Practice patterns and adherence to nutrition guidelines in acute pancreatitis: An international physician survey

BackgroundThere is agreement among GI society guidelines for recommending early oral nutrition with non-liquid diet in patients with mild acute pancreatitis (AP). There is less agreement regarding administration of tube feedings (TF) in AP. Data on physicians’ adherence to nutrition guidelines and practice variations are limited.AimsTo report practice patterns in the nutritional management of different severity profiles of AP.MethodsWe conducted an anonymous electronic survey among physician members of the International Association of Pancreatology and the American Pancreatic Association. We assessed nutrition practices based on severity of AP, and asked relevant questions regarding the preferred administration strategies for enteral nutrition. Responses were compared by practice location and subspecialty.ResultsA total of 178 physicians, mostly medical pancreatologists (40.4%) and surgeons (34.8%) from Europe (43.4%) and North America (32%) responded. Overall, only 26.7% initiated oral nutrition in mild AP on day 1, 40.9% waited >48 h, and 57.3% initiated nutrition with liquid diets. Physicians reported frequently using TF in patients with moderately-severe (30–75%, depending on the amount and location of necrosis) and severe AP (75–80%). Two-thirds of physicians preferred initiating TF after 48 h, administering it post-pylorically, and using semi-elemental or polymeric formulas. Median TF duration was 11 days (IQR, 7–21). Significant variations were noted based on geographic location and physician subspecialty for several aspects of nutritional practices in both mild and non-mild AP.ConclusionAdherence to oral nutrition guideline recommendations for mild AP is low. There is significant variability in the use of TF in AP. Our study highlights opportunities for improving consistency of nutrition care in AP and identify potential areas for research.     

Structural and Binding Studies of SAP-1 Protein With Heparin

SAP-1 is a low molecular weight cysteine protease inhibitor (CPI) which belongs to type-2 cystatins family. SAP-1 protein purified from human seminal plasma (HuSP) has been shown to inhibit cysteine and serine proteases and exhibit interesting biological properties, including high temperature and pH stability. Heparin is a naturally occurring glycosaminoglycan (with varied chain length) which interacts with a number of proteins and regulates multiple steps in different biological processes. As an anticoagulant, heparin enhances inhibition of thrombin by the serpin antithrombin III. Therefore, we have employed surface plasmon resonance (SPR) to improve our understanding of the binding interaction between heparin and SAP-1 (protease inhibitor). SPR data suggest that SAP-1 binds to heparin with a significant affinity (K_D = 158 nm ). SPR solution competition studies using heparin oligosaccharides showed that the binding of SAP-1 to heparin is dependent on chain length. Large oligosaccharides show strong binding affinity for SAP-1. Further to get insight into the structural aspect of interactions between SAP-1 and heparin, we used modelled structure of the SAP-1 and docked with heparin and heparin-derived polysaccharides. The results suggest that a positively charged residue lysine plays important role in these interactions. Such information should improve our understanding of how heparin, present in the reproductive tract, regulates cystatins activity.     

Microwave-assisted facile synthesis of poly(luminol-co-phenylenediamine) copolymers and their potential application in biomedical imaging

Conjugated copolymers have attracted much attention because of their outstanding photo-physical properties. The present work reports for the first time, microwave-assisted copolymerization of o-phenylenediamine with luminol using different weight ratios of the two monomers. The composition of the copolymers was confirmed by Fourier transform infrared spectroscopy (FTIR) and nuclear magnetic resonance spectroscopy (¹H-NMR) while monomer reactivity ratios were determined using the Fineman–Ross method. Ultraviolet-visible spectroscopy revealed the variation in polaronic states upon copolymerization while X-ray diffraction (XRD) and transmission electron microscopy (TEM) analyses showed the morphology of the copolymers to be intermediate between that of the homopolymers. Confocal analysis and fluorescence studies revealed that the copolymers showed composition based blue as well as red emission which could be utilized for in vivo imaging of cancer cells.

Development of bioimaging agents based on poly(o-phenylendiamine and luminol).     

Potential and Prospects of Shikonin Production Enhancement in Medicinal Plants

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Plants are a rich source of valuable chemicals that are used as herbal and modern medicines. Shikonin, a...     

In Vitro and In Vivo Study of Argyreia speciosa on Chronic Gastric Ulceration and Metabolic Studies

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Chronic gastric ulcer being the most prevalent gastrointestinal disorder is considered a major cause of...     

“Dynamic” liver retraction at laparoscopy: An easy and effective technique

Liver retraction is an essential step during any laparoscopic upper gastrointestinal operation, especially during dissection at the oesophageal hiatus. However, the generally employed Nathanson retractor may cause significant postoperative liver dysfunction secondary to congestion of the liver.1,2 It may be technically cumbersome to systematize its frequent use intraoperatively and it may not be readily available at large. Furthermore, the unabated pressure it inflicts on the left lobe of the liver, especially during prolonged surgeries, may lead to hepatic ischaemic necrosis, gangrene, or even unexpected mortality.1 While few recently developed innovative liver retraction techniques seem useful in this context, 2-5 they tend to offer a “static” liver retraction. In this paper, we describe an easy-to-use method of laparoscopic liver retraction wherein any 5mm laparoscopic instrument can be used to manipulate the “heavy” liver so as to provide a “dynamic” counter-traction at will.