Effects of multilayered bags vs ethylvinyl-acetate bags on oxidation of parenteral nutrition

BACKGROUND: We evaluate the effects of multilayered bags vs ethylvinyl-acetate bags on peroxidate formation of various emulsions for all-in-one total parenteral nutrition solutions (TPN) during storage. METHODS: Twenty-four parenteral nutritions were prepared with 4 commercial i.v. lipid emulsions (Soyacal 20%, Grifols; Intralipid 20%, Fresenius-Kabi; Lipofundina 20%, Braun; and Clinoleic 20%, Clintex) and 2 different bags (multilayered [ML] bag, Miramed; and 1 ethylvinyl-acetate [EVA] bag, Miramed). Each kind of TPN was prepared in triplicate. Samples were taken at 3 different times: immediately after preparation (time 0), after 6 days at 4 degrees C and 48 hours at 37 degrees C (time 1), and finally after a total of 14 days at 37 degrees C (time 2). Oxidation of TPN was evaluated by analysis of hydroperoxides by ferrous oxidation-xylenol orange (FOX) reactive, lipoperoxides by thiobarbituric acid reactive species (TBARS), alpha-tocopherol by high-performance liquid chromatography (HPLC), and ascorbic acid and dehydroascorbic acid by HPLC. RESULTS: TPN admixtures in ML bag showed less oxidation evaluated by peroxide determination using FOX than EVA bag. Lipoperoxides by TBARS did not show significant differences between 2 bags. Ascorbic acid and dehydroascorbic acid disappeared in EVA bags at time 1. No important differences were found in alpha-tocopherol content. CONCLUSIONS: Multilayered bags minimize oxidation.     

Physical characteristics of total parenteral nutrition bags significantly affect the stability of vitamins C and B1: a controlled prospective study

BACKGROUND: Vitamin degradation occurring during the storage of total parenteral nutrition (TPN) mixtures is significant and affects clinical outcome. This study aimed to assess the influence of the TPN bag material, the temperature, and the duration of storage on the stability of different vitamins. METHODS: Solutions of multivitamin and trace elements at recommended doses were injected into either an ethylvinyl acetate (EVA) bag or a multilayered (ML) bag filled with 2500 mL of an identical mixture of carbohydrates (1200 kcal), fat (950 kcal), and amino acids (380 kcal). The bags were then stored at 4 degrees C, 21 degrees C, or 40 degrees C. Concentrations of vitamins A, B1, C, and E were measured up to 72 hours after compounding, using high-pressure liquid chromatography. RESULTS: Ten percent to 30% of vitamin C degradation occurred within the first minutes after TPN compounding. Vitamin C was more stable in ML bags (half-life: 68.6 hours at 4 degrees C, 24.4 hours at 21 degrees C, and 6.8 hours at 40 degrees C) than in EVA bags (half-life: 7.2 hours at 4 degrees C, 3.2 hours at 21 degrees C, and 1.1 hour at 40 degrees C). Moreover, appearance of dehydroascorbic acid in the TPN mixture did not compensate for vitamin C losses. Vitamin B1 was stable at 21 degrees C, but a 43% loss occurred at 40 degrees C after 72-hour storage in EVA bags. The other vitamins were stable in the TPN mixture stored in both bags at any temperature and without daylight protection. CONCLUSIONS: Degradations of vitamins C and B, are significantly reduced in ML bags compared with EVA bags. To prevent vitamin C deficiencies, its initial dose should be adapted to its degradation rate, which depends on the TPN bag material, the ambient temperature, and the length of time between TPN compounding and the end of infusion to the patient.     

