Enteral Delivery Research Articles

Proteins-Based Nanoparticles for Benznidazole Enteric Delivery.

Chagas disease, caused by Trypanosoma cruzi (T. cruzi), affects millions worldwide, particularly in Latin America. Despite its prevalence, treatment options remain limited. Current drugs, such as benznidazole, cause adverse effects possibly due to ineffective administration. In this context, nanoparticles offer a promising solution to target and control drug delivery by leading the effector site and minimizing side effects. This article focuses on zein-casein-based nanoparticles (Bioparticles, BP) coated with Eudragit L100-55 (BP:EU) for enteric delivery of benznidazole. BP:EU structures are synthesized to minimize premature drug release in the stomach, promoting release in the small intestine. Physical characterization confirmed the successful synthesis of BP:EU and their pH-responsive trigger for drug release. These findings suggest that this material can be a promising approach for Chagas disease treatment, addressing challenges in benznidazole delivery that can lead to improved therapeutic responses.

Development of Enteric Diclofenac Sodium Microparticles Through a Spray-Drying Process Facilitated by Different Aqueous Dispersion Systems

The objective of this study was to prepare enteric diclofenac sodium microparticles using an aqueous dispersion system via spray-drying. Two aqueous-based solvent systems, phosphate buffer at pH 7.0 and ammonium hydrogen carbonate solution, were employed as the feed dispersion media in the spray-drying process based on the solubility characteristics of Eudragit® L100. At a drug-to-polymer ratio of 1:1, the optimal solids concentration in the feed dispersion was determined to be 2% w/v, as it enabled an approximately 5-30 µm smooth-surfaced spherical microparticle with a high production yield. Diclofenac sodium was efficiently encapsulated within the microparticles, existing as solid dispersion in a partially amorphous form. Notably, the spray-drying conditions utilized in this study obviated the need for further heating for microparticles prepared using ammonium hydrogen carbonate solution, as the residual ammonium could be completely eliminated during the spray-drying process. The two-stage biorelevant drug release profile of enteric microparticles demonstrated their ability to inhibit drug dissolution under acidic conditions while facilitating drug release under basic conditions. The phosphate buffer-based microparticles exhibited greater protection efficiency under acidic conditions compared to ammonium hydrogen carbonate-based systems, despite residual alkaline salt being present in the microparticles. These results validate the potential of the developed microparticles for use as an enteric drug delivery system.

Enhanced bioavailability and efficacy in antimalarial treatment through QbD approach enteric encased inclusion delivery.

Aim: In this study, we aimed to prepare enteric encapsulated spheroids containing inclusion complex using quality by design approach.Methods: A Box-Behnken design was employed to determine effects of variables on selected responses. Risk assessment was conducted using Ishikawa fishbone diagram. A model with a p-value was less than 0.5 for being a significant error of model was determined based on significance 'lack of fit' value. Spheroids were formulated using the extrusion spheronization technique and were characterized using analytical techniques.Results: In vitro release was performed in both acidic (pH 1.2) and simulated intestinal (pH 6.8) conditions. Permeability studies demonstrated tenfold enhancement compared with arteether. In vivo studies further validated increase of 51.8% oral bioavailability. Exvivo studies revealed 3.4-fold enhancement in antimalarial activity compared with arteether.Conclusion: These findings highlight effectiveness of inclusion complexation technique as a viable approach to enhance solubility and bioavailability for drugs with low aqueous solubility.

Formulation and evaluation of Mesalamine mini-tablets in enteric-coated capsule for the treatment of ulcerative colitis using a factorial design approach

The Enteric Capsule Drug Delivery Technology (ECDDT) was designed to enable oral administration while ensuring complete enteric protection and swift release in the upper gastrointestinal (GI) tract, without the need for coatings. Current study used a 32factorial design (Stat-Ease Design Expert v12) to formulate a mini-tablet in an enteric-coated capsule to treat ulcerative colitis utilising ECDDT and mini-tablets. Mesalamine, an amino salicylate, was used as a model drug to study the effects of independent variables like HPMC K4M as a release retarding polymer at 10-20% and Crospovidone as a super disintegrant at 2-5% on in vitro drug release to meet desired Q points of dissolution. higher value of Tmax (10 Hours) and T1/2 (9 Hours) was observed for the Optimized formulation with Cmax value of (35.24 ± 0.45 ng/mL), AUC (0-48) (411.58 ± 1.45 hr.ng/mL) and Ke (0.077 ± 0.010 hr-1) it may be due to delayed release formulation.

