Influence of adding pyrroloquinoline quinone to parenteral nutrition on gut-associated lymphoid tissue

Background: Experimental intravenous (IV) parenteral nutrition (PN) diminishes gut‐associated lymphoid tissue (GALT) cell number and function. PN solution cannot maintain GALT at the same level as a normal diet, even when delivered intragastrically (IG). Previous studies demonstrated pyrroloquinoline quinone (PQQ)–deficient mice to be less immunologically responsive. Because standard (STD) PN solution lacks PQQ, PQQ supplementation may prevent PN‐induced GALT changes. This study was designed to determine the influence of adding PQQ to PN on GALT. Methods: In experiment 1, mice (n = 32) were randomized to chow, IV‐STD‐PN, and IV‐PQQ‐PN groups. The chow group was fed chow with the same caloric content as PN. The IV‐STD‐PN group received STD‐PN solution, whereas the IV‐PQQ‐PN group was given PQQ (3 mcg/d)–enriched PN by the IV route. After 5 days of feeding, lymphocytes were isolated from the Peyer's patch (PPs), intraepithelial space (IE), and lamina propria (LP) of the small intestine. GALT lymphocyte number and phenotype (αβTCR+, γδTCR+, CD4+, CD8+, B220+ cells) and intestinal immunoglobulin A (IgA) level were determined. In experiment 2, mice (n = 28) were randomized to IG‐STD‐PN or IG‐PQQ‐PN group. After IG nutrition supports, GALT mass and function were determined as in experiment 1. Results: The IV‐PQQ‐PN group showed increased PP lymphocyte number and PP CD8+ cell number compared with the IV‐STD PN group. The IG‐PQQ‐PN group had significantly greater PP lymphocyte number and PP CD4+ cell numbers than the IG‐STD‐PN group. Neither IV nor IG PQQ treatment raised IgA level. Conclusions: PQQ added to PN partly restores GALT mass, although its effects on GALT function remain unclear.     

Whole Body Protein Turnover and Net Protein Balance After Pediatric Thoracic Surgery: A Noninvasive Single‐Dose 15N Glycine Stable Isotope Protocol With End‐Product Enrichment

Background : We used the ¹⁵N glycine urinary end‐product enrichment technique to quantify whole body protein turnover following thoracic surgery. Materials and Methods : A single dose of ¹⁵N glycine (2 mg/kg) was administered orally on postoperative day 1 to children (1–18 years) following thoracic surgery. ¹⁵N enrichment of ammonia and urea was measured in mixed urine after 12 and 24 hours, respectively, and protein synthesis, breakdown, and net balance determined. Nitrogen balance (dietary intake minus urinary excretion) was calculated. Urinary 3‐methylhistidine:creatinine ratio was measured as a marker of skeletal muscle protein breakdown. Results : We enrolled 19 subjects—median (interquartile range): age, 13.8 years (12.2–15.1); weight, 49.2 kg (38.4–60.8)—who underwent thoracotomy (n = 12) or thoracoscopic (n = 7) surgery. Protein synthesis and breakdown by ¹⁵N enrichment were 7.1 (5.5–9) and 7.1 (5.6–9) g·kg^?1·d^?1 with ammonia (12 hours) as the end product, and 5.8 (3.8–6.7) and 6.7 (4.5–7.6) with urea (24 hours), respectively. Net protein balance by the ¹⁵N glycine and urinary urea nitrogen methods were ?0.34 (?0.47, ?0.3) and ?0.48 (?0.65, ?0.28) g·kg^?1·d^?1, respectively (r_s = 0.828, P < .001). Postoperative change in 3‐methylhistidine:creatinine ratio did not correlate significantly with protein breakdown or balance. Conclusion : The single‐dose oral administration of ¹⁵N glycine stable isotope with measurement of urinary end‐product enrichment is a feasible and noninvasive method to investigate whole body protein turnover in children. After major surgery, children manifest increased protein turnover and net negative balance due to increased protein breakdown.     

