Gastric Feeding Research Articles

Continuous versus Bolus Gastric Tube Feeding in Very Low Birth Weight Infants Supported with Noninvasive Respiratory Support: A Randomized, Pilot Study.

This study aimed to compare time to full feeding (TFF) between continuous gastric feeding (CGF) and bolus feeding (BF) in very low birth weight (VLBW) infants supported with noninvasive ventilation (NIV) and to evaluate feasibility and identify methodological pitfalls for future large-scale studies. This study is a randomized controlled, prospective, pilot study. VLBW premature infants, supported with NIV, were randomized while still on trophic feeding <20 mL/kg/day to receive feeding over 2 hours of CGF or over 15- to 30-minute BF. The primary outcome was TFF. Analysis was done by intention to treat. Overall, 32 infants were included in this analysis, 17 in the CGF group and 15 in the BF group. Infants in the CGF group were significantly younger than the BF group (mean ± standard deviation [SD] gestational age [GA] 26.9 ± 1.2 vs. 28.9 ± 1.5 weeks, respectively). TFF was comparable with median (interquartile range [IQR]) for the two groups, 10.0 (10.0, 19.0) days in the BF group versus 12.0 (9.0, 13.0) days in the CGF group (p = 0.59). Feeding length was not found to significantly affect TFF in multivariate analysis correcting for GA. Groups were comparable in weight gain, gastrointestinal complications, length of NIV, bronchopulmonary dysplasia incidence, and age at discharge. Most infants from both groups (60% of BF and 70% of CGF) required changes in feeding length. In this pilot study, among VLBW infants supported with NIV, TFF was comparable between the BF and CGF groups. These results should be interpreted with caution due to the small sample size and despite the multivariate analysis correcting for the different GA. Interestingly, most infants required changes in feeding length regardless of their allocation. This feasibility study emphasizes the need for careful attention to randomization and strict feeding protocols including criteria for switching allocation in future large-scale studies aimed at determining the preferred feeding length during NIV in VLBW infants. · Among infants supported with NIV, length of feeding affects gastric venting.. · BF might increase gastrointestinal reflux, while continuous feeding hinders gastric decompression.. · Among infants supported by NIV, feeding tolerance was comparable between bolus and continuous groups..

Impact of fasting on the gastric volume of critically ill patients before extubation: a prospective observational study using gastric ultrasound.

A period of fasting before tracheal extubation of ventilated patients in the ICU is common practice, aiming to reduce gastric volume and aspiration risk. As the volume of gastric content is unknown at the time of extubation, the efficacy of this practice is uncertain. A prospective, observational study using gastric ultrasound was undertaken. Images were obtained at four time points: (i) at baseline, with gastric feeds running; (ii) after suctioning of gastric contents through a gastric tube; (iii) after a 4 h period with no gastric feed running; and (iv) after both a 4 h fasting period and gastric tube suctioning. The primary outcome was the proportion of patients classed as low risk of aspiration with each intervention, using qualitative and quantitative gastric ultrasound. Fifty-four patients in the ICU were enrolled. Forty-four (81%) subjects had images that were suitable for analysis. Suctioning of stomach content through a gastric tube and fasting were equivalent with 39/44 (88.6%) and 5/44 (11.4%) subjects classified as low risk and at risk of aspiration, respectively. A period of fasting followed by suction resulted in 41/44 (93.2%) patients being at low risk. Suctioning of stomach contents through the gastric tube and a 4 h fasting period appear equivalent at reducing gastric volume below a safe threshold. A small percentage did not reach the threshold despite all interventions.

Serial Ultrasonographic-measurement of Gastric Residual Volume in Critically Ill Patients for Prediction of Gastric Tube Feed Intolerance.

