Artificial nutrition support in intensive care units in Spain

Objective A multicenter survey to study the use of nutritional support in patients admitted to the ICU in Spain.Design The survey was announced during the annual Spanish Society of Intensive Care Medicine and Coronary Units (SEMIUC) congress meeting.Setting Questionnaires designed to determine current clinical practice concerning artificial nutrition were sent to the 27 ICU who accepted to participate.Patients and participants In each center the 235-question form was filled out individually for each patient admitted to the ICU during the month of March, 1992.Interventions To validate the study a preliminary pilot surveys were conducted to ensure that there was a correct interpretation of the questions. The replies were entered into a database for analysis.Results A total of 1261 patients were studied; 33.9% received artificial nutrition (AN). The administration of AN was significantly higher in the medical group (44%), than in the surgical (37%) and the trauma group (19%). AN was significantly lower in patients admitted to private clinic than public institutions (26.7% versus 34.7%). Among the patients who received AN, enteral nutrition (EN) was administered to 59.7% of the patients, total parenteral nutrition (TPN) to 38.5%, and peripheral parenteral nutrition (PPN) to 18.2%. Medical patients received significantly more EN than surgical and trauma patients. Surgical patients received more PN than medical and trauma groups.Conclusions Nutritional support is a common practice in the treatment of ICU patients in our country. All information concerning its use is necessary to optimize it.     

Fluid Flow through Filtering Appendages of Insects

Many organisms use structures composed of arrays of cylindersto capture particulate food or molecules form the water or airaround them. The performance of such filters depends on thevelocity of fluid movement through them; hence, mathematicalmodels of flow through fibrous structures can provide insightsabout the functional morphology of biological filters. In thispaper, the authors address the case of feather-like biologicalfilters of finite width and assess several possible models forfluid motion through them by comparing model predictions withobservational data. Two examples of insect appendages are considered:the cephalic fans of black fly aquatic larvae that capture particulatefood and the antennae of adult male moths that catch sex-attractantmolecules released by female moths. The results suggest thatflow through such structures can be much slower than ambientcurrents, that the finest hairs in the structure are the morphologicalfeatures with the greatest effect on leakiness, and that thevelocity of movement (or of ambient flow), as well as the morphologyof such filters, can be critical in determining their performance.     

Effect of limited access to sucrose on overeating and patterns of feeding

Four groups of adult rats, housed on a 12-12, light-dark cycle, were allowed access to a nutritionally complete diet and water. Three of these groups were also offered a 32% solution of sucrose. The sucrose was available for either the 24-hour period, the 12 hours of light or the 12 hours of dark. Access to sucrose led to overeating and excessive weight gain. These effects were more pronounced when the sucrose was available for the 24-hour period or during the dark. Limited access to sucrose produced a reversal of the rat's usual circadian pattern of feeding when the sucrose was available during the light and increased the rat's nocturnal hyperphagia when it was available during the dark. Sucrose intake and the proportion of calories taken from sucrose were higher in the 24-hour access group and the dark access group than the light access group. Access to sucrose did not induce a pattern of dietary selection that compromised growth or health. It appears that access to a palatable carbohydrate solution can lead to overeating and major changes in the circadian organization of feeding behavior. These data emphasize the potent role that external factors can play in the control of ingestive behavior.     

Carbohydrate feeding and exercise: effect of beverage carbohydrate content

Summary The purpose of this study was to determine the effect of ingesting fluids of varying carbohydrate content upon sensory response, physiologic function, and exercise performance during 1.25 h of intermittent cycling in a warm environment (T _db=33.4°C). Twelve subjects (7 male, 5 female) completed four separate exercise sessions; each session consisted of three 20 min bouts of cycling at 65% , with each bout followed by 5 min rest. A timed cycling task (1200 pedal revolutions) completed each exercise session. Immediately prior to the first 20 min cycling bout and during each rest period, subjects consumed 2.5 ml·kg BW⁻¹ of water placebo (WP), or solutions of 6%, 8%, or 10% sucrose with electrolytes (20 mmol·l⁻¹ Na⁺, 3.2 mmol·l⁻¹ K⁺). Beverages were administered in double blind, counterbalanced order. Mean (±SE) times for the 1200 cycling task differed significantly: WP=13.62±0.33 min, *6%=13.03±0.24 min, 8%=13.30±0.25 min, 10%=13.57±0.22 min (*=different from WP and 10%,P<0.05). Compared to WP, ingestion of the CHO beverages resulted in higher plasma glucose and insulin concentrations, and higher RER values during the final 20 min of exercise (P<0.05). Markers of physiologic function and sensory perception changed similarly throughout exercise; no differences were observed among subjects in response to beverage treatments for changes in plasma concentrations of lactate, sodium, potassium, for changes in plasma volume, plasma osmolality, rectal temperature, heart rate, oxygen uptake, rating of perceived exertion, or for indices of gastrointestinal distress, perceived thirst, and overall beverage acceptance. Compared to ingestion of a water placebo, consumption of beverages containing 6% to 10% sucrose resulted in similar physiologic and sensory response, while ingestion of the 6% sucrose beverage resulted in significantly improved end-exercise performance following only 60 min of intermittent cycling exercise.     

