Parenteral Nutrition Research Articles

Nutritional support in children treated for advanced adrenocortical carcinoma.

Adrenocortical carcinoma (ACC) is a rare, aggressive pediatric malignancy. Advanced ACC requires multimodal treatment, including surgery and systemic chemotherapy including cisplatin, etoposide, doxorubicin, and mitotane. This is associated with significant gastrointestinal toxicity, resulting in many patients being unable to complete scheduled therapy. Often, supplemental nutrition is required if oral intake during treatment is poor. We assessed the frequency of nutritional supplement use in pediatric patients treated for advanced ACC. This was a retrospective observational study of patients with ACC treated at St. Jude Children's Research Hospital over 10years (2012-2022). Patient demographics, treatment received, and the need for supplemental enteral or parenteral nutrition were reviewed. A total of 18 patients with ACC were treated from 2012 to 2022, with 11 having advanced ACC. 54.5% of patients required supplemental nutrition, both enteral and parenteral. All patients requiring supplemental nutrition were intolerant of oral intake, with a mean weight loss of 13.8% (range: 5.9-35%). Mean duration of nutritional support was 362 ± 337days. Patients requiring supplemental nutrition tended to be younger than others (mean age: 4.45 ± 3.63 vs. 9.14 ± 4.59years; median age: 3.35 vs. 8.40years; range: 0.90-11.0 vs. 3.30-15.1years) (p = 0.082). Most patients with stage IV ACC require nutritional support during their treatment course, especially younger patients. Preemptive feeding tube placement should be considered to avoid delays in treatment.

Comprehensive quantification of C4 to C26 free fatty acids using a supercritical fluid chromatography-mass spectrometry method in pharmaceutical-grade egg yolk powders intended for total parenteral nutrition use.

Free fatty acids (FFAs) are important energy sources and significant for energy transport in the body. They also play a crucial role in cellular oxidative stress responses, following cell membrane depolarization, making accurate quantification of FFAs essential. This study presents a novel supercritical fluid chromatography-mass spectrometry (SFC-MS) method using selected ion recording in negative electrospray ionization mode, enabling rapid quantification of 31 FFAs within 6min without derivatization. FFAs are identified and quantified using an HSS C18 SB column and a secondary mobile phase consisting of methanol with formic acid by detecting their [M - H]- ions. Calibration curves showed strong linearity (R2 ≥ 0.9910), spanning 1000-12,000ng/mL for short-chain FFAs and 50-1200ng/mL for medium- and long-chain FFAs. The method achieves detection limits as low as 1ng/µL for short-chain FFAs and 0.05pg/µL for other FFAs per on-column injection. The method demonstrated high accuracy and precision, with bias and coefficients of variation maintained below 15% across five quality control levels. Freeze-thaw and autosampler stability studies confirmed the behavior of matrix-matched standards under optimal storage conditions. The validated method was applied to the analysis of pharmaceutical-grade egg yolk powders, using 13 deuterated FFAs as internal standards (IS) in comparison with heptadecanoic acid (C17:0). Significant variations in FFA quantification using two different IS approaches underscore the importance of selecting an appropriate IS. In summary, this study introduces a reliable and validated SFC-MS method for analyzing FFAs ranging from C4 to C26, requiring minimal sample preparation.

Changes in nutritional management after gastrointestinal cancer surgery over a 12-year period: a cohort study using a nationwide medical claims database

