/kg/d, and mean VO(2) was 110 ± 35 mL/min. Mean values of VO(2) and REE did not change within the first 24 hours after surgery. There was poor correlation between MREE at 8 hours and the EEE using the World Health Organization equation (r = 0.32, P = .11). Most patients (n = 19, 73%) were either normometabolic or hypometabolic. Lack of hypermetabolism was significantly associated with higher intraoperative serum lactate level and positive fluid balance compared with the rest of the group.Conclusions: The authors report a low prevalence of hypermetabolism in children with single-ventricle defects after Fontan surgery. Measured REE had poor correlation with equation-estimated energy expenditure in a majority of the cohort. The absence of increased energy expenditure after CPB will influence energy prescription in this group.","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"685-92"},"PeriodicalIF":3.4,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0148607112445581","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40186889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 38

Stress prophylaxis in intensive care unit patients and the role of enteral nutrition. 重症监护病房病人的应激预防及肠内营养的作用。

IF 3.4

JPEN. Journal of parenteral and enteral nutrition Pub Date : 2012-11-01 Epub Date: 2012-03-12 DOI: 10.1177/0148607112436978

Ryan T Hurt, Thomas H Frazier, Stephen A McClave, Neil E Crittenden, Christopher Kulisek, Mohamed Saad, Glen A Franklin

{"title":"Stress prophylaxis in intensive care unit patients and the role of enteral nutrition.","authors":"Ryan T Hurt, Thomas H Frazier, Stephen A McClave, Neil E Crittenden, Christopher Kulisek, Mohamed Saad, Glen A Franklin","doi":"10.1177/0148607112436978","DOIUrl":"https://doi.org/10.1177/0148607112436978","url":null,"abstract":"Use of acid-suppressive therapy (AST) to prevent stress gastropathy in the intensive care unit has grown rapidly over the past 20 years. The primary indications for such use of AST include need for mechanical ventilation, overt gastrointestinal bleeding, severe burn, and head trauma. Despite this limited list of indications, proton pump inhibitors (PPIs) often are overprescribed for purposes of stress prophylaxis. Decreased mucosal blood flow with subsequent tissue ischemia is thought to be the mechanism responsible for stress-induced gastropathy. Subsequent activation of inflammatory and vasoconstrictive mediators determines the severity of the gastropathy. Numerous basic science studies suggest that enteral nutrition (EN) can improve mucosal blood flow and reverse the generation of these inflammatory mediators. Clinical studies evaluating the effectiveness of EN vs acid-suppressive medications, however, have shown variable results (and there are no randomized controlled trials to date). In hypersecretory states (such as head trauma and burns), AST should be given, even in patients who are tolerating EN. In the absence of a hypersecretory state, pharmacologic AST may be avoided or discontinued in patients who are tolerating EN. Stress prophylaxis medications also should be discontinued in patients who do not have a clear indication for their use. Overt bleeding in a patient receiving EN for stress prophylaxis should prompt the initiation of a PPI. Randomized controlled studies investigating the efficacy of EN for stress ulcer prophylaxis are needed. Protocols should be developed to alert healthcare teams to consider discontinuation of AST, especially when tolerance of EN is achieved.","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"721-31"},"PeriodicalIF":3.4,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0148607112436978","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40159087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 39

Colonic GLP-2 is not sufficient to promote jejunal adaptation in a PN-dependent rat model of human short bowel syndrome. 在pn依赖的人类短肠综合征大鼠模型中，结肠GLP-2不足以促进空肠适应。

IF 3.4

JPEN. Journal of parenteral and enteral nutrition Pub Date : 2009-11-01 Epub Date: 2009-07-30 DOI: 10.1177/0148607109336597

Matthew C Koopmann, Xiaowen Liu, Christopher J Boehler, Sangita G Murali, Jens J Holst, Denise M Ney

{"title":"Colonic GLP-2 is not sufficient to promote jejunal adaptation in a PN-dependent rat model of human short bowel syndrome.","authors":"Matthew C Koopmann, Xiaowen Liu, Christopher J Boehler, Sangita G Murali, Jens J Holst, Denise M Ney","doi":"10.1177/0148607109336597","DOIUrl":"https://doi.org/10.1177/0148607109336597","url":null,"abstract":"Background: Bowel resection may lead to short bowel syndrome (SBS), which often requires parenteral nutrition (PN) due to inadequate intestinal adaptation. The objective of this study was to determine the time course of adaptation and proglucagon system responses after bowel resection in a PN-dependent rat model of SBS.Methods: Rats underwent jugular catheter placement and a 60% jejunoileal resection + cecectomy with jejunoileal anastomosis or transection control surgery. Rats were maintained exclusively with PN and killed at 4 hours to 12 days. A nonsurgical group served as baseline. Bowel growth and digestive capacity were assessed by mucosal mass, protein, DNA, histology, and sucrase activity. Plasma insulin-like growth factor I (IGF-I) and bioactive glucagon-like peptide 2 (GLP-2) were measured by radioimmunoassay.Results: Jejunum cellularity changed significantly over time with resection but not transection, peaking at days 3-4 and declining by day 12. Jejunum sucrase-specific activity decreased significantly with time after resection and transection. Colon crypt depth increased over time with resection but not transection, peaking at days 7-12. Plasma bioactive GLP-2 and colon proglucagon levels peaked from days 4-7 after resection and then approached baseline. Plasma IGF-I increased with resection through day 12. Jejunum and colon GLP-2 receptor RNAs peaked by day 1 and then declined below baseline.Conclusions: After bowel resection resulting in SBS in the rat, peak proglucagon, plasma GLP-2, and GLP-2 receptor levels are insufficient to promote jejunal adaptation. The colon adapts with resection, expresses proglucagon, and should be preserved when possible in massive intestinal resection.","PeriodicalId":520701,"journal":{"name":"JPEN. Journal of parenteral and enteral nutrition","volume":" ","pages":"629-38; discussion 638-9"},"PeriodicalIF":3.4,"publicationDate":"2009-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0148607109336597","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40002193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 18