Lack of enteral nutrition delays nuclear factor kappa B activation in peritoneal exudative cells in a murine glycogen-induced peritonitis model

Background: Early enteral nutrition is associated with a lower incidence of intraabdominal abscess in severely injured patients than parenteral nutrition (PN). We explored the underlying mechanisms by examining the influence of nutrition route on nuclear factor κB (NFκB) activation in peritoneal exudative cells (PECs) and peritoneal cytokine levels. Methods: Thirty male Institute Cancer Research mice were randomized to chow (n = 10), IV PN (n = 10), or intragastric (IG) PN (n = 10) and fed for 5 days. PECs were harvested at 2 or 4 hours after intraperitoneal injection of 2 mL of 1% glycogen. Intranuclear NFκB activity in PECs was examined by laser scanning cytometry. Cytokine (tumor necrosis factor‐α [TNF‐α], macrophage inflammatory protein‐2 [MIP‐2], interleukin‐10 [IL‐10]) levels in peritoneal lavaged fluid were determined by enzyme‐linked immunosorbent assay. Results: Intranuclear NFκB at 2 hours was significantly higher in the chow and IG‐PN groups than in the IV‐PN group. TNF‐α and IL‐10 levels of the chow group were significantly higher than those of IV‐PN mice at 2 hours, whereas those of IG‐PN mice were midway between those of the chow and IV‐PN groups. MIP‐2 was significantly higher in the chow group than in the IG‐PN and IV‐PN mice at 2 hours. TNF‐α levels correlated positively with intranuclear NFκB activity in PECs. Conclusions: Enteral nutrition may improve peritoneal defense by preserving early NFκB activation in PECs and cytokine responses.     

The Influence of Habitual Protein Intake on Body Composition and Muscular Strength in Career Firefighters

Objective: The aim of this research was to determine the relationship among protein (PRO) intake, body composition, and muscle strength in overweight and obese firefighters. A secondary objective was to evaluate differences in body composition and muscle strength among overweight and obese firefighters with low (L; < 0.8 g·kg^?1), moderate (M; 0.8–1.0 g·kg^?1), and high (H; > 1.0 g·kg^?1) PRO intake.

Methods: Relative PRO intake [r_PRO] was evaluated from 3-day dietary logs, self-reported by 43 overweight and obese male career firefighters (mean ± standard deviation; age = 37.3 ± 7.2 years; body mass index = 33.2 ± 5.0 kg·m^?2; percent body fat [%BF] = 28.9 ± 4.0%). Body composition (fat mass [FM], %BF, lean mass [LM], percent LM [%LM]) and muscle strength (peak torque [PT], relative peak torque [r_PT] of the leg extensors) were measured using dual-energy x-ray absorptiometry and isokinetic dynamometry, respectively.

Results: Greater r_PRO was associated with less FM, %BF, LM (r = ?0.498 to ?0.363) and greater %LM (r = 0.363), but not muscle strength (p > 0.05). Fat mass (r = ?0.373) and %BF (r = ?0.369) were associated with lower r_PT; %LM was associated with greater r_PT (r = 0.373). Individuals with L r_PRO had greater FM (mean difference ± standard error: L–H = 10.08 ± 3.18 kg), %BF (L–H = 3.8% ± 1.4%) and lower %LM (L–H = ?3.7% ± 1.3%) than those with H r_PRO (p < 0.05) but no significant differences in muscle strength (p > 0.05).

Conclusions: Protein intake > 0.8 g·kg^?1 was associated with more favorable body composition in male career firefighters.     

Seasonal Variations in Toxic Metal Levels of Two Fish Species,Mugil cephalus and Mullus barbatus and Estimation of Risk for Children

Concentrations of five toxic metals were determined in two fish species namely, Mugil cephalus and Mullus barbatus consumed in two neighboring Turkish cities during 2010–2011. Lead concentrations (mean 900 μg kg^?1) for M. cephalus were found to be higher than the maximum allowances concentration (MAC) of 300 μg kg^?1. Similarly, Cr (mean 410 μg kg^?1), Ni (mean 331 μg kg^?1) and Cu (mean 834 μg kg^?1) concentrations in M. cephalus were significantly higher than in M. barbatus (mean 341 μg Cr kg^?1, 256 μg Ni kg^?1 and 568 μg Cu kg^?1). Although concentrations of some metals exceed the limits set by the authorities, the estimated non-carcinogenic and carcinogenic health risks by the Target Hazard Quotient and target carcinogenic risk indicate that there is no carcinogenic risk for humans, and the risk of developing cancer over a human lifetime is between 2 and 12 in 1,000,000.     