BackgroundNutritional management in patients after gastrointestinal cancer surgery has changed throughout the 2000s. However, its evolution has not been formally studied. This study aimed to evaluate changes in nutritional management using real-world data.MethodsPatient data from 2011 to 2022 were extracted from a nationwide medical claims database. Patients were divided into four groups based on their year of hospital admission: period I, 2011–2013; II, 2014–2016; III, 2017–2019; IV, 2020–2022. For each period, feeding routes in all patients and prescribed doses of parenteral energy and amino acids in fasting patients during postoperative days (POD) 1–7 were determined. The results of the four different periods were compared using statistical trend tests.ResultsThe study cohort was comprised of 365,125 patients. During POD 1–3, the proportion of patients administered any oral intake increased over time (I, 40.3%; II, 47.1%; III, 49.4%; IV, 54.2%; P < 0.001), while that of patients receiving parenteral nutrition (PN) decreased (I, 60.1%; II, 55.0%; III, 50.3%; IV, 45.5%; P < 0.001). Of 19,661 patients with PN alone (i.e., neither oral intake nor enteral nutrition) during POD 1–7, the median (interquartile range) prescribed doses on POD 7 of energy (kcal/kg) [I, 15.3 (10.3–21.9); II, 13.9 (8.4–20.0); III, 13.2 (7.7–19.2); IV, 12.9 (7.0–18.7); P < 0.001] and amino acids (g/kg) [I, 0.65 (0.30–0.94); II, 0.58 (0.24–0.89); III, 0.56 (0.00–0.86); IV, 0.56 (0.00–0.87); P < 0.001] both decreased over time.ConclusionFrom 2011 to 2022, more patients who underwent gastrointestinal cancer surgery in Japan were administered early oral intake, while fewer patients were administered early PN. Overall, the energy and amino acid doses prescribed in PN were far below the guideline recommendations.

Association between early postnatal hydrocortisone and retinopathy of prematurity in extremely preterm infants.

Introduction Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness. We investigated the association of early postnatal low-dose intravenous hydrocortisone used for the prevention of bronchopulmonary dysplasia (BPD) with ROP-outcome among extremely preterm infants in a Swedish cohort. Methods This retrospective cohort study included extremely preterm infants born before 28 weeks of gestational age (GA). Infants born September 2020 - August 2022, treated with low-dose intravenous hydrocortisone for prevention of BPD, were compared to untreated controls born September 2016 - August 2020. Hydrocortisone was administered postnatally with a dose of 0.5 mg/kg twice daily for seven days, followed by 0.5 mg/kg per day for three days. Logistic regression, adjusted for GA, birth weight (BW), sex, and parenteral nutrition, was used in the primary analysis. For robustness we performed 1:1 propensity score (PS) matching followed by logistic regression. Results Of 245 preterm infants included, 65 were treated with low-dose hydrocortisone and 180 were untreated controls. Incidence of ROP treatment was reduced in the hydrocortisone group 18.5% (12/65) versus controls 32.2% (58 /180), p=0.038. One-to-one PS-matching (n= 62+62) confirmed the reduced incidence of ROP treatment in the hydrocortisone-treated infants (OR 0.38, 95% CI 0.16 - 0.88, p=0.025). After adjusting for GA, BW, sex, and parenteral nutrition ≥14 days the reduced risk of ROP treatment after early hydrocortisone treatment persisted (OR 0.31, 95% CI 0.16 - 0.60, p=0.0005). Conclusion Early postnatal low-dose intravenous hydrocortisone used to prevent BPD may reduce the risk of ROP treatment among extremely preterm infants.

A murine model of acute and prolonged abdominal sepsis, supported by intensive care, reveals time-dependent metabolic alterations in the heart

