Intralipid Research Articles

N-3 Polyunsaturated Fatty Acid Supplementation Affects Oxidative Stress Marker Levels in Patients with Type II Intestinal Failure: A Randomized Double Blind Trial.

Type II intestinal failure (IF-II) is a condition in which the gastrointestinal tract is compromised. Liver complications may occur because of the pathology and/or prolonged use of parenteral nutrition (PN); oxidative stress has been implicated as one of the causes. Lipid emulsions containing n-3 polyunsaturated fatty acids (PUFAs) have been proposed for the treatment. We aimed to evaluate the effect of 7-day n-3 PUFA supplementation on oxidative stress in IF-II patients receiving PN. This was a randomized, controlled, double-blinded, pilot trial of adult patients with IF-II, receiving either conventional PN (control) or PN enriched with n-3 PUFAs (intervention). Twenty patients were included (14 men, 49 ± 16.9 years), with the ANCOVA analysis the glucose (p = 0.003), and direct bilirubin (p = 0.001) levels reduced; whereas the high-density lipoprotein cholesterol (HDL-C) increased (p = 0.017). In the random-effect linear regression analysis, a reduction (p < 0.0001) in the malondialdehyde (MDA) level was found in the intervention group when the covariables age, HDL-C level, and alanine aminotransferase activity were considered. After 1 week of PN supplementation with n-3 PUFAs, the marker levels of some oxidative stress, blood lipids, and hepatic biomarkers improved in patients with IF-II.

Composite lipid emulsion use and essential fatty acid deficiency in pediatric patients with intestinal failure with high parenteral nutrition dependence: A retrospective cohort study.

Reports of essential fatty acid deficiency (EFAD) in patients receiving parenteral nutrition (PN) and a composite lipid (mixed oil intravenous lipid emulsion [MO ILE]) are predominantly when managed by lipid restriction. The objective of this study was to determine the prevalence of EFAD in patients with intestinal failure (IF) who are PN dependent without lipid restriction. We retrospectively evaluated patients, ages 0-17 years, followed by our intestinal rehabilitation program between November 2020 and June 2021 with PN dependency index (PNDI) of >80% on a MO ILE. Demographic data, PN composition, PN days, growth, and plasma fatty acid profile were collected. A plasma triene-tetraene (T:T) ratio >0.2 indicated EFAD. Summary statistics and Wilcoxon rank sum test evaluated to compare between PNDI category and ILE administration (grams/kilograms/day). P < 0.05 was considered significant. Twenty-six patients (median age, 4.1 years [interquartile range (IQR) = 2.4-9.6]) were included. The median duration of PN was 1367 days (IQR = 824-3195). Sixteen patients had a PNDI of 80%-120% (61.5%). Fat intake for the group was 1.7 g/kg/day (IQR = 1.3-2.0). The median T:T ratio was 0.1 (IQR = 0.1-0.2) with no values >0.2. Linoleic and arachidonic acid were low in 85% and 19% of patients, respectively; however, Mead acid was normal in all patients. This report is the largest to date on the EFA status of patients with IF on PN. These results suggest that, in the absence of lipid restriction, EFAD is not a concern when using MO ILEs in children receiving PN for IF.

Effect of reduced versus usual lipid emulsion dosing on bilirubin neurotoxicity and neurodevelopmental impairment in extremely preterm infants: study protocol for a randomized controlled trial

