Fluid Nutrition Research Articles

Management of community-acquired pneumonia in older adults.

Community-acquired pneumonia (CAP) is an increasing problem among the elderly. Multiple factors related to ageing, such as comorbidities, nutritional status and swallowing dysfunction have been implicated in the increased incidence of CAP in the older population. Moreover, mortality in patients with CAP rises dramatically with increasing age. Streptococcus pneumoniae is still the most common pathogen among the elderly, although CAP may also be caused by drug-resistant microorganisms and aspiration pneumonia. Furthermore, in the elderly CAP has a different clinical presentation, often lacking the typical acute symptoms observed in younger adults, due to the lower local and systemic inflammatory response. Several independent prognostic factors for mortality in the elderly have been identified, including factors related to pneumonia severity, inadequate response to infection, and low functional status. CAP scores and biomarkers have lower prognostic value in the elderly, and so there is a need to find new scales or to set new cut-off points for current scores in this population. Adherence to the current guidelines for CAP has a significant beneficial impact on clinical outcomes in elderly patients. Particular attention should also be paid to nutritional status, fluid administration, functional status, and comorbidity stabilizing therapy in this group of frail patients. This article presents an up-to-date review of the main aspects of CAP in elderly patients, including epidemiology, causative organisms, clinical features, and prognosis, and assesses key points for best practices for the management of the disease.

Faecal incontinence in rural and regional northern Queensland community-dwelling adults

In Australia, faecal incontinence, the involuntary loss of liquid or solid stool with or without a person's awareness, has been reported in 8% of the South Australian and 11% of the urban New South Wales community-dwelling populations. Studies conducted in 2004 and 2005 reported faecal incontinence in more than 20% of colorectal and urogynaecological clinic patients at Townsville Hospital (a referral centre serving rural North Queensland). This prompted concern regarding the level of faecal incontinence in the community. The aim of this study was to investigate the prevalence of faecal incontinence in the North and Far North Queensland urban and rural communities. The sample size was based on the New South Wales postal surveys (11% prevalence). Higher rates were expected in North/Far North Queensland, so prevalence there was estimated at 12.1% (confidence interval ± 2%, ie the true level to be between 10.1% and 14.1%). The sample for each of the Townsville, Cairns (in Far North Queensland) and rural/remote settings was calculated at 1022. The database for the present study was compiled using a systematic randomised process selecting two private names from each column on each page of the Cairns and Townsville White Pages® (Cairns: 1112 urban, 481 rural, 226 remote; Townsville: 1049 urban, 432 rural, 320 remote). The questionnaire covered personal demographics, health/risk factors, bowel habits, nutrition (fibre and fluid intake) and physical activity. Faecal incontinence was defined as accidental leakage of solid or liquid stool in the past 12 months that was not caused by a virus, medication or contaminated food. To improve the response rate a participation incentive of a chance to win a $250 voucher or one of ten $50 vouchers was offered in the initial mail-out. The initial survey was mailed out in July 2007; two follow-up surveys were mailed out to non-responders in September 2007 and January 2008. One hundred randomly selected non-responders were telephoned in February 2008. A total of 1523 responses provided a 48.1% response rate. Faecal incontinence prevalence was 12.7% (174/1366) with no gender or locality differences. Prevalence increased significantly with age in men (p=0.034), but not in women. Only 10 respondents with faecal incontinence consulted their doctor in the previous year for this reason. Incontinent respondents had significantly more medical conditions including urinary incontinence, coeliac disease, irritable bowel syndrome, injury to the anus, bowel cancer, spinal cord disease, neurological disease and psychiatric problems (all, p< 0.05). Stool-related accidental bowel leakage including faecal incontinence (defined), soiling with flatus or urgency, was 18.2%. An additional 3% were possibly incontinent, having disclosed leakage of mucus, bothersome or passive staining. Of the remaining respondents, 16.2% reported incontinent episodes due to an acute illness, 22.9% could not always differentiate between flatus and stool, and only 35.2% reported neither concerns with nor accidental bowel leakage. There is a high level of untreated faecal incontinence in North/Far North Queensland communities. Demand for treatment will increase because of the ageing population and the expectations of younger, more assertive cohorts.

