Risk Of Intolerance Research Articles

Elevated glucagon and postprandial hyperglycemia in fatty liver indicate early glucose intolerance in metabolic dysfunction associated steatotic liver disease

In Japan, fatty liver cases with elevated body mass index are increasing. Because of being non-malignant, these are often neglected unless accompanied by diabetes. This study investigated the risk of glucose intolerance in individuals with non-alcoholic fatty liver. We included 165 men (mean age 56.3 years; range 29–75 years) who underwent an overnight 2-day physical examination at our Health Evaluation Center. All patients underwent abdominal ultrasonography to examine fatty liver. Fasting blood glucose and 75-g glucose tolerance test (OGTT) were conducted. alanine aminotransferase (ALT) (p < 0.01) and triglyceride (p < 0.001) levels were significantly higher in the fatty liver group (FL) than in the non-fatty liver group. HbA1c, fasting blood glucose, and blood glucose level at OGTT (0 and 30 min) did not show significant differences. In the FL, OGTT was significantly elevated at 60 min(p < 0.01)and 120 min (p < 0.001), insulin level was significantly elevated at 0 and 30 min (p < 0.001), and glucagon level was significantly elevated at 0 min (p < 0.05) and 30 min (p < 0.01), with no significant differences between the groups at 60 and 120 min. This is the first study to demonstrate elevated glucagon levels after OGTT. Metabolic dysfunction-associated steatotic liver disease (MASLD) requires treatment for insulin resistance with glucagon dysregulation likely associated with its pathogenesis.

Gestational diabetes in early pregnancy is associated with postpartum glucose intolerance: A perspective from the diabetes and pregnancy outcome for mother and baby study in Japan.

To compare perinatal outcomes and postpartum glucose tolerance between women diagnosed with gestational diabetes mellitus (GDM) before 20 weeks of gestation (EGDM) and those diagnosed at or after 24 weeks of gestation (LGDM) in a Japanese population. Data were obtained from a prospective GDM registry. Multivariate analysis was conducted to examine the association between the timing of GDM diagnosis (EGDM vs LGDM) and perinatal outcomes (preterm birth, small for gestational age, large for gestational age, pregnancy-induced hypertension, and neonatal hypoglycemia), as well as postpartum glucose intolerance. A total of 1,275 mother-infant pairs were analyzed for perinatal outcomes. Of these, 924 women underwent postpartum testing for glucose intolerance. No significant differences in perinatal outcomes were observed between the EGDM and LGDM groups, except that overweight/obese women with EGDM had 2.5-fold higher rate of preterm birth than those with LGDM. Postpartum glucose intolerance was 1.5 times more likely in the EGDM group than in the LGDM group. Women with EGDM had a significantly higher risk of postpartum glucose intolerance than those with LGDM, despite similar perinatal outcomes between the two groups.

Bempedoic Acid's Chemistry, Pharmacological Characteristics and Bioanalytical Techniques: An Updated Review

Background: Elevated blood cholesterol has been established as a major risk factor for atherosclerotic cardiovascular disease (ASCVD). Adults with hyperlipidemia have a significantly increased risk of developing cardiovascular diseases (CVD). First-line treatments for hyperlipidemia include statins, which help raise HDL-C levels in cases of severe and familial hypercholesterolemia and decrease LDL-C and TG levels. Numerous adverse effects on muscles have been associated with statins, such as asymptomatic elevations in blood creatine kinase activity and potentially fatal rhabdomyolysis. Non-statin drugs are advised for people whose very high cardiovascular risk or heterozygous familial hypercholesterolemia make statin therapy insufficient. A novel lipid-lowering medication with a distinct mode of action is bempedoic acid. Elevated blood cholesterol is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD). Individuals with hyperlipidemia are at a higher risk for developing cardiovascular diseases. Statins are the primary treatment for hyperlipidemia, raising HDL-C levels and lowering LDL-C and TG levels. However, statins can adversely affect muscles, including muscle-related complications like increased blood creatine kinase activity and rhabdomyolysis. Therefore, nonstatin drugs may be recommended for individuals. Bempedoic acid is a brand-new, first-in-class, oral small molecule that inhibits cholesterol manufacturing like statins, consequently reducing lowdensity lipoprotein cholesterol (LDL-C) through activating LDL receptors. Methods: This study offers helpful information on how to utilize bempedoic acid to decrease LDLC, as well as recommendations for which individuals could benefit and safety monitoring tips during therapy. A novel family of drugs called bempedoic acid is identified as a prodrug that becomes bempedoyl- CoA in the liver via an enzyme called very longchain consisting of acyl-CoA synthetase 1. Bempedoic acid can control cholesterol metabolism. Low-density lipoprotein cholesterol levels appeared to be dramatically reduced by bempedoic acid, according to clinical investigations. The toleration of bempedoic acid was good. Results: A cardiovascular outcomes trial is now evaluating bempedoic acid to determine its impact on major cardiovascular events in patients with or at high risk for cardiovascular disease and statin intolerance. Conclusion: This review describes the chemistry, mechanism of action, pharmacokinetics, analytical potential, and safety of bempedoic acid. Bempedoic acid is an effective and often well-tolerated drug used to further reduce LDL-C levels in patients taking the maximum dosage of tolerated statins or to control LDL-C levels in persons who can not take statins. The results of the clear Outcomes research, which is looking into whether bempedoic acid might reduce the frequency of serious cardiovascular events, are expected in 2025.

