Constipation Is More Frequent Than Diarrhea in Patients Fed Exclusively by Enteral Nutrition: Results of an Observational Study

Background: Digestive complications in enteral nutrition (EN) can negatively affect the nutrition clinical outcome of hospitalized patients. Diarrhea and constipation are intestinal motility disorders associated with pharmacotherapy, hydration, nutrition status, and age. The aim of this study was to analyze the frequency of these intestinal motility disorders in patients receiving EN and assess risk factors associated with diarrhea and constipation in hospitalized patients receiving exclusive EN therapy in a general hospital. Materials and Methods: The authors performed a sequential and observational study of 110 hospitalized adult patients fed exclusively by EN through a feeding tube. Patients were categorized according to the type of intestinal transit disorder as follows: group D (diarrhea, 3 or more watery evacuations in 24 hours), group C (constipation, less than 1 evacuation during 3 days), and group N (absence of diarrhea or constipation). All prescription drugs were recorded, and patients were analyzed according to the type and amount of medication received. The authors also investigated the presence of fiber in the enteral formula. Results: Patients classified in group C represented 70% of the study population; group D comprised 13%, and group N represented 17%. There was an association between group C and orotracheal intubation as the indication for EN (P<.001). Enteral formula without fiber was associated with constipation (logistic regression analysis: P<.001). Conclusion: Constipation is more frequent than diarrhea in patients fed exclusively by EN. Enteral diet with fiber may protect against medication-associated intestinal motility disorders. The addition of prokinetic drugs seems to be useful in preventing constipation. (Nutr Clin Pract. XXXX;xx:xx-xx)

Extremely slow feeding in a tropical drilling ectoparasite, Vitularia salebrosa (King and Broderip, 1832) (Gastropoda: Muricidae), on molluscan hosts from Pacific Panama

This study documents one of the slowest feeding behaviors ever recorded for a muricid gastropod in one of the most biotically rigorous regions on the planet. In Pacific Panama, Vitularia salebrosa attacks mollusks by drilling through their shells. The duration of attacks estimated by isotope sclerochronology of oyster shells collected during attacks in progress range from 90 to 230 days, while experimental observation of interactions documented one attack greater than 103 days. The prolonged nature of attacks suggests that V. salebrosa is best characterized as an ectoparasite than as a predator, which is the ancestral condition in the Muricidae. An ectoparasitic lifestyle is also evident in the unusual interaction traces of this species, which include foot scars, feeding tunnels and feeding tubes, specialized soft anatomy, and in the formation of male-female Pairs, which is consistent with protandrous hermaphroditism, as is typical in sedentary gastropods. To delay death of its host, V. salebrosa targets renewable resources when feeding, such as blood and digestive glands. A congener, Vitularia miliaris from the Indo-Pacific, has an identical feeding biology The origin and persistence of extremely slow feeding in the tropics challenges our present understanding of selective pressures influencing the evolution of muricid feeding behaviors and morphological adaptations. Previously, it has been suggested that faster feeding is advantageous because it permits predators to spend a greater proportion of time hiding in enemy-free refugia or to take additional prey, the energetic benefits of which could be translated into increased fecundity or defenses. The benefits of exceptionally slow feeding have received little consideration. In the microhabitat preferred by V. salebrosa (beneath boulders), it is possible that prolonged interactions with hosts decrease vulnerability to enemies by reducing the frequency of risky foraging events between feedings . Ectoparasitic feeding through tunnels by V. salebrosa may also reduce competitive interactions with kleptoparasites (e.g., crabs, snails) that steal food through the gaped valves of dead or dying hosts.

Duodenal stenting for malignant gastric outlet obstruction: Prospective study

AIM: To evaluate the results of duodenal stenting for palliation of gastroduodenal malignant obstruction by using a gastric outlet obstruction score (GOOS). METHODS: A prospective, non-randomized study was performed at a tertiary center between August 2005 and April 2010. Patients were eligible if they had malignant gastric outlet obstruction (GOO) and were not candidates for surgical treatment. Medical history and patient demographics were collected at baseline. Scheduled interviews were made on the day of the procedure and 15, 30, 90 and 180 d later or unscheduled as necessary. RESULTS: Fifteen patients (6 male, 9 female; median age 61 years) with GOO who had undergone duodenal stenting were evaluated. Ten patients had metastasis at baseline (66.6%) and 14 were unable to accept oral intake (93.33%), including 7 patients who were using a feeding tube. Laboratory data showed biliary obstruction in eight cases (53.33%); all were submitted to biliary drainage. Two patients developed obstructive symptoms due to tumor ingrowth after 30 d and another due to tumor overgrowth after 180 d. Two cases of stent migration occurred. A good response to treatment was observed, with a mean time of approximately 1 d (19 h) until toleration of a liquid diet and slightly more than 2 d for both soft solids (51 h) and a solid food/normal diet (55 h). The mean time to first failure to maintain liquid intake (GODS >= 1) was 93 d. During follow-up, the mean time to first failure to maintain the previously achieved GODS of 2-3 (solid/semi-solid food), considered technical failure, was 71 d. On the basis of oral intake a GODS is defined: 0 for no oral intake; 1 for liquids only; 2 for soft solids only; 3 for low-residue or full diet. CONCLUSION: Enteral stenting to alleviate gastroduodenal malignant obstruction improves quality of life in patients with limited life expectancy, which can be evaluated by using a GOO scoring system. (C) 2012 Baishideng. All rights reserved.