The stability of ascorbic acid in TPN mixtures stored in a multilayered bag

Because of the susceptibility of some vitamins to oxidation, they are not normally added to TPN mixtures until shortly before addministration. Vitamin C (ascorbic acid) is oxidised rapidly, especially in the presence of trace elements. The aim of this study was to investigate the stability of ascorbic acid in complete TPN mixtures in Ultrastab multilayer bags, which are designed to reduce oxygen transmission and thus oxidation, in comparison with standard EVA bags. Ascorbic acid content was determined in two typical TPN mixtures providing 16 g nitrogen, 2000 kilocalories, electrolytes, trace elements and multivitamins, with and without fat emulsion, during storage at 5 degrees C for up to 3 months. In EVA bags ascorbic acid degraded by more than 75% during 24 h and was undetectable in 2-3 days. In contrast, there was a comparatively small initial loss of 15-30% ascorbic acid in mixtures stored in multilayer bags, with little further loss during 1-3 months. Bags containing fat emulsion retained higher concentrations of ascorbic acid after storage compared to those without fat emulsion, but all mixtures in multilayer bags maintained 60-80% ascorbic acid activity after 3 months. Since ascorbic acid is the most oxygen-sensitive vitamin, complete TPN mixtures with vitamins could be compounded in multilayer bags for an extended shelf life, rather than admixing just prior to administration.     

Stability of cocarboxylase in parenteral nutrition mixtures stored in multilayer bags

The aim of this study was to determine the stability of cocarboxylase, a thiamine derivative employed as a vitamin B1 source in multivitamin additives, in parenteral nutrition (PN) mixtures containing different commercial amino acid infusions. In particular, the influence of a metabisulphite-containing amino acid product, Freamine III, was investigated. A liquid chromatographic assay method for cocarboxylase was developed and employed to investigate cocarboxylase degradation during extended storage of PN mixtures at 5 degrees C in multilayered bags. Results indicated that cocarboxylase was relatively stable over the 28-day storage period in PN mixtures containing Synthamin or Vamin products as amino acid source. In contrast, degradation was accelerated in PN mixtures containing Freamine III, suggesting that cocarboxylase is degraded by sodium metabisulphite, showing similar sensitivity to thiamine.     

The photodegradation of vitamins A and E in parenteral nutrition mixtures during infusion

BACKGROUND & AIMS: Vitamins A and E are the most light-sensitive vitamins. Vitamin A is degraded by photolysis, while vitamin E degrades by photo-oxidation. The composition of the parenteral nutrition mixture and the container could therefore influence degradation during daylight administration. The aim of this study was therefore to determine the influence of fat emulsion and the type of bag on the photo-degradation of vitamins A and E in Parenteral Nutrition (PN) mixtures during simulated infusion in daylight. METHODS: Representative adult PN mixtures, with and without fat emulsion, were prepared. Samples for analysis were taken from infusates and each bag during simulated infusion. Degradation of vitamins A and E was determined by stability-indicating HPLC analysis. RESULTS: Results indicated that vitamin A loss proceeded rapidly during infusion, resulting in up to 80% loss in 6 hours, even with light protection of the bag. The presence of fat emulsion did not provide significant light protection. Vitamin E degradation was substantial if mixtures were prepared in EVA bags but was largely prevented if PN mixtures were compounded and stored in multi-layered bags. CONCLUSIONS: It is recommended that all PN bags should be light-protected during infusion in daylight. The use of multi-layered bags will prevent vitamin E losses during infusion.     

Storage of milk powders under adverse conditions. 2. Influence on the content of water-soluble vitamins