Alternative LDL Cholesterol–Lowering Strategy vs High-Intensity Statins in Atherosclerotic Cardiovascular Disease

In patients with atherosclerotic cardiovascular disease (ASCVD), intensive lowering of low-density lipoprotein (LDL) cholesterol levels with high-intensity statins is generally recommended. However, alternative approaches considering statin-related adverse effects and intolerance are needed. To compare the long-term efficacy and safety of an alternative LDL cholesterol-lowering strategy vs high-intensity statin strategy in patients with ASCVD in randomized clinical trials. PubMed, Embase, and other websites (ClinicalTrials.gov, European Society of Cardiology, tctMD) were systematically searched from inception to April 19, 2024. Randomized clinical trials comparing an alternative LDL cholesterol-lowering strategy vs a high-intensity statin strategy in patients with ASCVD, with presence of cardiovascular events as end points. Individual patient data were obtained from randomized clinical trials that met the prespecified eligibility criteria: RACING (Randomized Comparison of Efficacy and Safety of Lipid-Lowering With Statin Monotherapy vs Statin/Ezetimibe Combination for High-Risk Cardiovascular Disease) and LODESTAR (Low-Density Lipoprotein Cholesterol-Targeting Statin Therapy vs Intensity-Based Statin Therapy in Patients With Coronary Artery Disease). The moderate-intensity statin with ezetimibe combination therapy in the RACING trial and the treat-to-target strategy in the LODESTAR trial were classified as alternative LDL cholesterol-lowering strategies. The primary analysis was based on a 1-stage approach. The primary end point was a 3-year composite of all-cause death, myocardial infarction, stroke, or coronary revascularization. The secondary end points comprised clinical efficacy and safety end points. Individual patient data from 2 trials including 8180 patients with ASCVD (mean [SD] age, 64.5 [9.8] years; 2182 [26.7%] female; 5998 male [73.3%]) were analyzed. The rate of the primary end point did not differ between the alternative strategy and high-intensity statin strategy groups (7.5% [304 of 4094] vs 7.7% [310 of 4086]; hazard ratio, 0.98; 95% CI, 0.84-1.15; P = .82). The mean (SD) LDL cholesterol level during treatment was 64.8 (19.0) mg/dL in the alternative strategy group and 68.5 (20.7) mg/dL in the high-intensity statin strategy group (P < .001). The alternative strategy group had a lower rate of new-onset diabetes (10.2% [271 of 2658] vs 11.9% [316 of 2656]; P = .047), initiation of antidiabetic medication for new-onset diabetes (6.5% [173 of 2658] vs 8.2% [217 of 2656]; P = .02), and intolerance-related discontinuation or dose reduction of assigned therapy (4.0% [163 of 4094] vs 6.7% [273 of 4086]; P < .001). Results of this systematic review and individual patient data meta-analysis suggest that compared with a high-intensity statin strategy, the alternative LDL cholesterol-lowering strategy demonstrated comparable efficacy regarding 3-year death or cardiovascular events in patients with ASCVD, with an associated reduction in LDL cholesterol levels and risk for new-onset diabetes and intolerance. PROSPERO CRD42024532550.