Selection of Top 10 Quality Indicators for Nutrition Therapy

Background: The identification of useful quality indicators for nutrition therapy (QINTs) is of great interest and a challenge. This study attempted to identify the 10 QINTs that best suit the practice of quality control in nutrition therapy (NT) by evaluating the opinion of experts in NT with the use of psychometric techniques and statistical tools. Methods: Thirty-six QINTs available for clinical application in Brazil were assessed in 2 distinct phases. In phase 1, 26 nutrition experts ranked QINTs by scoring 4 attributes (utility, simplicity, objectivity, low cost) to assess each QINT on a 5-point Likert scale. The top 10 QINTs were identified from the 10 best scores obtained, and the reliability of expert opinion for each indicator was assessed by Cronbach's alpha. In phase 2, experts provided feedback regarding the selected top 10 QINTs by answering 2 closed questions. Results: The top 10 QINTs, in descending order, are the frequency of nutrition screening of hospitalized patients, diarrhea, involuntary withdrawal of enteral feeding tubes, feeding tube obstruction, fasting longer than 24 hours, glycemic dysfunction, estimated energy expenditure and protein needs, central venous catheter infection, compliance of NT indication, and frequency of application of subjective global assessment. Opinions were consistent among the interviewed experts. During feedback, 96% of experts were satisfied with the top 10 QINTs, and 100% had considered them in accordance with their previous opinion. Conclusion: The top 10 QINTs were identified according to their usefulness in clinical practice by obtaining adequate agreement and representativeness of opinion of nutrition experts. (Nutr Clin Pract. 2012;27:261-267)

Extreme bariatric endoscopy: stenting to reconnect the pouch to the gastrojejunostomy after a Roux-en-Y gastric bypass

Among the possible complications of bariatric surgery, fistula and partial dehiscence of the gastric suture are well known. Reoperation often is required but results in significant morbidity. Endoscopic treatment of some bariatric complications is feasible and efficient. A modified metallic stent was placed between the gastroaesophageal junction and the alimentary jejunal limb, allowing the passage of a nasoenteric feeding tube into the jejunal limb. Endoscopy showed disruption of nearly the entire staple line at the gastric pouch. The modified stent was placed and allowed wound healing. After 31 days, the stent had migrated and was removed endoscopically. Total clousure of the fistula was reported 30 days afterward. Endoscopic treatment of some bariatric surgery complications is feasible and has been reported previously. This report presents a case of a serious leakage treated by placement of a self-expandable metal stent to bridge the fistula.

Lipidic and proteic absorption in digestive tract of tropical fat snook (Centropomus parallelus, POEY 1860)

The tropical fat snook Centropomus parallelus is a species of recognized ecological importance and with a high economical potential for fisheries and aquaculture. The investigations of digestive tube morphology in association with their feeding abilities are fundamental to improve techniques for aquaculture feeding procedures. Sudan black staining and Perl`s method were used to evaluate their absorption capacity of fat and protein respectively. The Sudan black stain was performed 12 h after the ingestion of lipids. The lipids are intensely absorbed in the ceca epithelium and less intensely in the intestine and rectum. The Perl`s method was performed 12 h after the ingestion of ferritin. The proteins are absorbed only in the rectum. This is the first description of fat and protein absorption ability by the digestive tube of fat snook. These data enhance the possibility of the addition of macromolecules in rations that can show a diversity of physiological effects. The histological implications of each segment of the digestive tube in association with fish biology are further discussed. (C) 2010 Elsevier B.V. All rights reserved.

