Nutrition
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We previously reported that omega-6 fat emulsion increases cytokine production in burned rats. Effects of soybean oil emulsion on surgical stress responses and lymphocyte function according to the surgical severity have not been studied in detail. We investigated the effects of soybean oil emulsion, which contains 50% omega-6 fatty acid, on postoperative stress responses and cell-mediated immune function according to the severity of surgical stress. ⋯ Soybean oil emulsion amplifies the stress responses and possibly suppresses cell-mediated immune function induced by surgical stress in severely stressed patients, but not in moderately stressed patients.
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The most basic mechanism of cellular protection involves the expression of a highly conserved family of essential proteins, known as heat shock or stress proteins (HSPs). The expression of these proteins after a sublethal insult can induce "stress tolerance" and protect against a subsequent stress that otherwise would be lethal. Experimental data have shown that preinduction of the heat stress response can provide marked protection against many forms of cellular injury, including ischemia and reperfusion, lung injury, and shock. ⋯ Further, recent data from me and my colleagues indicate that a single dose of intravenous GLN can enhance HSP expression, decrease end-organ injury, and enhance survival from septic shock in the intact rat. Thus GLN, which is beneficial in many settings of critical illness and injury, may be a clinically applicable enhancer of HSP expression. These results indicate that GLN could be used to enhance HSP expression and attenuate end-organ injury in situations when a major clinical stress is anticipated, such as before major surgical procedures (e.g., cardiac, vascular, and transplantation) or in the critically ill.
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Randomized Controlled Trial Clinical Trial
Early nasojejunal feeding in acute pancreatitis is associated with a lower complication rate.
We investigated the effect of early jejunal feeding on septic complications and mortality rate in patients with acute pancreatitis in a two-phase, prospective, controlled study. ⋯ We believe that the combination of early enteral nutrition and selective, adequate antibiotic prophylaxis may prevent multiple organ failure in patients with acute pancreatitis.
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Randomized Controlled Trial Clinical Trial
Glutamine supplementation and GH/IGF-I treatment in critically ill patients: effects on glutamine metabolism and protein balance.
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Renal transplantation is associated with an increased risk of atherosclerotic cardiovascular disease and marked racial and ethnic disparities in graft and patient survival. We characterized differences in racial and ethnic susceptibility to weight gain, diabetes, and alterations in circulating lipid levels and isolated independent predictors of those changes in a diverse population of kidney transplant recipients. ⋯ Multiple regression analysis confirmed the predominant independent effect of African American race or ethnicity on weight gain; however, hypercholesterolemia was independent of race or ethnicity and predicted by cyclosporine treatment and post-transplant diabetes. Therefore, kidney transplantation represents a state of accelerated atherogenic risk induced in part by the metabolic effects of immunosuppressive medications and compounded by marked racial and ethnic disparities in weight gain and diabetes risk.