Short Bowel Syndrome

Short bowel syndrome (SBS) occurs as a result of intestinal resection, and in many patients is associated with complications, such as diarrhea, dehydration, weight loss, and nutrition deficiencies. Many individuals with SBS develop intestinal failure and require parenteral nutrition (PN) and/or intravenous (IV) fluids (PN/IV). Although PN is essential for survival, some patients with SBS who require long-term PN experience significant complications that contribute to morbidity and mortality. Consequently, therapies that decrease reliance on PN are of considerable importance. Intestinal adaptation, which results in morphologic and functional changes that increase performance of the remnant bowel, occurs spontaneously after intestinal resection. These effects can be enhanced with nutrition and pharmaceutical approaches. For example, oral or tube-fed nutrients stimulate growth and adaptation of intestinal tissues. In addition, prebiotics support growth of beneficial intestinal microbiota that produce short-chain fatty acids, which have been shown in preclinical studies to enhance intestinal structure and function. Finally, glucagon-like peptide 2 (GLP-2) is an endogenous peptide that promotes intestinal rehabilitation and improves intestinal absorption. Teduglutide, a recombinant human GLP-2 analog, has recently been approved in the United States for the treatment of adults with SBS who are dependent on PN. In pharmacodynamic and clinical studies, teduglutide has been shown to promote changes in intestinal structure, such as increases in villus height and crypt depth, and to improve intestinal absorption, as indicated by reduced PN/IV dependence. This article presents a brief overview of SBS, including effects on survival and quality of life and current treatment options.

Blood Pressure and Cardiovascular Mortality in Dialysis Patients With Left Ventricular Systolic Dysfunction

In patients chronically treated with hemodialysis, the prevalence of heart failure is high with a consequently poor prognosis. The role played by blood pressure (BP) on cardiovascular (CV) mortality of these patients has not been clearly defined. In this follow-up study, we investigated the relationship of pre- and postdialysis measurements of BP with CV and all-cause mortality in a cohort of 557 dialysis patients with a left ventricular (LV) ejection fraction <50%. During the follow-up (mean = 21.6 ± 8.8 months), 179 deaths were recorded. Ninety-eight patients died from CV causes. By the Cox multivariable analysis, we constructed a predictive model of CV mortality including age, duration on dialysis, diabetes, serum albumin, diffusive dialysis technique, predialysis mean arterial pressure (MAP) (hazard ratio (HR) = 0.978; 95% confidence interval (CI) = 0.956-0.999), and postdialysis MAP (HR = 1.035; 95% CI = 1.010-1.061). The relationship with mortality was inverse for predialysis MAP and direct for postdialysis MAP. In a subsequent analysis, we found that pre- and postdialysis systolic BP, but not diastolic BP, were predictive of CV mortality. Predialysis MAP was in a direct relationship with body mass index. Postdialysis MAP had an inverse relationship with weight loss during dialysis session. CV mortality in dialysis patients with LV dysfunction is associated with both pre- and postdialysis BP interacting in a complex relationship. Nutritional state and fluid balance and removal are possible clues to this relationship.

Long-term Safety and Efficacy of Teduglutide for the Treatment of Intestinal Failure Associated with Short Bowel Syndrome: Final Results of the STEPS-2 Study, a 2-year, Multicenter, Open-label Clinical Trial