ABSTRACTObjectiveTo study the use of serial ultrasound gastric residual volume (GRV) measurements in predicting feed intolerance in critically ill patients.Patients and methodsThis study was conducted in various intensive care units (ICUs) of All India Institute of Medical Sciences, New Delhi. Forty-three critically ill patients aged more than 18 years were studied for a total of 130 enteral feeding days. Gastric residual volume was obtained by calculating the antral cross-sectional area (CSA), which is the product of anteroposterior (AP) and craniocaudal (CC) diameters of gastric antrum obtained using ultrasound in the right lateral decubitus position. A baseline measurement was done before the initiation of the enteral feed and termed GRV0, the ultrasound scanning was repeated every 1 hour for the first 4 hours and termed GRV1, GRV2, GRV3, and GRV4, respectively, and the patients were watched for feed intolerance. The receiver operating characteristic (ROC) curves were constructed to correlate the GRV at each time with feed intolerance.ResultsThe data from 43 medical and surgical critically ill patients were analyzed. Out of 130 feeding days, 13 were noted to be feed intolerant. Gastric residual volume at the end of the fourth hour of feed, that is, GRV4 was the best predictor of feed intolerance with 99.3% area under the curve (AUROC), sensitivity of 99%, specificity of 99.3%, and 95% CI, 0.89–0.98 followed by GRV3, with AUROC of 96% and sensitivity and specificity of 92.3 and 96%, respectively, with 95% CI, 0.92–0.99.How to cite this articleAnkalagi B, Singh PM, Rewari V, Ramachandran R, Aggarwal R, Soni KD, et al. Serial Ultrasonographic-measurement of Gastric Residual Volume in Critically Ill Patients for Prediction of Gastric Tube Feed Intolerance. Indian J Crit Care Med 2022;26(9):987–992.

The The Colon Interposition as Esophageal Replacement in Long-Gap Esophageal Atresia

Background: Long-gap Esophageal Atresia (LGEA) remains one of the most challenging congenital conditions. When primary anastomoses attempts had failed, esophageal replacement (ER) is indicated in these patients. Some infants with LGEA are born with other congenital anomalies, such as rectourethral fistula. In this study, we reported our experience in managing newborn with LGEA and rectourethral fistula. Case: A 1-day-old male neonate complained of unable to swallow any breast milk and presence of feces-like discharge from external urethral orifice within 24 hours after birth. Oral gastric tube was unable to pass into the stomach and x-ray examination revealed curled gastric tube in esophagus, and there wasn’t any bubble seen from patient’s stomach. Patient then was diagnosed with long gap esophageal atresia without fistula. Esophageal replacements using left colon interposition technique was performed as closing and final procedure. Gastrostomy tube insertion, sigmoid colostomy, and cervical esophagostomy were immediately performed. Posterior sagittal anorectoplasty (PSARP) for patient’s recto-urethral fistula were performed six months after sigmoid colostomy. Patient was hospitalized with total of 32 days and gastric feeding tube can be removed three months after surgery. Conclusion: colon interposition can be safely used in long gap esophageal atreasia although patient had undergone previous colostomy repair. Long-term follow up will be needed. Further large-scale studies regarding this matter are necessary and hopefully comprehensive treatment can be established in the future.&#x0D;

Postoperative feeding in neonatal duodenal obstruction

BackgroundFindings from manometry studies and contrast imaging reveal functioning gastric physiology in newborns with duodenal atresia and stenosis. Stomach reservoir function should therefore be valuable in aiding the postoperative phase of gastric feeding. The aim of this study was therefore to compare the feasibility of initiating oral or large volume(s) gavage feeds vs small volume bolus feeds following operation for congenital duodenal anomalies.MethodsSingle-center electronic medical records of all babies with duodenal atresia and stenosis admitted to a university surgical center during January 1997–September 2021 were analyzed. A fast-fed group (FF) included newborns fed with oral or gavage feeds advanced at a rate of at least 2.5 ml/kg and then progressed more than once a day vs slow-fed group (SF) fed with gavage feeds at incremental rate less than 2.5 ml/kg/day for each time period of oral tolerance or by drip feeds. Total feed volume was limited to 120–150 ml/kg/day in the respective study cohort populations.ResultsFifty-one eligible patients were recruited in the study - twenty-six in FF group and twenty-five in SF group. Statistically significant differences were observed in the (i) date of first oral feeds (POD 7.7 ± 3.2 vs 16.1 ± 7.7: p < 0.001), and (ii) first full feeds (POD 12.5 ± 5.3 vs 18.8 ± 9.7: p < 0.01) in FF vs SF study groups.ConclusionInitial feeding schedules with oral or incremental gavage-fed rates of at least 2.5 ml/kg in stepwise increments and multi-steps per day is wholly feasible in the postoperative feeding regimens of neonates with congenital duodenal disorders. Significant health benefits are thus achievable in these infants allowing an earlier time to acquiring full enteral feeding and their hospital discharge.

Human Umbilical Cord Wharton Jelly Cells Treatment Prevents Osteoporosis Induced by D-Galactose.