Correlated changes in feeding behavior on selection for large and small body size in mice

An automated method was used to record the temporal pattern of feeding of lines of mice selected over 15 generations for high and low body weight (L-mice and S-mice, respectively). Both L-mice and S-mice eat in meals concentrated during the night, and meal frequency is similar in the two lines, but L-mice consume much larger meals, each made up of many more separate feeding bouts. The outbred strain from which the selected lines were derived has a similar basic pattern of feeding in meals, which becomes like that of L-mice when the animal's thermogenic metabolic rate is high, and like that of S-mice when it is low, suggesting that the differences between the feeding patterns of the two selected lines are a secondary consequence of alterations in whole body metabolic rate.     

Disruption of diurnal feeding and weight gain cycles in weanling rats by ventromedial and dorsomedial hypothalamic lesions

At the age of 28 days, male Sprague-Dawley rats received bilateral electrolytic lesions in the ventromedial (VMN) and dorsomedial (DMN) hypothalamic nuclei, repectively. Sham-operated rats served as controls. Food intake and body weight gains were measured for 13 days at the beginning of the light period (0800–2000 hr) and prior to the start of the dark period (2000-0800 hr). Both types of hypothalamic lesions caused a disruption of the naturally occurring diurnal feeding and weight gaining cycles. In accordance with previous data, the VMN rats remained normophagic and made normal weight gains while DMN animals were hypophagic and gained weight subnormally; linear growth was reduced in both types of lesioned animals, but only the VMN rats became obese. The data suggest the existence in the medial hypothalamus of an area that is involved in feeding and weight gaining cycles. From the standpoint of overall-caloric intake, this area consists of two types of neuronal assemblies that differ fuctionally as profoundly as they are anatomically separate.     

Effects of intracerebroventricular injections of 2-deoxy-D-glucose,d-glucose and xylose on operant feeding in pigs

The effects, on operant feeding, of injection into the lateral cerebral ventricle of 50 μmoles CaCl₂, 4 mmoles D-glucose, 2-deoxy-D-glucose (2DG) or xylose, or NaCl, have been studied in five pigs. All the sugars and CaCl₂ were given in 1 ml of normal saline. Each of the sugar solutions produced transient drinking. Only CaCl₂ and 2DG significantly increased food intake during the hour following injection. The results show that the mechanism by which the pig responds to intracerebroventricular 2DG is similar to that of the rat and different from that of the sheep.     

Sleep during Ramadan intermittent fasting

During the month of Ramadan intermittent fasting, Muslims eat exclusively between sunset and sunrise, which may affect nocturnal sleep. The effects of Ramadan on sleep and rectal temperature (Tre) were examined in eight healthy young male subjects who reported at the laboratory on four occasions: (i) baseline 15 days before Ramadan (BL); (ii) on the eleventh day of Ramadan (beginning of Ramadan, BR); (iii) on the twenty-fifth day of Ramadan (end of Ramadan, ER); and (iv) 2 weeks after Ramadan (AR). Although each session was preceded by an adaptation night, data from the first night were discarded. Polysomnography was taken on ambulatory 8-channel Oxford Medilog MR-9000 II recorders. Standard electroencephalogram (EEG), electro-oculogram (EOG) and electromyogram (EMG) recordings were scored visually with the PhiTools ERA. The main finding of the study was that during Ramadan sleep latency is increased and sleep architecture modified. Sleep period time and total sleep time decreased in BR and ER. The proportion of non-rapid eye movement (NREM) sleep increased during Ramadan and its structure changed, with an increase in stage 2 proportion and a decrease in slow wave sleep (SWS) duration. Rapid eye movement (REM) sleep duration and proportion decreased during Ramadan. These changes in sleep parameters were associated with a delay in the occurrence of the acrophase of Tre and an increase in nocturnal Tre during Ramadan. However, the 24-h mean value (mesor) of Tre did not vary. The nocturnal elevation of Tre was related to a 2-3-h delay in the acrophase of the circadian rhythm. The amplitude of the circadian rhythm of Tre was decreased during Ramadan. The effects of Ramadan fasting on nocturnal sleep, with an increase in sleep latency and a decrease in SWS and REM sleep, and changes in Tre, were attributed to the inversion of drinking and meal schedule, rather than to an altered energy intake which was preserved in this study.     

A case of de novo interstitial deletion of chromosome 9(p12p13)

The present paper describes a girl with a small de novo deletion of chromosome 9(p12p13). This deletion has not been published previously. The deleted fragment is clearly outside the region involved in the so-called deletion 9p syndrome. The patient had mild dysmorphic features and feeding problems during the first weeks of life, but is now developing well. Because of the lack of severe clinical features in this patient, we speculate that the deletion may be prevalent in other patients who have no clinical indication for chromosome investigation.