Construction and SHAP interpretability analysis of a risk prediction model for feeding intolerance in preterm newborns based on machine learning

ObjectiveTo construct a highly accurate and interpretable feeding intolerance (FI) risk prediction model for preterm newborns based on machine learning (ML) to assist medical staff in clinical diagnosis.MethodsIn this study, a sample of 350 hospitalized preterm newborns were retrospectively analysed. First, dual feature selection was conducted to identify important feature variables for model construction. Second, ML models were constructed based on the logistic regression (LR), decision tree (DT), support vector machine (SVM) and eXtreme Gradient Boosting (XGBoost) algorithms, after which random sampling and tenfold cross-validation were separately used to evaluate and compare these models and identify the optimal model. Finally, we apply the SHapley Additive exPlanation (SHAP) interpretable framework to analyse the decision-making principles of the optimal model and expound upon the important factors affecting FI in preterm newborns and their modes of action.ResultsThe accuracy of XGBoost was 87.62%, and the area under the curve (AUC) was 92.2%. After the application of tenfold cross-validation, the accuracy was 83.43%, and the AUC was 89.45%, which was significantly better than those of the other models. Analysis of the XGBoost model with the SHAP interpretable framework showed that a history of resuscitation, use of probiotics, milk opening time, interval between two stools and gestational age were the main factors affecting the occurrence of FI in preterm newborns, yielding importance scores of 0.632, 0.407, 0.313, 0.313, and 0.258, respectively. A history of resuscitation, first milk opening time ≥ 24 h and interval between stools ≥ 3 days were risk factors for FI, while the use of probiotics and gestational age ≥ 34 weeks were protective factors against FI in preterm newborns.ConclusionsIn practice, we should improve perinatal care and obstetrics with the aim of reducing the occurrence of hypoxia and preterm delivery. When feeding, early milk opening, the use of probiotics, the stimulation of defecation and other measures should be implemented with the aim of reducing the occurrence of FI.

The impact of frailty on chemotherapy intolerance in patients with cervical cancer: A longitudinal study

PurposeTo explore the potential effects of frailty on chemotherapy intolerance in patients with cervical cancer. MethodsA longitudinal study of patients with cervical cancer undergoing postoperative Adjuvant Chemotherapy (ACT) was conducted at a hospital in Northwest China from July 2020 to December 2021. Baseline frailty was assessed using the Tilburg Frailty Indicator. Chemotherapy intolerance was obtained from electronic medical records during the intervals between each postoperative chemotherapy session. We used Generalized Estimating Equations (GEE) to determine the predictors and cox regression analysis to analyze the impact of frailty on chemotherapy intolerance. ResultsA total of 259 patients with postoperative cervical cancer with a mean age of 52.5 years (SD = 10.3) participated in this study. The incidence of chemotherapy intolerance in the frail group at T1, T2, T3 and T4 was 51.6%, 38.9%, 55.6% and 73.7%, respectively. The patients with frailty were more likely to have chemotherapy intolerance (OR = 1.495, 95% CI: 1.074–2.080, P < 0.05), prolonged hospitalizations (OR = 1.577, 95% CI: 1.086–2.291, P < 0.05) and unplanned readmissions (OR = 2.304, 95% CI: 1.387–3.829, P < 0.05) compared to the patients without frailty. Cox regression analysis showed that frailty increased the risk of chemotherapy intolerance by 1.681-fold (HR = 1.681, 95%CI 1.041–2.713; P < 0.05) and unplanned readmissions by 2.812-fold (HR = 2.812, 95%CI 1.521–5.200; P < 0.05). ConclusionsFrailty can lead to an increased risk of chemotherapy intolerance in patients with cervical cancer undergoing postoperative ACT, and patients with frailty are more likely to experience prolonged hospitalizations and unplanned readmissions.

The association between the dietary salt intake and glucose intolerance in the non-diabetic populations: from the Korean National Health and Nutritional Examination Survey (KNHANES)