Methods Sixteen male mice were randomly divided into 4 groups: control (ordinary feeding), D-gal (D-galactose) group, D-gal + MSC (human umbilical cord Wharton jelly cells), and D-gal + MSC-TNFα groups. Except for the control group (fed with same amount of saline solution), other mice received gastric feeding of 250 mg/kg D-galactose every day for 8 weeks. TNFα (10 ng/mL for 24 h) cocultured or noncocultured HUCWJCs (5 × 105) were suspended in 0.1 ml of sterile PBS and injected into tail veins every other week in D-gal + MSC-TNFα and D-gal + MSC groups, respectively, and only 0.1 ml of sterile PBS for control and D-gal groups. The bone mass was detected by qPCR, ELISA, microcomputed tomography (μCT), and hematoxylin-eosin staining. Proliferation, apoptosis, and differentiation of periosteal-derived osteoblasts (POB) were assessed. Transwell assay and scratch healing were performed to detect POB migration and invasion ability. The effect of HUCWJCs on POB signaling pathway expression was evaluated by immunoblotting. Results The malondialdehyde (MDA) in serum was higher and superoxide dismutase (SOD) was lower in the D-gal group compared to the other groups (p < 0.05). Mice in D-gal group showed significantly decreased bone mass when compared to the control group, while HUCWJCs treatment partially rescued the phenotype, as demonstrated by μCT and histology (p < 0.05). Mechanically, HUCWJCs treatment partially promoted proliferation and migration and decreased apoptosis of POB induced by oxidative stress via activating the mitogen-activated protein kinase (MAPK) signaling pathway. Conclusion HUCWJCs can prevent the progression of osteoporosis by inhibiting oxidative stress, which may act by regulating osteoblasts fate through the MAPK signaling pathway.

Foods for Special Medical Purposes in Home Enteral Nutrition-Clinical Practice Experience. Multicenter Study.

BackgroundEnteral nutrition (EN) with foods for special medical purposes (FSMP) is recommended for most patients on home enteral nutrition (HEN). Although there are disease-specific guidelines for energy, protein, and micronutrient provision, only a few studies are showing real-life experience in the long-term use of FSMP.MethodsIn a multicenter study, the influence of the FSMP composition and administration technique (bolus vs. continuous) on protein and energy provision in HEN was analyzed. Provision of vitamins and minerals was compared to recommended daily allowance (RDA) and upper tolerable limit (UL).ResultsApproximately, 772 patients on HEN, mostly (88.6%) with oncological and neurological diseases, were enrolled. The patients on standard FSMP received less protein and energy than those on hypercaloric and protein enriched despite receiving higher volumes of EN (p < 0.05). No differences were observed in jejunal feeding with oligomeric vs. polymeric FSMP in terms of energy, protein, and volume. Continuous gastric feeding provided more protein, energy, and volume vs. bolus feeding (p < 0.05). Significant number of patients received less than 100% RDA of vitamin D (50.5%), vitamin B3 (49%), vitamin K (21.8%), vitamin B5 (64.3%), vitamin B9 (60%). Majority of the patients received less than 100% RDA of sodium (80.2%), potassium (99%), chloride (98%), calcium (67%), magnesium (87%), fluoride (99%), and iodine (43%). Approximately, 43.63% of cancer and 49.9% of neurological patients received less than 1 g/kg/day of protein and 51.7% of cancer and 55.5% of neurological patients received less than 25 kcal/kg/day.ConclusionAwareness of the available compositions of FSMP and advantageous profiles of specific diets may lead to the implementation of recommendations for EN. HEN professionals need to analyze all the patient’s needs and requirements to provide more tailored matching of nutritional support.

Nutrition in acute pancreatitis: when, what and how.

This review intends to discuss recently available evidence in three topics related to nutrition in patients with acute pancreatitis, namely timing of refeeding, type of nutritional therapy and its route of administration. Recent lines of research confirm that early oral feeding leads to shorter length of stay, fewer complications and lower costs in patients with acute pancreatitis. Moreover, early (<48 h) enteral nutrition led to decreased hospital mortality in patients with mild and severe acute pancreatitis; thus, in case of intolerance to oral feeding or severe disease, nutritional therapy should be offered within 24-72 h. Furthermore, enteral nutrition should be preferred against parenteral nutrition, as it is related to shorter length of stay and less complications, while initial data bring to light the potential role of the soluble dietary fibre polydextrose as an agent that could lead to faster achievement of energy goal with concomitant lower rates of feeding intolerance. Finally, enteral nutrition can be administered through gastric or jejunal feeding, depending on digestive tolerance, whereas latest data also address the safety of percutaneous gastrostomy with a jejunal extension for enteral nutrition administration. However, more data about its real benefit are warranted. Accumulating evidence confirms the importance of early oral refeeding or early administration of enteral nutrition as vital parts of the armamentarium for the management of patients with acute pancreatitis.