BackgroundBilirubin neurotoxicity (BN) occurs in premature infants at lower total serum bilirubin levels than term infants and causes neurodevelopmental impairment. Usual dose lipid infusions in preterm infants may increase free fatty acids sufficiently to cause bilirubin displacement from albumin, increasing passage of unbound bilirubin (UB) into the brain leading to BN and neurodevelopmental impairment not reliably identifiable in infancy. These risks may be influenced by whether cycled or continuous phototherapy is used to control bilirubin levels.ObjectiveTo assess differences in wave V latency measured by brainstem auditory evoked responses (BAER) at 34–36 weeks gestational age in infants born ≤ 750 g or < 27 weeks’ gestational age randomized to receive usual or reduced dose lipid emulsion (half of the usual dose) irrespective of whether cycled or continuous phototherapy is administered.MethodsPilot factorial randomized controlled trial (RCT) of lipid dosing (usual and reduced) with treatment groups balanced between cycled or continuous phototherapy assignment. Eligible infants are born at ≤ 750 g or < 27 weeks’ gestational age enrolled in the NICHD Neonatal Research Network RCT of cycled or continuous phototherapy. Infants will randomize 1:1 to reduced or usual dose lipid assignment during the first 2 weeks after birth and stratified by phototherapy assignment. Free fatty acids and UB will be measured daily using a novel probe. BAER testing will be performed at 34–36 weeks postmenstrual age or prior to discharge. Blinded neurodevelopmental assessments will be performed at 22–26 months. Intention-to-treat analyses will be performed with generalized linear mixed models with lipid dose and phototherapy assignments as random effects covariates, and assessment for interactions. Bayesian analyses will be performed as a secondary analysis.DiscussionPragmatic trials are needed to evaluate whether lipid emulsion dosing modifies the effect of phototherapy on BN. This factorial design presents a unique opportunity to evaluate both therapies and their interaction. This study aims to address basic controversial questions about the relationships between lipid administration, free fatty acids, UB, and BN. Findings suggesting a reduced lipid dose can diminish the risk of BN would support the need for a large multicenter RCT of reduced versus usual lipid dosing.Trial registrationClinical Trials.gov, NCT04584983, Registered 14 October 2020, https://clinicaltrials.gov/ct2/show/NCT04584983Protocol version: Version 3.2 (10/5/2022).

Surface modification of cellulose nanocrystals by physically adsorbing lactoferrin as pickering stabilizers: Emulsion stabilization and in vitro lipid digestion

Surface modification is a prerequisite procedure for using cellulose nanocrystals (CNCs) in food and other industries. This study reports a simple and safe procedure for CNCs surface modification using physically absorbing food protein (lactoferrin, LF) that could improve the emulsification performance and modulating emulsion lipid digestion in vitro. Modification of CNCs by LF was characterized by adsorption percentage (%), zeta-potential, atom force microscopy, and contact angle. The modification occurred electrostatically between negatively CNCs and positively LF. LF-modified CNCs are more hydrophobic and aggregation-prone depending on the ratio of protein to CNCs and pH. Emulsions stabilized by LF-modified CNCs which are characterized by visual appearance, microstructure, droplet size, and stability against lipid oxidation. Modification of CNCs by LF could improve the emulsification performance of CNCs and show high stability against lipid oxidation. In vitro gastrointestinal digestion of emulsions stabilized by LF-modified CNCs was also investigated by Free fatty acid released (FFA, %) and microstructure. Overall, emulsions stabilized by CNCs particles have lower lipid digestion extent than that of tween 20. The findings would have potential applications in fabrication of novel functional emulsions in food and other industries.

SAFETY OF REGIONAL ANESTHESIA IN UKRAINE SURVEY: ARE HOSPITALS READY FOR THE LOCAL ANESTHETIC SYSTEMIC TOXICITY (LAST)?

Background. A survey was conducted among anesthesiologists in 38 Ukrainian hospitals to evaluate the current incidence and treatment quality of the local anesthetic systemic toxicity (LAST). With the growing preference for regional anesthetic techniques, implementation of measures for timely detection and treatment of LAST is becoming a priority for many surgical hospitals. This study aims to provide primary country-wide epidemiological data to guide further safety improvement in Ukraine.&#x0D; It should be noted, that the survey was performed before the beginning of the full-scale Russian invasion of Ukraine. The resulting surge in the incidence of limb injury has resulted in an unprecedented scale of application of regional anesthesia, including out-of-hospital cases with very limited monitoring, which will no doubt generate great amount of new data on the subject. We hope that our current analysis may be used as a reference point for the future research on this subject.&#x0D; Material and methods. A link to the survey was distributed via e-mail to the members of the Association of Anesthesiologists of Ukraine. Data submission was anonymous. Statistical analysis was performed using Microsoft Excel. Descriptive statistics are provided.&#x0D; Results. Responses were submitted by 186 anesthesiologists from 38 Ukrainian cities. Among them, 65.9% practice in public hospitals, 25.4% - in private hospitals, 8.7% - in university hospitals. Majority of respondents (60.3%) reported performing over 100 regional anesthetic procedures per year. Peripheral nerve blocks were routinely performed in the hospitals of 76.9% of respondents. 42.4% are using peripheral nerve blocks or more times per week, 24.4% perform this amount monthly, 21.7% - yearly, with 11.5% not utilizing peripheral nerve blocks at all.&#x0D; Ultrasound guidance was commonly used by 64.1% of anesthesiologists, 60.3% reported relying on landmark techniques often and 38.5% are routinely using a neuromuscular electrical stimulator.&#x0D; LAST cases were previously encountered by 37.2% of respondents. However, only 37% have reported having a LAST protocol in their hospital and 42.3% did not have a lipid emulsion available. Regarding patient education, in 62.8% of cases the patients were specifically warned about the possible complications of regional anesthesia prior to procedures, where it was performed. When the local anesthetic related adverse events did occur, they were recorded in the patient’s card in 27.2% of cases; the chief of anesthesiology department was informed in 36.9%, while in 35.9% the event was not reported in any way.&#x0D; Conclusions. The practice of regional anesthesia is becoming more widespread in Ukraine, but the minimal measures required to provide patient safety during such procedures are still not being employed in many hospitals.