Abstract Background Diabetes is known to be a strong risk factor for cardiovascular disease (CVD), and controlling salt intake in patients with type 2 diabetes may be a strategy to reduce the risk of CVD. However, the clear interaction between salt intake and glucose homeostasis has yet to be investigated. Our study evaluated the frequency and risk of glucose intolerance (pre-diabetes) according to dietary salt intake in the non-diabetic population in Korea. Methods The Korean National Health and Nutritional Examination Survey (KNHANES) database was utilized for this study (https://knhanes.cdc.go.kr). A total of 72,751 subjects were enrolled in the KNHANES database from 2010 to 2018. The subjects were categorized into the following: normal fasting glucose (i.e., no pre-diabetes; FPG &amp;lt; 100 mg/dL), stage 1 pre-diabetes (FPG 100–109 mg/dL), stage 2 pre-diabetes (FPG 110–125 mg/dL). All subjects were divided into 8-equal groups according to their sodium intake: Group 1: ≤ 3.5 g, Group 2: 3.5 to 5.0 g, Group 3: 5.0 to 6.3 g, Group 4: 6.3 to 7.8 g, Group 5: 7.8 to 9.5 g, Group 6: 9.5 to 11.8 g, Group 7: 11.8 to 15.5 g, Group 8: &amp;gt; 15.5 g. This study is a retrospective cross-sectional study, so future risks cannot be assessed, but only the disease status assessment at the same time. Results Of the total 57,165 subjects without diabetes, 29.5% (16,874 subjects) were pre-diabetic, of which 22.0% (12,577 patients) were stage I pre-diabetic, and 7.5% (4,297 subjects) were stage II pre-diabetic. From the lowest salt intake group (group 1, salt intake &amp;lt;3.5g) to the highest salt intake group (group 8, salt intake&amp;gt;.5g), the pre-diabetes prevalence continuously increased from 22.9% to 33.3%. The range of stage 1 pre-diabetes was 16.4% to 26.4%, and the range of stage 2 diabetes was 6.5% to 8.7%. The odds ratio (OR) of pre-diabetic risk according to salt intake in the non-diabetic population, compared with group 1, group 2 was 1.16 (95% confidence interval [CI]: 1.07-1.25), group 3 was 1.32 (95% CI: 1.23 -1.43), group 4 was 1.46 (95% CI: 1.35-1.57), group 5 was 1.51 (95% CI: 1.40-1.63), group 6 was 1.57 (95% CI: 1.46-1.69), group 7 was 1.65 (95% CI: 1.53-1.78), group 8 was 1.68 (95% CI: 1.56-1.81). Conclusions High salt intake is significantly associated with pre-diabetes prevalence in the non-diabetic Korean population.

The association between the dietary salt intake and glucose intolerance in healthy populations: from the Korean National Health and Nutritional Examination Survey (KNHANES)

Abstract Background Diabetes is known to be a strong risk factor for cardiovascular disease (CVD), and controlling salt intake in patients with type 2 diabetes may be a strategy to reduce the risk of CVD. However, the clear interaction between salt intake and glucose homeostasis has yet to be investigated. Our study evaluated the frequency and risk of glucose intolerance (pre-diabetes) according to dietary salt intake in a healthy population in Korea. Methods The Korean National Health and Nutritional Examination Survey (KNHANES) database was utilized for this study (https://knhanes.cdc.go.kr). A total of 72,751 subjects were enrolled in the KNHANES database from 2010 to 2018. The subjects were categorized into the following: normal fasting glucose (i.e., no pre-diabetes; FPG &amp;lt; 100 mg/dL), stage 1 pre-diabetes (FPG 100–109 mg/dL), stage 2 pre-diabetes (FPG 110–125 mg/dL). All subjects were divided into 8-equal groups according to their sodium intake: Group 1: ≤ 3.5 g, Group 2: 3.5 to 5.0 g, Group 3: 5.0 to 6.3 g, Group 4: 6.3 to 7.8 g, Group 5: 7.8 to 9.5 g, Group 6: 9.5 to 11.8 g, Group 7: 11.8 to 15.5 g, Group 8: &amp;gt; 15.5 g. This study is a retrospective cross-sectional study, so future risks cannot be assessed, but only the disease status assessment at the same time. Results Of the total 36,782 healthy adults, 17.6% (6,481 subjects) were pre-diabetic, of which 14.7% (5,397 subjects) were stage I pre-diabetic, and 2.9% (1,084 patients) were stage II pre-diabetic. From the lowest salt intake group (group 1, salt intake &amp;lt;3.5g) to the highest salt intake group (group 8, salt intake&amp;gt;.5g), the pre-diabetes prevalence continuously increased from 9.2% to 22.8%. The range of stage 1 pre-diabetes was 7.3% to 18.3%, and stage 2 diabetes was 1.9% to 4.5%. The odds ratio (OR) of pre-diabetic risk according to salt intake in the non-diabetic population, compared with group 1, group 2 was 1.46 (95% confidence interval [CI]: 1.30-1.68), group 3 was 1.84 (95% CI: 1.62 -2.08), group 4 was 2.24 (95% CI: 1.99-2.54), group 5 was 2.43 (95% CI: 2.15-2.75), group 6 was 2.49 (95% CI: 2.20-2.81), group 7 was 2.83 (95% CI: 2.51-3.19), group 8 was 2.90 (95% CI: 2.57-3.27). Conclusions High salt intake is significantly associated with pre-diabetes prevalence in healthy Korean population.