Flexible surface acoustic wave technology for enhancing transdermal drug delivery.

Transdermal drug delivery provides therapeutic benefits over enteric or injection delivery because its transdermal routes provide more consistent concentrations of drug and avoid issues of drugs affecting kidneys and liver functions. Many technologies have been evaluated to enhance drug delivery through the relatively impervious epidermal layer of the skin. However, precise delivery of large hydrophilic molecules is still a great challenge even though microneedles or other energized (such as electrical, thermal, or ultrasonic) patches have been used, which are often difficult to be integrated into small wearable devices. This study developed a flexible surface acoustic wave (SAW) patch platform to facilitate transdermal delivery of macromolecules with fluorescein isothiocyanates up to 2000kDa. Two surrogates of human skin were used to evaluate SAW based energized devices, i.e., delivering dextran through agarose gels and across stratum corneum of pig skin into the epidermis. Results showed that the 2000kDa fluorescent molecules have been delivered up to 1.1mm in agarose gel, and the fluorescent molecules from 4 to 2000kDa have been delivered up to 100µm and 25µm in porcine skin tissue, respectively. Mechanical agitation, localised streaming, and acousto-thermal effect generated on the skin surface were identified as the main mechanisms for promoting drug transdermal transportation, although micro/nanoscale acoustic cavitation induced by SAWs could also have its contribution. SAW enhanced transdermal drug delivery is dependent on the combined effects of wave frequency and intensity, duration of applied acoustic waves, temperature, and drug molecules molecular weights.

Current surgical practice for central venous access to deliver chemotherapy and enteral access for nutritional support in pediatric patients with an oncological diagnosis.

Central venous access through tunneled central venous catheters (CVCs) are one of the cornerstones of modern oncologic practice in pediatric patients since CVCs provide a reliable access route for the administration of chemotherapy. Establishing best practices for CVC management in children with cancer is essential to optimize care. This article reviews current best practices, including types of devices, their placement, complications, and long-term outcomes. Additionally, nutrition status and nutritional support are also very important determinants of outcomes and care in pediatric surgical oncology patients. We review current nutritional assessment, support, access for enteral and parenteral nutrition delivery, and their complications, mainly from a surgical perspective. Overall, access surgery, whether for CVCs, or for enteral access can be challenging, and best practice guidelines supported by current though limited evidence are necessary to minimize complications and optimize outcomes.

Effect of Residual Gastric Volume on Risk of Ventilator-Associated Pneumonia in Adults Receiving Mechanical Ventilation and Early Enteral Feeding

Abstract Background Early enteral nutrition is the standard of care in critically ill patients receiving invasive mechanical ventilation. However, numerous studies have shown that early enteral nutrition is frequently not used. The main reason for nonuse is gastrointestinal intolerance to enteral nutrition which has been ascribed to gastroparesis with increased gastric volume, gastroesophageal reflux, and regurgitation or vomiting carrying a risk of aspiration and ventilator-associated pneumonia. Aim of the Work To test the hypothesis that the risk of ventilator-associated pneumonia is not increased when residual gastric volume is not monitored compared with routine residual gastric volume monitoring in patients receiving invasive mechanical ventilation and early enteral nutrition. Furthermore residual gastric volume monitoring may be associated with decreased calorie delivery and therefore, with underfeeding and increased morbidity. Patients and Methods This is a Prospective cohort study that was conducted at Ain Shams University Hospitals& Rashid General hospital for 6 months on critically ill patients admitted to ICU with mechanical ventilation. Sample sizes of 215 in each group totaling 430 in the study achieve 80% power to detect a non-inferiority margin difference between the group proportions of -0.0800. The reference group proportion is 0.158. The treatment group proportion is assumed to be 0.078 under the null hypothesis of inferiority. Results There was no significant difference between groups regard BMI (is calculated as weight in kilograms divided by height in meters squared), SAPS II or SOFA regard sex distribution the majority were male in both groups with no significant difference and also DM and HTN distributed with no significant difference between groups. Considering cause of admission and risk factors distribution between studied groups, in our study there is no significant difference or association between the two groups and the majority admission causes of both groups were respiratory and cancer. No significant difference between groups regard hospital stay or ICU days but MV days were significantly shorter in intervention group. In our study, Ventilator-Associated Pneumonia was significantly associated with control group as 47.4% had pneumonia while only 11.2% in intervention group had it. In the present study, cumulative calories deficit was significantly lower in intervention group, Intolerance and Prokinetic TTT were significantly associated with control group. Conclusion The current study supports the hypothesis that a protocol of enteral nutrition management without residual gastric volume monitoring is not inferior to a similar protocol including residual gastric volume monitoring in terms of protection against VAP. Residual gastric volume monitoring leads to unnecessary interruptions of enteral nutrition delivery with subsequent inadequate feeding and should be removed from the standard care of critically ill patients receiving invasive mechanical ventilation and early enteral nutrition.