Application of response surface methodology in the development of parenteral emulsion using ultrasonic emulsification

Abstract: Intravenous lipid emulsion is a critical component of parenteral nutrition. Long-term administration of such therapy lead to liver dysfunction. As the cause of liver failure can be the size of lipid emulsion droplets, their reduction can positively affect the clinical condition of patients. This study aimed to develop and optimize the preparation process of intravenous lipid emulsions with reduced droplet size compared to commercially available formulations. The response surface methodology was applied to optimize the ultrasonic emulsification. The reduction of lipid droplet size was achieved by the use of a combination of 1.2% (w/w) soy phospholipids and various concentrations of Tween 80 (2, 3, and 4% (w/w)). The other variables were sonication amplitude and time of sonication. During the optimization process, fifteen soybeans oil-based intravenous lipid emulsions were developed. All formulations were characterized by the physicochemical properties appropriate for intravenous administration, i.e., MDD ranging from 119.1 ± 0.6 nm to 177.1 ± 2.1 nm, PdI below 0,219 ± 0,009. The pH and osmolarity ranged from 6.23 ± 0.01 to 6.58 ± 0 and from 328 ± 3 to 568 ± 8 mOsm/kg, respectively. The Box Behnken methodology allowed for optimizing the preparation of intravenous lipid emulsion using ultrasonic emulsification.

Stability of furosemide and torasemide in parenteral nutrition admixture

Furosemide and torasemide (loop diuretics) are used to treat hypertension or pulmonary edema. They are often administered in the parenteral route. In critically ill patients, there is a problem of a limited number of venous accesses, which complicates the polytherapy. Drugs of unknown compatibility must be administered separately, and the problem increases in patients receiving parenteral nutrition. Lipid emulsions have been introduced into clinical practice as a high-calorie, non-glucose source of energy for parenteral administration, but they can also be used as lipophilic drug carriers. In this paper, the parenteral nutrition admixture (PNA) Nutriflex Lipid special was used as a drug carrier for furosemide and torasemide. For this purpose, drug stability tests (HPLC method) were carried out in various light and temperature conditions, imitating clinical conditions, and the parameters of the lipid emulsion (pH, zeta potential, the size of the emulsion droplets and polpolydispersity) were tested. Furosemide and torasemide added to Nutriflex Lipid special did not cause significant changes in the physicochemical properties of PNA. Changes in pH and MDD were within acceptable limits. Both drugs when added to Nutriflex Lipid special were degraded, dependent on the storage conditions and the chemical structure.

Допоміжні засоби фармакологічної терапії при гострих отруєннях фосфорорганічими сполуками антихолінестеразної дії (огляд літератури)

The current standards of treatment the acute OPC poisoning with anticholinesterase action remain insufficient, despite the significant number of researches in this area conducted in the world. One of the ways to solve this problem is to use a wider range of pathogenetically determined pharmacologic agents. The Aim of the Research. To observe and summarize the published results of investigation the pharmacological therapeutic appliance for acute OPC poisoning at the stages of preclinical and early clinical evaluation. Methods. System content analysis of literature data using the PubMed and Google Scholar databases. Results and Conclusions. The investigation of pharmacological therapeutic appliance effectiveness for acute anticholinesterase OPC poisoning remains relevant when taking into account the complexity of the intoxication pathogenesis. The main lines of pharmacological agents’ research for the acute anticholinesterase OPC poisoning include the study of n-cholinoreceptor antagonists, benzodiazepine receptor agonists, NMDA-receptor antagonists, H1-histamine receptor antagonists, alpha-adrenergic receptor agonists, enzymatic antidote, antioxidants, agonists of beta-adrenergic blockers, and also magnesium sulfate, sodium bicarbonate, lipid emulsions. The investigations of clinically available therapeutic appliance continue both in animal experiments and at the clinical application stage. Such investigations are also important given the need for poisoning emergency care under conditions when specific therapies are missing or limited. Keywords: organophosphorus compounds, acute poisoning, therapeutic appliance.

