Oesophageal atresia: The growth gap

Poor growth is an under-recognised yet significant long-term sequelae of oesophageal atresia(OA) repair. Few studies have specifically explored the reasons for growth impairment in this complex cohort. The association between poor growth with younger age and fundoplication appears to have the strongest supportive evidence, highlighting the need for early involvement of a dietitian and speech pathologist, and consideration of optimal medical reflux management prior to referring for anti-reflux surgery. However, it remains difficult to reach conclusions regarding other factors which may negatively influence growth, due to conflicting findings, inconsistent definitions and lack of validated tool utilisation. While swallowing and feeding difficulties are particularly frequent in younger children, their relationship with growth remains unclear. It is possible that these morbidities impact on the diet of children with OA, but detailed analysis of dietary composition and quality, and its relationship with these complications and growth, has not yet been conducted. Another potential area of research in OA is the role of the microbiota in growth and nutrition. While the microbiota has been linked to growth impairment in other paediatric conditions,it is yet to be investigated in OA. Further research is needed to identify the most,important contributory factors to poor growth, the role of the intestinal microbiota, and effective interventions to maximise growth and nutritional outcomes in this cohort.     

A review of postoperative feeding regimens in infantile hypertrophic pyloric stenosis

Infantile hypertrophic pyloric stenosis is a condition well known to pediatric surgeons. Postoperative length of hospital stay is a financial concern and remains a potential target for reduction in hospital costs. Ultimately, these costs are directly affected by the ability to effectively advance postoperative enteral nutrition. This review will serve to: 1) identify clinically relevant postoperative feeding patterns following pyloromyotomy, 2) review the relevant literature to determine an optimal feeding pattern, and 3) identify possible preoperative predictors that may determine the success of postoperative feeding regiments.     

Food selectivity in children with and without an autism spectrum disorder: Investigation of diagnosis and age

Feeding problems are common in children with autism spectrum disorders (ASDs), with food selectivity being the most frequently reported. Selectivity based on type and/or texture of food is of concern in those with ASD. Variations in symptom presentation of food selectivity in children with different autism spectrum diagnoses across childhood have not often been investigated. Parent-report of food selectivity was examined in 525 children age 2–18 years diagnosed with autistic disorder, PDD-NOS, Asperger's disorder, atypical development, and typical development using information garnered from the Autism Spectrum Disorder-Comorbidity for Children (ASD-CC), a tool to assess emotional issues and comorbid psychopathology. Individuals with an ASD were reported to have significantly more food selectivity than both the atypically developing group and the typically developing group. In addition, the ASD groups, when looked at together, showed a decrease in food selectivity across childhood with significant decrease in the Asperger's disorder group.     

机械通气患儿能量代谢特点和喂养状态研究

目的：通过间接测热法测定机械通气患儿静息能量消耗,研究其能量代谢特点和喂养状态,为改进营养支持策略提供依据。方法以2013年2月至2013年11月入住PICU,符合间接测热条件的37例机械通气患儿为研究对象,自符合测定条件起第1、4、7、10、14和21天测定静息能量消耗( measurement of resting energy expenditure,MREE),运用Schofield-HTWT公式计算预测静息能量消耗值( predicted resting energy expenditure,PREE),并统计每日热量摄入值。按MREE/PREE比值评定代谢状态：低代谢(<90％)、正常代谢(90％~110％)和高代谢(>110％)。按热量摄入值/MREE 比值评定喂养状态：喂养不足(<90％)、喂养适当(90％~110％)和喂养过度(>110％)。结果37例危重症儿童机械通气第1天,15例(40.5％)为低代谢,9例(24.3％)为正常代谢,13例(35.1％)为高代谢;机械通气第7天,呈高代谢状态患儿比例增加至46.7％,但较第1天无统计学差异(χ2＝0.516,P＝0.972)。营养支持应用率为81.1％;实施营养支持者,累计实施间接测热82次,每日热量摄入值为(33.4±22.2)kcal/(kg?d),显著低于MREE水平[(53.7±17.4)kcal/(kg?d)](t＝6.505,P<0.01)。在实施营养支持过程中,机械通气患儿有62 d(75.6％)喂养不足,8 d(9.8％)喂养适当,12 d(14.6％)喂养过度。结论 PICU滞留期间机械通气患儿能量代谢状态不断变化,且PICU滞留期间有近90％的时间里患儿喂养不达标。     

Nicotine withdrawal increases body weight, neuropeptide Y and Agouti-related protein expression in the hypothalamus and decreases uncoupling protein-3 expression in the brown adipose tissue in high-fat fed mice

Nicotine is known to decrease body weight in normal rodents and human smokers, whereas nicotine withdrawal or smoking cessation can increase body weight. We have found that mice fed a high fat diet do not show the anorectic effect of chronic nicotine treatment, but do increase their body weight following nicotine withdrawal. Nicotine withdrawal is accompanied by increased expression of the orexigenic peptides neuropeptide Y and Agouti-related protein in the hypothalamus, and decreased expression of the metabolic protein uncoupling protein-3 in brown adipose tissue. These data suggest that diet can influence the ability of nicotine to modulate body weight regulation and demonstrate that chronic nicotine exposure results in adaptive changes in central and peripheral molecules which regulate feeding behavior and energy metabolism.     