Purpose: Treatment with teduglutide (TED) promotes intestinal adaptation and absorptive capacity in patients (pts) with intestinal failure associated with short bowel syndrome (SBS-IF). In a 24-wk placebo (PBO)-controlled phase III study (STEPS), TED significantly reduced parenteral nutrition and/or intravenous fluid (PN/IV) volume requirements and number of infusion days in pts with SBS-IF. The primary objective of STEPS-2 was to further assess long-term safety and efficacy of TED in pts with SBS-IF. Methods: This extension study enrolled pts who completed 24 wks of treatment with TED (TED/TED) or PBO (PBO/TED) in STEPS or qualified for STEPS but were not treated because target enrollment numbers were met (NT/TED). For safety analysis, PBO/TED and NT/TED groups were combined (PBO+NT/TED). All pts who completed the study received subcutaneous TED (0.05 mg/kg/d) for ≥24 mo; pts in the TED/TED group received TED for 30 mo. Clinical response was defined as a 20%-100% reduction from baseline in weekly PN/IV volume. Results: Of 88 adults enrolled (TED/TED, n=37; PBO/TED, n=39; NT/TED, n=12), 65 (74%) pts completed the study. At 24 mo, clinical response was achieved by 28/30 (93%) TED/TED pts, 16/29 (55%) PBO/TED pts, and 4/6 (67%) NT/TED pts. Mean PN/IV volume reduction from baseline was 7.6 (66%) L/wk, 3.1 (28%) L/wk, and 4.0 (39%) L/wk in the TED/TED, PBO/TED, and NT/TED groups, respectively. Overall, TED treatment resulted in additional days off PN/IV, with 25/65 (38%) pts achieving ≥3-d/wk reduction (TED/TED, 18/30 [60%] pts; PBO/TED, 5/29 [17%]; NT/TED, 2/6 [33%]). 13/88 (15%) pts, including 10 in the TED/TED group, achieved independence from PN/IV. These pts achieved independence from PN/IV after 24-114 wks of TED treatment. Treatment-emergent adverse events occurred in 84/88 (95%) pts; the most common were abdominal pain (34%), catheter sepsis (28%), and episodes of decreased weight (25%). Twenty-three pts discontinued treatment [16/51 (31%) in PBO+NT/TED and 7/37 (19%) in TED/TED groups]. 64% of pts experienced serious AEs. Conclusion: Long-term treatment with TED resulted in additional, clinically meaningful reductions in PN/IV support. Complete independence from PN/IV support was achieved by a heterogeneous group of pts with SBS-IF who received TED. No unexpected safety signals were detected. These data suggest that long-term TED treatment is associated with continued reductions in PN/IV support, and independence from PN/IV for some pts. This research was funded by NPS Pharmaceuticals, Inc., Bedminster, NJ. Disclosure - Lauren K. Schwartz is a consultant for NPS Pharmaceuticals, Inc. Stephen J. D. O'Keefe is a consultant and has received grant/research support from NPS Pharmaceuticals, Inc. Palle B. Jeppesen has received grant/research support and has been an advisory board member as well as other (site investigator on clinical trials) for NPS Pharmaceuticals, Inc. Marek Pertkiewicz is a consultant as well as other (site investigator on clinical trials) for NPS Pharmaceuticals, Inc. Nader N. Youssef is an employee of NPS Pharmaceuticals, Inc. Ken Fujioka is a consultant for NPS Pharmaceuticals, Inc.

Indirect Boundary Element Method for Calculation of Inviscid Compressible Flow Past a Joukowski Aerofoil with Linear Element Approach Using Doublet Distribution Alone

In this paper, an indirect boundary element method is used to give solution for surface as well as ground water bodies which are major nutrition fluids. The inviscid compressible flow (i.e., velocity distribution) over the surface of the joukowski aerofoil has been calculated with linear element approach using doublet distribution alone whereas in our previous research papers, we applied constant boundary element approach for this purpose. To check the accuracy of the method, the computed flow velocity is compared with the exact velocity. The comparison of these results has been given in the tables and graphs. It is found that the computed results are in good agreement with the analytical results.

ADULT NUTRITIONAL STATUS ASSESSMENT: CROSS SECTIONAL FOLLOW UP STUDY IN A UNITED KINGDOM HOSPITAL

IntroductionMalnutrition in hospital is widely under-recognised (1). In 2011 a cross sectional study was carried out into nutritional status assessments at a UK District General Hospital. Out of 100 patients...

Teduglutide: A Review of its Use in the Treatment of Patients with Short Bowel Syndrome

The recombinant analogue of human glucagon-like peptide-2 (GLP-2) teduglutide (Gattex(®), Revestive(®)) is a novel therapy for short bowel syndrome (SBS). GLP-2 is a naturally occurring hormone that regulates the growth, proliferation and maintenance of cells lining the gastrointestinal tract. Subcutaneous teduglutide is the first long-term medical therapy approved for the treatment of adult patients with SBS who are dependent on parenteral support (parenteral nutrition and/or intravenous fluids). In a pivotal, double-blind, multicentre, phase III study in adult patients with SBS who were dependent on parenteral support, a significantly higher proportion of teduglutide 0.05 mg/kg/day recipients than placebo recipients achieved at least a 20% reduction from baseline in weekly parenteral support volume at week 20 and maintained at week 24 (primary endpoint). The overall mean reduction in weekly parenteral support volume from baseline was greater in patients who received teduglutide compared with those who received placebo. Additionally, more teduglutide-treated patients achieved at least a one-day reduction in parenteral support than those receiving placebo. Subcutaneous teduglutide had an acceptable tolerability profile; the most frequently reported adverse events were of gastrointestinal origin, consistent with the underlying disease condition and the known mechanism of action of teduglutide.

