摘要:

This study evaluated the effect of 5 days of starvation followed by 5 days of refeeding on immunoreactive plasma and serum fibronectin and associated opsonic activity as studied by peritoneal macrophage monolayer bioassay in 12 healthy women volunteers. The temporal alteration of fibronectin was compared with the serum albumin, total iron‐binding capacity, and retinol‐binding protein levels. Fibronectin concentration and opsonic activity were also determined in two cachectic patients who were 61 and 78% of their ideal body weight. Prior to starvation, plasma fibronectin was 292 ± 20 μg/ml and serum fibronectin was 182 ± 16 in all subjects. After 5 days of starvation, immunoreactive fibronectin decreased (p<0.05) by 20–25%. This decrease was not great enough to impair opsonic activity as tested by the in vitro macrophage assay. Starvation caused no decrease in serum albumin or total iron‐binding capacity, although retinol‐binding protein decreased by 35%. During refeeding, subjects were randomized to a diet with (n = 6) and without (n = 6) carbohydrate. After 5 days of refeeding, fibronectin levels were normalized on the carbohydrate‐containing diet, but were still low (82% of normal) on the carbohydrate‐free diet. Retinol‐binding protein did not fully normalize after 5 days of refeeding. In the two cachectic patients, fibronectin levels prior to total parenteral nutrition were 25 and 75% of normal. Thus, starvation can lower fibronectin levels and this protein is rapidly restored with adequate nutrition. (Journal of Parenteral and Enteral Nutrition8:237–244, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008003237

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/014860718400800302

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

We used decision analysis to compare three strategies for reducing the incidence of nutrition‐associated complications in patients undergoing gastrointestinal surgery: treat all patients with nutritional support, treat no patients, or perform a test which categorizes patients as high or low risk (treating only the high risk patients). We use the model to make management recommendations based on current knowledge and to set priorities for future research. The “test strategy” is optimal in the majority of cases which we believe are clinically encountered when the test involves subjective global assessment of nutritional status on admission (sensitivity 0.82, specificity 0.72) and nutritional support must be delivered by a central venous catheter. However, the result is particularly sensitive to the predictive properties associated with the test and is less sensitive to the effectiveness rate of nutritional support in reducing the incidence of postoperative complications. We conclude that in future research priority should be given to studying and improving the predictive properties of nutritional assessment techniques. (Journal of Parenteral and Enteral Nutrition8:245–253, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008003245

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

Manganese (Mn) was analyzed by flameless atomic absorption spectrophotometry in a variety of commercially produced solutions and additives commonly used in total parenteral nutrition (TPN). The amount of Mn in preparations tested varied among manufacturers and among lots. It was generally present in very small amounts with amino acid preparations supplying the major portion in the TPN formulas. Among amino acid solutions, Aminosyn 10% had the highest Mn content (5.2–17.0μg/liter) with Veinamine 8%, FreAmine II, 8.5%, Travasol 10%, and Nephramine having less than 6.7 μg/liter. Other large volume parenterals contained appreciably less Mn, eg, Dextrose 50% had 0.64–2.5 μg/liter. Some of the additives were high in Mn, eg, potassium phosphate—280 μg/ liter, magnesium sulfate 50%—up to 225 μg/liter, and Berocca C—245.8 μg/liter but their actual contributions to daily TPN intake was no more than 3.3 μg. The calculated Mn content in TPN formulas with varying source materials ranged from 8.07–21.75 μg per total daily volume. These values agreed with those obtained from analysis of actual TPN solutions. The values for 10% Intralipid and 20% Liposyn were 0.5 and 3.0 μg/liter, respectively. (Journal of Parenteral and Enteral Nutrition8:254–257, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008003254