Storage of milk powder under unfavourable conditions accelerates the normally slow deterioration in nutritional quality. The effects of such storage on the water-soluble vitamin composition were examined. (a) Spray-dried whole milk containing 25 g water/kg was stored at 60 degrees and 70 degrees and sampled weekly to 9 weeks. (b) Spray-dried whole milk and skimmed milk were adjusted to contain 40 and 100 g water/kg and stored at 37 degrees in nitrogen and in oxygen. Samples were taken for analysis at intervals during storage. The samples were analysed for eight B-complex vitamins and ascorbic acid, and also for total lysine, 'reactive lysine' and 'lysine as lactulosyl-lysine'. Storage at 60 degrees caused rapid destruction of folic acid (53% loss at 4 weeks) and slower loss of thiamin, vitamin B6 and pantothenic acid (18% at 8 weeks). There was no change in the content of riboflavin, biotin, nicotinic acid and vitamin B12. At 70 degrees the rate of destruction of the four labile vitamins was much increased; 18% or less survived at 4 weeks. At 37 degrees and 40 g water/kg there was little change in total and 'reactive' lysine during storage for 57 d. Lactulosyl-lysine was demonstrably present but at low concentration. There was considerable loss of folate (72%) and ascorbate (91%) during storage for 30 d in O2, but no significant loss in N2. Thiamin fell by approximately 12% in 57 d, equally in O2 and N2. The content of the remaining vitamins was unchanged. At 100 g water/kg there were progressive Maillard changes. During 27 d in N2 the colour changed from cream to pale brown, but in O2 there was no perceptible colour change. Total lysine fell by 20% in 27 d, and 'reactive lysine' by 30%. Folate was stable during 16 d in N2, but largely (94%) destroyed in O2. Ascorbic acid was also destroyed in N2 as in O2. Thiamin fell by 41% in 27 d, equally in O2 and N2. Vitamin B6 was more labile, especially in N2, falling by 71% in 16 d. With skimmed-milk powder containing 100 g water/kg, storage at 37 degrees in O2 and N2 gave much the same results as for the corresponding whole-milk powder. The presence of milk fat had no marked effect on the stability of the water-soluble vitamins. Destruction of vitamins was clearly linked to the progress of Maillard-type reactions and was strongly influenced by time and temperature of storage, moisture content and, in some instances, by the presence of O2.     

Stability of ascorbic acid in a standard total parenteral nutrition mixture

We investigated the stability of ascorbic acid (AA) and the sum of AA plus dehydroascorbic acid (TAA) in a total parenteral nutrition (TPN) mixture that contained 1000 ml Vamin 14, 1000 ml glucose 30%, 500 ml Intralipid 20%, potassium phosphate, a multivitamin preparation (Cernevit) and trace elements. We used a spectrophotometer to measure AA and TAA. AA decreased from 42.2 (+/-0.9) mug/ml to 6.8 (+/-0.2) mug/ml in 7 days. Over the same time the concentration of TAA decreased from 42.2 (+/-0.5) mug/ml to 35.9 (+/-0.6) mug/ml, i.e. 63.3 (+/-1.2)% of the original concentration. When the solution was stored in glass bottles and saturated with nitrogen or when trace elements were omitted, the concentration decreased by only 25.2 (+/-0.2)% and 23.8 (+/-1.6)% respectively over 7 days. The influence of oxygen, lipids, trace elements and underfilling the bag was also investigated. We conclude that it is acceptable to prepare these bags in advance and to store them for 7 days at 2-4 degrees C.     

Precipitation of trace elements in parenteral nutrition mixtures

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.     

Brief communication: clinical experience with high branched-chain parenteral nutrition.

Patients who appear to respond best to high branched-chain amino acid (BCAA) solutions have been previously described by objective measurements such as total urinary nitrogen (TUN) excretion, oxygen consumption index (O2Cl), plasma lactate, plasma pyruvate, plasma glucose (PG) and urinary 3-methylhistidine. Use of these measurements in assessing possible candidates for high BCAA solutions may not be convenient for some institutions. The purpose of this study is to describe our clinical practice experience with patients receiving high BCAA parenteral nutrition (PN) and how we apply the criteria previously developed. Forty critically ill adult patients (19 males, 21 females; 50 +/- 19 years) who received BCAA-enriched PN were prospectively monitored for demographic information as well as objective biochemical measurements and current clinical status within a time window of 72 hours before or after beginning the high BCAA solution. Patients demonstrated marked elevations in O2Cl (168 +/- 44 ml/min/m2), TUN (18 +/- 6 g/day), and PG (157 +/- 63 mg/dl), and decreased serum albumin (2.4 +/- 0.6 g/dl) and transferrin (123 +/- 50 mg/dl). Patients were categorized according to primary diagnosis: malignant tumor (n = 10), organ transplant (n = 12), trauma (n = 1), chronic or acute disease (n = 1, n = 3), and chronic or acute disease requiring surgery (n = 7, n = 6). Clinical statuses within the 72-hour time window were as follows: infection (n = 26), renal dysfunction (n = 15), pulmonary dysfunction (n = 22), liver dysfunction (n = 14), and multiple organ failures (n = 14).(ABSTRACT TRUNCATED AT 250 WORDS)     