Effect of enteral nutrition as replacement of traditional bowel preparation on the intraperitoneal and intraluminal disseminated tumor cells, recurrence and metastasis in patients with colorectal cancer

To study the effect of enteral nutrition as replacement of mechanical bowel preparation on peritoneal and intraluminal disseminated tumor cells, recurrence and metastasis in patients with colorectal cancer. A total of 120 colorectal cancer patients between March 2007 and December 2011 were enrolled prospectively and randomly divided into two groups. Group A (n=60) received preoperative bowel preparation with enteral nutrition fluid (30 ml·kg(-1)·d(-1)), without enema, taxative or antibiotics. Group B (n=60) underwent traditional intestinal preparation consecutively 3 days before operation, including fasting, oral antibiotic, and cleaning enema. All the patients received peritoneal lavage with 400 ml of normal saline at the time of laparotomy and 200 ml of the lavage fluid was collected. All the cases underwent distal colorectal lavage with 1000 ml of normal saline before anastomosis, and 500 ml of the lavage fluid was collected. Fluid samples were quickly sent for exfoliated cytological examination. The positive rates of exfoliated cancer cell in peritoneal cavity and intraluminal cavity, postoperative complication, recurrence and metastasis were compared between the two groups. In group A, exfoliated cancer cells were found in 5 of 60 cases (8.3%) in peritoneal lavage fluid and in 9 of 60 cases (15.0%) in distal colorectal lavage fluid, while in group B, cancer cells were found in 13 of 60 cases (12.5%) and 19 of 60 cases (31.7%) respectively. There were significant differences between group A and B (P=0.041, P=0.031). Fifty-five patients in group A were followed up from 16 to 46 months after surgery, as well 57 patients in group B. Rates of local recurrence and distant metastasis in Group A and B were 5.5% vs. 7.0% and 10.9% vs. 10.5% respectively. There were no significant differences (P=0.733, P=0.984). There was no significant difference in 3-year survival rate between the two groups (80% vs. 78%, P=0.312). Enteral nutrition instead of traditional bowel preparation can decrease the positive rate of disseminated cancer cells in peritoneal cavity or colorectal lumen, while dose not affect recurrence and metastasis rates in patients with colorectal cancer.

The novel use of peptide analogs in short bowel syndrome

The approval of the peptide analog, tedu -glutide, by the US FDA and EMA in 2012 for the treatment of short bowel syndrome (SBS) is anticipated to increase the aware -ness of this rare, serious, potentially life-threatening, orphan condition. SBS results from surgical resection, congenital defect or disease-associated loss of absorption. Patients with intestinal insufficiency main -tain their metabolic balances though oral compensation, pharmacologic or physi-ologic adaptation, whereas supplemental parenteral support (PS; parenteral nutri-tion and/or intravenous fluids) through a central catheter is required to maintain fluid, electrolytes, trace elements, vita-mins, nutrient balances and ultimately life in patients with SBS with intestinal failure (SBS-IF)

Increased Intestinal Absorption in the Era of Teduglutide and Its Impact on Management Strategies in Patients With Short Bowel Syndrome–Associated Intestinal Failure