BackgroundSepsis-induced cardiomyopathy (SICM) often occurs in the acute phase of sepsis and is associated with increased mortality due to cardiac dysfunction. The pathogenesis remains poorly understood, and no specific treatments are available. Although SICM is considered reversible, emerging evidence suggests potential long-term sequelae. We hypothesized that metabolic and inflammatory cardiac changes, previously observed in acute sepsis as potential drivers of SICM, partially persist in prolonged sepsis.MethodsIn 24-week-old C57BL/6J mice, sepsis was induced by cecal ligation and puncture, followed by intravenous fluid resuscitation, subcutaneous analgesics and antibiotics, and, in the prolonged phase, by parenteral nutrition. Mice were killed after 5 days of sepsis (prolonged sepsis, n = 15). For comparison, we included acutely septic mice killed at 30 h (acute sepsis, n = 15) and healthy controls animals (HC, n = 15). Cardiac tissue was collected for assessment of inflammatory and metabolic markers through gene expression, metabolomic analysis and histological assessment.ResultsIn prolonged sepsis, cardiac expression of IL-1β and IL-6 and macrophage infiltration remained upregulated (p ≤ 0.05). In contrast, tissue levels of Krebs cycle intermediates and adenosine phosphates were normal, whereas NADPH levels were low in prolonged sepsis (p ≤ 0.05). Gene expression of fatty acid transporters and of the glucose transporter Slc2a1 was upregulated in prolonged sepsis (p ≤ 0.01). Lipid staining and glycogen content were elevated in prolonged sepsis together with increased gene expression of enzymes responsible for lipogenesis and glycogen synthesis (p ≤ 0.05). Intermediate glycolytic metabolites (hexose-phosphates, GADP, DHAP) were elevated (p ≤ 0.05), but gene expression of several enzymes for glycolysis and mitochondrial oxidation of pyruvate, fatty-acyl-CoA and ketone bodies to acetyl-CoA were suppressed in prolonged sepsis (p ≤ 0.05). Key metabolic transcription factors PPARα and PGC-1α were downregulated in acute, but upregulated in prolonged, sepsis (p ≤ 0.05 for both). Ketone body concentrations were normal but ketolytic enzymes remained suppressed (p ≤ 0.05). Amino acid metabolism showed mild, mixed changes.ConclusionsOur results suggest myocardial lipid and glycogen accumulation and suppressed mitochondrial oxidation, with a functionally intact Krebs cycle, in the prolonged phase of sepsis, together with ongoing myocardial inflammation. Whether these alterations have functional consequences and predispose to long-term sequelae of SICM needs further research.

Validation the modified subjective global nutrition assessment (mSGNA) for assessing malnutrition among hospitalized children.

To validate a modified Subjective Global Nutritional Assessment (mSGNA) for assessing nutritional status among Vietnamese children. A cross-sectional study was conducted at the National Children's Hospital in Vietnam, where 200 children were assessed using mSGNA, Subjective Global Nutritional Assessment (SGNA), and a standardized method developed by the Academy of Nutrition and Dietetics (AND) and the American Society for Parenteral and Enteral Nutrition (ASPEN). The mSGNA showed high accuracy with 82.9% sensitivity and 90.8% specificity when compared to SGNA, and moderate accuracy (72.0% sensitivity, 77.3% specificity) against AND/ASPEN. The kappa value for mSGNA-SGNA agreement was 0.8 (95% CI 0.686-0.849), indicating substantial agreement, while the kappa value for mSGNA-AND/ASPEN agreement was 0.5 (95%CI 0.304-0.567), reflecting moderate agreement. The results suggest that mSGNA is a reliable tool for identifying malnutrition in Vietnamese pediatric patients, with high sensitivity and specificity in comparison to SGNA and moderate effectiveness against AND/ASPEN standards.

Targeted nutritional strategies in postoperative care.

Immunonutrition, which uses specific nutrients to modulate the immune response, has emerged as a vital adjunct to perioperative care. Surgery-induced stress triggers immune responses that can lead to complications, such as infections and delayed wound healing. Traditional nutritional support often overlooks the immunological needs of surgical patients. Immunonutrition addresses this oversight by providing key nutrients, such as arginine, omega-3 fatty acids, glutamine, nucleotides, and antioxidants (vitamins C and E) to enhance immune function and support tissue repair. This review examined the efficacy and safety of immunonutrition in surgical settings, guided by the recommendations of the American Society for Parenteral and Enteral Nutrition and the European Society for Clinical Nutrition and Metabolism. Both organizations recommend immunonutrition for high-risk or malnourished patients undergoing major surgery and support its use in reducing complications and improving recovery. The key nutrients in immunonutrition aim to improve immune cell function, reduce inflammation, and enhance wound healing. Clinical studies and meta-analyses have demonstrated that immunonutrition lowers the infection rate, shortens the length of hospital stay, and accelerates recovery. Challenges hindering the clinical application of immunonutrition include cost, logistics, and a lack of standardized and personalized protocols. Future studies should focus on biomarker-driven approaches, pharmacogenomics, and innovative nutrient formulations. Addressing these issues will help to integrate immunonutrition into clinical practice, ultimately improving surgical outcomes and patient recovery.