Nutritional Composition, in vitro Antioxidant Activity and Artemia salina L. Lethality of Pulp and Seed of Tamarindus indica L. Extracts

This study was designed to examine the nutritional composition, antioxidant activity and medium lethal concentration (LC50 value) of Tamarindus indica L. pulp and seed extracts in vitro. The extraction was set at 40?C, 60?C and 100?C for 12 hours, 6 hours and 15 minutes respectively to determine the optimum extraction parameter whereas the anti-oxidant activity of the extracts was measured using iron (III) reduction (FRAP) assay. Total phenolic content (TPC) of the extracts was estimated as gallic acid equivalent by Folin-Ciocalteau method. Toxicity potential of the extract was assessed in vitro by Artemia salina lethality test both in seed and pulp samples. The results showed that tamarind seed contained a higher percentage of carbohydrate, protein, fat and energy (15%, 82%, 95% and 33.13% respectively) than the pulp. On the other hand, the pulp demonstrated a high moisture (51.1%) and ash (34.84%) content than the seed. For the mineral analysis, tamarind seed contained higher Ca and C (1.0% and 50.73% respectively) than the pulp (0.27% and 40.40% respectively). No heavy metals were detected in both samples. Seed extracted at 60?C/6 hours and 100?C/15 minutes showed the highest TPC value and were significantly different (p<0.05) than the seed extracted at 40?C/12 hours. Anti-oxidant activity is positively correlated to the TPC value of the extracts (R=0.991). The pulp and seed extracted at 100?C/15 minutes showed the highest FRAP value among its groups (216.17 ± 14.06 μmol (Fe)/g and 659.74 ± 16.40 μmol (Fe)/g respectively). This study indicates that tamarind pulp and seed extracts possess beneficial antioxidant properties and the optimum extraction parameter is 100?C for 15 minutes. In Artemia salina lethality test, tamarind pulp caused significant mortality of the crustacean larvae with LC50 in the range of 26-28 μL/mL. Tamarind seed were not toxic to Artemia salina since the LC50 of the extracts was higher than 1000 μL/mL.     

Adequacy of maternal pyridoxine supplementation during pregnancy in relation to the vitamin B6 status and growth of neonates at birth

To evaluate the adequacy of maternal pyridoxine supplementation during pregnancy for both maternal and neonatal status at birth, vitamin B6 status, assessed by plasma pyridoxal phosphate (PLP), pyridoxal (PL) and total aldehyde vitamer (PLP + PL) concentrations, and the growth of neonates, including weight, length, head and chest circumferences, were examined for 209 neonates whose mothers were supplemented with 0, 1, 2 or 3 mg pyridoxine.HCl (PN.HCl)/d during pregnancy. Maternal PN.HCl supplementations were positively correlated to both maternal (r = 0.62) and cord (r = 0.78) plasma PLP concentrations (p < 0.0001). Mothers supplemented with 2 or 3 mg/d PN.HCl had significantly higher plasma concentrations of PLP and total B6 aldehyde vitamer in maternal and cord blood compared with those receiving 0 or 1 mg PN.HCl/d. A growth benefit for neonates whose mothers had maternal and cord plasma PLP concentrations > or = 40 nM was revealed by the maternal supplementation of 2 mg PN.HCl/d during pregnancy. Thus, in healthy pregnant women, according to our study, a daily supplement of 2 mg PN.HCl provides the adequacy of maternal and neonatal vitamin B6 status and the satisfactory growth of neonates at birth.     

Antihistamine effect of supplemental ascorbic acid and neutrophil chemotaxis.