Short bowel syndrome-associated intestinal failure (SBS-IF) as a consequence of extensive surgical resection of the gastrointestinal (GI) tract results in a chronic reduction in intestinal absorption. The ensuing malabsorption of a conventional diet with associated diarrhea and weight loss results in a dependency on parenteral nutrition and/or intravenous fluids (PN/IV). A natural compensatory process of intestinal adaptation occurs in the years after bowel resection as the body responds to a lack of sufficient functional nutrient-processing intestinal surface area. The adaptive process improves bowel function but is a highly variable process, yielding different levels of symptom control and PN/IV independence among patients. Intestinal rehabilitation is the strategy of maximizing the absorptive capacity of the remnant GI tract. The approaches for achieving this goal have been limited to dietary intervention, antidiarrheal and antisecretory medications, and surgical bowel reconstruction. A targeted pharmacotherapy has now been developed that improves intestinal absorption. Teduglutide is a human recombinant analogue of glucagon-like peptide 2 that promotes the expansion of the intestinal surface area and increases the intestinal absorptive capacity. Enhanced absorption has been shown in clinical trials by a reduction in PN/IV requirements in patients with SBS-IF. This article details the clinical considerations and best-practice recommendations for intestinal rehabilitation, including optimization of fluids, electrolytes, and nutrients; the integration of teduglutide therapy; and approaches to PN/IV weaning.

Nutrition and Fluid Optimization for Patients With Short Bowel Syndrome

Short bowel syndrome (SBS) is characterized by nutrient malabsorption and occurs following surgical resection, congenital defect, or disease of the bowel. The severity of SBS depends on the length and anatomy of the bowel resected and the health of the remaining tissue. During the 2 years following resection, the remnant bowel undergoes an adaptation process that increases its absorptive capacity. Oral diet and enteral nutrition (EN) enhance intestinal adaptation; although patients require parenteral nutrition (PN) and/or intravenous (IV) fluids in the immediate postresection period, diet and EN should be reintroduced as soon as possible. The SBS diet should include complex carbohydrates; simple sugars should be avoided. Optimal fat intake varies based on patient anatomy; patients with end-jejunostomies can tolerate a higher proportion of calories from dietary fat than patients with a remnant colon. Patients with SBS are prone to deficiencies in vitamins, minerals, and essential fatty acids; serum levels should be periodically monitored and supplements provided as needed. Prebiotic or probiotic therapy may be beneficial for patients with SBS, although further research is needed to determine optimal protocols. Patients with SBS, particularly those without a colon, are at high risk of dehydration; oral rehydration solutions sipped throughout the day can help maintain hydration. One of the primary goals of SBS therapy is to reduce or eliminate dependence on PN/IV; optimization of EN and hydration substantially increases the probability of successful PN/IV weaning.

Extending total parenteral nutrition hang time in the neonatal intensive care unit: Is it safe and cost effective?

To investigate the effects of prolonging hang time of total parenteral nutrition (TPN) fluid on central line-associated blood stream infection (CLABSI), TPN-related cost and nursing workload. A before-after observational study comparing the practice of hanging TPN bags for 48 h (6 February 2009-5 February 2010) versus 24 h (6 February 2008-5 February 2009) in a tertiary neonatal intensive care unit was conducted. The main outcome measures were CLABSI, TPN-related expenses and nursing workload. One hundred thirty-six infants received 24-h TPN bags and 124 received 48-h TPN bags. Median (inter-quartile range) gestation (37 weeks (33,39) vs. 36 weeks (33,39)), mean (±standard deviation) admission weight of 2442 g (±101) versus 2476 g (±104) and TPN duration (9.7 days (±12.7) vs. 9.9 days (±13.4)) were similar (P > 0.05) between the 24- and 48-h TPN groups. There was no increase in CLABSI with longer hang time (0.8 vs. 0.4 per 1000 line days in the 24-h vs. 48-h group; P < 0.05). Annual cost saving using 48-h TPN was AUD 97,603.00. By using 48-h TPN, 68.3% of nurses indicated that their workload decreased and 80.5% indicated that time spent changing TPN reduced. Extending TPN hang time from 24 to 48 h did not alter CLABSI rate and was associated with a reduced TPN-related cost and perceived nursing workload. Larger randomised controlled trials are needed to more clearly delineate these effects.