Concentration and Bioaccumulation of Cyanobacterial Bioactive and Odorous Metabolites Occurred in a Large,Shallow Chinese Lake

The distributions of cyanobacterial bioactive and odorous metabolites were investigated in the fifth largest lake in China in the fishing season 2012. The highest microcystins (MCs) concentration in water reached 3.4 µg L^?1. A high β-ionone concentration reached 35.6 ng L^?1 in water. Mean MCs concentration in muscle was highest in omnivorous Carassius auratus (20.9 ng g^?1 dry weight), followed by phytoplanktivorous Hypophthalmichthys molitrix (7.4 ng g^?1 DW) and carnivorous Coilia ectenes (3.0 ng g^?1 DW). The maximum off-flavor concentrations kept 9.5 µg kg^?1 wet weight for geosmin (C. auratus), 5.5 µg kg^?1 WW for β-cyclocitral (C. ectenes) and 25.5 µg kg^?1 WW for β-ionone (C. ectenes). Positive correlation was found between the off-flavor and fat contents in C. ectenes. To be different with MCs, β-cyclocitral content was highest in fore-gut contents (87.6 µg kg^?1 WW) in H. molitrix. It should not be reliable to predict odorous compounds level in fish muscle by only measuring the off-flavor in lake water only.     

Route and type of nutrition and surgical stress influence secretory phospholipase A2 secretion of the murine small intestine

Background: The function of secretory phospholipase A2 (sPLA2) is site dependent. In tissue, sPLA2 regulates eicosanoid production; in circulation, sPLA2 primes neutrophils; and in the intestinal lumen, sPLA2 provides innate bactericidal immunity as a defensin‐related protein. Since parenteral nutrition (PN) primes leukocytes while suppressing intraluminal mucosal immunity, the authors hypothesized that (1) PN would diminish luminal sPLA2 activity but increase activity in intestinal tissue and serum and (2) stress would accentuate these changes. Methods: Mice received chow, a complex enteral diet (CED), intragastric PN (IG‐PN), or PN in experiment 1 and chow, chow+stress, PN, or PN+stress in experiment 2. Results: In experiment 1, luminal sPLA2 activity was greatest in chow and decreased in CED, IG‐PN, and PN, with PN lower than CED and IG‐PN. Compared to that after chow, serum sPLA2 activity dropped after CED, IG‐PN, and PN. Serum sPLA2 was higher in portal than systemic serum. In experiment 2, PN lowered luminal sPLA2 activity vs chow. Stress lowered luminal sPLA2 activity in chow, without change in PN. Following stress, luminal immunoglobulin A increased in chow but not PN. Serum sPLA2 activity increased in PN. Conclusions: PN attenuates sPLA2 activity in intestinal fluid, consistent with suppressed innate mucosal defense. Stress suppresses luminal fluid sPLA2 activity in chow but not the immunoglobulin A response; PN impairs both. Stress significantly elevates serum sPLA2 in PN‐fed mice, consistent with known increased neutrophil priming with PN. PN reduces innate bactericidal immunity of the gut but upregulates serum proinflammatory products poststress.     

Enteral feeding induces early intestinal adaptation in a parenterally fed neonatal piglet model of short bowel syndrome

Background: Successful small intestinal (SI) adaptation following surgical resection is essential for optimizing newborn growth and development, but the potential for adaptation is unknown. The authors developed an SI resection model in neonatal piglets supported by intravenous and enteral nutrition. Methods: Piglets (n = 33, 12–13 days old) were randomized to 80% SI resection with parenteral nutrition feeding (R‐PN), 80% SI resection with PN + enteral feeding (R‐EN), or sham SI transection with PN + enteral feeding (sham‐EN). In resected pigs, the distal 100 cm of ileum (residual SI) and 30 cm of proximal SI were left intact. All pigs received parenteral nutrition postsurgery. Enteral nutrition piglets received continuous gastric infusion of elemental diet from day 3 (40:60 parenteral nutrition:enteral nutrition). Piglets were killed 4, 6, or 10 days postsurgery. Results: By 10 days, R‐EN piglets had longer residual SI than R‐PN and sham‐EN pigs (P < .05). At days 6 and 10, R‐EN piglets had greater weight per length of intact SI (P < .05) and isolated mucosa (P < .05) compared to other groups. Greater gut weight in R‐EN piglets was facilitated by a greater cellular proliferation index (P < .01) by 4 days compared to other groups and greater overall ornithine decarboxylase activity vs R‐PN piglets (P < .05). Conclusions: This new model demonstrated profound SI adaptation, initiated early postsurgery by polyamine synthesis and crypt cell proliferation and only in response to enteral feeding. These changes translated to greater gut mass and length within days, likely improving functional capacity long term.     