Renewed interest in the antihistamine action of ascorbic acid has emerged with the recently recognized immunosuppressive role of histamine. We examined the antihistamine effect of acute and chronic vitamin C (VC) administration and its effect on neutrophil chemotaxis in healthy men and women. In the chronic study, 10 subjects ingested a placebo during weeks 1, 2, 5 and 6, and 2 g/day of VC during weeks 3 and 4. Fasting blood samples were collected after the initial 2-week period (baseline) and at the end of weeks 4 and 6. Plasma ascorbate rose significantly following VC administration compared to baseline and withdrawal values. Neutrophil chemotaxis rose 19% (NS) during VC administration, and fell 30% after VC withdrawal, but these changes were not correlated to plasma ascorbate levels (r = 0.01). Chemotaxis was inversely correlated to blood histamine (r = -0.32, p = 0.045), and, compared to baseline and withdrawal values, histamine levels were depressed 38% following VC supplementation. Blood histamine and neutrophil chemotaxis did not change 4 hours following a single 2 g dose of ascorbic acid, although plasma ascorbate rose 150%. These data indicate that VC may indirectly enhance chemotaxis by detoxifying histamine in vivo.     

Endotoxin-mediated hepatic lipid accumulation during parenteral nutrition in rats

OBJECTIVE: To assess the effect of endotoxemia on hepatic lipid content during parenteral nutrition (PN) in rats. METHODS: Twenty male Sprague-Dawley rats (185-230 gm) were randomized to receive PN (n=9) or PN plus a continuous infusion of E. coli 026:B6 lipopolysaccharide (LPS; n= 11). All animals received isocaloric (170 kcal/kg/day), isonitrogenous (1.1 g N/kg/day), glucose-based PN for the next 78 hours. After 30 hours of adaptation to TPN, the animals were randomized to receive PN or PN plus LPS at 6 mg/kg/day for the remaining 48 hours of study. The animals were euthanized and the livers were harvested. RESULTS: Liver weight increased significantly (by 60%) from 7.5+/-0.6 g to 12.1+/-2.4 g (p < or = 0.01) in the animals who received PN versus LPS, respectively. The proportion of liver water remained the same for PN and LPS groups (72.9+/-3.2% versus 72.3+/-3.8%, respectively, p = N.S.). However, liver fat increased disproportionately (by about 130%) from 0.20+/-0.05 g to 0.46+/-0.20 g (p < or = 0.01) total fat weight or from 9.6+/-1.8% to 13.6+/-4.1% (p < or = 0.02) lipid content (g/g) of the dry liver weight for the PN and LPS groups, respectively. CONCLUSION: Endotoxin, when given concomitantly with parenteral nutrition, increases hepatic lipid accumulation and thus augments the development of parenteral nutrition-associated fatty liver in rats.     

Effect of a single oral dose of ascorbic acid on body temperature and trace mineral fluxes in healthy men and women.

Several metabolic changes characteristic of the acute-phase response were examined in healthy men and women following a single 1 g dose of ascorbic acid. Utilizing a placebo-controlled, double-blind protocol, oral body temperatures were recorded in rested, fasted subjects (0900 hr) prior to the consumption of 1 g L-ascorbic acid or placebo (n = 10/group). Temperatures were recorded hourly for the next 8 hours, and again the next morning in the rested, fasted state (0900 hr). Blood samples, collected at 0, 4, and 24 hours post-dose, were analyzed for plasma ascorbate, iron, and zinc. Mean oral body temperature was significantly elevated 2 hours post-dose in the experimental subjects compared to controls (+0.7 degrees F, p = 0.03). In the vitamin-dosed subjects, mean plasma ascorbate rose 32% over the control value after 4 hours (1.11 +/? 0.08 and 0.84 +/? 0.06 mg/100 ml, ns). Serum iron levels were similar in the two groups at 0 and 4 hours post-dose, but at 24 hours post-dose mean serum iron of the vitamin-dosed subjects fell to 73% of that recorded for the control subjects (77 +/? 8 and 105 +/? 10 micrograms/100 ml, p = 0.04). Plasma zinc levels were similar for both groups at 0, 4, and 24 hours post-dose. These data indicate that ascorbate administration, at a level commonly supplemented in the US diet, elicits several host metabolic responses similar to those observed following exposure to infectious or inflammatory agents. These metabolic changes are most likely due to the reducing potential of the vitamin and may factor in the reported prophylactic success of vitamin C supplementation.     