Associations between bioelectrical impedance parameters and cardiovascular events in chronic dialysis patients

Malnutrition and fluid overload contribute to the poor cardiovascular prognosis of dialysis patients. Since bioelectrical impedance analysis is an option for the evaluation of body composition and for the monitoring of hydration state, it may assist in the identification of subjects at high cardiovascular risk. The objective of this study was to evaluate the association between bioelectrical impedance parameters and cardiovascular events. The association between bioelectrical impedance parameters and fatal and non-fatal cardiovascular outcome was evaluated in 145 dialysis patients. The mean age of the population studied was 54.9 ± 15.4 years, 49.7 % were males, and 35.9 % had diabetes. Forty (27.6 %) patients developed cardiovascular events during the 16 months (8; 32) of follow-up. Comparison of patients with and without cardiovascular events revealed higher extracellular mass/body cell mass (ECM/BCM) and extracellular water/total body water ratios and higher C-reactive protein levels in the former. Survival analysis showed that an ECM/BCM ratio >1.2 and a phase angle <6° were associated with poor cardiovascular prognosis. Among nondiabetic patients, these parameters and capacitance were independently associated with cardiovascular events, suggesting that poor nutritional status and fluid overload are associated with the occurrence of these events. Phase angle, capacitance and ECM/BCM ratio are valuable parameters for the evaluation of cardiovascular prognosis, supporting the use of bioelectrical impedance for the clinical assessment of dialysis patients.

Identification and Early Treatment of Dehydration in Home Parenteral Nutrition and Home Intravenous Fluid Patients Prevents Hospital Admissions

Early identification and treatment of dehydration is prudent in patients requiring home parenteral nutrition (HPN) or home intravenous fluids (HIVF) to prevent hospital admissions for dehydration. Our home nutrition support service (HNS) developed a protocol in 2010 to provide additional bags of HIVF to be kept on hand for immediate use in patients identified at risk of developing dehydration. A retrospective review was performed on all HPN and HIVF patients from a clinical database who received additional HIVF during 2010. Standard treatment for dehydration was 1 L HIVF daily for 3 days in addition to prescribed infusions. Of 308 HNS patients in 2010, additional HIVF were ordered in 161 patients with malabsorption, fistula, or obstruction. Of the 161 patients, 63% (n = 102) required additional HIVF and had 201 episodes of dehydration recorded. Increased enterostomy output (P = .021), negative intake and output (I/O data) (P = .014), and age (P = .021) were predictors of multiple dehydration episodes. I/O data were consistent with signs and symptoms of dehydration 80% of the time. One hundred seventy episodes (84.5%) of dehydration were successfully treated at home compared with 9 emergency room (ER) admissions (4.5%) and 22 hospital admissions (11%) for dehydration. We demonstrate 84.5% of episodes of dehydration successfully treated in the home in patients initially identified at risk by our protocol. Education of patients at risk of dehydration prior to discharge and providing additional HIVF on hand for immediate use may avoid ER treatment or hospitalization and potentially save healthcare costs.

Long Term Therapy with Teduglutide: Characteristics of Patients With Short Bowel Syndrome Who Achieve Complete Independence from Parenteral Nutrition and/or Intravenous Fluid Support

Long Term Therapy with Teduglutide: Characteristics of Patients With Short Bowel Syndrome Who Achieve Complete Independence from Parenteral Nutrition and/or Intravenous Fluid Support

350 Effects of Different Fatty Acids on Red Blood Cell Morphology

Background and AimsRecently echinocytosis and subsequent haemolytic anaemia was described in a premature infant receiving omega-3 fatty acids (Omegaven) in parenteral nutrition. It was presumed that omega-3 fatty acids caused...

Ibuprofen-loaded chitosan and chemically modified chitosans—Release features from tablet and film forms

The biopolymer chitosan was chemically modified in two sequences of reactions: (i) immobilization of methyl acrylate followed by cysteamine and (ii) the sequence of immobilization reactions involving ethylene sulfide, methyl acrylate and finally cysteamine. In both cases the pendant chains have attached nitrogen, oxygen and sulfur basic centers. The corresponding structures were characterized through elemental analysis, infrared spectroscopy, nuclear magnetic resonance in the solid state for carbon, thermogravimetry and scanning electron microscopy. The newly synthesized biopolymers have abilities to immobilize and controllably release the non-steroidal drug ibuprofen. The ibuprofen-loaded biomaterials as tablets or as films crosslinked with glutaraldehyde revealed that drug release is pH sensitive. The chemically modified chitosan may allow reduction of drug release in stomach fluids, since the functional groups cause a decrease in swelling rate at pH 1.2, opposite to the behavior that occurs at pH 7.4, that of nutritional fluid, where an increase of the rate of swelling occurs. In such conditions the negatively charge ibuprofen is electrostatically repelled by negative chitosan derivative surfaces.