Withdrawal of life‐sustaining treatment in Japanese home care: A cross‐sectional survey

AbstractBackgroundIn Japan, legal and social concerns exist about withdrawing life‐sustaining treatment (LST) even at the end of life. This study aimed to investigate the experience of physicians and nurses involved in home care with LST withdrawal.MethodsA web‐based questionnaire survey was conducted among physicians and nurses who were members of the Japanese Association for Home Care Medicine in 2020. The survey collected data on the experience of respondents with withdrawing LST, the decision‐making processes involved in withdrawing treatment, and their experience with patients attempting voluntarily stopping eating and drinking (VSED).ResultsResults from 203 respondents, including 150 physicians and 53 nurses, showed that the most commonly withdrawn LSTs were intravenous infusions (115 respondents), tube feeding (69 respondents), and oral administration of medicine (74 respondents). A few respondents withdrew respiratory management, such as mechanical ventilation (11 respondents) or home oxygen therapy (12 respondents). The main diagnoses of patients who had LSTs withdrawn were malignancy, senility, and dementia. Many respondents made decisions through discussions with the families of patients (117 respondents) or multidisciplinary discussions at their facilities (80 respondents). There were 23 respondents who made the decision alone, and they were all physicians. Thirty‐two respondents had experience with patients who had completed VSED.ConclusionIt was found that many Japanese home care physicians and nurses had experienced withdrawal of LSTs, and a significant number among them had experienced patients attempting VSED. Given this situation, there is an urgent need to provide ethics support in Japanese home care.

Near-Death Quality of Life in Cancer Patients on Home Parenteral Nutrition.

Background: The impact of home parenteral nutrition (HPN) on the quality of life (QoL) of cancer patients has been previously investigated. However, scarce data are available regarding near-death QoL in patients with cancer receiving HPN. This study aims to investigate the changes of QoL in these patients in the last two months before death. Methods: This is a secondary analysis of a previous, prospective, longitudinal, observational study. QoL was assessed using the EORTC QLQ-C30 questionnaire. Results: Eighty-four adult cancer patients who died on HPN and had filled out the questionnaire between 31 and 60 days (M2) and within 30 days prior (M1) to death were included in this analysis. The questionnaires filled out at M2 and M1 were compared with those filled out by the same patients at HPN start (T0). At M2, there was a significant improvement in both the global QoL and symptoms scales (p < 0.001 and p < 0.033, respectively), while at M1, a significant improvement in the global QoL scale persisted (p < 0.035) compared with T0. Conclusions: Our study first reports that HPN, if started early and according to European guidelines, is associated with an improvement in the QoL of patients with cancer even in the last two months before death.

Clinical characteristics and management of reoperation for high jejunal atresia: a retrospective study.

To analyze the clinical characteristics and available treatment strategies for reoperation of neonatal high jejunal atresia, and recommend preventive measures to reduce the reoperation rate of high jejunal atresia. The clinical data of 16 children with high jejunal atresia who underwent reoperation in the Neonatal Surgery Department at Children's Hospital of Zhejiang University School of Medicine from January 2018 to January 2023 were retrospectively analyzed. Among the 16 unplanned reoperations, 7 (43.6%) were performed for functional ileus, 3 (18.8%) for anastomotic stenosis, 3 (18.8%) for adhesive ileus, and 3 (18.8%) for postoperative proximal septum. Surgical procedures for reoperations include duodenoplasty, resection and re-anastomosis of the original anastomosis, resection of the duodenal septum and enterolysis. Among the 16 patients, 1 had short-bowel syndrome that required repeated hospital admission for parenteral nutrition treatment, and 1 patient died of recurrent pneumonia and heart failure after surgery. The other 14 patients recovered from reoperation and were discharged. The patients were followed up from 1month to 5years after surgery, and showed good growth. For children with high jejunal atresia, the operative procedure will vary according to each patient's circumstances. If postoperative functional obstruction occurs, a wider range of bowel cutting and re-anastomosis can be performed. During the first operation, the diaphragm at the proximal end of jejunal atresia should not be missed.