Feeding ecology of the Brazilian silverside Atherinella brasiliensis (Atherinopsidae) in a sub-tropical estuarine ecosystem

The feeding ecology of the Brazilian silverside, Atherinella brasiliensis, in a sub-tropical estuary of Brazil was investigated through the gut analysis of 1431 individuals. We described dietary composition and analysed seasonal, estuarine habitat, and body size variations in the diet; trophic level; feeding diversity; and gut fullness indices. Results reveal that A. brasiliensis is a typical, generalistic and opportunistic predator that makes use of a wide array of prey types (at least 89 different types), with zooplankton (mainly calanoids), diatoms, terrestrial insects, and plant detritus making up the bulk of the overall diet. The exotic calanoid Temora turbinata ranked as the primary prey. A wide feeding diversity (mean H` = 2.26), low trophic level (mean TROPH = 2.57), and high gut replenishment were persistent across seasons and habitats. Diet composition varied largely and significantly with respect to habitat, season, and body size. A closer assessment showed that habitat and season had a stronger effect on diet than fish size.

Evolutionary Diversification of Banded Tube-Dwelling Anemones (Cnidaria; Ceriantharia; Isarachnanthus) in the Atlantic Ocean

The use of molecular data for species delimitation in Anthozoa is still a very delicate issue. This is probably due to the low genetic variation found among the molecular markers (primarily mitochondrial) commonly used for Anthozoa. Ceriantharia is an anthozoan group that has not been tested for genetic divergence at the species level. Recently, all three Atlantic species described for the genus Isarachnanthus of Atlantic Ocean, were deemed synonyms based on morphological simmilarities of only one species: Isarachnanthus maderensis. Here, we aimed to verify whether genetic relationships (using COI, 16S, ITS1 and ITS2 molecular markers) confirmed morphological affinities among members of Isarachnanthus from different regions across the Atlantic Ocean. Results from four DNA markers were completely congruent and revealed that two different species exist in the Atlantic Ocean. The low identification success and substantial overlap between intra and interspecific COI distances render the Anthozoa unsuitable for DNA barcoding, which is not true for Ceriantharia. In addition, genetic divergence within and between Ceriantharia species is more similar to that found in Medusozoa (Hydrozoa and Scyphozoa) than Anthozoa and Porifera that have divergence rates similar to typical metazoans. The two genetic species could also be separated based on micromorphological characteristics of their cnidomes. Using a specimen of Isarachnanthus bandanensis from Pacific Ocean as an outgroup, it was possible to estimate the minimum date of divergence between the clades. The cladogenesis event that formed the species of the Atlantic Ocean is estimated to have occured around 8.5 million years ago (Miocene) and several possible speciation scenarios are discussed.

Replacement of fentanyl infusion by enteral methadone decreases the weaning time from mechanical ventilation: a randomized controlled trial

Introduction: Patients undergoing mechanical ventilation (MV) are frequently administered prolonged and/or high doses of opioids which when removed can cause a withdrawal syndrome and difficulty in weaning from MV. We tested the hypothesis that the introduction of enteral methadone during weaning from sedation and analgesia in critically ill adult patients on MV would decrease the weaning time from MV. Methods: A double-blind randomized controlled trial was conducted in the adult intensive care units (ICUs) of four general hospitals in Brazil. The 75 patients, who met the criteria for weaning from MV and had been using fentanyl for more than five consecutive days, were randomized to the methadone (MG) or control group (CG). Within the first 24 hours after study enrollment, both groups received 80% of the original dose of fentanyl, the MG received enteral methadone and the CG received an enteral placebo. After the first 24 hours, the MG received an intravenous (IV) saline solution (placebo), while the CG received IV fentanyl. For both groups, the IV solution was reduced by 20% every 24 hours. The groups were compared by evaluating the MV weaning time and the duration of MV, as well as the ICU stay and the hospital stay. Results: Of the 75 patients randomized, seven were excluded and 68 were analyzed: 37 from the MG and 31 from the CG. There was a higher probability of early extubation in the MG, but the difference was not significant (hazard ratio: 1.52 (95% confidence interval (CI) 0.87 to 2.64; P = 0.11). The probability of successful weaning by the fifth day was significantly higher in the MG (hazard ratio: 2.64 (95% CI: 1.22 to 5.69; P < 0.02). Among the 54 patients who were successfully weaned (29 from the MG and 25 from the CG), the MV weaning time was significantly lower in the MG (hazard ratio: 2.06; 95% CI 1.17 to 3.63; P < 0.004). Conclusions: The introduction of enteral methadone during weaning from sedation and analgesia in mechanically ventilated patients resulted in a decrease in the weaning time from MV.