Differences in the optimization of pharmacological treatment in patients with heart failure and reduced ejection fraction and advanced chronic kidney disease

Abstract Introduction Chronic kidney disease is very prevalent in patients with HF, makes their treatment difficult and worsens their prognosis, especially when it is advanced CKD (glomerular filtration rate &amp;lt;30 mL/min/m2). Renal insufficiency increases the risk of drug intolerance and an increase in serious side effects, which can lead to underuse, with consequent negative effects on patient prognosis. Purpose To analyze in a contemporary registry of HF patients followed in specialized HF units in Spain the achievement of dose targets for the most used drugs in HF with reduced ejection fraction (HFrEF) and the impact of advanced CKD. Methods We analyzed 914 patients with HFrEF consecutively included between 2019 and 2021 in the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology in 45 centers. We evaluated the proportion of patients treated with ACEI, ARA, ARNI, MRA, beta-blockers and SGLT2 inhibitors at the registry inclusion visit, the causes of non-prescription, and the achievement of the maximum dose recommended in the ESC clinical practice guidelines or the maximum tolerated dose in these patients, comparing the GFR groups, greater or less than 30 ml/min/m2. Results Of the 914 patients, 8.9% had a GFR&amp;lt;30 mL/min/m2. Their age was 76.9±9.7 years, 39.7% women, mean LVEF 32.8±9-6%. Patients with GFR&amp;lt;30 received in a significantly lower proportion all HF drugs except diuretics, ARBs and potassium chelators: sacubitril-valsartan 30.5% vs 59.2%; MRAs 31.7 vs 77.8%; SGLT2 inhibitors 34.1 vs 52.9% (p&amp;lt;0.001; Figure 1). The main reason for non-use was intolerance/contraindication for beta-blockers and "other" for the rest of the drugs (Figure 1). The proportion of patients in whom the maximum recommended, or maximum tolerated dose was reached was low in both groups, less than 40-50% for all drugs except MRA. There were no significant differences between the two groups in relation to the degree of renal dysfunction, although there was a tendency for the recommended doses to be obtained more frequently in the group with lower GFR (Figure 2). Conclusions In our contemporary cohort of real-life patients with HFrEF and advanced CKD, the use of recommended drugs for HF was significantly lower than in those patients with better renal function. However, where they were used, maximum recommended or tolerated doses were achieved in a higher proportion of patients. This indicates that with adequate selection it is possible to achieve the objectives proposed by the clinical practice guidelines in this complex group of patients.

Risk factors for bacterial stent colonization in patients with a double J ureteral stent: a prospective study.

The increasing use of double J ureteral stents (DJS) has increased the risk of early intolerance and long-term complications. Studies have reported stent colonization rates ranging from 19 to 90% with various bacterial profiles in the colonization of stents. To identify the risk factors associated with bacterial colonization of DJS and report the common micro-organisms isolated and drug susceptibility pattern. This study is a prospective study of patients who underwent DJS. A total of 48 patients from our institution were studied between March 2022 and August 2023. After the removal of DJS with a sterile technique, the tips of both ends (renal end and bladder end) of the stent were cut and processed in the microbiology lab. Bacterial colonies were detected in 56.25% (27 out of 48) of the stents. Among the pathogens identified, Enterococcus species, Pseudomonas aeruginosa and E. coli were the most frequently isolated. The colonization rate increased with the duration of stent placement and albuminuria. The study indicated that prolonged indwelling time and albuminuria are a risk factor for bacterial colonization on the stent therefore, it is advisable to use double J ureteral stent only when absolutely necessary and to remove them promptly.

Development and validation of a risk prediction model for feeding intolerance in neurocritical patients with enteral nutrition.

This study collects and analyzes clinical data on enteral nutrition therapy in neurocritical patients, develops and validates a feeding intolerance (FI) risk prediction model, and provides a theoretical basis for screening patients with high risk of feeding intolerance (FI) and delivering personalized care. A convenience sampling method was employed to select 300 patients who were admitted to a tertiary hospital in China for early enteral nutrition therapy in the neurointensive care unit between April 2022 and December 2022. Independent risk factors for FI were identified using univariate and logistic regression analyses. A prediction model was established, and the goodness of fit and discriminant validity of the model were evaluated. The incidence of FI in neurocritical patients receiving enteral nutrition was 71%. Logistic regression analysis identified age, Glasgow Coma Scale (GCS) scores, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, mechanical ventilation, feeding via the nasogastric tube route, hyperglycemia, and low serum albumin as independent risk factors for the development of FI (p < 0.05). The predictive formula for FI risk was established as follows: Logit p = -14.737 + 1.184 × mechanical ventilation +2.309 × feeding route +1.650 × age + 1.336 × GCS tertile (6-8 points) + 1.696 × GCS tertile (3-5 points) + 1.753 × APACHE II score + 1.683 × blood glucose value +1.954 × serum albumin concentration. The Hosmer-Lemeshow test showed χ2 = 9.622, p = 0.293, and the area under the ROC curve was 0.941 (95% confidence interval: 0.912-0.970, p < 0.001). The optimal critical value was 0.767, with a sensitivity of 85.9%, a specificity of 90.8%, and a Youden index of 0.715. The early enteral nutrition FI risk prediction model developed in this study demonstrated good predictive ability. This model can serve as a valuable reference for effectively assessing the risk of FI in neurocritical patients, thereby enhancing clinical outcomes.