Nosocomial outbreak of systemic candidosis associated with parenteral nutrition

Eight patients in two surgical units developed systemic candidosis during a 40-day period from June 5 to July 13, 1987 (in five cases Candida albicans was identified). Three of them died. All cases belonged to a group of 27 patients receiving parenteral nutrition (PN), while among the 108 patients who did not receive PN, no cases were observed (p = .000001). Candida was cultured from two PN bags administered to the cases. A specialized nutrition nurse was responsible for the PN compounding and for maintaining administration sets in the two wards involved. An epidemiological investigation, in which 19 uninfected patients who had had PN were used as controls, showed no significant difference between cases and controls except that lipids were more frequently added to bags administered to cases (p = .0005). Furthermore, the bags administered to cases contained a higher average number of multidose constituents (p = .0008) when the comparison was focused on the two days before the onset of symptoms. Given the favorable medium provided by lipids, even a low level contamination of PN solutions during compounding and/or administration could have been responsible for the exposure of cases to multidose vials suggests, although not conclusively, that an extrinsic contamination occurred during compounding. Six isolates of C albicans were available from four cases. C albicans was cultured from the pharyngeal swabs of two physicians and three nurses, including the specialized nutrition nurse.     

Improvement of shelf-life and microbiological quality of minimally processed refrigerated capsicum by gamma irradiation

Shelf-life, microbiological and chemical quality of minimally processed capsicum subjected to radiation doses of 1, 2 and 3 kGy followed by storage at 5 degrees C and 10 degrees C were evaluated. Irradiation at an optimal dose of 2 kGy reduced the initial bacterial population by 2-3 log cycles and eliminated the coliforms Listeria and Yersinia. Chemical analysis revealed that the initial contents of ascorbic acid (127.7 mg/100 g), carotenoid (110 microg/100 g) and chlorophyll (7.75 mg/g) were reduced marginally by 5-10% with increasing radiation dose. However, during subsequent storage, up to 4 weeks, the temperature-dependent losses in vitamin C and chlorophyll content of irradiated samples were less compared with non-irradiated samples. The total carotenoid content of capsicum irradiated and stored for up to 2 weeks at 10 degrees C showed a similar trend. Thus, gamma irradiation at 2 kGy was found to improve both the hygienic quality and shelf-life without affecting the nutritional quality of minimally processed capsicum.     

Effect of domestic processing and cooking methods on total,hcl extractable iron and in vitro availability of iron in spinach and amaranth leaves

Spinach (Spinacia oleracia) and amaranth (Amaranthus tricolor) leaves were stored in polyethylene bags and without packing for 24 and 48 hours in a refrigerator at 5 degrees C and 30 degrees C in polyethylene bags. The fresh leaves were also dried (oven and sun), blanched (5, 10 and 15 min) and cooked in an open pan and a pressure cooker. The processed leaves were analysed for total iron, its availability and antinutrient content. The iron content of these leaves varied from 26.54 to 34.14 mg/100 g, dry weight and its HCl-extractability and in vitro availability were 62.11-67.18% and 3.03-3.97% of total respectively. Drying and storage had no significant effect on total iron content, HCl-extractability and availability (in vitro), while blanching and cooking resulted in significant improvement of iron availability, and a significant reduction in oxalic acid content, while only blanching significantly reduced phytic acid and polyphenol contents. Thus cooking and blanching are good ways to improve HCl-extractability and in vitro availability of iron.     

