Assessment of clinical outcome after sudden alteration of home parenteral nutrition program from customised to commercially premixed admixtures. Experience with short bowel syndrome treatment

BACKGROUND & AIMS

Disruptions in the home parenteral nutrition (HPN) process may lead to failure to achieve the intended treatment purposes. This study aimed to evaluate the mid-term clinical outcome in a group of patients with short bowel syndrome (SBS) after a sudden change in the type of home parenteral nutrition programs from customized to commercially premixed admixtures.

METHODS

The study conducted in 2020 identified 51 patients with SBS: 27 (53%) women and 24 (47%) men. The SBS were classified as SBS with end jejunostomy 23 (45%) patients, with jejuno-colon anastomosis 23 (45%) patients, with jejuno-ileo anastomosis and total colon in continuity 5 (10%) patients. The following therapeutic program-related data were analysed: changes in nutritional status, body mass index (BMI), Controlling Nutritional Status (CONUT) score, and biochemical assessment. For statistical analysis, the Wilcoxon rank-sum and signed-rank paired tests with continuity corrections were used to compare the results. A p-value of <0.001 was considered statistically significant.

RESULTS

There was no statistically significant difference between the analysed groups in total energy, amino acid concentrations, and intravenous volume supplementation. BMI and CONUT assessments of nutritional status and selected biochemical parameters were stable during the study period.

CONCLUSIONS

The study demonstrated that a sudden change in the HPN therapy program from parenteral admixtures, tailored to meet individual patients' needs, to commercially premixed admixtures had no significant impact on the mid-term clinical condition of patients with SBS.

Complications of tunneled peripherally inserted and tunneled-cuffed central catheters in home parenteral nutrition

OBJECTIVES

We sought to compare complications associated with tunneled peripherally inserted central catheters (tPICCs) and tunneled-cuffed centrally inserted central catheters (tCICCs) in adult home parenteral nutrition (HPN).

METHODS

The study (2017-2019) identified 257 people with type III chronic intestinal failure requiring HPN. The data were analyzed for tPICC- and tCICC-related complications. The rate of catheter-related complications was recorded as the number of complications analyzed per 1000 d of catheter use, and rates were compared using the Mann-Whitney Wilcoxon test.

RESULTS

A total of 273 venous access devices were included to the analyses: 150 (55%) non-cuffed tPICCs and 123 (45%) tCICCs. In-dwelling time for tPICCs and tCICCs were 23 045 and 43 789 catheter d, respectively. Median (interquartile range) catheter days and duration of HPN, for tPICCs and tCICCs, were respectively 119 (166) and 324 (314) d and 108 (159) and 324 (322) d. The overall complication rates per 1000 catheter d for tPICCs and tCICCs were 1.52 and 0.8, respectively (P = 0.565). On analysis, there was no statistical difference between complication rates per 1000 catheter d. The removal rate and conversion ratio due to complications were similar for tPICCs and tCICCs.

CONCLUSIONS

Both tPICCs and tCICCs have similar complication rates per 1000 d. This study highlights that tCICCs, the preferred and currently used venous access devices in HPN, can be effectively and safely replaced by tPICCs, depending on the indications.

The role of artificial nutrition in gynecological cancer therapy

Cancer patients are at risk of developing malnutrition from underlying disease as well as from cancer treatment. Moreover, weight loss is considered as a predictive factor for disease progression and shorter survival time. As many as 10-20% of patients with cancer die from the results of malnutrition, instead of from the cancer itself. In the case of cancer-related malnutrition, it is necessary to quickly implement individualized nutritional support depending on the type and stage of the disease, metabolic changes, the patient's condition, expected survival and the function of the gastrointestinal tract. Artificial nutrition reduces the side effects of chemotherapy and improves immunity. Perioperatively it reduces the risk of infection, facilitates wound healing and shortens the length of hospitalization, thereby reducing the costs of the treat- ment. Initially, a malnourished patient, without gastrointestinal dysfunction, qualifies for nutritional counseling. When the energy needs cannot be met by normal feeding, nutritional supplements, taken orally, are recommended. The next step is to feed the patient by nasogastric tube or percutaneous endoscopic gastrostomy. Parenteral nutrition, which results in more side effects, is only started when enteral nutrition is insufficient to ensure adequate nutritional status or in cases of gastrointestinal tract obstruction. The benefit of parenteral nutrition is that it especially provides for those patients with gynaecological cancer who have radiation-induced intestinal damage and post-surgical complications such as short bowel syndrome. Palliative nutrition must to relieve hunger and thirst. Nutritional interventions should be individualized and focused on the changing nutrient needs of the patient and should be supported by physical activity. Regular assessment of the nutritional status of the patient should be an inherent element of the oncological treatment.

Polymorphism in exon 2 encoding the putative ligand binding pocket of the bovine insulin-like growth factor 1 receptor affects milk traits in four different cattle breeds

As a member of the somatotropic axis, insulin-like growth factor I receptor (IGF1R) seems to be a promising candidate gene. Two silent polymorphisms, identified by MspI and TaqI restriction enzymes, were selected within exon 2, encoding the majority of the putative ligand binding pocket. A total of 1169 cows of four pure breeds (Polish Holstein Friesian, Montbeliarde, Jersey and Holstein Friesian) were genotyped. The T (IGF1R/e2/MspI) and G (IGF1R/e2/TaqI) alleles were found to be prevalent. Three combinations of genotypes (TT/GG, TT/AG and CT/GG) were associated with the highest productivity (milk, protein and fat yields) among all breeds under study, as opposed to individuals carrying the worst CC/AA combination. In view of the specific structure of the ligand binding pocket and the significance of insulin-like growth factor I signalling promoting the development and differentiation in a variety of tissues (not only limited to mammary gland), the existence of missense mutation is unlikely. Potential mutations are likely limited to mRNA transcription and further post-transcriptional modifications. Further investigations should follow searching for the most useful IGF1R haplotypes, associated with higher milk production traits, exerting at the same time positive or neutral impact on health and welfare of individuals.