Evaluation of Taraxacum officinale phytoconstituents as potential JNK1 inhibitors: Perspectives from ADMET, molecular docking, molecular dynamics, and density functional theory

The impact of activated c-Jun N-terminal kinase isoform JNK1 chemical pathways in insulin biosynthesis poses a potential health risk of glucose intolerance. Blocking the activity of JNK1 is a promising route for the design of anti-diabetic drugs and associated metabolic syndromes. In this study, 17 extracts of Taraxacum officinale were chosen to bind JNK1 and ascertain their modulatory activity. We employed molecular dynamics, density functional theory and three docking approaches: standard precision, extra precision and quantum polarized ligand docking. The best binding free energy results were obtained from the quantum polarized ligand docking, with myricetin (1) showing a docking score of -10.464 kcal/mol, while quercetin (2) and daphnetin (3) displayed values of -9.769 and -7.136 kcal/mol respectively. Following this, 100 ns molecular dynamics simulations with Desmond showed stabilization average root mean square deviations of 2.34, 2.87, and 2.88 Å for myricetin, quercetin and daphnetin. Further, molecular dynamics revealed complexes of myricetin (ΔG = -38.81 kcal/mol) and quercetin (ΔG = -34.99 kcal/mol) as the most stable inside the JNK1 interface. The energy gaps for myricetin, quercetin and daphnetin were estimated to be 6.17, 6.00 and 6.53 eV employing the M06–2X functional in PCM solvation. Further, myricetin showed the strongest intramolecular hydrogen bonding with -13.06 kcal/mol. This study provides insights into possible anti-type-2 diabetes properties of Taraxacum officinale targeting JNK1.

Splanchnic and cerebral oxygenation during cyclic phototherapy in preterm infants with hyperbilirubinemia

Cyclic phototherapy (cPT) can achieve a reduction in total serum bilirubin comparable to that achieved with standard continuous PT in preterm infants. Our aim was to assess the effect of cPT on splanchnic (rSO2S) and cerebral (rSO2C) oxygenation measured by near-infrared spectroscopy (NIRS). We prospectively studied 16 infants with a gestational age of 25–34 weeks with hyperbilirubinemia requiring PT. Splanchnic regional oxygenation (rSO2S), oxygen extraction fraction (FOES), and cerebro-splanchnic oxygenation ratio (CSOR) were recorded before, during, and after cPT discontinuation. We found that rSO2S, FOES, and CSOR did not change during the study period. The overall duration of single or multiple courses of PT was 6.5 (6.0–13.5) h, but by cycling PT, the actual exposure was 3.0 (1.5–4.9) h. Twelve patients (75%) required 15 min/h cPT, and four (25%) required prolonging cPT to 30 min/h. None of the patients developed enteral feeding intolerance.Conclusions: cPT treatment of hyperbilirubinemia in preterm infants does not affect splanchnic oxygenation or intestinal oxygen blood extraction, likely due to the short exposure to PT light, and it could contribute to decreasing the risk of feeding intolerance.What is Known:• The assumption that phototherapy (PT) is innocuous with no serious adverse effects has been questioned.• Cyclic phototherapy (cPT) can achieve a reduction in total serum bilirubin comparable to that achieved with standard continuous PT in preterm infants.What is New:• Splanchnic and cerebral oxygenation measured by near-infrared spectroscopy did not change during KMC.• cPT can contribute to decrease the risk of feeding intolerance likely due to the short exposure to PT light.