Early Optimal Parenteral Nutrition During NICU Stay and Neurodevelopmental Outcomes in Very Preterm Infants: State of the Art.

Preterm infants (PIs) are more susceptible to neurodevelopmental impairment compared with term newborns. Adequate postnatal growth has been associated with improved neurocognitive outcomes; therefore, optimization of nutrition may positively impact the neurodevelopment of PIs. This study focused on macronutrient parenteral nutrition (PN) intake during the Neonatal Intensive Care Unit stay and their associations with neurodevelopmental outcomes in PIs in the first two years of life. The Embase, MEDLINE, and Cochrane Library databases were searched using the following subject headings and terms (MeSH): "premature infants", "parenteral nutrition", "growth", "brain", "neurodevelopment", and "central nervous system diseases". All relevant papers' reference lists were manually searched. PN and neurodevelopment studies concerning the first two years of life were collected and analyzed. 275 potential studies were retrieved, 64 were selected for full-text reading, and 22 were included (12 randomized controlled trials). While glucose intakes should be immediately provided and strictly monitored avoiding hyperglycemia, the long-term outcomes of aggressive PN caloric intakes are uncertain. Early amino acid (AA) supplementation is mandatory and improves short-term growth, though it is questionable whether increased AA and better neurodevelopment are directly related. Lipid infusion should be initiated right after birth, and further investigation will enable us to ascertain the potential impacts of lipid emulsions, particularly fish oil, on PI neurodevelopment. An aggressive PN and its possible metabolic complication could not favor neurodevelopment; the way forward could be a customized approach, depending on the patient's clinical state and tolerance. Long-term follow-up studies and the search for specific markers of tolerance are warranted.

Urinary Acetaminophen Metabolites and Clinical Outcomes in Extremely Premature Infants.

Extremely premature infants are treated with acetaminophen (APAP) for pain and patent ductus arteriosus. High doses of APAP in adults are toxic, and a recent study found an association between APAP metabolite levels in mothers' breast milk and both bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) in their premature infants. In this study, we determined levels of APAP metabolites in urine of infants at high risk for BPD and ROP. Biorepository urine samples from 314 infants <29 weeks' gestation in the multicenter TOLSURF and PROP studies were analyzed by untargeted UHPLC:MS/MS (Metabolon, Inc.). We performed multivariate logistic regression and meta-analysis to examine associations between APAP metabolite levels and clinical outcomes. 4-APAP sulfate was the most abundant of 8 detected APAP metabolites and was present in 95% of urines. There were high correlations between levels of 4-APAP sulfate and the other APAP metabolites. In longitudinal studies on a subgroup of infants (day 6-56), periods of elevated 4-APAP sulfate occurred in 24 of 28 infants and were of longer duration (10.5 vs 4.2 days, p=0.001) with higher levels (13.3 vs 5.6, p=0.01) in infants after transition to enteral from total parenteral nutrition. Episodes of elevated metabolite did not differ by BPD status. At both day 10 and 28 there were no significant associations between levels of APAP metabolites and either BPD or ROP for all infants or for infants exclusively on parenteral or enteral nutrition. In two cohorts of extremely premature infants, levels of urinary APAP metabolites were not associated with increased risk for two adverse clinical outcomes.