Tungsten (W) bioavailability in paddy rice soils and its accumulation in rice (Oryza sativa)

The aim of this study was to investigate the accumulation characteristics of tungsten (W) by different indica rice cultivars from the soil and to assess the potential risks to human health via dietary intake of W in rice consumption. A total of 153 rice (ear) samples of 15 cultivars and the corresponding surface soil samples were collected from 7 cities in Fujian Province of southeastern China. The available soil W were extracted using H₂C₂O₄·2H₂O-(NH₄)₂C₂O₄·H₂O at pH 3.3). Results showed that the total soil W ranged from 2.03 mg kg^?1 to 15.34 mg kg^?1 and available soil W ranged from 0.03 mg kg^?1 to 1.61 mg kg^?1. The W concentration in brown rice varied from 7 μg kg^?1 to 283 μg kg^?1 and was significantly correlated with the available soil W. The highest mean TF_avail (transfer factor based on available soil W) was 0.91 for Te-you 627 (hybrid, indica rice), whereas the lowest was 0.08 for Yi-you 673 (hybrid, indica rice). The TF_avail decreased with the increase in available soil W, clay content, and cation exchange capacity. The consumption of the brown rice produced from the investigated areas in some cultivars by the present study may cause risks to human health.     

A retrospective analysis of synthetic protein prescription in Irish children with phenylketonuria

Background: Phenylketonuria (PKU) is an inherited inborn error of metabolism resulting in the inability of the patient to metabolise the essential amino acid (AA) phenylalanine (Phe) and convert it to tyrosine. Untreated, a build‐up of Phe occurs that damages the brain and leads to mental retardation (Williams et al., 2008). Management guidelines for the treatment of the disorder by the Medical Research Council (MRC) make recommendations on the quantity of AA substitute to be provided and the desired ranges for Phe levels. The aim of this study was to address the hypothesis that children consuming less than recommendation for synthetic AA intake can grow normally and achieve good biochemical control. Methods: Patients with moderate to classical hyperphenylalaninaemia born between the 1 January 1998 and December 2008 were retrospectively identified from the patient database of the National Centre for Inherited Metabolic Disorders for inclusion in the study. Anthropometric data and protein intake data were collected from medical records of 121 patients from birth to the age of 2 years, at six specific time‐points. From these data, exact weight/height centiles and change in centile z‐scores were calculated. Intakes (g kg^?1) of synthetic AAs and natural protein were calculated at each time‐point based on protein intake reported by parents and noted in dietetic notes. The cohort was split into groups based on synthetic AA intake: ≥ 3g kg^?1day^?1, representing those meeting the MRC guidelines, 1.5–1.99 g kg^?1 day^?1 and 2–2.5 g kg^?1 day^?1. These groups were then statistically compared in terms of growth parameters and biochemical control using Student's t‐tests and Mann–Whitney U‐tests depending on data distribution. Results: At 2 years, subjects in the groups achieving lower than the recommended synthetic AA intake displayed a significantly smaller decrease in the change in z‐score for height (P = 0.001 for 2–2.5 g kg^?1 group, P = 0.034 for 1.5–1.99g kg^?1 group compared to ≥3 g kg^?1 day^?1) and weight (P = 0.006 for 2–2.5 g kg^?1 group compared to ≥3 g kg^?1 day^?1), indicating that they had less of a growth deficit compared to those meeting the AA intake guideline. Mean blood Phe levels over the time‐points investigated were also significantly lower in the groups consuming less than the MRC guideline. Discussion: This study has shown that the growth deficit is less in patients consuming decreased amounts of synthetic protein. Schaefer et al. (1994) found no correlation between Phe intake and the rates of growth, although they did not analyse the effect of synthetic protein intake on these parameters. In the current study, significant negative correlations were found between change in weight and height centile z‐scores and synthetic AA intake at 2 years. This negative correlation was upheld, even when the confounding effect of natural protein intake was controlled for. These results are contrary to previously published studies showing no correlation between protein intake and growth retardation (Weglage et al., 1994; Dobbelaere et al., 2003). As with the study by Schaefer et al. (1994), these studies did not analyse the two separate fractions of protein that PKU patients consume (i.e. natural and synthetic). These results support the hypothesis that children can achieve adequate growth and biochemical control at synthetic AA intakes below the MRC recommendation. Conclusions: This study provides a base upon which prospective studies should be designed to determine a more appropriate synthetic AA intake recommendation for children with PKU. References: Dobbelaere, D., Michaud, L., Debrabander, A., Vanderbecken, S., Gottrand, F., Turck, D. et al. (2003) Evaluation of nutritional status and pathophysiology of growth retardation in patients with phenylketonuria. J. Inherit. Metab. Dis. 26 , 1–11. MRC (1993) Recommendations on the dietary management of phenylketonuria. Report of Medical Research Council Working Party on Phenylketonuria. Arch. Dis. Child. 68 , 426–427. Schaefer, F., Burgard, P., Batzler, U., Rupp, A., Schmidt, H., Gilli G., et al. (1994) Growth and skeletal maturation in children with phenylketonuria. Acta Paediatr. 83 , 534–541. Weglage, J., Bramswig, J.H., Koch, H.G., Karassalidou, S. and Ullrich, K. (1994) Growth in patients with phenylketonuria. Eur. J. Pediatr. 153 , 537–538. Williams, R., Mamotte, C., Burnett, J. (2008) Phenylketonuria: an inborn error of phenylalanine metabolism. Clin. Biochem. Rev. 29 , 31–41. Yi, S. and Singh, R. (2008) Protein substitute for children and adults with phenylketonuria. Cochrane Database Syst. Rev.CD004731.     