胃肠道手术后规范化序贯肠内肠外营养支持疗法与肠外营养支持的临床随机对照研究

目的 比较胃肠道手术后规范化序贯肠内肠外营养支持疗法与肠外营养支持的临床疗效.方法 采用随机数字表法,将126例拟行开腹胃肠道手术的患者随机分为早期肠内肠外营养支持疗法组(EEN+PN组,n=62)和肠外营养支持组(PN组,n=64),分别于手术前,手术后第3、7天监测患者的体重、体重指数、血清白蛋白、前白蛋白、血脂、血生化、血淋巴细胞计数、血C反应蛋白变化情况,比较两组患者术后胃肠道功能恢复时间、手术并发症、营养支持相关费用及住院天数.结果 术前两组患者的营养相关指标、血生化指标和炎症及免疫指标差异均无统计学意义(P>0.05);术后第3天,EEN+PN组患者前白蛋白水平显著高于PN组[(160.3±23.0)g/L比(137.0±28.7)g/L,P=0.000];术后第7天,EEN+PN组患者前白蛋白[(210.6±34.6)g/L比(154.8±36.9)g/L,P=0.000]、白蛋白[(33.6±3.8)g/L比(31.8±4.7)g/L,P=0.042]、淋巴细胞计数[(2.33±0.53)×109/L比(1.04±0.36)×109/L,P=0.046]水平均显著高于PN组,血γ-谷氨酰转肽酶[(48.12±33.84)U/L比(71.54±34.00)U/L,P=0.048]、C反应蛋白[(31.15±19.00)mmol/L比(45.90±23.21)mmol/L,P=0.042]、总胆固醇[(3.09±0.83)mmol/L比(3.29±0.91)mmoL/L,P=0.045]、低密度脂蛋白[(2.01±0.39)mmoi/L比(2.31±0.72)mmol/L,P=0.049]水平显著低于PN组.EEN+PN组患者术后胃肠道功能恢复时间显著短于PN组[(65.7±15.6)h比(75.1±27.0)h,P=0.036],围手术营养支持疗法总费用显著低于PN组[(2634.5±1306.8)元比(3058.6±1216.0)元,P=0.046].结论 胃肠道手术后早期规范化序贯肠内肠外营养支持疗法可以改善机体术后前白蛋白水平,有益于术后患者免疫功能和组织损伤水平的恢复,促进早期胃肠道功能恢复,降低营养支持疗法相关费用.

Abstract：

Objective To compare the clinical efficacy between standard sequential early enteral nutrition (EEN) plus parenteral nutrition (PN) and PN alone in patients undergoing gastrointestinal surgery. Methods Werandomly divided 126 patients who underwent laparotomy gastrointestinal surgery into EEN + PN group (n = 62) and PN group (n = 64). The levels of blood nutrition-related indicators, biochemical indicators, and inflammatory indicators were determined before surgery and 3 and 7 days after surgery, and the gastrointestinal function recovery time, complications, nutritional support cost, and length of hospital stay were compared between two groups. Results The preoperative nutrition-related indicators, biochemical indicators, and inflammatory indicators showed no significant differences between two groups (P >0. 05). Three days after operation, however, the levels of prealbumin in EEN + PN group were significantly higher than those in PN group [(160. 3 ±23. 0) g/L vs. (137.0±28.7) g/L, P=0.000]. Seven days after operation, the levels of albumin [(33.6±3.8) g/L vs. (31.8±4.7) g/L, P = 0.042], prealbumin [(210.6±34.6) g/L vs. (154.8 ±36.9) g/L, P=0.000], and lymphocyte cell count [(2.33±0.53) x 109/L vs. (1.04±0.36) × 109/L, P = 0. 046] in EEN + PN group were significantly higher than those in PN group, and the levels of serum γ-glutamyltransferase [(48. 12 ± 33.84) U/L vs. (71.54±34.00)U/L, P=0.048], C-reactive protein [(31.15 ± 19.00) mmol/L vs. (45.90 ± 23.21) mmol/L, P=0.042], total cholesterol [(3.09±0.83) mmol/L vs. (3.29±0.91) mmol/L, P = 0. 045] and low density lipoprotein [(2.01 ± 0. 39) mmol/L vs. (2. 31 ± 0. 72 ) mmol/L, P = 0. 049] were significantly lower than those in PN group. The postoperative gastrointestinal function recovery time in EEN + PN group was significantly shorter than that in PN group [(65. 7 ± 15. 6) hours vs. (75. 1 ± 27. 0) hours, P = 0. 036], and the total cost of perioperative nutrition in EEN + PN group was also significantly lower than in PN [(2634. 5 ±1306. 8) RMB vs. (3058. 6 ± 1216. 0) RMB, P= 0.046]. Conclusion Standard sequential EEN plus PN can increase the post-operative prealbumin level, improve the immune function, promote the recovery of gastrointestinal function, and decrease the cost of nutritional support.     