The impact of a tailored nutrition intervention delivered for the duration of hospitalisation on daily energy delivery for patients with critical illness (INTENT): a phase II randomised controlled trial

BackgroundNutrition interventions commenced in ICU and continued through to hospital discharge have not been definitively tested in critical care to date. To commence a program of research, we aimed to determine if a tailored nutrition intervention delivered for the duration of hospitalisation delivers more energy than usual care to patients initially admitted to the Intensive Care Unit (ICU).MethodsA multicentre, unblinded, parallel-group, phase II trial was conducted in twenty-two hospitals in Australia and New Zealand. Adult patients, requiring invasive mechanical ventilation (MV) for 72–120 h within ICU, and receiving < 80% estimated energy requirements from enteral nutrition (EN) were included. The intervention (tailored nutrition) commenced in ICU and included EN and supplemental parenteral nutrition (PN), and EN, PN, and/or oral nutrition after liberation from MV, and was continued until hospital discharge or study day 28. The primary outcome was daily energy delivery from nutrition (kcal). Secondary outcomes included duration of hospital stay, ventilator free days at day 28 and total blood stream infection rate.Main resultsThe modified intention to treat analysis included 237 patients (n = 119 intervention and n = 118 usual care). Baseline characteristics were balanced; the median [interquartile range] intervention period was 19 [14–35] and 19 [13–32] days in the tailored nutrition and usual care groups respectively. Energy delivery was 1796 ± 31 kcal/day (tailored nutrition) versus 1482 ± 32 kcal/day (usual care)—adjusted mean difference 271 kcal/day, 95% CI 189–354 kcal. No differences were observed in any secondary outcomes.ConclusionsA tailored nutrition intervention commenced in the ICU and continued until hospital discharge achieved a significant increase in energy delivery over the duration of hospitalisation for patients initially admitted to the ICU.Trial registration ClinicalTrials.gov Identifier NCT03292237. First registered 25th September 2017. Last updated 10th Feb 2023.

Efficacy and Safety Assessment of Antifungal Prophylaxis with Posaconazole Using Therapeutic Drug Monitoring in Pediatric Patients with Oncohematological Disorders-A Single-Centre Study.

Posaconazole is recommended for prophylaxis in pediatric immunocompromised patients. Due to its variability in bioavailability and drug-to-drug interactions, EBMT recommends regimens based on therapeutic drug monitoring (TDM). In total, 171 oncohematological pediatric patients on posaconazole prophylaxis were included. Full pharmacokinetic posaconazole profiles were assessed in 51 children. The efficacy and safety of posaconazole was evaluated by measuring the drug concentration, with dose modification attempted in patients with suboptimal results. The influence of modifying factors on the posaconazole plasma concentration (PPC) was investigated. An insufficient PPC was the main issue, but no significant increase in prophylaxis failure was reported. The modification of the dosage resulted in the optimization of PPC in 50% of patients. No significant correlation between age, gender, diagnosis or the posaconazole dosage and the PPC was found. HCT, total parenteral nutrition and diarrhea were associated with a lower PPC. Hypoalbuminemia was related to both higher and lower PPC. The concomitant administration of specified drugs significantly impacted the PPC. TDM allows the identification of patients receiving non-optimal treatment and offers an opportunity to improve the efficacy and safety of the therapy. However, further research involving larger patient groups and longer observation periods are needed to determine the optimal dosing and target PPC in pediatric patients.

Utilizing preterm infant body composition assessments to guide neonatal nutrition.

The use of body composition to assess the quality of infant growth may add valuable information to pediatric clinical care. Preterm infants have differences in their fat and muscle mass development compared with infants born at term, which may be related to their early nutritional exposures. This review focuses on recent studies examining early nutrition in preterm infants and related body composition outcomes in the newborn period and beyond. Overall, the evidence shows that early nutrient delivery in parenteral nutrition and through formula supplementation or human milk fortification is associated with increased fat-free mass or lean mass in early life. However, future research is needed to fully understand the link between these body composition changes and longitudinal outcomes in preterm infants. Inclusion of body composition assessments in preterm infant nutrition research is critical to understand the factors associated with differences in adiposity and lean mass development in preterm infants. Medical fragility in preterm infants limits the routine use of body composition assessment tools which are currently validated, and additional studies are needed to thoroughly assess other methods which may be more feasible to integrate into bedside routine.

Outcomes of simple gastroschisis surgical treatment in a highly specialized hospital.

