Nutrition
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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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We respectively compared the nutritional and clinical efficacies of eucaloric and hypocaloric enteral feedings in 40 critically ill, obese patients admitted to the trauma or surgical intensive care unit. ⋯ These data suggest that hypocaloric enteral nutrition support is as least as effective as eucaloric feeding in critically ill, obese patients.
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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.