ISSN:0148-6071    

DOI:10.1177/0148607196020005315

出版商:SAGE Publications    

年代:1996

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/0148607196020005316

出版商:SAGE Publications    

年代:1996

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/0148607196020005319

出版商:SAGE Publications    

年代:1996

数据来源: WILEY

摘要:

Background:Few studies have made direct comparisons of the metabolic effects of growth hormone (GH) and insulin‐like growth factor 1 (IGF‐1). We have assessed the dose‐dependent effects of GH and IGF‐1 treatments on nitrogen metabolism, intestinal structure, and hepatic IGF‐1‐messenger RNA (mRNA) expression in postoperative parenterally fed rats.Methods:Rats were maintained on total parenteral nutrition (TPN) for 3 days after gastrectomy. GH (0.4 or 0.8 IU/kg/d) or IGF‐1 (1, 2, or 4 mg/kg/d) was infused throughout the experimental period. Anabolic effects of GH and IGF‐1 were assessed by body weight change, nitrogen excretion, and whole‐body protein turnover. Organ weights, intestinal structure, plasma IGF‐1 levels and hepatic IGF‐1‐mRNA contents were also determined.Results:Both GH and IGF‐1 attenuated body weight loss and nitrogen excretion and increased whole‐body protein synthesis and spleen weight. These observations suggest that the anabolic effects of 1 mg/kg/d of IGF‐1 were equivalent to those of 0.66 IU/kg/d of GH. IGF‐1, but not GH, reduced atrophy of the intestinal mucosa. GH treatment increased hepatic IGF‐1‐mRNA and the plasma IGF‐1 level, whereas IGF‐1 treatment increased the plasma IGF‐1 level with no change in the hepatic IGF‐1‐mRNA content.Conclusions:Administration of GH or IGF‐1 attenuates catabolism after surgery. The anabolic effects of 1 mg/kg/d of IGF‐1 are equivalent to those of 0.66 IU/kg/d of GH. IGF‐1 reduces intestinal mucosal atrophy. GH increases hepatic IGF‐1‐mRNA and the plasma IGF‐1 level.(Journal of Parenteral and Enteral Nutrition20:325–331, 1996)

ISSN:0148-6071    

DOI:10.1177/0148607196020005325

出版商:SAGE Publications    

年代:1996

数据来源: WILEY

摘要:

Background:Study of involuntary skeletal muscle function (MFA) has been well accepted in the area of nutrition assessment and potentially offers a means for following progress of the critically ill patient. We report on the application of this technique to intensive care patients.Methods:MFA was performed by study of the contraction/relaxation characteristics of the adductor pollicis muscle of the thumb after ulnar nerve stimulation. Serial measurements were made in 16 critically injured patients and 28 patients with severe sepsis and were compared with those obtained from 26 control subjects. Extent of loss of total body protein (TBP) was quantified within vivoneutron activation.Results:Significant difficulties exist in applying this technique to intensive care patients. In the critically injured, only five acceptable traces could be obtained from a possible 58 measurements. For patients with severe sepsis it was possible to obtain an acceptable trace on 12 of 56 occasions. Neuromuscular blockade and lack of patient cooperation were significant impediments to MFA study. Although frequently perceived as unpleasant by these patients, there was no long‐term morbidity associated with MFA. No significant differences were seen in maximal relaxation rate at 30 Hz (MMR30) or force frequency ratios (F10/50 and F30/ 50) between trauma patients and controls. In the sepsis patient group, a significantly higher F10/50 was measured (52% ± 3% severe sepsisvs40% ± 1% control subjects,p<.01). Six patients had MFA measured approximately 21 days after the illness, by which stage they had lost 11% of their initial TBP Compared with control subjects, no significant differences were observed in MRR30 or F30/50, whereas a higher value for F10/50 was measured (48% ± 1% critical illnessvs40% ± 1% control subjects,p<.01).Conclusions:The MFA technique is difficult to apply to intensive care patients. No significant disturbance to MFA is seen after critical injury. Severe sepsis results in an elevation of F10/ 50 only. When able to be obtained, MFA results do not reflect the extent of proteolysis but are indicative of the state of cellular energetics.(Journal of Parenteral and Enteral Nutrition20:332–337, 1996)

ISSN:0148-6071    

DOI:10.1177/0148607196020005332

出版商:SAGE Publications    

年代:1996

数据来源: WILEY

摘要:

Background:Short‐chain fatty acids (SCFAs) reportedly have a trophic effect on the small intestine. However, it is unclear if this is a local or primarily systemic effect. Loss of the ileocolonic junction (ICJ) may result in increased SCFAs and bacteria in the small intestine from colonic reflux. Our aim was to evaluate the effect of bypass of the ICJ on intestinal SCFA content and postresection adaptation.Methods:Thirty dogs were studied : transection control (TC, n = 10), distal resection of 50% in testine (DR, n = 10), and distal resection with bypass of ICJ (DRBP, n = 10). Animals were killed at 4 and 12 weeks. Luminal SCFAs and bacteria and adaptation of the small intestine were evaluated.Results:Caloric intake was significantly less in the two resected groups (67 ± 3 DR and 63 ± 3, DRBPvs78 ± 5 kcal/kgl d TC,p<.05). Body weight and albumin levels were decreased at 12 weeks but were similar between the resected groups (81% ± 3% and 74% ± 6% initial and 1.9 ± 0.1 and 2.1 ± 0.2 g/dL, DR and DRBP, respectively). Steatorrhea was present for 12 weeks after resection and was greater after DRBP (14.2% ± 3.8% vs 8.6% ± 1.9% at 4 weeks and 13.6% ± 2.5% vs 6.7% ± 0.6% at 12 weeks,p<.05). Bypassed animals had elevated intraluminal SCFA content (3126 ± 1094 vs 1791 ± 538 DR and 1600 ± 446 μg/mL TC,p<.05) and anaerobic bacterial counts (100%vs50% and 44%, respectively). Tissue inflammation and myeloperoxidase activity were similar. Small intestinal length (174 ± 10 and 180 ± 10 cm) and circumference (5.2 ± 0.4 and 5.2 ± 0.3 cm) increased to a similar extent in both resected groups at 12 weeks. Thickness of mucosa (1939 ± 162 vs 1662 ± 162 μm) and muscle (865 ± 45 vs 978 ± 79 [μm) layers were similar after DR and DRBP.Conclusion:(1) Bypass of the ICJ after distal resection results in increased growth of anaerobic bacteria and luminal SCFA and is associated with more marked steatorrhea. (2) Bypass of the ICJ does not influence structural adaptation of the small intestine. (3) These findings do not support a local trophic effect for SCFA.(Journal of Parenteral and Enteral Nutrition20:338–343, 1996)

ISSN:0148-6071    

DOI:10.1177/0148607196020005338

出版商:SAGE Publications    

年代:1996

数据来源: WILEY

摘要:

Background:Upregulation of major histocompatibility complex (MHC) class II antigen in response to the T‐cell lymphokine interferon‐gamma (IFN‐γ) is central to T cell‐macrophage cooperation and immune homeostasis. We evaluated this property in malnourished surgical patients and assessed the impact of nutrition repletion with total parenteral nutrition (TPN). Methods: Sixty‐two patients were studied: 37 malnourished and 25 controls. Whole blood was cultured with or without IFN‐γ (100 U mL−1), dual‐labeled with anti‐CD 14 (monocyte) and anti‐human leukocyte antigen‐DR antibodies and analyzed by flow cytometry. Phagocytosis was measured by flow cytometry. In a second study, 10 severely malnourished patients received 5 days of TPN and MHC class II expression was measured at the end of this period.Results:The magnitude of the increase in monocyte MHC class II expression in response to IFN‐γ was significantly increased in the control group compared with the malnourished group (107%vs53%;p<.05). This impairment directly correlated with severity of malnutrition, but did not correlate with age or disease type. The number of bacteria phagocytozed per cell was significantly decreased(p<.05) in the malnourished group. In study 2, there was a significant increase in MHC class II induction with IFN‐γ after short‐term TPN (58% before vs 173% after;p<.001).Conclusions:MHC class II induction in response to IFN‐γ is significantly impaired in malnourished patients, correlating with the severity of malnutrition. This defect is reversed by short‐term TPN. These data identify the reversible loss of a key mechanism, fundamental to host defense, that may enhance the risk of infection in malnourished patients.(Journal of Parenteral and Enteral Nutrition20:344–348, 1996)

ISSN:0148-6071    

DOI:10.1177/0148607196020005344

出版商:SAGE Publications    

年代:1996

数据来源: WILEY

摘要:

Background:The effect of an oral bile salt binder, cholestyramine, on parenteral nutrition‐related hepatic dysfunction and lidocaine metabolism was studied in rats.Methods:Rats were randomly assigned to one of three treatment groups: the PN group received infusions of dextrose and amino acids; the PNC group was treated the same as the PN group, but also received oral cholestyramine; CF group animals were fed rat food and water. Lidocaine metabolism was studied in livers isolated from animals after 7 days of parenteral nutrition.Results:No differences in liver function test values of PN and PNC groups were detected compared with group fed rat food. However, lidocaine metabolism was found to be significantly reduced in both the PN and PNC groups. Significant reductions were observed in the hepatic extraction ratio (23% and 15%) and in intrinsic clearance (61% and 53%) in PN and PNC animals, respectively(p<.05). Material balance at steady state showed that recovery of lidocaine was threefold higher in the PN group and twofold higher in the PNC group than the rat food group (p<.05). Metabolite‐to‐drug ratios were determined for each lidocaine metabolite and this revealed significant reductions inN‐dealkylation (64% and 57%) and aryl methyl hydroxylation (92% and 86%) in PN and PNC animals, respectively(p<.05).Conclusions:Histologic fmdings suggest that cholestyramine feeding prevented liver dysfunction, possibly through interruption of secondary bile salt reabsorption. However, lidocaine metabolism was still impaired after cholestyramine ingestion; the impairment mechanism remains unknown.(Journal of Parenteral and Enteral Nutrition20:349–356, 1996)

ISSN:0148-6071    

DOI:10.1177/0148607196020005349

出版商:SAGE Publications    

年代:1996

数据来源: WILEY

摘要:

Background:Intestinal adaptation is a complex physiological process that is not completely understood. Systemic administration of short‐chain fatty acids (SCFAs) has been shown to facilitate adaptation to small bowel resection; however the mechanisms underlying this phenomena are unknown.Methods:Forty‐six male Sprague‐Dawley rats underwent an 80% jejunoileal resection and jugular catheterization. After surgery, rats were randomly assigned to receive standard total parenteral nutrition (TPN) or an isoenergetic, isonitrogenous TPN supplemented with SCFAs. On day 3 or 7 after surgery, ileal samples were removed for determination of mucosal wet weight, DNA, RNA, and protein concentrations. Total cellular RNA was extracted for use in Northern blot analysis to quantify proglucagon and ornithine decarboxylase messenger RNAs (mRNAs). Results: Total, mucosal, and submucosal weights were increased(p<.05) in the SCFA group both 3 and 7 days after surgery. Ileal DNA and RNA concentrations were increased(p<.05) in the SCFA group at both time points; however ileal protein concentration did not differ between groups until 7 days after resection. Levels of proglucagon and ornithine decarboxylase messenger RNAs were higher(p<.05) in the SCFA group at both time points. Conclusion: The upregulation of proglucagon and ornithine decarboxylase gene expression may be the mechanism by which SCFAs facilitate intestinal adaptation.(Journal of Parenteral and Enteral Nutrition20:357–362, 1996)

ISSN:0148-6071    

DOI:10.1177/0148607196020005357

出版商:SAGE Publications    

年代:1996

数据来源: WILEY

摘要:

Background:Our group wanted to test the hypothesis that plasma levels of insulin‐like growth factor 1 (IGF‐1), transferrin, and prealbumin are useful markers of nutritional progress in severe sepsis and multiple injury.Methods:Measurements of IGF‐1 and plasma proteins were made in critically ill patients as soon as they were hemodynamically stable and 5, 10, 15, and 21 days later. The magnitude and direction of the measured changes were compared with the magnitude and direction of the change in total body protein in the same time period.Results:Fourteen patients with severe sepsis and 10 multiply injured patients were studied. As a group they had an increased metabolic expenditure that peaked at 153% of normal and lost ~12.0% of total body protein. An early fall in IGF‐1 and plasma proteins accompanied a marked acute phase response, and recovery occurred while hypermetabolism and net proteolysis continued. No correlation existed between changes in IGF‐1 or plasma proteins and the change in total body protein. Conclusions: Plasma levels of IGF‐1, transferrin, and prealbumin are not useful for following changes in protein stores early in the course of critical illness.(Journal of Parenteral and Enteral Nutrition20:363–370, 1996)

ISSN:0148-6071    

DOI:10.1177/0148607196020005363

出版商:SAGE Publications    

年代:1996

数据来源: WILEY