Capillary electrokinetic chromatography for studying interactions between β-blockers and Intralipid emulsion

Toxicity of β-blockers is one of the most common causes of poison-induced cardiogenic shock throughout the world. Therefore, methodologies for in vivo removal of the drugs from the body have been under investigation. Intralipid emulsion (ILE) is a common commercial lipid emulsion used for parenteral nutrition, but it has also been administered to patients suffering from drug toxicities. In this work, a set of β-blockers of different hydrophobicity’s (log KD values ranging from 0.16 to 3.8) were investigated. The relative strength of the interactions between these compounds and the ILE was quantitatively assessed by means of binding constants and adsorption constants of the formed β-blocker-ILE complexes. The binding constants were determined by capillary electrokinetic chromatography and the adsorption constants were calculated based on different adsorption isotherms. Expectedly, the binding constants were strongly related to the log KD values of the β-blockers. The binding and adsorption constants also show that less hydrophobic β-blockers interact with ILE, suggesting that this emulsion could be useful for capturing such compounds in cases of their overdoses. Thus, the use of ILE for treatment of toxicities caused by a larger range of β-blockers is worth further investigation.

102: A Comparison of First-line Intravenous Lipid Emulsions SMOFlipid Versus Intralipid on Incidence and Time to Resolution of Cholestasis in Hospitalized Pediatric Patients

102: A Comparison of First-line Intravenous Lipid Emulsions SMOFlipid Versus Intralipid on Incidence and Time to Resolution of Cholestasis in Hospitalized Pediatric Patients

Implementation of sustainable development goals in the cosmetics industry based on the example of cleansing cosmetics containing a surfactin-rich digestate extract

The implementation of sustainable development goals in the cosmetics industry is focused primarily on the phase of product design and the formulation of fully functional cosmetics based on raw materials of natural origin. The aim of the present study was to evaluate the feasibility of using a surfactin-rich digestate extract—a raw material of biotechnological origin—as an ingredient in cleansing cosmetics. A composition was designed, and shower gels based on the digestate extract were formulated. In the next stage of the study, the prototypical products were subjected to a quality assessment with an emphasis on the properties determining their functionality and safety of use by consumers. The shower gels formulated with raw materials of natural origin with the addition of the surfactin-rich extract show acceptable functional properties including viscosity, foaming ability and fat emulsification properties. Importantly, the use of the digestate extract was found to significantly improve the safety in use of the evaluated cosmetic prototypes. This finding is corroborated by a significant decrease in the zein value, which is a measure of the irritant effect of cosmetic formulations. A slight decrease in the ability to emulsify fats found for the tested prototypes confirmed their appropriate functionality and mild effect on the skin. Through the use of the surfactin-rich digestate extract, the cosmetics acquired a natural color derived from the extract. Colorimetric analysis shows that the color changes in the samples should be noticeable even by inexperienced observers.Graphical

A comparison of the effects of pulsatile and bolus flushing methods on lipid emulsion residues that lead to bacterial growth in intravenous catheters.

The aim of this study was to compare the efficacies of pulsatile and bolus flushing methods for removing residual parenteral nutrients in common shapes of central venous (CV) and peripheral venous (PV) catheters. Straight or looped tubes filled with parenteral nutrients containing indocyanine green (ICG) were flushed with 10 mL of saline at various speeds with several pulsatile intervals. Pseudomonas aeruginosa engineered with a luciferase gene was inoculated in the flushed CV catheters. The imaging technique detected the ICG remaining and the bacterial growth in the flushed catheters. In the CV catheter, the residue was greater with pulsatile flushing with longer intervals than with bolus flushing at a relatively high flushing speed. In the PV catheter, the flushing speed with any pulsatile intervals did not affect the residue. A looped catheter showed less residue than the straight catheter regardless of the flushing condition. Bacterial growth occurred in the nutrient residue in the flushed tubes. Speed of flushing and the shape of catheters, but not pulsatile flow generation, are essential components for the efficacious removal of parenteral nutrients in the catheter. Moreover, the slight differences in remaining nutrients inside the catheter affected subsequent bacterial growth.