High-carbohydrate/low-protein-induced hyperinsulinemia does not improve protein balance in children after cardiac surgery

ObjectiveIn pediatric cardiac surgery, fluid-restricted low-protein (LoProt) diets account for cumulative protein deficits with increased morbidity. In this setting, we aimed to inhibit proteolysis by a high-carbohydrate (HiCarb)-intake–induced hyperinsulinemia and improve protein balance.MethodsThe effect of a HiCarb/LoProt (glucose 10 mg · kg^?1 · min^?1/protein 0.7 g · kg^?1 · d^?1) versus a normal-carbohydrate (NormCarb)/LoProt (glucose 7.5 mg · kg^?1 · min^?1/protein 0.3 g · kg^?1 · d^?1) enteral diet on whole-body protein breakdown and balance was compared in a prospective, randomized, single-blinded trial in 24 children after cardiac surgery. On the second postoperative day, plasma insulin and amino acid concentrations, protein breakdown (endogenous rate of appearance of valine), protein synthesis (non-oxidative disposal of valine), protein balance, and the rate of appearance of urea were measured by using an isotopic infusion of [1-¹³C]valine and [¹⁵N₂]urea.ResultsThe HiCarb/LoProt diet led to a serum insulin concentration that was three times higher than the NormCarb/LoProt diet (596 pmol/L, 80–1833, and 198 pmol/L, 76–1292, respectively, P = 0.02), without differences in plasma glucose concentrations. There were no differences in plasma amino acid concentrations, non-oxidative disposal of valine, and endogenous rate of appearance of valine between the groups, with a negative valine balance in the two groups (?0.65 μmol · kg^?1 · min^?1, ?1.91 to 0.01, and ?0.58 μmol · kg^?1 · min^?1, ?2.32 to ?0.07, respectively, P = 0.71). The serum cortisol concentration in the HiCarb/LoProt group was lower compared with the NormCarb/LoProt group (204 nmol/L, 50–544, and 532 nmol/L, 108–930, respectively, P = 0.02).ConclusionIn children with fluid restriction after cardiac surgery, a HiCarb/LoProt diet compared with a NormCarb/LoProt diet stimulates insulin secretion but does not inhibit proteolysis further and therefore cannot be advocated for this purpose.     

Plasma Arginine Levels and Blood Glucose Control in Very Preterm Infants Receiving 2 Different Parenteral Nutrition Regimens