Incidence and risk factors of nasogastric feeding intolerance in moderately-severe to severe acute pancreatitis

BackgroundThe importance of enteral nutrition (EN) in acute pancreatitis (AP) has been emphasised. Nasogastric (NG) feeding has been the preferred route for EN delivery in most AP patients intolerant to oral intake. However, gastric feeding intolerance (GFI) was frequently reported, especially in patients with more severe diseases. This study aimed to investigate the incidence and risk factors for GFI in moderately-severe to severe AP.MethodsThis is a single-centre, retrospective study. All the data were extracted from an electronic database from April 2020 to May 2021. Data were prospectively collected during hospitalisation. Patients diagnosed with moderately-severe to severe AP and admitted within seven days from the onset of abdominal pain were assessed for eligibility. Patients who showed signs of intolerance to gastric feeding and required switching to nasojejunal (NJ) feeding were deemed GFI. Multivariable logistic regression was performed to assess potential risk factors of GFI.ResultsA total of 93 patients were analysed, of whom 24 were deemed GFI (25.8%), and the rest tolerated NG feeding well (n = 69). In patients with GFI, the median time of switching to NJ feeding was five days (interquartile range: 4–7 days) after admission. The multivariable analysis showed that respiratory failure (odds ratio = 3.135, 95% CI: 1.111–8.848, P = 0.031) was an independent risk factor for GFI.The mean daily energy delivery in the following three days after switching to NJ feeding was significantly higher than the first three days after initiation of NG feeding in patients with GFI [920.83 (493.33–1326) vs. 465 (252.25–556.67) kcal, P < 0.001].ConclusionGFI is common in moderately-severe to severe AP patients with an incidence of 25.8%, and the presence of respiratory failure may increase the risk of GFI.

Ventilator-associated pneumonia prevention in the Intensive care unit using Postpyloric tube feeding in China (VIP study): study protocol for a randomized controlled trial

BackgroundVentilator-associated pneumonia is a challenge in critical care and is associated with high mortality and morbidity. Although some consensuses on preventing ventilator-associated pneumonia are reached, it is still somewhat controversial. Meta-analysis has shown that postpyloric tube feeding may reduce the incidences of ventilator-associated pneumonia, which still desires high-quality evidence. This trial aims to evaluate the efficacy and safety profiles of postpyloric tube feeding versus gastric tube feeding.Methods/designIn this multicenter, open-label, randomized controlled trial, we will recruit 924 subjects expected to receive mechanical ventilation for no less than 48 h. Subjects on mechanical ventilation will be randomized (1:1) to receive postpyloric or gastric tube feeding and routine preventive measures simultaneously. The primary outcome is the proportion of patients with at least one ventilator-associated pneumonia episode. Adverse events and serious adverse events will be observed closely.DiscussionThe VIP study is a large-sample-sized, multicenter, open-label, randomized, parallel-group, controlled trial of postpyloric tube feeding in China and is well-designed based on previous studies. The results of this trial may help to provide evidence-based recommendations for the prevention of ventilator-associated pneumonia.Trial registrationChictr.org.cn ChiCTR2100051593. Registered on 28 September 2021

A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge and Practice of Nasogastric Tube Feeding to Adult Patient among Nursing Personnel Working in Selected Hospitals, Bangalore