Injectable Lipid Emulsion and Clinical Outcomes in Patients Exclusively Receiving Parenteral Nutrition in an ICU: A Retrospective Cohort Study Using a Japanese Medical Claims Database.

Guidelines for the nutritional management of critically ill patients recommend the use of injectable lipid emulsion (ILE) as part of parenteral nutrition (PN). The ILE's impact on outcomes remains unclear. Associations between prescribed ILE and in-hospital mortality, hospital readmission, and hospital length of stay (LOS) in critically ill patients in the intensive care unit (ICU) were investigated. Patients who were ≥18 years old in an ICU from January 2010 through June 2020, receiving mechanical ventilation, and fasting for >7 days, were selected from a Japanese medical claims database and divided, based on prescribed ILE during days from 4 to 7 of ICU admission, into 2 groups, no-lipid and with-lipid. Associations between the with-lipid group and in-hospital mortality, hospital readmission, and hospital LOS were evaluated relative to the no-lipid group. Regression analyses and the Cox proportional hazards model were used to calculate the odds ratios (OR) and regression coefficients, and hazard ratios (HR) were adjusted for patient characteristics and parenteral energy and amino acid doses. A total of 20,773 patients were evaluated. Adjusted OR and HR (95% confidence interval) for in-hospital mortality were 0.66 (0.62-0.71) and 0.68 (0.64-0.72), respectively, for the with-lipid group relative to the no-lipid group. No significant differences between the two groups were observed for hospital readmission or hospital LOS. The use of ILE for days 4 to 7 in PN prescribed for critically ill patients, who were in an ICU receiving mechanical ventilation and fasting for more than 7 days, was associated with a significant reduction in in-hospital mortality.

The impact of glycerol monostearate's similarity to fats and fatty acid composition of fats on fat crystallization, destabilization, and texture properties of ice cream.

Fat significantly affects the properties of ice cream. Prior studies have investigated the correlation between fat crystallization, fat destabilization, and ice cream quality. However, the role of fatty acid composition, the similarity between fat and emulsifier in these characteristics, and their impact on final product quality remains unclear. To investigate the influence of the fatty acid composition of fats, as well as their similarity to glycerol monostearate (GMS), on fat crystallization and destabilization during the aging and freezing stages, ice creams were formulated using a combination of two types of fats (coconut oil and palm olein) in five different ratios. In oil phases, decreased saturation of fatty acids (from 93.38% to 46.69%) and increased similarity to GMS (from 11.96% to 46.01%) caused a reduction in the maximum solid fat content. Moreover, the rise in unsaturated long-chain fatty acids (from 34.61% to 99.57%) and similarity to GMS enhanced the formation of rare and coarse fat crystals, leading to a sparse crystalline network. This, in turn, reduced the crystallization rate and the stiffness of the fat in emulsions. Assuming consistent overrun across all ice creams, the enhanced interactions between fat globules in ice cream improved its hardness, melting properties, and shrinkage. The crystalline properties of fat in emulsions were influenced by oil phases, impacting fat destabilization and ultimately enhancing the quality of ice cream. The present study offers valuable insights for the optimization of fat and monoglyceride fatty acid ester selection, with the potential to improve ice cream quality. © 2023 Society of Chemical Industry.

Celecoxib Oral Solution and the Benefits of Self-Microemulsifying Drug Delivery Systems (SMEDDS) Technology: A Narrative Review.