Incidence of Enteral Nutrition-Related Diarrhea Among Critically Ill Patients in Intensive Care Units.

Enteral nutrition is a common nutritional modality in intensive care units. Despite its valuable benefits, it has many complications among which diarrhea is the most important. However, the incidence of enteral nutrition-related diarrhea is variable in the literature, with no established baseline in Jordan. The aim of this study was to investigate the incidence of enteral nutrition-related diarrhea in intensive care units of a major public hospital in Jordan. A prospective cohort design was adopted over 4 months. Using a consecutive sampling technique, 84 critically ill patients receiving enteral nutrition were recruited. King's Stool Chart was used. The incidence of enteral nutrition-related diarrhea calculated per patient and per feeding day was 63.1% and 13.2%, respectively. Significant positive associations were found between the incidence of diarrhea with feeding days (r = .356, p = .001) and intensive care unit length of stay (r = .254, p = .020). The same was found for the frequency of diarrhea (r = .633, p = .000; r = .439, p = .000, respectively). Conversely, a significant negative association was found between baseline serum albumin and frequency of diarrhea (r = -.250, p = .037). Enteral nutrition-related diarrhea is prevalent in Jordanian intensive care units, but it should not be a barrier to enteral nutrition delivery. It would be beneficial for intensive care unit nurses to improve their nutritional practices by following a nurse-led enteral nutrition protocol to guide the enteral nutrition practices utilizing multidisciplinary approaches.

Recent advancements in lipid nanoparticle technology for oral insulin delivery

Nanotechnology is important in many industries, particularly in drug delivery and administration. This technology has been used to create nanocarriers for enteral drug delivery. There are different types of nanocarriers including polysaccharide-based and lipid-based nanocarriers. Lipid nanoparticles have recently been developed for loading and administering insulin via the enteral route to treat diabetes mellitus. Insulin cannot be administered orally due to its low bioavailability, extreme gastrointestinal conditions, and instability. When insulin is loaded onto these nanocarriers, it increases bioavailability, stability, drug release pattern control, and protects insulin from extreme conditions. This review article aims to discuss recent applications as well as novel methods and approaches for oral insulin delivery using liposomes, solid lipid nanoparticles, and nanostructured lipid carriers.

Fabrication of nanocrystal forms of ᴅ-cycloserine and their application for transdermal and enteric drug delivery systems.

ᴅ-cycloserine (DCS), an FDA-approved medicine for the treatment of tuberculosis, is also a partial agonist at the glycine recognition site of N-methyl-ᴅ-aspartate (NMDA) receptor and has shown significant treatment efficacy for central nervous system (CNS) disorders including depression, schizophrenia, Alzheimer's disease, and post-traumatic stress disorder. The physicochemical properties of DCS, however, limit the options of formulation and medicinal applications of DCS, and warrants further investigation for the development of CNS therapeutics. Nanocrystals play an important role in pharmaceutic design and development. The properties of nanocrystals are remarkably different from their bulk material counterpart, attributed to the large surface-area-to-volume ratio which can improve the bioavailability. In this study, for the first time, DCS, a highly water-soluble compound, has formed nanocrystals and this was confirmed by scanning electronic microscopy and X-ray powder diffraction. Furthermore, DCS nanocrystals were applied to several formulations to test their stability and then to the in vitro Franz diffusion test with reservoir patch formulation as well as in vivo pharmacokinetics study with enteric capsules. We tested these formulations regarding their nanocrystal physical properties, size effect, and dissolution rate, respectively. We found that DCS nanocrystals showed good performance in the Franz diffusion test and rodent pharmacokinetic studies due to the nanoparticle size and faster dissolution as compared with the commercial DCS powder. These DCS nanocrystal formulations could offer a new approach for the development of an advanced drug delivery system for the treatment of CNS disorders.