Background: Improving parenteral nutrition (PN) amino acid (AA) intake in very preterm infants is associated with less hyperglycemia. AAs stimulate newborn insulin secretion with arginine, demonstrating a specific effect. We hypothesized that low arginine levels would be associated with increased insulin‐treated hyperglycemia and higher mean daily blood glucose levels in very preterm infants. Methods: We performed a secondary analysis on previous study data comparing high‐protein/calorie PN (HPC‐PN) and control groups in infants <29 weeks’ gestation. Infants were substratified (within original groups) according to high (highARG) and low (lowARG) plasma arginine levels on days 8–10 using a reference population‐derived threshold for high/low arginine (57 µmol/L). Daily protein, arginine, carbohydrate intake, mean daily blood glucose, and insulin treatment data from the first 15 days of life were collected. Results: Control group infants (n = 60) were stratified into lowARG (n = 41) and highARG (n = 19) groups. There were no differences in basic demographic data or carbohydrate intake. LowARG infants had higher mean daily blood glucose levels (P < .05) and a trend to more insulin treatment on days 6–10. HPC‐PN group infants (n = 55) were stratified into lowARG (n = 33) and highARG (n = 22) groups. LowARG infants had lower gestation and birth weight and were sicker than highARG infants. There were no differences in carbohydrate intake. LowARG infants had higher mean daily blood glucose levels (P < .01) and more insulin treatment (P < .01) on days 1–5 and 6–10. Insulin‐treated hyperglycemia was also associated with low plasma glutamine levels. Conclusion: Low plasma arginine levels (≤57 µmol/L) in very preterm infants are associated with poorer blood glucose control.     

Degradation Dynamics of Emamectin Benzoate on Cabbage Under Subtropical Conditions of Punjab, India

Emamectin benzoate (Proclaim 5 SG) was applied to cabbage at 8.5 and 17 g a.i. ha^?1, during the head initiation stage. A high performance liquid chromatography (HPLC) analytical method, for the determination of emamectin benzoate in cabbage, was developed. Average recoveries of emamectin benzoate ranged from 92 % to 96 % at different fortification levels (0.05, 0.25 and 0.50 mg kg^?1). The initial deposits, 0.11 and 0.21 mg kg^?1 of emamectin benzoate at 8.5 and 17 g a.i. ha^?1, dissipated below the determination limit of 0.05 mg kg^?1 in 3 and 5 days, respectively.     

Characteristics,distribution, source apportionment,and potential health risk assessment of polycyclic aromatic hydrocarbons in urban street dust of Kerman metropolis,Iran

ABSTRACT

In this study, the concentrations of street dust-bound polycyclic aromatic hydrocarbons (PAHs) in Kerman metropolis as a typical arid urban area were determined to investigate the contamination, molecular composition, toxicity, and sources of PAHs. Sixteen individual PAHs on the United States Environmental Protection Agency priority list were analyzed using gas chromatography-mass spectrometry in street dust samples from 30 sites. ∑PAHs ranged between 165 and 5314.7 µg·kg^?1 with a mean of 770.8 µg·kg^?1. The most abundant individual PAHs were fluoranthene, phenanthrene, pyrene, and chrysene, respectively. High molecular weight PAHs (4-6 rings) made 74.8% of ∑PAHs mass and were dominant in all sites. Source apportionment was performed using ring classification, diagnostic ratios, and principal component analysis-multiple linear regression. The results indicated that primary contributors of PAHs in the street dust of Kerman could be liquid fossil fuel combustion, natural gas combustion, and petrogenic sources, accounting for 82.4%, 11.5%, and 6.1%, respectively. The calculated incremental lifetime cancer risk is 8.13 × 10^?4 for children and 6.27 × 10^?4 for adults. Hence, both children and adults in Kerman are potentially exposed to a high carcinogenic risk via ingestion and dermal contact.     

Enteral Refeeding Rapidly Restores PN‐Induced Reduction of Hepatic Mononuclear Cell Number Through Recovery of Small Intestine and Portal Vein Blood Flows

Background: Absence of enteral nutrition (EN) reduces hepatic mononuclear cell (MNC) numbers and impairs their functions. However, enteral refeeding (ER) for as little as 12 hours following parenteral nutrition (PN) rapidly restores hepatic MNC numbers. We hypothesized that changes in small intestine and portal vein blood flows related to feeding route might be responsible for this phenomenon. Methods: In experiment 1, mice (n = 19) were randomized to Chow (n = 5), PN (n = 7) or ER (n = 7) groups. The Chow group was given chow ad libitum with intravenous (IV) saline for 5 days. The PN group was fed parenterally for 5 days, while the ER group was re‐fed with chow for 12 hours following 5 days of PN. Then, small intestine and portal vein blood flows were monitored and hepatic MNCs were isolated and counted. In experiment 2, the effects of intravenous administration of prostaglandin E₁ (PGE₁) on hepatic MNC numbers were examined in fasted mice for 12 hours. Mice (n = 28) were randomized to Control (n = 8), PG0 (n = 10), or PG1 (n = 10) groups. The Control group was fed chow ad libitum with IV saline, while the PG0 and PG1 groups were fasted for 12 hours with infusions, respectively, of saline and PGE₁ at 1μ g/kg/minute. Blood flows and hepatic MNC numbers were examined. Results: Experiment 1: ER restored PN‐induced reductions in small intestine and portal vein blood flows and hepatic MNC number to the levels in the Chow group. Small intestine and portal vein blood flows correlated positively with hepatic MNC number. Experiment 2: Fasting decreased small intestine and portal vein blood flows and hepatic MNC number. However, PGE₁ restored portal vein blood flow to the level of the Control group, and moderately increased hepatic MNC number. There was a positive correlation between portal blood flow and hepatic MNC number. Conclusions: Reduced small intestine and portal vein blood flows may contribute to impaired hepatic immunity in the absence of EN. ER quickly restores hepatic MNC number through recovery of blood flow in both the small intestine and the portal vein.     