Tissue concentrations and proliferative effects of massive doses of ascorbic acid in the mouse

The effect of ascorbic acid supplementation on CF1 mice fed ascorbic acid for approximately six months at dose levels of 1%, 5%, and 10% of diet was investigated by analysis of tissue ascorbic acid concentration in the liver, kidney, stomach, small intestine, and large bowel. The effect on epithelial cell proliferation was also examined in the small and large bowel but only at the 5% level. In the control animals, ascorbic acid concentration was lowest in the liver (0.406 +/- 0.07 mg/g) and highest in the small bowel (0.754 +/- 0.16 mg/g). Dietary intake of 5% and 10% ascorbic acid significantly elevated levels in the liver (0.741 +/- 0.13; p less than 0.05), and all doses of ascorbic acid significantly raised tissue concentrations in the kidney and colon. No difference was observed in the percentage of DNA-synthesizing cells in the jejunum of controls or animals fed 5% ascorbic acid at 1 or 24 hours after 3HTdR injection. However, at 1 hour a significantly decreased level of proliferation was observed in the distal colon of ascorbic-acid-treated mice compared with controls (labeling index [L.I.] = 7.3 +/- 0.28 vs. 10.1 +/- 1.15; p less than 0.05), and an even greater suppression of DNA synthesis was achieved by 24 hours (L.I. = 11.4 +/- 1.06 vs. 18.6 +/- 1.61; p less than 0.01). None of the doses of ascorbic acid employed was toxic to the experimental mice.     

Characterization of Fatty Acid Profiles in Infants With Intestinal Failure–Associated Liver Disease

Background

The purpose of this study was to characterize fatty acid profiles (FAPs) in parenteral nutrition (PN)‐dependent infants with intestinal failure–associated liver disease (IFALD) receiving soybean oil–based lipid emulsion (SO) doses of ～3 and ～1 g/kg/d.

Methods

Prospectively collected data were retrospectively reviewed. Serum FAPs of patients <1 year old who experienced development of IFALD while receiving standard PN with SO were examined before transitioning to a fish oil–based lipid emulsion for IFALD treatment. Time on SO, dose, gestational age, and weight‐ and length‐for‐age z scores were also reviewed.

Results

Among the 49 patients analyzed, there were no differences in demographics or anthropometrics between patients who received standard SO (SO‐S) (n = 14, range of dosage 2.06–3.31 g/kg/d) and reduced SO (SO‐R) (n = 35, range of dosage 0.90–1.34 g/kg/d). Patients received SO for a median of 53 days (interquartile range 39, 73) before FAP measurement. Patients who received SO‐R had significantly higher Mead acid and lower α‐linolenic, eicosapentaenoic, linoleic, stearic, total ω‐3, and total ω‐6 fatty acid levels than patients who received SO‐S (P < .01). Triene:tetraene ratios were higher in patients who received SO‐R (P = .0009), and no patients experienced biochemical essential fatty acid deficiency (EFAD).

Conclusion

PN‐dependent infants with IFALD receiving SO‐R have different FAPs than patients receiving SO‐S. No patients in either group had biochemical EFAD.