Changes in Global Nutrition Practices in Critically Ill Children and the Influence of Emerging Evidence: A Secondary Analysis of the Pediatric International Nutrition Studies, 2009-2018

BackgroundThe timeline of the 3 Pediatric International Nutrition Studies (PINS) coincided with the publication of 2 major guidelines for the timing of parenteral nutrition (PN) and recommended energy and protein delivery dose. ObjectiveThe study's main objective was to describe changes in the nutrition delivery practice recorded in PINS1 and PINS2 (PINS1-2) (conducted in 2009 and 2011, preexposure epoch) vs PINS3 (conducted in 2018, postexposure epoch), in relation to the published practice guidelines. DesignThis study is a secondary analysis of data from a multicenter prospective cohort study. Participants/settingData from 3650 participants, aged 1 month to 18 years, admitted to 100 unique hospitals that participated in 3 PINS was used for this study. Main outcome measuresThe time in days from pediatric intensive care unit admission to the initiation of PN and enteral nutrition delivery were the primary outcomes. Prescribed energy and protein goals were the secondary outcomes. Statistical analyses performedA frailty model with a random intercept per hospital with stratified baseline hazard function by region for the primary outcomes and a mixed-effects negative binomial regression with random intercept per hospital for the secondary outcomes. ResultsThe proportion of patients receiving enteral nutrition (88.3% vs 80.6%; P < .001) was higher, and those receiving PN (20.6% vs 28.8%; P < .001) was lower in the PINS3 cohort compared with PINS1-2. In the PINS3 cohort, the odds of initiating PN during the first 10 days of pediatric intensive care unit admission were lower, compared with the PINS1-2 cohort (hazard ratio 0.8, 95% CI 0.67 to 0.95; P = .013); and prescribed energy goal was lower compared with the PINS1-2 cohort (incident rate ratio 0.918, 95% CI 0.874 to 0.965; P = .001). ConclusionsThe likelihood of initiation of PN delivery significantly decreased during the first 10 days after admission in the PINS3 cohort compared with PINS1-2. Energy goal prescription in children receiving mechanical ventilation significantly decreased in the postguidelines epoch compared with the preguidelines epoch.

Enteral Delivery of Pravastatin Sodium Tablets: Effect of Compounding into a Liquid Form and Co-Administration of Enteral Nutrition.

Compounding solid oral dosage forms into liquid preparations is a common practice for administering drug therapy to patients with swallowing difficulties. This is particularly relevant for those on enteral nutrition, where factors such as the administration procedure and co-administration of enteral nutrition play crucial roles in effective drug delivery. Due to the limited studies focused on this practice, the impact of co-administered nutrition remains unclear. Pravastatin tablets were compounded into two liquid formulations and administered through three independent tubes for ten cycles. The drug amount was quantified upstream and downstream of the tubes both with and without different (fiber content) nutritional boluses. The compounding procedure did not lower the drug amount with respect to the original tablets. However, when the liquid formulation was pumped through the tubes, a statistically significant reduction in the pravastatin administered (between 4.6% and 11.3%) was observed. The co-administration of different nutritional boluses or the compounding procedure did not affect the general results. Pravastatin loss appears unavoidable when administered via the enteral tube. Although, in this case, the loss was of limited clinical relevance, it is important not to underestimate this phenomenon, especially with drugs having a narrow therapeutic index.

Circumventing the Gastrointestinal Barrier for Oral Delivery of Therapeutic Proteins and Peptides (PPTs): Current Trends and Future Trajectories.