Administration of nutrients directly into the stomach, duodenum, or jejunum through a tube is more physiologically beneficial and cost effective than parenteral feeding. In the hospital settings, most of the critically ill patients are on naso gastric tube feeding to meet their nutritional needs. The unhygienic practices and improper insertion of naso gastric tube by the nursing personnel’s increases the risk of infection and other health hazards. Nursing practice still needs to understand how modern technology and instrumental device in naso gastric tube feeding works. Though the nursing personnel are handling the procedure with knowledge and skills, the exciting condition of the patient cannot be satisfied due to the misplacement of the tube. Hence the researcher conducted “A study to assess the effectiveness of structured teaching programme on knowledge and practice of Naso gastric tube feeding to adult patient among nursing personnel” working in selected hospitals, Bangalore. A quantitative research approach and Non probability convenient sampling technique was used. The sample was selected by using simple random technique was used to select 50 nursing personnel working in selected hospital, Bangalore. Structured questionnaire was used to assess the levels of knowledge and practice. Descriptive and inferential statistics were used for analysis and interpretation of data. Effectiveness of Structured teaching programme on the levels of knowledge and practice regarding Naso gastric tube feeding among nursing personnel was assessed by using Paired ‘t’test. Association between pretest knowledge level with the selected demographic variables was analyzed using Chi-square test. Keywords: Naso gastric tube feeding, Nursing personnel, adult patient.

JPN clinical practice guidelines 2021 with easy-to-understand explanations for the management of acute pancreatitis.

In preparing the Japanese (JPN) guidelines for the management of acute pancreatitis 2021, the committee focused the issues raised by the results of nationwide epidemiological survey in 2016 in Japan. In addition to a systematic search using the previous JPN guidelines, papers published from January 2014 to September 2019 were searched for the contents to be covered by the guidelines based on the concept of GRADE system. Thirty-six clinical questions (CQ) were prepared in 15 subject areas. Based on the facts that patients diagnosed with severe disease by both Japanese prognostic factor score and contrast-enhanced computed tomography (CT) grade had a high fatality rate and that little prognosis improvement after 2 weeks of disease onset was not obtained, we emphasized the importance of Pancreatitis Bundles, which were shown to be effective in improving prognosis, and the CQ sections for local pancreatic complications had been expanded to ensure adoption of a step-up approach. Furthermore, on the facts that enteral nutrition for severe acute pancreatitis was not started early within 48h of admission and that unnecessary prophylactic antibiotics was used in almost all cases, we emphasized early enteral nutrition in small amounts even if gastric feeding is used and no prophylactic antibiotics are administered in mild pancreatitis. All the members of the committee have put a lot of effort into preparing the extensively revised guidelines in the hope that more people will have a common understanding and that better medical care will be spread.

Duodenal versus gastric feeding in patients with traumatic brain injury: a systematic review and meta-analysis

IntroductionEnteral nutrition support is very important to improve the prognosis of patients with traumatic brain injury (TBI). We aimed to assess the role of duodenal versus gastric feeding in TBI patients, to provide insights into the clinical practice and nursing care.Material and methodsWe searched PubMed and other databases for RCTs on the role of duodenal versus gastric feeding in TBI patients up to Dec 15, 2021. Cochrane Collaborations risk of bias tool was used to assess the methodological quality and risk of bias of included studies. The RevMan 5.3 software was used for data analysis, risk rate (RR) or mean differences (MDs) with 95% confidence interval (CI) were calculated, and publication bias were evaluated by funnel plots.ResultsA total of 16 RCTs were included in this meta-analysis. Synthesized outcomes indicated that compared with gastric feeding, duodenal feeding is beneficial to reduce the incidence of pneumonia[RR =0.46, 95% CI (0.38, 0.57)], aspiration[RR =0.30, 95% CI (0.14, 0.63)], reflux esophagitis[RR =0.25, 95% CI (0.17, 0.38)], diarrhea [RR =0.58, 95% CI (0.44, 0.77)], abdominal distension[RR =0.41, 95% CI (0.25, 0.68)], no significant difference in the mortality[RR =0.85, 95% CI (0.50, 1.47), P=0.57] was found. Egger regression test indicated that there were no publication biases in the synthesized outcomes (all p&gt;0.05).ConclusionsDuodenal feeding may be superior to gastric feeding in the treatment and nursing care of TBI patients with less complications. Future studies with larger sample size and rigorous design are needed to further elucidate the effects and safety of duodenal versus gastric feeding.