Behavioral and neural responses to gustatory stimuli delivered non-contingently through intra-oral cannulas

The act of eating requires a decision by an animal to place food in its mouth. The reasons to eat are varied and include hunger as well as the food's expected reward value. Previous studies of tastant processing in the rat primary gustatory cortex (GC) have used either anesthetized or awake behaving preparations that yield somewhat different results. Here we have developed a new preparation in which we explore the influences of intra-oral and non-contingent tastant delivery on rats' behavior and on their GC neural responses. We recorded single-unit activity in the rat GC during two sequences of tastant deliveries, PRE and POST, which were separated by a waiting period. Six tastants ranging in hedonic value from sucrose to quinine were delivered in the first two protocols called 4TW and L-S. In the third one, the App L-S protocol, only hedonically positive tastants were used. In the 4TW protocol, tastants were delivered in blocks whereas in the two L-S protocols tastants were randomly interleaved. In the 4TW and L-S protocols the probability of ingesting tastants in the PRE sequence decreased exponentially with the trial number. Moreover, in both protocols this decrease was greater in the POST than in the PRE sequence likely because the subjects learned that unpleasant tastants were to be delivered. In the App L-S protocol the decrease in ingestion was markedly slower than in the other protocols, thus supporting the hypothesis that the decrease in appetitive behavior arises from the non-contingent intra-oral delivery of hedonically negative tastants like quinine. Although neuronal responses in the three protocols displayed similar variability levels, significant differences existed between the protocols in the way the variability was partitioned between chemosensory and non-chemosensory neurons. While in the 4TW and L-S protocols the former population displayed more changes than the latter, in the App L-S protocol variability was homogeneously distributed between the two populations. We posit that these tuning changes arise, at least in part, from compounds released upon ingestion, and also from differences in areas of the oral cavity that are bathed as the animals ingest or reject the tastants.     

Evaluating feeding as unconditioned stimulus for conditioning of an endocrine effect in Nile tilapia

This study tested the adequacy of feeding as an unconditioned stimulus (US) to condition an endocrine response (plasma cortisol increase) in the cichlid fish Nile tilapia (Oreochromis niloticus). In a first study, conditioning was confirmed in grouped fish in the only experiment using single-held Nile tilapia. In this test a conditioned stimulus (CS - aeration off) was associated with a stressor (air emersion for 2 min- US). We then assessed whether several events of paired CS-US resulted in a conditioned endocrine response (CR), in this case an increase in plasma cortisol after presentation of the CS only. Before testing feeding as US, the postprandial or social holding condition for feeding effects on cortisol levels was tested. Nile tilapia showed increased cortisol after feeding associated to social context (grouped fish), but not to food only (single-held fish). In a third study, feeding was tested as US in an experiment similar to the first study but an increase in feeding-induced cortisol could not be conditioned. The absence of CR suggests that the stressor affects acquisition of this response, which may be a consequence of stimulus intensity or biological relevance. This study expands the recently reported Pavlovian conditioning paradigm for endocrine response in fish.     

鼻饲方法的改进对呼吸机相关性肺炎控制的影响

目的：观察改进鼻饲方法对降低机械通气患者呼吸机相关性肺炎（VAP）发生率的作用。方法：将58例行气管切开机械通气治疗48 h以上患者随机分为观察组（32例）和对照组（26例）,对照组采用常规的置管方法,注射器抽吸间歇喂养方法,观察组采用小口径鼻饲管,在半卧位时持续滴注的方法,观察两组机械通气1周、2周及2周后VAP发生率以及机械通气时间。结果：机械通气1周、2周观察组VAP发生率低于对照组（均P〈0.05）,机械通气时间短于对照组（P〈0.01）结论：鼻饲方法改进可显著减少VAP的发生,缩短机械通气时间。     

Long-term toxicity study on transgenic rice with Cry1Ac and sck genes

In the present work, we evaluated the chronic effects of the transgenic insect-resistant rice carrying Cry1Ac and sck genes on Sprague–Dawley (SD) rats through a 78-week feeding study. Based on the gender and weight, 180 SD rats were randomly and evenly assigned into three groups. GM rice and non-GM rice were separately formulated into diets at high levels. AIN-93 diet was used as a nutritional control. Body weight, food consumption, hematology and serum chemistry were monitored regularly. Rats were sacrificed for organ weight measurement and pathological examination at 52 weeks and 78 weeks. Body weight, food consumption, mortality rates, tumor incidences and pathological findings showed no significant difference among the three groups. Although certain differences in some hematology, serum chemistry parameters and relative organ weights were observed between GM rice group and control groups, they were not considered as treatment-related. Taken together, long-term intake of transgenic rice carrying Cry1Ac and sck genes at a high level exerts no unintended adverse effects on rats.     

未成年人参与保健食品试食试验的立法探索——以“黄金大米”事件为例

“黄金大米”事件反映了我国保健食品试食试验制度中未成年人参与保护的法律缺陷。目前,我国试食试验制度与医学人体试验制度混同适用。但混同立法难以体现二者试验利益的差别,不能充分保护难以正确表意的未成年人的健康权利,也与儿童保健品监管的现实问题脱节。域外立法一般将两者区分。在国外关于与试食试验利益类似的“非治疗性试验”的法律规定中,对未成年人健康利益保护的立法模式包括限制模式、监护人决定模式以及风险利益评估模式,其中保护未成年人权利的立法宗旨和具体规定均值得借鉴。我国立法应以试验利益为依据,对未成年人参与试食试验采取原则上限制并辅以个别例外情形的立法模式,以切实保护其合法权益。