Therapeutic proteins and peptides (PPTs) have become one of the most important biological molecules for the management of many common and complex diseases due to their high specificity and high bioactivity. However, these biomolecules are mainly given by the hypodermic injection, which often leads to poor patient compliance due to the invasive nature of this route of administration. The oral route has been considered the most convenient and patient-friendly route for drug delivery relative to hypodermic injection. Despite the ease and simplicity conferred by oral administration, this drug delivery route suffers rapid peptide degradation in gastric fluid and low intestinal uptake. In order to circumvent these issues, several strategies, such as enzyme inhibitors, permeation enhancers, chemical modification, mucoadhesive and stimuli-responsive polymers, and specialised particulate formulation have been developed. Such strategies are designed with the aim of protecting proteins and peptides from the harsh gastrointestinal environment as well as providing a strategy to enhance the uptake of the therapeutic across the gastrointestinal tract. This review aims to provide an overview of the current development in enteral drug delivery strategies for proteins and peptides. The design of these drug delivery systems in overcoming physical and chemical barriers along the gastrointestinal tract while improving oral bioavailability will be highlighted and discussed.

Enhanced exclusive enteral nutrition delivery during the first 7 days is associated with decreased 28-day mortality in critically ill patients with normal lactate level: a post hoc analysis of a multicenter randomized trial

Background and aimsExclusive enteral nutrition (EN) is often observed during the first week of ICU admission because of the extra costs and safety considerations for early parenteral nutrition. This study aimed to assess the association between nutrition intake and 28-day mortality in critically ill patients receiving exclusive EN.MethodsThis is a post hoc analysis of a cluster-randomized clinical trial that assesses the effect of implementing a feeding protocol on mortality in critically ill patients. Patients who stayed in the ICUs for at least 7 days and received exclusive EN were included in this analysis. Multivariable Cox hazard regression models and restricted cubic spline models were used to assess the relationship between the different doses of EN delivery and 28-day mortality. Subgroups with varying lactate levels at enrollment were additionally analyzed to address the potential confounding effect brought in by the presence of shock-related hypoperfusion.ResultsOverall, 1322 patients were included in the analysis. The median (interquartile range) daily energy and protein delivery during the first week of enrollment were 14.6 (10.3–19.6) kcal/kg and 0.6 (0.4–0.8) g/kg, respectively. An increase of 5 kcal/kg energy delivery was associated with a significant reduction (approximately 14%) in 28-day mortality (adjusted hazard ratio [HR] = 0.865, 95% confidence interval [CI]: 0.768–0.974, P = 0.016). For protein intake, a 0.2 g/kg increase was associated with a similar mortality reduction with an adjusted HR of 0.868 (95% CI 0.770–0.979). However, the benefits associated with enhanced nutrition delivery could be observed in patients with lactate concentration ≤ 2 mmol/L (adjusted HR = 0.804 (95% CI 0.674–0.960) for energy delivery and adjusted HR = 0.804 (95% CI 0.672–0.962) for protein delivery, respectively), but not in those > 2 mmol/L.ConclusionsDuring the first week of critical illness, enhanced nutrition delivery is associated with reduced mortality in critically ill patients receiving exclusive EN, only for those with lactate concentration ≤ 2 mmol/L.Trial registration: ISRCTN12233792, registered on November 24, 2017.

Quick response‐encoded chip engraved onto multifunctional aspirin loaded enteric films by fused filament fabrication‐3D printing

AbstractDigital fabrication technology revolutionizing the pharmaceutical industry, offering patient‐centric personalized medicine with tailored pharmacotherapy. In this study, we demonstrated fused filament fabrication coupled with hot melt extrusion for the fabrication of aspirin (ASP) loaded enteric film engraved onto QR‐encoded polylactic acid films for enteric intestinal specific ASP delivery. Further, QR‐encoded films (QRFs) were formulated and its physicochemical properties were assessed systematically. All the QRFs were scannable and readable. Interestingly, due to the advantage of the plasticizing effect of ASP, the formulation was optimized with drug and polymer ratio excluding the usage of any filler and plasticizers. The compatibility study was assessed by attenuated total reflectance and Raman spectroscopy. The physicochemical evaluation was further performed by scanning electron microscopy, x‐ray diffraction, differential scanning calorimetry, and thermogravimetric analysis. Gastric resistance was assessed via performing dissolution study at gastric pH for 4 h, with a lag phase followed by radical increase in an alkaline for next 8 h. Korsmeyer–Peppas model was found to be the best‐fit mathematical kinetic model (R2 &gt; 0.9475 and n = 0.514). This type of QRFs can help the tailoring doses and patients can know the details of the drug that has to be taken.