The effects of abdominal-based early progressive mobilisation on gastric motility in endotracheally intubated intensive care patients: A randomised controlled trial

ObjectiveTo examine whether an abdominal-based early progressive mobilisation program improves gastric motility and reduces feeding intolerance in critically ill patients with endotracheal intubation. Design and MethodsA randomised controlled trial was designed. Adult patients admitted to the intensive care unit who were intubated and had an order for enteral nutrition were randomly assigned to partake in an three stages of abdominal-based progressive mobilisation program (passive abdominal massage, bed-side bicycle and ambulating) or standard of care. Gastric antral motility was measured by bedside ultrasound. ResultsA total of 83 critically ill patients were included in the study. The intervention group displayed a statistically significant improvement in the antral motility index than the control group (p < .001), as well as in complications of feeding intolerance, including the incidence of abdominal distention (9.8% vs 33.3%, p = .009), vomiting (0% vs 16.7%, p = .019) and diarrhoea (22% vs 50%, p = .008). However, no significant difference for the full enteral feeding rate on the third day was observed between the groups.Furthermore, time on mechanical ventilation (4.52 ± 2.77 days vs 6.24 ± 3.90 days, p = .023) was shorter in intervention group, but no significant difference of length of intensive care unit stay was observed between the groups. ConclusionsImplementation of an abdominal-based early progressive mobilisation program can improve gastric motility and feeding intolerance in critically ill patients with an endotracheal tube.

Is nasojejunal feeding as effective as we think? An evaluation of nasojejunal feeding in the Intensive Care Unit

Early enteral feeding is important in maintaining the integrity of the gastrointestinal tract mucosal barrier and associated with less bacterial translocation and decreased stimulation of the systemic inflammatory response and subsequent improved outcomes in intensive care (ICU) patients. Enteral feeding by nasogastric (NG) tubes is the preferred route of nutritional support for most ICU patients. However, ICU patients with delayed gastric emptying and poor intestinal motility may not tolerate gastric feeding and may therefore benefit from post-pyloric feeding via nasojejunal (NJ) tubes1.

Implications of pre-operative NG fasting on nutrition in major burn patients: an audit of practice

Background: The hypermetabolic response seen following a major burn injury increases protein and energy requirements, necessitating the early establishment of enteral feeding. Early gastric feeding reduces the risk of gastrointestinal bacterial translocation, ileus, gastric ulceration and addresses the increase metabolic demands of the patient. Nasogastric feeding is commonly employed as a first line method of enteral feeding. However this needs to be stopped pre-operatively during the fasting period in a cohort of patients who attend the operating theatre frequently on their road to recovery, thereby resulting in missed calories and protein.

Gastrojejunal (GJ) tube feeding: developing a service and evaluating associated complications in a paediatric surgical centre.

Gastrojejunal (GJ) tubes are becoming an established alternative method of delivering nutrition to children who do not tolerate gastric feeding. However, there is limited literature surrounding patient outcomes, the longevity of tubes or complications. We aim to highlight the development and evaluation of a service to provide children with GJ tube feeding. A retrospective case-note review of children either undergoing an initial gastrostomy to gastrojejunal tube conversion or gastrojejunal tube replacement in our tertiary paediatric surgical centre between January 2015 and June 2018. 134 GJ feeding tubes were placed in 33 neurologically impaired children with a median age of 4.9years (8months-17years) having a median 4 tube placements per child (1-11) within the study period. All tubes were 14 or 16Fr 'AMT G-JET' tubes with a median replacement time of 174.9days (13-504days). The most common indication was foregut dysmotility in children with global developmental delay. The complication rate was 34.3% (46 tubes). In the study period, 2 patients (6.1%) reverted to oral feeding, 6 patients (18.2%) to gastric feeding and 25 children (75.7%) continued with jejunal feeding. No child required fundoplication. There were no procedure-related mortalities or mortality. GJ tube feeding is an effective and safe method of managing children with foregut dysmotility. Many patients do not require permanent jejunal feeding, and thus the reversibility of this method is an asset. A dedicated team is needed to co-ordinate tube replacements and provide efficient long-term jejunal feeding. IV.

Comparison of Three Different Glucose-lowering Drugs on Serum Levels of Glucose and Pancreas Histopathology in Streptozotocin-Induced Diabetic Rats