The oral route of drug delivery is the most widespread and preferred route of administration, but it has several limitations, including variable pharmacokinetics (PK), reduced dissolution and absorption, and gastrointestinal irritation. Further, many compounds have low aqueous solubility, which also limits intestinal absorption. For this narrative review, we conducted a literature search of PubMed until August 2022, focusing on emulsions, microemulsions, nanoemulsions, and self-emulsifying drug delivery systems. The self-microemulsifying drug delivery system (SMEDDS) overcomes these limitations of hydrophobic compounds to enhance their bioavailability. A SMEDDS formulation is a clear, thermodynamically stable, oil-in-water emulsion of lipid, solubilized drug, and two surfactants, which spontaneously forms droplets < 100nm in diameter. These components help deliver presolubilized drugs to the gastrointestinal tract, while protecting them from degradation in gastric acid or first-pass hepatic metabolism. SMEDDS formulations have improved oral drug delivery in the treatment of cancer (paclitaxel), viral infections (ritonavir), and migraine headache (ibuprofen and celecoxib oral solution). The American Headache Society recently updated their consensus statement for the acute treatment of migraine and included a selective cyclo-oxygenase-2 selective inhibitor formulated in SMEDDS, celecoxib oral solution. This SMEDDS formulation showed pronounced improvement in bioavailability compared with celecoxib capsules, allowing for a low dose of celecoxib in the oral solution to provide safe and effective acute migraine treatment. Here, we will focus on SMEDDS formulations, what differentiates them from other analogous emulsions as vehicles for poorly soluble drugs, and their clinical application in the acute treatment of migraine. Oral drugs reformulated in SMEDDS have shown accelerated times to peak plasma drug concentrations and increased maximum plasma concentrations, compared with capsules, tablets, or suspensions. SMEDDS technology increases both drug absorption and bioavailability of lipophilic drugs, compared with other formulations. Clinically, this allows the use of lower doses with improved PK profiles without compromising efficacy, as shown with celecoxib oral solution for the acute treatment of migraine.

#6129 INTRADIALYTIC PARENTERAL NUTRITION IMPROVES PROTEIN STORES IN CHRONIC HEMODIALYSIS PATIENTS

Abstract Background and Aims Intradialytic parenteral nutrition (IDPN) is a form of supplemental nutrition used to treat patients with malnutrition who receive hemodialysis (HD) and in which the oral feeding is not enough to cover basic caloric needs. Although this technique could improve biochemical markers of nutrition, information regarding its effect on body deposits is lacking. We evaluated the effect of IDPN on body composition parameters and nutritional status in prevalent HD patients. Method Retrospective observational study that included all prevalent hemodialysis patients who received NPID for more than 3 months at our Center from January 2018 to December 2022. All the patients received a concentrated 3-in-1 parenteral nutrition formula consisting of glucose solution, a lipid emulsion and an amino acid solution without electrolytes (OLIMEL N9®, Baxter). IDPN was infused at a constant rate not exceeding 300 ml/hour, via the venous drip chamber of HD monitor using infusion pump. Changes in lean tissue mass (LTM), intracellular water (ICW), and body cell mass (BCM) assessed by multifrequency bioimpedance spectroscopy (BIS) at baseline and at 3, 6, 9 and 12 months (primary outcomes) and other biochemical and anthropometric parameters (secondary outcomes) were used to assess the effect of NPID. Results Seventeen patients were included (women: 9, 53%; mean age: 68±15 y). After IDPN initiation, a gradual improvement in LTM, ICW and BCM was observed, reaching statistical significance at Month 3, 6, 9 and 12. Changes in fat inversely mirrored those of LTM (Table 1). Albumin levels and the normalized protein appearance increased, with a significant reduction in high-sensitive C-reactive protein and extracellular/intracellular body water ratio at month 9 and 12. Conclusion IDPN for 1-year was associated to increased muscle mass, supporting the hypothesis that this supplement nutrition could benefit nutritional status and revert protein-energy wasting in HD patients.

Improvement in Intestinal-Failure-Associated Liver Disease by Using Parenteral Fish Oil as Monotherapy: Case-Based Review of the Literature

Intestinal-failure-associated liver disease (IFALD) is a common complication of prolonged parenteral nutrition (PN). Risk factors for IFALD include clinical features, as well as medical interventions, and its management was initially based on the decrease or interruption of parenteral nutrition while increasing enteral nutrition. However, the tolerance of full enteral nutrition in children with intestinal failure may require prolonged intestinal rehabilitation over a period of years. As a consequence, infants unable to wean from PN are prone to develop end-stage liver disease. We describe the case of an infant receiving long-term PN who was diagnosed with IFALD wherein we were able to reverse IFALD by switching lipid emulsions to fish oil monotherapy. A systemic review of case reports and case series on reversing IFALD using fish oil lipid emulsion follows the case description.

Effects of Concentration and Type of Lipids on the Droplet Size, Encapsulation, Colour and Viscosity in the Oil-in-Water Emulsions Stabilised by Rapeseed Protein.