Breast Milk Lead Concentrations of Mothers Living Near Tin Smelters

We compared Pb concentration in human milk from 37 mothers living in a neighborhood of tin-ore smelters to that from 45 mothers living in a fishing community. The median breast-milk-Pb (BM-Pb) concentration was significantly (p = 0.0000001) higher (11.3 μg L^?1; ≤0.96–29.4 μg L^?1) in mothers living in the vicinity of smelters than that of rural mothers (1.9 μg L^?1; ≤0.96–20.0 μg L^?1). These mothers also showed a statistically significant correlation between length of residence and BM-Pb concentration (Spearman r = 0.6864; p < 0.0001). The estimated median exposure (for infants <6 months) was 3.0 μg kg^?1 b.w. for rural infants compared to 7.5 μg kg^?1 b.w. for infants in the vicinity of metal smelters. Overall, most BM-Pb concentrations (79 %) in the metal smelter area were above the critical limit of 5.0 μg L^?1 set by the WHO.     

Metabolic Requirement of Septic Shock Patients Before and After Liberation From Mechanical Ventilation

Objectives: This study identified the difference in energy expenditure and substrate utilization of patients during and upon liberation from mechanical ventilation. Methods: Patients under intensive care who were diagnosed with septic shock and dependent on mechanical ventilation were recruited. Indirect calorimetry measurements were performed during and upon liberation from mechanical ventilation. Results: Thirty‐five patients were recruited (20 men and 15 women; mean age, 69 ± 10 years). Measured energy expenditures during ventilation and upon liberation were 2090 ± 489 kcal·d⁻¹ and 1910 ± 579 kcal·d⁻¹, respectively (P < .05). Energy intake was provided at 1148 ± 495 kcal·d⁻¹ and differed significantly from all measured energy expenditures (P < .05). Mean carbohydrate utilization was 0.19 ± 0.1 g·min⁻¹ when patients were on mechanical ventilation compared with 0.15 ± 0.09 g·min⁻¹ upon liberation (P < .05). Mean lipid oxidation was 0.08 ± 0.05 g·min⁻¹ during and 0.09 ± 0.07 g·min⁻¹ upon liberation from mechanical ventilation (P > .05). Conclusions: Measured energy expenditure was higher during than upon liberation from mechanical ventilation. This could be the increase in work of breathing from the continuous positive pressure support, repeated weaning cycles from mechanical ventilation, and/or the asynchronization between patients’ respiration and ventilator support. Future studies should examine whether more appropriately matching energy expenditure with energy intake would promote positive health outcomes.     

Effect on immune indices of preoperative intravenous glutamine dipeptide supplementation in malnourished abdominal surgery patients in the preoperative and postoperative periods

ObjectiveTo determine if parenteral glutamine dipeptide supplementation given only in the preoperative period in malnourished patients after gastrointestinal surgery would sustain its effects into the first postoperative week, as shown by immune indices.MethodsA prospective randomized study on malnourished adult patients for abdominal surgery was done where one group (n = 17) received preoperative glutamine supplementation (0.3 g · kg^?1 · d^?1) for 5 d and the other (n = 17) had none. Both received isocaloric (30 kcal · kg^?1 · d^?1) and isonitrogenous (1.5 g · kg^?1 · d^?1) nutrition. Outcomes were 1) immune indices on admission (day 1), the day before surgery (day 2), and the seventh postoperative day (day 3); and 2) clinical outcomes were infection, wound complication, days in the intensive care unit, and mortality. Statistical tests were repeated samples analysis of variance, Friedman's test, Wilcoxon's test, and t test for individual comparison.ResultsThe glutamine-supplemented group showed an increase in total white blood cells (from 8700 on day to 11 080 on day 2, P = 0.026), granulocytes (from 6177 on day 1 to 8568 on day 2, P = 0.039), and lymphocytes (from 1516 on day 1 to 1747 on day 2, P = 0.049). Significant decreases in glutamine-supplemented group values from day 2 to day 3 occurred in granulocytes, lymphocytes, and CD8, CD22, and CD19 cells. Clinical outcome was similar in both groups. Intake was adequate in both groups (preoperative 85% versus postoperative 82% computed) and the mean glutamine delivered was 18 g/d.ConclusionParenteral glutamine supplementation in the preoperative period resulted in increased white blood cell, granulocyte, and lymphocyte counts, which was not sustained in the first week of the postoperative period, when supplementation was discontinued before surgery.     

