Parenteral nutrition support for burn injury in China began to develop in 1970s along with improvement in burn foundational research of burn injury and the marketing of parenteral nutrition solutions manufactured by Chinese amino acids pharmaceutical industry. Up to 1980s many kinds of parenteral nutrition products were used in clinical therapy, and they were proved to be effective and safe. Meanwhile the guide for parenteral nutrition support of China was drafted to ensure standardized administration. Some problems should be called for attention in present practice of parenteral nutrition support. First, immuno nutrients have been proved to possess synergistic effect on parenteral/enteral nutrition support. But for those critical patients in sepsis/MODS period, more attention should be paid to the use of immuno nutrients in time of administration and optimal dosage because of the complicate physiopathologic reactions. Secondly, the use of growth hormone has been proved to be effective for promoting healing in patients with burn in many cases. However, the indications of growth hormone should be strictly observed and the regime of a low dose and short course should be adopted 7 days after burn for ensuring safety. Thirdly, we should pay attention to the best path of giving nutrition, whether enteral or parenteral. Parenteral nutrition support should be adopted for critical burn patients in early period with intestinal dysfunction, and enteral nutrition support should be used when intestinal functions recover partially. For patients with burn hypermetabolism, the application of enteral and parenteral nutrition support is complimentary, and it is aptly called total nutrition.
Burns ; therapy ; Humans ; Parenteral Nutrition ; methods

OBJECTIVE: To investigate the serum vitamin D level and its determinant factors in stroke patients. METHODS: Fifty-one stroke patients who had documented serum level of 25-hydroxyvitamin D(25(OH)D) were included. Patients were divided into subacute (n=23) and chronic groups (n=28). The mean levels of 25(OH)D of the two groups were compared. Correlations between each 25(OH)D level and post-stroke duration were also analyzed. To assess other possible influencing factors, patients were subdivided by ambulation ability and feeding methods for comparison of 25(OH)D level. RESULTS: The mean level of 25(OH)D was significantly lower in the chronic group than in the subacute group (12.3 vs. 16.3 ng/mL; p < 0.05). The serum 25(OH)D level decreased according to the duration after stroke (r=−0.52, p=0.01). Patients with a history of total parenteral nutrition had lower 25(OH)D levels than subjects who had enteral nutrition in the subacute group (7.3 vs. 18.8 ng/mL; p < 0.01). However, the levels of 25(OH)D were not different between the oral feeding and tube feeding groups. Among the chronic group subjects, patients who could walk without assistance had higher 25(OH)D levels than non-ambulatory patients (ambulatory vs. non-ambulatory group; 18.3 vs. 11.3 ng/mL; p < 0.05). CONCLUSION: After stroke onset, serum vitamin D level decreases with time regardless of feeding methods, and total parenteral nutrition may aggravate its deficiency. In terms of long-term care, non-ambulatory patients might be at a higher risk of vitamin D deficiency. Supplementation of vitamin D should be considered especially for stroke patients who are non-ambulatory and on total parenteral nutrition.
Enteral Nutrition ; Feeding Methods ; Humans ; Long-Term Care ; Parenteral Nutrition, Total ; Stroke* ; Vitamin D Deficiency ; Vitamin D* ; Vitamins* ; Walking

OBJECTIVE: To investigate the serum vitamin D level and its determinant factors in stroke patients. METHODS: Fifty-one stroke patients who had documented serum level of 25-hydroxyvitamin D(25(OH)D) were included. Patients were divided into subacute (n=23) and chronic groups (n=28). The mean levels of 25(OH)D of the two groups were compared. Correlations between each 25(OH)D level and post-stroke duration were also analyzed. To assess other possible influencing factors, patients were subdivided by ambulation ability and feeding methods for comparison of 25(OH)D level. RESULTS: The mean level of 25(OH)D was significantly lower in the chronic group than in the subacute group (12.3 vs. 16.3 ng/mL; p < 0.05). The serum 25(OH)D level decreased according to the duration after stroke (r=−0.52, p=0.01). Patients with a history of total parenteral nutrition had lower 25(OH)D levels than subjects who had enteral nutrition in the subacute group (7.3 vs. 18.8 ng/mL; p < 0.01). However, the levels of 25(OH)D were not different between the oral feeding and tube feeding groups. Among the chronic group subjects, patients who could walk without assistance had higher 25(OH)D levels than non-ambulatory patients (ambulatory vs. non-ambulatory group; 18.3 vs. 11.3 ng/mL; p < 0.05). CONCLUSION: After stroke onset, serum vitamin D level decreases with time regardless of feeding methods, and total parenteral nutrition may aggravate its deficiency. In terms of long-term care, non-ambulatory patients might be at a higher risk of vitamin D deficiency. Supplementation of vitamin D should be considered especially for stroke patients who are non-ambulatory and on total parenteral nutrition.
Enteral Nutrition ; Feeding Methods ; Humans ; Long-Term Care ; Parenteral Nutrition, Total ; Stroke* ; Vitamin D Deficiency ; Vitamin D* ; Vitamins* ; Walking