The objective of this study was to extract the rapeseed protein from by-products and further examine the effect of lab-made rapeseed protein on the droplet size, microstructure, colour, encapsulation and apparent viscosity of emulsions. Rapeseed protein-stabilised emulsions with an increasing gradient of milk fat or rapeseed oil (10, 20, 30, 40 and 50%, v/v) were fabricated using a high shear rate homogenisation. All emulsions showed 100% oil encapsulation for 30 days of storage, irrespective of lipid type and the concentration used. Rapeseed oil emulsions were stable against coalescence, whereas the milk fat emulsion showed a partial micro-coalescence. The apparent viscosity of emulsions raised with increased lipid concentrations. Each of the emulsions showed a shear thinning behaviour, a typical behaviour of non-Newtonian fluids. The average droplet size was raised in milk fat and rapeseed oil emulsions when the concentration of lipids increased. A simple approach to manufacturing stable emulsions offers a feasible hint to convert protein-rich by-products into a valuable carrier of saturated or unsaturated lipids for the design of foods with a targeted lipid profile.

P4: Successful VA-Extracorporeal Membrane Oxygenation course in a patient with intentional Calcium Channel Blocker overdose without the need for mechanical ventilation

Background: Cardiovascular medication overdose constitutes about 3.5% of all drug overdoses, and carries a mortality of 16%. Calcium channel blockers (CCBs) and beta blockers account for more than 65% of these deaths. Overdose of cardiovascular medications cause impaired cardiac contractility, vasoplegia, and/or rhythm disturbances. We review the current literature and case reports of VA ECMO being utilized to support patients with cardiovascular medication overdose. Methods: We present a case of a 20-year-old female with no medical history presenting with bradycardia and hypotension after ingesting ninety ezetimibe 10mg, seventy-five nebivolol 10mg, and one hundred and eighty amlodipine 5mg, from her mother’s medication, with the intent of self harm. Patient received glucagon, calcium, lipid emulsion, and was being supported on vasopressin, norepinephrine, epienephrine, phenylephrine and dopamine. The patients HR 78 and SBP 68mmHg. Laboratory significant for leukocytosis and elevated lactic acid. On exam, patient was lethargic, without respiratory distress. Echocardiogram revealed EF 55-65% and a large right ventricular mass suspicious for atrial myxoma. Patient was initiated on peripheral Veno-Arterial ECMO using Femoral-Femoral configuration to provide circulatory support as a bridge to allow drug metabolism and clearance. Results: Following 72 hours of VA-ECMO, vasopressors were weaned, with ECMO successfully being discontinued. Throughout the ECMO course, the patient had no respiratory compromise and did not require intubation or mechanical ventilation. Following decannulation, the patient was discharged to follow for an elective resection of the atrial myxoma. Conclusion: ECMO has been reported as a rescue therapy in CCB and Beta blocker overdose when refractory to medical therapy. Conventional medical therapy includes limiting absorption, increasing elimination and hemodynamic support using vasopressor agents, intravenous (IV) calcium infusion, hyperinsulinemia therapy, glucagon infusion, and IV lipid emulsion. This unique case demonstrates the successful utilization of VA ECMO to support patients with cardiovascular medication overdose and illustrates the potential for hemodynamic support without the need for ventilator support. This is the only known report of VA ECMO being utilized for calcium channel overdose while the patient is awake and unventilated throughout their ECMO course.

Potential influence of nutrients intake by adults on the population dynamics of Athetis lepigone (Lepidoptera: Noctuidae)

Athetis lepigone is an important pest on corn, but little is known about the nutritional requirements of adult A. lepigone and how nutrients affect their reproduction and longevity. Here, we explored the effects of different nutrients on the reproduction, longevity, and population growth of A. lepigone. Carbohydrates were beneficial for adult reproduction and longevity, with feeding 5% sucrose having the best effect by resulting in an average of 424.83 eggs per female. When females consumed carbohydrates, the net reproductive rate (R0) and the intrinsic rate of increase (rm) were higher. However, the fecundity of adults fed only amino acids and high concentration fat emulsion decreased significantly, with an average of 60 to 160 eggs per female. The main food source of Lepidoptera insects is the nectar from flowering plants in the field. Due to compound planting patterns, flowering plants are widely distributed around farmland. The nectar secreted by them usually contains rich carbohydrates, which can be provided for adults. Therefore, we must also consider the potential impact of flowering plants on A. lepigone, in order to improve pest control efficiency.