Prospective analysis of serum carotenoids,vitamin A,and tocopherols in adults with short bowel syndrome undergoing intestinal rehabilitation

ObjectiveCarotenoids, vitamin A, and tocopherols serve important roles in many key body functions. However, availability of these compounds may be decreased in patients with short bowel syndrome (SBS) due to decreased oral intake of fruits and vegetables and/or decreased intestinal absorption. Little information is available on serum concentrations of carotenoids, vitamin A, and tocopherols during chronic parenteral nutrition (PN) or during PN weaning. The aim of this study was to prospectively examine serum concentrations of a wide variety of carotenoids, vitamin A, and tocopherols in patients with SBS undergoing an intensive 12-wk intestinal rehabilitation program.MethodsTwenty-one PN-dependent adult patients with SBS were enrolled in a 12-wk intestinal rehabilitation program, which included individualized dietary modification, multivitamin supplementation, and randomization to receive subcutaneous placebo (n = 9) or human growth hormone (0.1 mg · kg^?1 · d^?1; n = 12). PN weaning was initiated after week 4 and advanced as tolerated. Serum concentrations of carotenoids, vitamin A, and tocopherols were determined at baseline and at weeks 4 and 12.ResultsA significant percentage of subjects exhibited low serum concentrations for carotenoids and α-tocopherol at study entry, and a few subjects had low concentrations of retinol (5%). Carotenoid and vitamin A valves did not improve over time, while α-tocopherol levels rose. Serum α-tocopherol concentration was negatively associated with PN lipid dose (r = ?0.34, P < 0.008).ConclusionPatients with SBS are depleted in diet-derived carotenoids despite oral and intravenous multivitamin supplementation and dietary adjustment during intestinal rehabilitation and PN weaning. Reduction of PN lipid infusion may improve serum α-tocopherol concentrations.     

Effects of Enteral Immunonutrition on the Maintenance of Gut Barrier Function and Immune Function in Pigs With Severe Acute Pancreatitis

Background: This study evaluated the effects of enteral immunonutrition (EIN) supplemented with glutamine, arginine, and probiotics on gut barrier function and immune function in pigs with severe acute pancreatitis (SAP). Methods: The model was induced by retrograde injection of 5% sodium taurocholate and trypsin via the pancreatic duct. After induction of SAP, 18 pigs were randomly divided into 3 groups, in which either parenteral nutrition (PN), control enteral nutrition (CEN), or EIN was applied for 8 days. Serum and pancreatic fluid amylase concentration was determined. Intestinal permeability (lactulose to mannitol ratio) was measured by high‐performance liquid chromatography, and plasma endotoxin was quantified by the chromogenic limulus amebocyte lysate technique. Samples of venous blood and organs were cultured using standard techniques. Pancreatitis severity and villi of ileum were scored according to histopathologic grading. Plasma T‐lymphocyte subsets were measured by flow cytometry, and immunoglobulins (Igs) were determined via enzyme‐linked immunosorbent assay. Results: There were no significant differences in serum and pancreatic fluid amylases concentrations or in pancreatitis severity between any 2 of the 3 groups. Compared with PN and CEN, EIN significantly decreased intestinal permeability, plasma endotoxin concentration, and the incidence and magnitudes of bacterial translocation, but increased ileal mucosal thickness, villous height, crypt depth, and percentage of normal intestinal villi. Significant differences were found in CD3⁺, CD4⁺ lymphocyte subsets, the ratio of CD4⁺: CD8⁺ lymphocyte subsets, and serum IgA and IgG, but not IgM, between any 2 of the 3 groups. Conclusions: EIN maintained gut barrier function and immune function in pigs with SAP.