Study protocol for TARGET protein: The effect of augmented administration of enteral protein to critically ill adults on clinical outcomes: A cluster randomised, cross-sectional, double cross-over, clinical trial

BackgroundIt is unknown whether increasing dietary protein to 1.2–2.0 g/kg/day as recommended in international guidelines compared to current practice improves outcomes in intensive care unit (ICU) patients. The TARGET Protein trial will evaluate this. ObjectiveTo describe the study protocol for the TARGET Protein trial. Design, setting, and participantsTARGET Protein is a cluster randomised, cross-sectional, double cross-over, pragmatic clinical trial undertaken in eight ICUs in Australia and New Zealand. Each ICU will be randomised to use one of two trial enteral formulae for three months before crossing over to the other formula, which is then repeated, with enrolment continuing at each ICU for 12 months. All patients aged ≥16 years in their index ICU admission commencing enteral nutrition will be eligible for inclusion. Eligible patients will receive the trial enteral formula to which their ICU is allocated. The two trial enteral formulae are isocaloric with a difference in protein dose: intervention 100g/1000 ml and comparator 63g/1000 ml. Staggered recruitment commenced in May 2022. Main outcomes measuresThe primary outcome is days free of the index hospital and alive at day 90. Secondary outcomes include days free of the index hospital at day 90 in survivors, alive at day 90, duration of invasive ventilation, ICU and hospital length of stay, incidence of tracheostomy insertion, renal replacement therapy, and discharge destination. ConclusionTARGET Protein aims to determine whether augmented enteral protein delivery reduces days free of the index hospital and alive at day 90. Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12621001484831).

Medical line entanglement: The unspoken patient safety hazard of medical devices

In February 2022, the US Food and Drug Administration published a safety communication regarding the risk of strangulation from enteral feeding delivery sets. When it comes to the causes of accidental strangulation or asphyxiation, it is common knowledge that household items, such as window blind cords, are potential hazards. However, many people may not expect that medical devices may pose similar risks because of medical line entanglement (MLE). A survey of clinicians from pediatric acute care and outpatient facilities and caregivers of patients with medical lines was conducted with a goal to understand if clinicians and caregivers are aware of MLE, if healthcare facilities have policies and procedures related to the prevention of MLE, and if education about the risks of MLE is provided to caregivers when they first receive a medical device. The survey was shared through clinician organizations and patient advocacy groups. Responses were received from 191 clinicians and 117 caregivers. A majority of clinicians reported awareness of the risk of entanglement; however, few received direction from their employer on managing these risks. Caregivers (N = 106) reported that their child had experienced MLE, however only 9% of those caregivers recalled receiving any education on MLE from their healthcare providers. This survey demonstrates the need for healthcare facilities to develop programs for managing risks of MLE and for healthcare teams and caregivers to discuss prevention methods whenever an at-risk patient is sent home with a medical device that poses a risk for entanglement.

Continuation of enteral nutrition until extubation in critically ill patients.

There is substantial variation in enteral nutrition practices for airway procedures in critically ill patients across individual specialists and intensive care units (ICUs). Fasting times can vary between 0 h and longer than 24 h before planned extubations. 1 Varghese JA Tatucu-Babet OA Miller E et al. Fasting practices of enteral nutrition delivery for airway procedures in critically ill adult patients: a scoping review. J Crit Care. 2022; 72154144 Crossref PubMed Scopus (0) Google Scholar Patients receiving mechanical ventilation are often underfed, and interruptions are one of the main causes that energy prescriptions are not met. 2 Torrini F Gendreau S Morel J et al. Prediction of extubation outcome in critically ill patients: a systematic review and meta-analysis. Crit Care. 2021; 25: 391 Crossref PubMed Scopus (11) Google Scholar Airway procedures, such as extubation or tracheotomy, lead to the longest fasting periods in the ICU, but the implementation of unit-wide guidelines can reduce fasting time and maximise caloric intake. 3 Segaran E Barker I Hartle A Optimising enteral nutrition in critically ill patients by reducing fasting times. J Intensive Care Soc. 2016; 17: 38-43 Crossref PubMed Scopus (26) Google Scholar , 4 Hoffmann M Schwarz CM Fürst S et al. Risks in management of enteral nutrition in intensive care units: a literature review and narrative synthesis. Nutrients. 2020; 13: 82 Crossref PubMed Scopus (4) Google Scholar However, most of this common practice comes from the theatre, and mainly preoperative fasting practice guidelines are being used with the hope of minimising the risk of aspiration in airway procedures. 5 Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017; 126: 376-393 Crossref PubMed Scopus (450) Google Scholar Patients are at increased risk of aspiration due to oropharyngeal dysfunction for several hours following extubation 6 Schefold JC Berger D Zürcher P et al. Dysphagia in mechanically ventilated ICU patients (DYnAMICS): a prospective observational trial. Crit Care Med. 2017; 45: 2061-2069 Crossref PubMed Scopus (95) Google Scholar and up to 20% of patients have to be reintubated within 7 days. 2 Torrini F Gendreau S Morel J et al. Prediction of extubation outcome in critically ill patients: a systematic review and meta-analysis. Crit Care. 2021; 25: 391 Crossref PubMed Scopus (11) Google Scholar A question that remained unanswered was whether it is really safe to continue enteral nutrition until attempting to extubate. Continued enteral nutrition until extubation compared with fasting before extubation in patients in the intensive care unit: an open-label, cluster-randomised, parallel-group, non-inferiority trialContinued enteral nutrition until extubation in critically ill patients in the intensive care unit was non-inferior to a 6-h fasting maximum gastric vacuity strategy comprising continuous gastric tube suctioning, in terms of extubation failure within 7 days (a patient-centred outcome), and thus represents a potential alternative in this population. Full-Text PDF