To assess the outcomes of three surgical techniques in the management of simple gastroschisis. An observational, descriptive, retrospective, longitudinal study was carried out. Medical records of patients diagnosed with simple gastroschisis and treated with different surgical techniques -Simil-Exit, primary closure, and deferred closure- were reviewed. 38 gastroschisis patients undergoing either the Simil-Exit (n=10), the primary closure (n=11), or the deferred closure (n=17) techniques were analyzed. The Simil-Exit technique involved a shorter operating time than primary closure and deferred closure. Both Simil-Exit and primary closure patients required a shorter mechanical ventilation time, fewer days of parenteral nutrition, shorter time to oral feeding initiation, and a shorter hospital stay than deferred closure patients. The deferred closure technique had more frequent complications, such as sepsis. The Simil-Exit and the primary closure techniques demonstrated favorable outcomes in patients with simple gastroschisis. In addition, the former involved shorter operating times, it required less exposure of the small bowel loops to the environment, it was easily reproducible, and it provided a better cosmetic result.

Evaluation of health-related quality of life and performance in intestinal transplant and rehabilitation patients: a cross-sectional study.

We aimed to evaluate health-related quality of life (HRQoL) in intestinal failure (IF) patients after different modes of intestinal rehabilitation. HRQoL was assessed using the generic 36-item Short Form Survey (SF-36, ver. 2) and visual analogue scale (VAS) in 6 different areas: diet, sleep, gastrointestinal (GI) symptoms, diarrhea, musculoskeletal pain, and other symptoms. Twenty-two patients completed the questionnaires, of which 7 had received intestinal transplant (ITx), 9 were continuing home total parenteral nutrition (HPN), and 6 had tapered off total parenteral nutrition (TPN). SF-36 physical component summary scores were highest in the ITx group (median, 65.6; interquartile range [IQR], 31.6-80.3) compared to the HPN (median, 48.4; IQR, 44.7-66.3) or tapered group (median, 54.2; IQR, 45.2-61.6). Mental component summary scores were lowest in the ITx group (median, 48.8; IQR, 37.1-63.6), compared to the TPN (median, 60.2; IQR, 41.6-78.5) or tapered group (median, 51.0; IQR, 48.8-56.0). Differences were not significant in all items of the SF-36. VAS scores showed that patients in the ITx group showed the best results in diet (0.9), gastrointestinal (GI) symptoms (1.4), and musculoskeletal pain (2.4). There was a significant difference in sleep (P = 0.036), with the ITx (1.43) and HPN groups (1.33) showing better outcomes compared with the tapered group (4.67). Patients in the tapered group showed the least favorable results in all performance areas, except GI symptoms. SF-36 did not show a significant difference between the ITx, HPN, and tapered groups, but VAS showed a significant difference in sleep between groups. Further studies, including serial data, will allow a better understanding of the effects of different modes of intestinal rehabilitation.

Establishment and Validation of a Machine-Learning Prediction Nomogram Based on Lymphocyte Subtyping for Intra-Abdominal Candidiasis in Septic Patients.

This study aimed to develop and validate a nomogram based on lymphocyte subtyping and clinical factors for the early and rapid prediction of Intra-abdominal candidiasis (IAC) in septic patients. A prospective cohort study of 633 consecutive patients diagnosed with sepsis and intra-abdominal infection (IAI) was performed. We assessed the clinical characteristics and lymphocyte subsets at the onset of IAI. A machine-learning random forest model was used to select important variables, and multivariate logistic regression was used to analyze the factors influencing IAC. A nomogram model was constructed, and the discrimination, calibration, and clinical effectiveness of the model were verified. High-dose corticosteroids receipt, the CD4+T/CD8+ T ratio, total parenteral nutrition, gastrointestinal perforation, (1,3)-β-D-glucan (BDG) positivity and broad-spectrum antibiotics receipt were independent predictors of IAC. Using the above parameters to establish a nomogram, the area under the curve (AUC) values of the nomogram in the derivation and validation cohorts were 0.822 (95% CI 0.777-0.868) and 0.808 (95% CI 0.739-0.876), respectively. The AUC in the derivation cohort was greater than the Candida score [0.822 (95% CI 0.777-0.868) vs. 0.521 (95% CI 0.478-0.563), p < 0.001]. The calibration curve showed good predictive values and observed values of the nomogram; the Decision Curve Analysis (DCA) results showed that the nomogram had high clinical value. In conclusion, we established a nomogram based on the CD4+/CD8+ T-cell ratio and clinical risk factors that can help clinical physicians quickly rule out IAC or identify patients at greater risk for IAC at the onset of infection.