Animals ; Animals, Newborn ; Bifidobacterium ; growth & development ; metabolism ; Gastrointestinal Tract ; microbiology ; Liver Function Tests ; Parenteral Nutrition ; methods ; Rabbits

BACKGROUNDHyperglycemia is associated with poor clinical outcomes and mortality in several patients. However, studies evaluating hyperglycemia variation in tumor patients receiving total parenteral nutrition (TPN) are scarce. The aim of this study was to assess the relationship between glycemia and tumor kinds with TPN by monitoring glycemic variation in tumor patients.

METHODSThis retrospective clinical trial selected 312 patients with various cancer types, whose unique nutrition treatment was TPN during the monitoring period. All patients had blood glucose (BG) values assessed at least six times daily during the TPN infusion. The glycemic variation before and after TPN was set as the indicator to evaluate the factors influencing BG.

RESULTSThe clinical trial lasted 7.5 ± 3.0 days adjusted for age, gender, family cancer history and blood types. There were six cancer types: Hepatic carcinoma (HC, 21.8%), rectal carcinoma (17.3%), colon carcinoma (CC, 14.7%), gastric carcinoma (29.8%), pancreatic carcinoma (11.5%), and duodenal carcinoma (DC, 4.8%). The patients were divided into diabetes and nondiabetes groups. No statistical differences in TPN glucose content between diabetes and nondiabetes groups were found; however, the tumor types affected by BG values were obvious. With increasing BG values, DC, HC and CC were more represented than other tumor types in this sequence in diabetic individuals, as well as in the nondiabetic group. BG was inclined to be more easily influenced in the nondiabetes group. Other factors did not impact BG values, including gender, body mass index, and TPN infusion duration time.

CONCLUSIONSWhen tumor patients are treated with TPN, BG levels should be monitored according to different types of tumors, besides differentiating diabetes or nondiabetes patients. Special BG control is needed for DC, HC and CC in both diabetic and nondiabetic patients. If BG overtly increases, positive measurements are needed to control BG values. The ClinicalTrials.gov ID is NCT02024321.

Aged ; Blood Glucose ; analysis ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Neoplasms ; blood ; Parenteral Nutrition, Total ; methods

OBJECTIVETo explore the effect of perioperative nutrition support on nutritional condition and complications of the patients with postoperative pancreatic head cancer.

METHODSThirty four patients received perioperative nutrition support, including enteral nutrition and parenteral nutrition (treatment group). Forty eight patients received routine postoperative parenteral nutrition (control group). According to the operative method, these two groups were further divided into two sub-groups: (1) pancreaticoduodenectomy (PD) subgroup, including 13 cases from treatment group, and 24 cases from control group; (2) palliative operation subgroup, including 21 cases from treatment group, and 24 cases from control group. Body weight, total protein (TP), serum albumin (ALB), and the complications after operation were compared.

RESULTSThe concentrations of ALB and TP in the treatment group were significantly higher than those in the control group (P< 0.05). Body weight and TP of the patients received PD in the treatment group were significantly better than those of the control group (P < 0.05).

CONCLUSIONPerioperative nutrition support can improve postoperative nutritional condition and reduce the postoperative complications in patients with pancreatic head cancer.