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

Selenium (Se) status was evaluated in patients with intestinal failure requiring home parenteral nutrition (HPN). Ninety‐two percent of patients (11 of 12) studied just prior to starting HPN had low serum Se values, and the mean value was 42 ng/ml, significantly less than mean values in disease controls with Crohn's disease not on HPN (76 ng/ml) and healthy controls (88 ng/ml). Eighty‐five percent of patients (22 of 26) already on HPN for 2 to 109 months when studied had low serum Se levels (mean 38.4 ng/ml). The mean 24‐hr urinary Se values were 3.7 μg in patients on HPN who did not have Crohn's disease, 10.9 μg in HPN patients with Crohn's, and 17.9 μg in healthy controls. In patients with Crohn's disease on HPN, a significant direct correlation existed between serum Se and the activity of whole blood glutathione peroxidase, a selenoprotein; and a significant inverse correlation was found between serum Se and months of HPN. This study confirms that Se deficiency is very common in patients before starting and during HPN. These data and recent reports of cardiomyopathies associated with Se deficiencies in patients on HPN increase the importance of proper Se replacement and maintenance. (Journal of Parenteral and Enteral Nutrition8:258–262, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008003258

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

Patients on long‐term total parenteral nutrition (TPN) have an increased incidence of gallstones. To determine the pathophysiologic mechanisms responsible for gallstone formation in these patients, we fed three groups of prairie dogs intravenously for 10 days with continuous infusions of isocaloric, isovolemic, and isonitrogenous solutions with either 0, 25, or 50% of nonprotein calories provided as Intralipid. A fourth group of prairie dogs was hyperalimented with the 25% solution for 28 days. Control animals were fed Purina rat Chowad libitum.Each animal's bile salt pool was labeled with iv3H‐cholic acid 16 hr prior to collecting gallbladder and hepatic bile specimens. The ratio of gallbladder to hepatic bile3H‐cholic acid specific activity (dpm/mol of bile acid), an index of gallbladder stasis, was significantly (p<0.05) lower in TPN animals (<0.65 ± 0.19) compared to controls (1.07 ± 0.11).This finding indicates that gallbladder stasis developed in all animals fed by TPN. TPN did not alter gallbladder or hepatic bile lithogenic index. Two of five 28‐day TPN animals developed biliary sludge, and one of these animals formed pigment gallstones. TPN without lipid decreased serum cholesterol concentration. As the lipid concentration of the TPN solution was increased, serum cholesterol increased. These data indicate that TPN induces gallbladder stasis regardless of caloric source but does not increase bile lithogenic index despite a dose‐related rise in serum cholesterol as the percent of calories provided as lipid is increased. We conclude that TPN‐induced gallbladder disease results from gallbladder stasis and not from increased bile cholesterol saturation. (Journal of Parenteral and Enteral Nutrition8:263–268, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008003263

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

Conflicting reports exist regarding the relative tocopherol isomer content of Intralipid ranging from 99% as α‐tocopherol to as much as 90% as γ‐tocopherol. Our direct assay of Intralipid as well as plasma levels measured in premature infants receiving Intralipid confirm the existence of a low α, high γ‐tocopherol content and imply the need for α‐tocopherol supplementation in patients receiving Intralipid, particularly the relatively tocopherol‐deficient premature infant. Furthermore, the observation of abnormal erythrocyte hemolysis test values despite “normal” total tocopherol plasma concentrations may be explained by high plasma levels of non‐α, biologically less active isomers. The quantitation of tocopherol isomers helps explain this discrepancy and suggests the need for future studies of vitamin E status to employ measurements of tocopherol isomers in reporting results. (Journal of Parenteral and Enteral Nutrition8:269–273, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008003269