Critical Care Therapy After Cytoreductive Nephrectomy for Metastatic Kidney Cancer.

To examine critical care therapy rates after cytoreductive nephrectomy in metastatic kidney cancer patients. Relying on the National Inpatient Sample (2000-2019), we addressed critical care therapy use (total parenteral nutrition, invasive mechanical ventilation, renal replacement therapy, percutaneous endoscopic gastrostomy tube insertion, and tracheostomy) and in-hospital mortality in surgically treated metastatic kidney cancer patients. Estimated annual percentage changes and multivariable logistic regression models were fitted. None. Of 10,915 patients, 802 (7.3%) received critical care therapy and 249 (2.4%) died in-hospital. Over time, critical care therapy rates did not differ significantly (6.6% in 2000 to 5.7% in 2019; p = 0.07), while in-hospital mortality decreased from 2.3% to 1.9% (p = 0.004). Age 71 years old or older (odds ratio [OR], 1.43; p < 0.001) and higher comorbidity burden (Charlson Comorbidity Index [CCI] ≥ 3: OR, 2.92; p < 0.001 and CCI 1-2: OR, 1.45; p < 0.001) independently predicted higher critical care therapy rates. Conversely, partial nephrectomy (OR, 0.51; p = 0.003) and minimally invasive surgery (OR, 0.33; p < 0.001) predicted lower critical care therapy rates. Virtually the same associations were recorded for in-hospital mortality. After cytoreductive nephrectomy, critical care therapy rate was 7.3% vs. in-hospital mortality was 2.4%. Of patients at highest risk of critical care therapy need were those with CCI greater than or equal to 3 and those 71 years old or older. Ideally, these patients should represent targets for thorough assessment of risk factors for complications before cytoreductive nephrectomy.

A multicenter study on enteral autonomy outcome of pediatric intestinal failure patients from a middle-income country.

To identify predictors of enteral autonomy and survival in pediatric intestinal failure patients followed up at three pediatric intestinal rehabilitation centers from a middle-income country. This retrospective multicenter cohort study evaluated patients with intestinal failure from three high-volume intestinal rehabilitation centers on long-term parenteral nutrition between 2014 and 2023. The primary outcome was status at the end of the follow-up: parenteral nutrition dependence, enteral autonomy, transplantation, or death. Secondary outcomes were complications resulting from treatment and current parenteral nutrition dependency index. Competing risk analysis, Cox regression, and a decision tree model were employed. The cohort comprised 207 patients with a median (interquartile range) age at admission of 6.2 (3.1; 12.9) months and a median follow-up of 29.4 (10.2; 49.6) months. Short bowel (85%) and motility disorders (10.6%) were the primary causes of intestinal failure. Cumulative incidence of 5-year for enteral autonomy and survival rates were 37% and 88%, respectively. Intestinal failure-associated liver disease was present in 24% of patients on admission. Enteral autonomy was associated with remnant intestine length >40cm (hazard ratio: 2.0; 95% confidence interval: 1.7; 3.6); age at admission <6.2 months (hazard ratio: 1.8; 95% confidence interval: 1.0; 3.3); and preserved ileocecal valve (hazard ratio: 3.4; 95% confidence interval: 1.9; 6.0). The overall mortality rate was 7.7%. The overall survival rate was 92.3% and the 5-year cumulative incidence of enteral autonomy was 37%. The probability of achieving enteral autonomy was associated with early arrival at the intestinal rehabilitation center and favorable bowel anatomy.