Adult ; Aged ; Combined Modality Therapy ; Enteral Nutrition ; Female ; Humans ; Male ; Middle Aged ; Nutritional Support ; methods ; Pancreatic Neoplasms ; surgery ; therapy ; Pancreaticoduodenectomy ; Parenteral Nutrition ; Postoperative Complications ; prevention & control

PURPOSE: This study evaluated the nutritional status and effect of nutritional support team (NST) management in critically ill patients.METHOD: From January 2015 to August 2017, the study retrospectively investigated 128 patients aged above 19 years admitted to a medical intensive care unit (MICU). The patients were divided into two groups: NST (n=65) and non-NST (n=63) groups. Nutritional status, classification of bedsore risks, incidence rate of bedsore and clinical outcomes were compared.RESULTS: The study found a higher rate of the use of enteral nutrition in the NST group (χ²=45.60, p < .001). The prescription rate of parenteral nutrition (PN) was found to be lower in the NST group (4.6%) compared to the non-NST group (60.3%). There was a higher PN of total delivered/required caloric ratio in the NST, compared to the non-NST, group (χ²=3.33, p=.025). There were significant differences for higher albumin levels (t=2.50, p=.014), higher total protein levels (t=2.94, p =.004), and higher proportion of discharge with survival rates (χ²=18.26, p < .001) in the NST group.CONCLUSION: Providing NST management to critically ill patients showed an increase in the nutrition support. Further, to achieve effective clinical outcomes, measures such as nutrition education and continuous monitoring and management for the provision of nutritional support by the systemic administration of a nutritional support team should be considered.
Classification ; Critical Care ; Critical Illness ; Education ; Enteral Nutrition ; Humans ; Incidence ; Intensive Care Units ; Methods ; Nutritional Status ; Nutritional Support ; Parenteral Nutrition ; Prescriptions ; Pressure Ulcer ; Retrospective Studies ; Survival Rate

OBJECTIVETo summarize experience of pediatric intensive care and explore the incidence of complications, the involved pathogens among liver recipients to determine the effective strategies for preventing complications.

METHODSBetween June 2006 and July 2009, 35 children under the age of 14 yr received 35 liver transplantations (LTs) performed at the center. A retrospective review of 22 infants weighing 8.8 kg or less underwent 23 transplants was conducted. Indication for transplantation was biliary atresia. Central venous pressure and arterial blood pressure were monitored continuously and fluid monitoring was performed every 2 hours in the first postoperative week. Blood loss, ascites, and intraoperative transudate loss were primarily replaced with 5% albumin and crystalloids to maintain a central venous pressure between 4 and 6 cm H(2)O. Oral food intake was allowed as soon as possible. To identify vascular or biliary complications, liver doppler ultrasound was performed intraoperatively immediately after reperfusion and after closure of the abdominal wall and postoperatively, twice daily during the first week after surgery. Immunosuppression was initially cyclosporine based, in combination with steroids. Cyclosporine was begun one day prior to transplantation at a dose of 10 mg/(kg·d) divided into two doses, except for cases with hepatic encephalopathy and severe infection. The subsequent doses were adjusted on the basis of recommended trough blood concentrations at different stages. Steroids were eventually discontinued at a time point exceeding 6 months after transplantation. The diagnosis of rejection was confirmed by histology on needle biopsy specimens. Acute graft rejection episodes were treated with a 3-day scheme of IV methylprednisolone 10 mg/(kg·d) followed by recycling doses during the following 3 days (7.5, 5 and 2.5 mg/(kg·d).

RESULTSThe most common postoperative complications were infections (18 cases), gastrointestinal bleeding (3 cases), and vascular complications (4 cases). Rejection occurred in 25% of patients. There was one perioperative death from primary graft non-function. The most common isolated bacteria of the pathogen spectrum were Staphylococcus epidermidis. The median length of stay (LOS) in the PICU for 22 patients (23 transplants) was 10 days (range 5 - 21) and the mean length of stay in the hospital was (18.5 ± 116) days (range, 11 - 48 days). Mean requirement for artificial ventilation was 37.6 h. Mean use of dobutamine, prostaglandin E1 and dopamine was 3.3, 7.5 and 8.8 days, respectively. Preoperatively, 3 children had gastrointestinal bleeding, 18 had ascites, 2 had encephalopathy, 22 had jaundice, and 16 had coagulopathy. There were multiple early operative complications in these infants, including one graft with primary non-function (4.5%). Two patients (9.1%) returned for a total of three times for gastrointestinal bleeding or intra-abdominal hematoma. Three patients (13.6%) had early postoperative intestinal perforations related to adhesions or enterotomy, one was associated with a bowel obstruction. There were 26 episodes of bacterial or fungal infections in 18 (81.8%) patients in the early postoperative period, and infection was the direct/contributing cause of death in one infant. These infections included pneumonia, intra-abdominal abscess or sepsis. All of the bacterial and fungal infections were successfully treated with the appropriate antibacterial and antifungal agents, except for one patient who developed overwhelming sepsis after small bowel perforation. Four (18.2%) patients developed five episodes of acute allograft rejection during the first 15 days after LT. Three of the four patients who developed rejection were transplanted before 2007. All episodes of rejection were treated successfully with intravenous steroid pulse and optimization of cyclosporine levels or FK506 conversion. Of the 20 survivors beyond the perioperative period, two cases (10%) had hypertension requiring therapy.