Introduction: Diabetes mellitus is a metabolic disorder resulting from a defect in insulin secretion, insulin action, or both. The aim of the present study was to compare the effect of three different blood glucose-lowering drugs in streptozotocin-induced diabetic rats. &#x0D; Materials and methods: A total of 60 male Wistar rats (220–250 g and 2-3 months of age) were selected for the current study, and they then were divided into five equal groups. Group 1 included healthy control rats receiving standard diet, group 2 involved diabetic rats receiving standard diet plus acarbose (25mg/kg/day) via gastric feeding tube daily for 8 weeks, group 3 embraced diabetic rats receiving standard diet plus pioglitazone (1 mg/kg/day) via gastric feeding tube daily for 4 weeks, and group 4 received of diabetic rats receiving standard diet plus repaglinide (10 mg/kg/day) via gastric feeding tube daily for 4 weeks. Diabetes was induced by intraperitoneal injection of streptozotocin at a dosage of 65 mg/kg body weight. At the end of the study, the samples were taken for histopathological investigation of pancreas and serum glucose levels. The mean diameter of pancreatic islets and the percentage of beta and alpha cells were calculated in all groups.&#x0D; Results: The fasting blood glucose in three treated and normal control rats was significantly less than the diabetic control group. One hour after treatment the blood glucose level reduced significantly in three treated and normal control rats compared to the diabetic control group. On day 7, the percentage of alpha cells in the pioglitazone and acarbose groups increased significantly, compared to the diabetic control group. On day 28, the percentage of beta cells in the treated groups increased significantly, compared to normal and diabetic control groups. Moreover, the mean of islet diameter in the treated groups increased significantly, compared to the normal and diabetic control groups. The percentage of alpha cells in the repaglinide group significantly reduced on day 28, compared to the diabetic control group.&#x0D; Conclusion: Among the administrated drugs, pioglitazone had the most positive effects on controlling blood glucose, increasing beta cells as well as improving the diameter of pancreatic islets.

Should we believe the benefit of intravenous erythromycin in critically ill adults with gastric feeding intolerance? Reinspecting the pieces of evidence from a series of meta-analyses.

In critically ill adults, unachieved nutrition targets owing to feeding intolerance are associated with poor outcomes. Erythromycin, a macrolide of antibiotics, exerts its gastrointestinal prokinetic as a motilin receptor agonist and subsequently promotes bowel movement. The application of erythromycin has been mentioned in the European Society for Clinical Nutrition and Metabolism (ESPEN) guideline with a grade B recommendation and strong consensus based on significant results from a meta-analysis of only three randomized controlled trials in a Mantel-Haenszel random-effects model. We reinspected the evidence by a random-effects model of meta-analyses through the frequentist approach with the Hartung-Knapp-Sidik-Jonkman (HKSJ) method, trial sequential analysis (TSA), and Bayesian inference. The results analyzed by the HKSJ method showed a risk ratio (RR) of 0.50 (95% confidence interval, 0.19-1.33; I2 = 74.55%). TSA indicated the false-positive results with insufficient cases. Bayesian inference showed a RR of 0.38 (95% credible interval, 0.04-1.62). The effect of intravenous erythromycin in feeding intolerance for critically ill adults remained inconclusive, with very low certainty of evidence. Further large-scale randomized controlled trials with increased rigor are warranted to provide a solid conclusion.

Edible folic acid and medicinal folinic acid produce cardioprotective effects in late-stage triple-transgenic Alzheimer's disease model mice by suppressing cardiac hypertrophy and fibrosis.

Some clinical studies have indicated the patients with Alzheimer's disease (AD) display an increased risk of cardiovascular disease (CVD). Here, to examine the relationship between AD and CVDs, we investigated the changes in heart function in triple-transgenic late-stage AD model mice (3× Tg-AD; APPSwe, PS1M146V, and tauP301L). We fed the AD mice folic acid (FA) or folinic acid (FN) and analyzed the protective effects of the compounds on the heart; specifically, 20-month-old triple-transgenic AD mice, weighing 34-55 g, were randomly allocated into three groups-the AD, AD + FA, and AD + FN groups-and subject to gastric feeding with FA or FN once daily at 12 mg/kg body weight (BW) for 3 months. Mouse BWs were assessed throughout the trial, at the end of which the animals were sacrificed using carbon dioxide suffocation. We found that BW, whole-heart weight, and left-ventricle weight were reduced in the AD + FA and AD + FN groups as compared with the measurements in the AD group. Furthermore, western blotting of excised heart tissue revealed that the levels of the hypertrophy-related protein markers phospho(p)-p38 and p-c-Jun were markedly decreased in the AD + FA group, whereas p-GATA4, and ANP were strongly reduced in the AD + FN group. Moreover, the fibrosis-related proteins uPA, MMP-2, MEK1/2 and SP-1 were decreased in the heart in both AD + FN group. In summary, our results indicate that FA and FN can exert anti-cardiac hypertrophy and fibrosis effects to protect the heart in aged triple-transgenic AD model mice, particular in FN.