Feeding habits of Guiana dolphins, Sotalia guianensis, from south-eastern Brazil: new items and a knowledge review

This study presents new information on feeding habits of Guiana dolphins, Sotalia guianensis, in south-eastern Brazil, together with new regression equations to evaluate the weight and length of fish from otoliths, showing an overview on the knowledge about this species' diet in this area. Eighteen stomach contents had been analysed and compared to 180 samples collected in another eight feeding studies. The analysed specimens were either incidentally caught in gillnets used in coastal waters by the fleet based in the Cananeia main harbour (25 degrees 00'S 47 degrees 55'W), south of Sao Paulo State, or found dead in inner waters of the Cananeia estuary between 2003 and 2009. Based on the index of relative importance analysis, the most important fish species were the banded croaker, Paralonchurus brasiliensis. Doryteuthis plei was the most representative cephalopod species. Stellifer rastrifer was the most important fish species observed in dolphins in inner estuarine waters and P. brasiliensis in recovered dolphins from coastal waters. Loliguncula brevis is the only cephalopod species reported from dolphins found in inner estuarine waters up to date. Doryteuthis plei was the most important cephalopod species observed in coastal dolphins. When considering other feeding studies, the most representative fish family in the diet of S. guianensis was Sciaenidae, which is mainly represented by demersal fishes. The main preys of S. guianensis are abundant in the studied areas, which may indicate an opportunistic feeding habit. The majority of them are not the most important target species by the commercial fishery in south-eastern Brazil.

Prey-capture efficiency between juveniles and adults, feeding habitat and abundance of Wattled Jacana foragers in northern Pantanal, Mato Grosso state, Brazil

The choice of foraging strategies implies an attempt at gaining energy by predators. Supposedly, the difference in employing the "sit and wait" or "active foraging" behavior lays in hunter skills, experience and the kind of prey consumed. With the hypothesis that "active foraging" demands no learning, in this study we compared the prey capture efficiency among Wattled Jacana juveniles and adults, and also present descriptive information about feeding habitat and the abundance variation of foragers throughout the day in the northern Pantanal. Prey capture efficiency did not differ significantly among juveniles and adults, corroborating our initial hypothesis that "active foraging" is an instinctive behavior and demands no experience to be effective. However, future work is necessary to compare the energetic quality of consumed items by juveniles and adults, searching for differences explained by adults' experience. Foraging individuals were found at an average distance of 14 m ranging from 2 to 42 m) from the margin of the sampled swamps, however 64% of the foragers were found closer to the margins. The average depth of foraging sites was 17 cm, ranging from 5 to 40 cm, although no preference for specific classes of depth was found (p > 0,05). Despite the accepted general pattern of birds being more active in the early morning, the largest number of individuals foraging was observed between 11:00 and 12:00 AM, but no significant difference was found in the abundance of foraging individuals among different periods of the day. Factors, which were not analyzed, such as food availability and presence of competitors and predators need to be studied to reveal the main factors of the spatial and temporal distribution of the Wattled Jacana.

Feeding ecology of the American freshwater goby Ctenogobius shufeldti (Gobiidae, Perciformes) in a sub-tropical estuary

The feeding ecology of the American freshwater goby Ctenogobius shufeldti in a low salinity salt-marsh habitat in the Paranagua Bay estuarine complex (Brazil) was assessed through the gut analysis of 632 individuals. The effects of a set of abiotic factors (type of sediment, salinity, temperature and estuarine reach), season and body size on dietary composition were analysed. Seasonal and size-related changes in feeding strategy, feeding intensity and trophic level were assessed. The effects of gape and body size on prey size use were also analysed. The results showed that C. shufeldti is a typical omnivorous, generalized benthic predator of low trophic levels throughout the seasons and size classes, feeding on 56 dietary items; tanaids, chlorophyte algae, ostracods, gastropods, detritus and benthic diatoms made up the bulk of its diet. The tanaid Kalliapseudes schubarti was the main prey item in both numerical and volumetric terms. The gut fullness was persistently high across the seasons. As expected for a typical generalized, opportunistic omnivorous feeder: (1) seasonal and spatial-temporal variability of abiotic factors had a significant effect on diet structure, (2) season accounted for most of the dietary variation and (3) diet composition and the size of prey consumed did not vary across the size classes.