Clinical effects of hybrid debranching technique for acute Stanford type A aortic dissection

BackgroundTo investigate the clinical effects and safety of the hybrid debranching technique for patients with acute Stanford type A aortic dissection (AD).MethodsOne hundred nine patients with acute Stanford type a AD were selected and divided into observation group and control group according to the different surgical methods. Fifty-five patients in the observation group were treated with hybrid debranching, and 54 patients in the control group were treated with Sun’s operation. The operation duration, clamp time, cardiopulmonary bypass duration, volume of blood transfusion, ventilator application duration, duration of stay in the intensive care unit, aortic rupture, second thoracotomy due to hemorrhage, gastrointestinal hemorrhage, stroke, paraplegia, renal failure, and all-cause mortality were recorded. Postoperative follow-up was conducted. The number of cases that underwent follow-up and the number of cases with complete thrombosis of the false aneurysm cavity detected by computed tomography angiography (CTA) was recorded.ResultsThe surgical success rate was 100% in both groups, and there were no cases with unplanned secondary surgery. Compared with the control group, only the difference in the volume of blood transfusion was not significantly significant between the two groups (P = 0.052), while the rest of the observation indicators were significantly lower in the observation group than in the control group (P < 0.001 for all). The proportion of cases with complete thrombosis of the false aneurysm cavity was significantly higher in the observation group than in the control group at 3 and 6 months after surgery (P < 0.05).ConclusionIn patients with acute Stanford type A AD involving the arch, the hybrid debranching technique was safe and effective. It was recommended for patients with advanced age and a high risk of intolerance to deep hypothermic circulatory arrest.

Comparative Assessment of Machine Learning Models for Predicting Glucose Intolerance Risk

Comparative Assessment of Machine Learning Models for Predicting Glucose Intolerance Risk

Prokinetic effect of erythromycin in the management of gastroparesis in critically ill patients-our experience and literature review.

Gastroparesis is a disorder characterized by impaired gastric emptying and the accumulation of food in the intestines without any clear mechanical cause. Gastroparesis in critical care patients is a prevalent issue in the intensive care unit. The disruption of normal gastrointestinal motility in critically ill patients is linked to a significant risk of intolerance to enteral feeding, colonization of the gastrointestinal tract with pathogenic bacterial strains, increased permeability of the intestinal wall, translocation of the intestinal microbiota, leading to progressive malnutrition, and potential development of bacterial infection. The literature was reviewed to assess the benefits and risks associated with the use of this medication. The aim of the study was to treat the symptoms of gastroparesis and stimulate gastrointestinal motility. Consequently, the aim was to reduce the amount of backed-up food content in the stomach, accelerate gastrointestinal motility, and return to intestinal feeding. Gastroparesis is a frequent issue among patients in the intensive care unit. Critical illness can lead to gastrointestinal motility disorders, causing slowed gastric emptying. This increases the risk of problems such as intolerance to enteral feeding, regurgitation, and aspiration of gastrointestinal contents into the respiratory tract, as well as colonization of the gastrointestinal tract by pathogens. Over time, impaired intestinal absorption can result in malnutrition, necessitating the initiation of parenteral nutrition. After analysis of the literature and published scientific reports, as well as considering their own research, it is evident that erythromycin, as a prokinetic drug, effectively enhances gastrointestinal motility. This contributes to stimulating gastric emptying in critically ill patients with gastroparesis who are hospitalized in an intensive care unit. The use of erythromycin in combination with metoclopramide and/or itopride hydrochloride allows for a synergistic effect, leading to the quickest possible return to enteral feeding.

Multivariate analysis of factors associated with the successful prediction of initial blind placement of a nasointestinal tube in the stomach based on X-ray imaging: a retrospective, single-center study

BackgroundPatients in the intensive care unit (ICU) are highly susceptible to malnutrition, and while enteral nutrition via nasogastric tube is the preferred method, there is a risk of inadvertent reflux and aspiration. Therefore, clinicians have turned to nasointestinal tubes (NET) for enteral nutrition as an alternative option. But the precise localization of NET presents an ongoing challenge. We proposed an innovative approach to provide a valuable reference for clinicians involved in NET placement.MethodData were obtained retrospectively from the medical records of adult patients with a high risk of aspiration or gastric feeding intolerance who had a NET placed in the ICU of Zhejiang Provincial People’s Hospital between October 1, 2017, and October 1, 2023. The collected data were subjected to statistical analysis using SPSS and R software.ResultThere were 494 patients who met the inclusion and exclusion criteria. The first-pass success rate was 81.4% (n = 402). The success of a patient’s initial NET placement was found to be associated with Angle SPC and Distance CP, as determined by univariate analysis (25.6 ± 16.7° vs. 41.9 ± 18.0°, P < 0.001; 40.0 ± 26.2 mm vs. 62.0 ± 31.8 mm, P < 0.001, respectively). By conducting a multivariate regression analysis, we identified a significant association between pyloric types and the success rate of placing NET (OR 29.559, 95%CI 14.084–62.038, P < 0.001).ConclusionAngle SPC, Distance CP, and the type of pylorus are independently associated with successful initial placement of NET. Besides, patients with the outside type of pylorus (OP-type) exhibit a higher rate of initial placement success.