The effect of colostral supplement on the serum protein fractions, health status and growth of calves

Abstract. The study aimed at evaluation of the effect of colostral supplement on humoral immunity, growth and health state of calves until the 3rd month of life. Examinations were carried out on 40 Polish Black-and-White Holstein-Friesian calves. After birth, the calves were separated into two groups (20 calves each): control group – without addition of colostral supplement, and experimental one – with colostral supplement in diet. Blood was sampled from each calf on day 5 and 30 of life, and total protein, albumin, and alpha, beta and gamma globulin levels were determined in it. Evaluation of calves’ growth and development course was carried out basing on weighing and daily gain results. The favourable effect of colostral supplement on calves’ health state and body weight gains was found. No significant effect of colostral supplement on total protein level or gamma-globulin fraction level was found. The effect of colostral supplement on reduction of alpha-globulin fraction decrease was found in a time period until the 30th day of calves’ life (P≤0.01). The study so far point to the purposefulness of using this supplement, in particular in the case of colostrum deficiency or its poor quality.

Association between genetic polymorphism of growth-hormone-releasing hormone and the yield, chemical composition and technological parameters of cow milk (Brief Report)

Abstract. Somatoliberin or growth-hormone-releasing hormone (GHRH) belongs to a group of hypothalamic hormones. It induces an increase in the concentration of endogenous growth hormone in the blood serum of cattle (Løvendahl et al. 1991), increasing mean and pulsatile liberation of somatotropin and thus affecting indirectly an increase in the milk productivity of cows (Dahl et al. 1993). The study aimed at searching for associations between the variants of the GHRH/HaeIII polymorphism, described for the first time by Moody et al. (1995), and production traits in the examined herds and comparing the technological usefulness of milk obtained from cows with different GHRH genotypes. According to Szewczuk et al. (2008), above mentioned polymorphism is the transversion A→C located at the position A44C within initial part of intron 2 (GenBank acc. no. EF210074).

Association between <i>IGF1/Tas</i>I polymorphism and milk traits of Polish Holstein Friesian cows

Abstract. The study was carried out on 658 Polish Holstein Friesian cows. A transversion of A→C in the P1 promoter region of bovine IGF1 gene at position 977 bp upstream from the start codon in exon 1 was identified using ACRS-PCR method. Reverse primer introduced an artificial TasI restriction site. Three genotypes (AA, AC, CC) were found in the analysed herd of dairy cows occurred with a frequency of 0.766, 0.213 and 0.021, respectively. In the presented study, the statistically significant differences between individuals of different IGF1/TasI genotypes were found in milk, fat and protein yield. In the 2nd and 3rd lactations, the cows carrying the CC genotype produced more milk than the AA individuals (P≤0.05). In the case of protein and fat yield, similar tendencies were observed.

A new ACRS-SNP in the 5’ flanking region of the bovine insulin-like growth factor 1 (<i>IGF1</i>) gene (Brief report)

Abstract. A number of polymorphisms within the bovine insulin-like growth factor 1 (IGF1) gene were described at this time. One of these mutations, a low polymorphic (CA)n microsatellite in the 5’ flanking region of the gene, has been reported by KIRKPATRICK (1992). A T>C transition was identified in the P1 promoter region of the bovine IGF1K gene (GenBank Acc. No. AF017143; GE et al., 2001). LIEN et al. (2000) identified a 4-bp deletion (TTTG) and nine point mutations within non-coding regions of the gene (GenBank Acc. No. AF210383-387). In our study, the sequencing of (CA)n microsatellite fragment revealed another single nucleotide polymorphism (SNP) in the 5’ flanking region of the bovine IGF1 gene. The DNA sequence has been deposited to GenBank under accession number DQ975234.

Auswirkungen der Weidehaltung tragender Jungrinder in einer auf ein Erstkalbealter von 24 Monaten ausgerichteten intensiven Aufzucht auf Körperentwicklung, Abkalbung und Milchleistung

Abstract. Title of the paper: Effect of grazing intensively reared pregnant replacement German Holstein heifers on body development, calving and milk performance The influence of grazing intensively reared pregnant Holstein heifers on body development; calving and milk performance was tested in a farm experiment. 51 heifers were kept on pasture after insemination (VGW) and 70 heifers were continuously reared in a barn (VGS) aimed at an age at first calving of 24 month. Grazing was realized at a periodically renewed low moor pasture. Insemination began when animals reached life weight of 400 kg. Included were only heifers pregnant before 530th day of life. Life weight gain from birth to 15th month was about 850 g/day in both groups. In contrast to the continuously gaining barn reared heifers the heifers of VG pasture suffered a decrease of life weight up to 1300 g/day after starting pasture. At the same time body condition score and heart girth decreased but increased hip height. Later on pasture life weight gain as well as heart girth turned to increase up to 800 g/day and 3.5 cm/month respectively whereas body condition score tended to be constant at about 3.5. The initially decrease in life weight gain is not discussed as depression of body development but as reduction of an excessive obesity. Statistically calving problems (score 1…4) were positively related with body condition score. Furthermore calving problems influenced milk yield in first 100 days of lactation negatively. Therefore the milk yield of VGW was significant higher than VGS.