CONCLUSIONSLiver transplantation in infants with biliary atresia appears technically demanding but acceptable. There should be essentially no age or size restriction for infants and transplantation can be performed with good outcome, although the frequency of complications is much higher than that seen in older children. The improvement in medical and nursing expertise in this group of very sick infants is based on judicious preoperative donor and recipient selection, meticulous surgical technique (vascular reconstruction and abdominal closure), immediate detection and prompt intervention of complications, and keen postoperative surveillance, which reflect a learning curve for both the technical aspects of liver transplantation and post-operative care of these very small patients in our institution. Liver transplantation for infants can be technically challenging.

Biliary Atresia ; surgery ; therapy ; Child, Preschool ; Critical Care ; methods ; Humans ; Infant ; Liver Transplantation ; Living Donors ; Parenteral Nutrition ; Postoperative Care ; methods ; Retrospective Studies ; Treatment Outcome

Anthropometry ; Child ; Child Nutritional Physiological Phenomena ; Child, Hospitalized ; Critical Care ; methods ; Critical Illness ; Enteral Nutrition ; Humans ; Infant ; Intensive Care Units, Pediatric ; Malnutrition ; diagnosis ; prevention & control ; Nutrition Assessment ; Nutritional Status ; Parenteral Nutrition ; Predictive Value of Tests

BACKGROUND: Recently Malassezia (M.) furfur fungemia has been increasingly recognized in premature infants and adults receiving parenteral nutrition. Accordingly, analysis of nucleic acids in M. furfur serovars and strain typing methods based on genetic differences and similarities are required for epidemiological studies. OBJECTIVE: This study was done to analyze nucleic acids in M. furfur serovars A, B and C and to adapt the method of restriction fragment length polymorphism (RFLP) analysis of DNA to differentiate the strains of M. furfur serovars for use in epidemiological studies. METHODS: Cellular nucleic acids were extracted from the strains of M. furfur serovars and electrophoresed, followed by digestion of DNA and electrophoresis of the resultant DNA fragmegments. RESULTS: Each of the six strains, grown both on solid medium and liquid medium, revealed a genomic DNA. Interestingly, unique extra bands of RNA were observed in four of the six strains which had grown on solid medium. These bands were also seen in three of them grown in broth. The size of these bands were from 0.5 to 5.0 kbp by comparison with a ‘1 kb DNA ladder’. The restriction patterns generated by EcoR I, Hae III, Hind III, and Hinf I were not unsuccessful. The DNA from serovar B was insensitive to the above restriction enzymes. CONCLUSIONS: Although DNA was extracted from the strains, the amounts were not thought to be enough for RFLP analysis and the DNA from the serovar B was insensitive to the above restriction enzymes. Thus, further development of an extraction method of DNA is required for obtaining enough DNA from M. furfur serovars, and other restriction enzymes would have to be investigated for their ability to differentiate strains of M. furfur in epidemiological studies. Also, further investigation of RNA bands might be able to adapt them for a typing method.
Adult ; Digestion ; DNA ; Electrophoresis ; Epidemiologic Studies ; Fungemia ; Humans ; Infant, Newborn ; Infant, Premature ; Malassezia* ; Methods ; Nucleic Acids* ; Parenteral Nutrition ; Polymorphism, Restriction Fragment Length ; RNA ; Serogroup*