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

The relationship between serum transferrin (TFN) and serum total iron‐binding capacity (TIBC) in a clinical setting was evaluated in two related studies. The initial study evaluated 101 blood samples representing a cross‐section of hospitalized adults. The samples were double assayed for TIBC using clinical and research methodologies. TFN was assayed by a commercial radial immunodiffusion method. Clinical laboratory TIBC correlated well with research laboratory TIBC (r = 0.87, slope = 0.97, p<0.001, n = 50) and the relationship of TIBC to TFN yielded the following equation: TFN = 0.83 TIBC — 5.6 (r = 0.82, p<0.001, n = 101) where TFN = mg/100 ml and TIBC =μg/100 ml. The second study evaluated a new TIBC assay and its effect on the TIBC/TFN relationship. Additionally, the TFN‐TIBC relationship was evaluated at low normal and abnormal TIBC levels. In this second study, TFN = 1.0 TIBC ‐ 18.8 (r = 0.88, p<0.01, n = 126). Subsample analysis for specimens with TIBC between 105 and 160 showed a TIBC‐TFN regression line that was not significantly different than the entire sample. Inclusion of ancillary patient data such as hemoglobin and hematocrit did not improve the relationship between TFN and TIBC in either study. The relationship was unaffected by age, sex, race, disease, treatment, fever, surgery, degree of nutritional support, blood transfusion, or blood chemistry parameters in either study. Laboratories deriving TFN from measured TIBC as a nutritional status indicator must determine the relationship for the specific procedures being used in their laboratories. (Journal of Parenteral and Enteral Nutrition8:274–278, 1983)

ISSN:0148-6071    

DOI:10.1177/0148607184008003274

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

Delayed hypersensitivity skin testing to five common recall antigens (Varidase, Candida, PPD, Trichophyton, and Mumps) was performed on 50 patients undergoing elective colorectal surgery. Eighteen patients showed an altered response to skin testing (11 relative anergy, seven total anergy) and this group of patients had a significant increase in both total septic complications (p<0.001) and major septic complications (p<0.05) following operation. Anergy in these patients did not correlate with nutritional status, but it did relate to stage of the tumor in patients with cancer. The low specificity of abnormal delayed hypersensitivity skin testing and its failure to be related to malnutrition limits the practical application of this technique in patients undergoing elective colorectal surgery. (Journal of Parenteral and Enteral Nutrition8:279–280, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008003279

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

The optimal levels of arginine (Arg) for growth and immunity were studied in mildly depleted, noninjured rats maintained on intravenous hyperalimentation. Three groups of S‐D rats (eight/group, weighing 275–300 g) underwent catheter insertion, 1 day of fasting, and then 7 days of intravenous hyperalimentation consisting of 20% dextrose, adequate minerals and vitamins, and three amino acid regimens: (1) FreAmine II (1.55 g Arg/liter); (2) FreAmine III (4.05 g Arg/liter); (3) experimental (7.5 g Arg/liter). The increase in arginine levels was achieved by lowering the glycine levels. There were no differences among the groups in terms of body weight gain (6.9 us 8.3 us 10.0 g) or in cumulative N balance (574 us 660us642 mg). Liver, spleen, and adrenal weights did not differ. Thymus weight was greater in groups B and C: (A) 345 ± 27 mg us (B) 445 ± 34 mg, p<0.05, us (C) 438 ± 26 mg, p<0.05) as were the total number of lymphocytes/thymus (×10−9) (A) 0.93 ± 0.12vs(B) 1.37 ± 0.18,p<0.05,vs(C) 1.46 ± 0.15,p<0.05). Mitogen‐induced thymocyte blastogenesis (cpm) was greatest in group C in response to phytohemagglutinin: (A) 9.558 ± 3,799 υs(B) 20,088 ± 5,890, NS,vs(C) 37,234 ± 6,209, p<0.01 us A and p<0.05vsB) and Concanavalin A: (A) 71,035 ± 15,228 us (B) 111,734 ± 15,021, NS, us (C) 172,967 ± 19,861, p<0.01 us A and p<0.05 us B). In the intravenous hyperalimentation‐maintained noninjured rat ARG concentrations more than 1.55 g/liter do not enhance N retention or growth. Larger doses of ARG have strong thymic immunostimulatory effects without any toxicity or growth reduction. (Journal of Parenteral and Enteral Nutrition8:281–284, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008003281

出版商:SAGE Publications    

年代:1984

数据来源: WILEY