Blended diet in enteral feeding: current guidance.

The practice of administering blended food via enteral feeding tubes has been growing in popularity in recent years. Concerns have been raised as this practice was perceived to increase risk of gastrointestinal intolerance, allergic reactions, nutritional insufficiency, tube blockages, and infection compared with using commercial enteral feed (CEF), the gold standard, as well as risk of litigation against the professional due to their support of practice that is not evidence-based. However, research has shown that the physical, social and emotional benefits from receiving blended diet may outweigh the previously suggested risks. Guidance has been updated to encourage discussions around blended diet while informing the tube-fed individuals, families and carers of potential risks, potential benefits, barriers, considerations for training, safety and contraindications.

Impact of breastfeeding on risk of glucose intolerance in early postpartum after gestational diabetes.

To determine the impact of breastfeeding on the risk of postpartum glucose intolerance in women with gestational diabetes. Sub-analysis of two multi-centric prospective cohort studies (BEDIP-N and MELINDA) in 1008 women with gestational diabetes. Data were collected during pregnancy and at a mean of 12 weeks postpartum. Multivariate logistic regression was used to estimate the effect of breastfeeding on glucose intolerance, with adjustment for ethnicity, education, income, professional activity and BMI. Of all participants, 56.3% (567) breastfed exclusively, 10.1% (102) gave mixed milk feeding and 33.6% (339) did not breastfeed. Mean breastfeeding duration was 3.8 ± 2.4 and 3.7 ± 2.1 months in the breastfeeding and mixed milk feeding groups (p=0.496). The rate of glucose intolerance was lower in both the breastfeeding [22.3% (126)] and mixed milk feeding [25.5% (26)] groups compared to the no breastfeeding group [29.5% (100)], with an adjusted OR of 0.7 (95% CI 0.5-1.0) for glucose intolerance in the breastfeeding group compared to no breastfeeding group and an adjusted OR of 0.7 (95% CI 0.4-1.2) for the mixed milk feeding group compared to the no breastfeeding group. Postpartum, breastfeeding women had a lower BMI, less often postpartum weight retention, lower fasting triglycerides, less insulin resistance and a higher insulin secretion-sensitivity index-2 than the mixed milk feeding and no breastfeeding group. The mixed milk feeding group was more often from an non-White background, had a lower blood pressure and lower fasting triglycerides compared to the no breastfeeding group. Breastfeeding (exclusive and mixed milk feeding) is associated with less glucose intolerance and a better metabolic profile in early postpartum in women with gestational diabetes.

Feeding intolerance scoring system in very preterm and very low birth weight infants using clinical and ultrasound findings.

Very preterm infants are at a high risk of developing feeding intolerance; however, there are no widely accepted definitions of feeding intolerance. This study aimed to develop a scoring system for feeding intolerance in very preterm infants by combining clinical symptoms and ultrasonography (US) findings. This prospective cohort study included very preterm and/or very low birth weight infants. We defined feeding intolerance as the inability to achieve full feeding (150 ml/kg/day) by 14 days of life. The clinical findings included vomiting, abdominal distention, and gastric fluid color. US findings included intestinal peristaltic frequency, gastric residual volume, peak systolic velocity, and the resistive index of the superior mesenteric artery. We conducted multivariate analyses to evaluate the potential predictors and developed a scoring system to predict feeding intolerance. A total of 156 infants fulfilled the eligibility criteria; however, 16 dropped out due to death. The proportion of patients with feeding intolerance was 60 (42.8%). Based on the predictive ability, predictors of feeding intolerance were determined using data from the US at 5-7 days of age. According to multivariate analysis, the final model consisted of 5 predictors: abdominal distention (score 1), hemorrhagic gastric fluid (score 2), intestinal peristaltic movement ≤18x/2 min (score 2), gastric fluid residue >25% (score 2), and resistive index >0.785 (score 2). A score equal to or above 5 indicated an increased risk of feeding intolerance with a positive predictive value of 84.4% (95% confidence interval:73.9-95.0) and a negative predictive value of 76.8% (95% confidence interval:68.4-85.3). The scoring system had good discrimination (area under the receiver operating characteristic curve:0.90) and calibration (p = 0.530) abilities. This study developed an objective, accurate, easy, and safe scoring system for predicting feeding intolerance based on clinical findings, 2D US, and color Doppler US.