Oral Delivery of Mouse β-Defensin 14 (mBD14)-Producing Lactococcus lactis NZ9000 Attenuates Experimental Colitis in Mice

Antimicrobial peptides (AMPs) play essential roles in maintaining intestinal health and have been suggested as possible therapeutic strategies against inflammatory bowel disease (IBD). However, the instability of AMPs in the process of transmission in vivo limits their application in the treatment of IBD. In this study, we constructed the mBD14-producing Lactococcus lactis NZ9000 (L. lactis/mBD14) to achieve enteric delivery of mBD14 and evaluated its protective effect on dextran sodium sulfate (DSS)-induced colitis. Mice treated with L. lactis/mBD14 exhibited milder symptoms of colitis (P < 0.01). Additionally, L. lactis/mBD14 treatment reversed DSS-induced epithelial dysfunction and reduced the production of pro-inflammatory cytokines in colon (P < 0.01). Mechanistically, L. lactis/mBD14 significantly inhibited NOD-like receptor pyrin domain containing three inflammasome-mediated pro-inflammatory response (P < 0.05) and regulated microbiota homeostasis by promoting the abundance of probiotic bacteria Akkermansia muciniphila and Faecalibacterium prausnitzii and decreasing the pathogenic Escherichia coli (P < 0.01). Taken together, this study demonstrates the protective effect of L. lactis/mBD14 in DSS-induced colitis, and suggests that oral administration of L. lactis/mBD14 may represent a potential therapeutic strategy for IBD.

Biomolecular 1D Necklace-like Nanostructures Tailoring 2D Janus Interfaces for Controllable 3D Enteric Biomaterials.

Construction of well-ordered two-dimensional (2D) and three-dimensional (3D) assemblies using one-dimensional (1D) units is a hallmark of many biointerfaces such as skin. Mimicking the art of difunctional properties of biointerfaces, which skin exhibits as defense and shelter materials, has inspired the development of smart and responsive biomimetic interfaces. However, programming the long-range ordering of 1D base materials toward vigorous control over 2D and 3D hierarchical structures and material properties remains a daunting challenge. In this study, we put forward construction of 3D enteric biomaterials with a two-strata 2D Janus interface assembled from self-adaptation of 1D protein-polysaccharide nanostructures at an oil-water interface. The biomaterials feature a protein dermis accommodating oil droplets as a reservoir for bioactive compounds and a polysaccharide epidermis protecting them from gastric degradation. Furthermore, the epidermis can be fine-tuned with different thicknesses rendering enteric delivery of a bioactive cargo (coumarin-6) with controllable retention in the intestinal tract from 6 to 24 h. The results highlight a skin-inspired construction of enteric biomaterials by self-adaptation of 1D nanostructures at the oil-water interface toward 2D Janus biointerfaces and 3D microdevices, which can be tailored for intestinal treatments with intentional therapeutic efficacies.