Differentiation and function of the ovarian somatic cells in the pseudoscorpion, Chelifer cancroides (Linnaeus, 1761) (Chelicerata: Arachnida: Pseudoscorpionida)

Pseudoscorpion females carry fertilized eggs and embryos in specialized brood sacs, where embryos are fed with a nutritive fluid produced and secreted by somatic ovarian cells. We used various microscopic techniques to analyze the organization of the somatic cells in the ovary of a pseudoscorpion, Chelifer cancroides. In young specimens, the ovary is a cylindrical mass of internally located germline cells (oogonia and early previtellogenic oocytes) and two types of somatic cells: the epithelial cells of the ovarian wall and the internal interstitial cells. In subsequent stages of the ovary development, the oocytes grow and protrude from the ovary into the hemocoel (opisthosomal cavity). At the same time the interstitial cells differentiate into the follicular cells that directly cover the oocyte surface, whereas some epithelial cells of the ovarian wall form the oocyte stalks – tubular structures that connect the oocytes with the ovarian tube. The follicular cells do not seem to participate in oogenesis. In contrast, the cells of the stalk presumably have a dual function. During ovulation the stalk cells appear to contribute to the formation of the external egg envelope (chorion), while in the post-ovulatory phase of ovary function they cooperate with the other cells of the ovarian wall in the production of the nutritive fluid for the developing embryos.

Nutritional support for acute kidney injury

Treatment for acute kidney Injury (AKI) primarily relies on treating the underlying cause and maintaining the patient until kidney function has recovered. Enteral and parenteral nutrition are commonly used to treat nutritional disorders in AKI patients, however their efficacy in treating AKI are still debated. This review was first published in 2010. To evaluate the effectiveness and safety of nutritional support for patients with AKI. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Chinese Biomedical Disc, VIP and China National Knowledge Infrastructure (CNKI).Date of last search: 4 July 2012 All randomised controlled trials (RCTs) reported for AKI and nutrition were included. Authors independently assessed study quality and extracted data. Results were expressed as risk ratio (RR) with 95% confidence intervals (CI) or mean difference (MD). Eight studies (257 participants) were included. An overall pooled analysis was not performed due to the different interventions used and different outcomes measured. Selection bias was not reported (unclear) in six studies and was adequately reported (low) for random sequence generation in two studies. Participant/personnel blinding was adequately reported in one study and unclear in seven. Incomplete outcome reporting bias was low in six studies and high in two. Selective reporting was low in six studies, unclear in one study, and high in one study. No other biases were detected. There was a significant increase in recovery rate for AKI (RR 1.70, 95% CI 1.70 to 2.79) and survival in dialysed patients (RR 3.56, 95% CI 0.97 to 13.08) for intravenous essential L-amino acids (EAA) compared to hypertonic glucose alone. Compared to lower calorie-total parenteral nutrition (TPN), higher calorie-TPN did not improve estimated nitrogen balance, protein catabolic rate, or urea generation rate; but increased serum triglycerides, glucose, insulin need and nutritional fluid administration. There was no difference between groups in estimated nitrogen balance, but there were differences between urea nitrogen appearance (MD 0.98, 95% CI 0.25 to 1.71) and net protein utilisation (MD 21.50%, 95% CI 0.39 to 42.61). Urea nitrogen appearance was lower in the low nitrogen intake group than in the high nitrogen intake group. There was no significant difference in death between EAA and general amino acids (GAA) (RR 1.52, 95% CI 0.63 to 3.68). High dose amino acids did not improve cumulative water excretion, furosemide requirement, nitrogen balance or death compared to normal dose amino acids. Glucose+EAA+histidin had better nitrogen balance than glucose+GAA; glucose+nitrogen+fat significantly increased serum creatinine compared with glucose+GAA; glucose+EAA+histidin significantly improved nitrogen balance, U/P urea and serum creatinine, but increased plasma urea compared to glucose+nitrogen+fat. There was insufficient evidence found to support the effectiveness of nutritional support for AKI. Further high quality studies are required to provide reliable evidence of the effect and safety of nutritional support.