High Cholesterol Feeding May Induce Tubular Dysfunction Resulting in Hypomagnesemia

Background/Aims: Hypomagnesemia may induce hypercholesterolemia, but the contrary has not been described yet. Thus, magnesium homeostasis was evaluated in rats fed a cholesterol-enriched diet for 8 days. This study has a relevant clinical application if hypomagnesemia, due to hypercholesterolemia, is confirmed in patients with long-term hypercholesterolemia. Methods: Both hypercholesterolemic (HC) and normocholesterolemic rats (NC) were divided into sets of experiments to measure hemodynamic parameters, physiological data, maximum capacity to dilute urine (C-H2O), variations (Delta) in [Ca2+](i) and the expression of transporter proteins. Results: HC developed hypomagnesemia and showed high magnesuria in the absence of hemodynamic abnormalities. However, the urinary sodium excretion and C-H2O in HC was similar to NC. On the other hand, the responses to angiotensin II by measuring Delta [Ca2+](i) were higher in the thick ascending limb of Henle's loop (TAL) of HC than NC. Moreover, high expression of the cotransporter NKCC2 was found in renal outer medulla fractions of HC. Taken together, the hypothesis of impairment in TAL was excluded. Actually, the expression of the epithelial Mg2+ channel in renal cortical membrane fractions was reduced in HC. Conclusion: Impairment in distal convoluted tubule induced by hypercholesterolemia explains high magnesuria and hypomagnesemia observed in HC. Copyright (C) 2011 S. Karger AG, Basel

FEEDING HABITS OF THE ATLANTIC SPOTTED DOLPHIN, Stenella frontalis, IN SOUTHEASTERN BRAZIL

This study presents new information on the feeding habits of the Atlantic spotted dolphins, Stenella frontalis, in the Western South Atlantic. Nine stomach contents of S. frontalis incidentally caught in fishing operations conducted by the gillnet fleet based on main harbour of Cananeia (25 degrees 00' S; 47 degrees 55'W), southeastern Brazil, were analyzed. These specimens were captured between 2005 and 2007. A total of 1 422 cephalopod beaks, 147 otoliths and three crustaceans were recovered from the stomach contents. The dolphins assessed preyed on at least eight different fish species of the families Trichiuridae, Carangidae, Sparidae, Merluccidae, Engraulidae, Sciaenidae, Congridae and Scombridae, five cephalopod species of the families Loliginidae, Sepiolidae, Tremoctopodidae and Thysanoteuthidae, and one shrimp species of the Penaeidae family. Based on the analysis of the Index of Relative Importance (IRI), the Atlantic cutlassfish, Trichiurus lepturus, was the most important fish species represented. Of the cephalopods, the squid Doryteuthis plei was by far the most representative species. Several items were reported for the first time as prey of the S. frontalis: Xiphopenaeus kroyeri, Tremoctopus violaceus, Semirossia tenera, Merluccius hubbsi, Pagrus pagrus and Paralonchurus brasiliensis. S. frontalis presented teuthophagous and ichthyofagous feeding habits, with apparent predominance of the first, and preyed mainly on pelagic and demersal items.

Human Fallopian Tube Mesenchymal Stromal Cells Enhance Bone Regeneration in a Xenotransplanted Model

We have recently reported that human fallopian tubes, which are discarded during surgical procedures of women submitted to sterilization or hysterectomies, are a rich source of human fallopian tube mesenchymal stromal cells (htMSCs). It has been previously shown that human mesenchymal stromal cells may be useful in enhancing the speed of bone regeneration. This prompted us to investigate whether htMSCs might be useful for the treatment of osteoporosis or other bone diseases, since they present a pronounced capacity for osteogenic differentiation in vitro. Based on this prior knowledge, our aim was to evaluate, in vivo, the osteogenic capacity of htMSCs to regenerate bone through an already described xenotransplantation model: nonimmunosuppressed (NIS) rats with cranial defects. htMSCs were obtained from five 30-50 years old healthy women and characterized by flow cytometry and for their multipotenciality in vitro capacity (osteogenic, chondrogenic and adipogenic differentiations). Two symmetric full-thickness cranial defects on each parietal region of seven NIS rats were performed. The left side (LS) of six animals was covered with CellCeram (Scaffdex)-a bioabsorbable ceramic composite scaffold that contains 60% hydroxyapatite and 40% beta-tricalciumphosphate-only, and the right side (RS) with the CellCeram and htMSCs (10(6) cells/scaffold). The animals were euthanized at 30, 60 and 90 days postoperatively and cranial tissue samples were taken for histological analysis. After 90 days we observed neobone formation in both sides. However, in animals euthanized 30 and 60 days after the procedure, a mature bone was observed only on the side with htMSCs. PCR and immunofluorescence analysis confirmed the presence of human DNA and thus that human cells were not rejected, which further supports the imunomodulatory property of htMSCs. In conclusion, htMSCs can be used successfully to enhance bone regeneration in vivo, opening a new field for future treatments of osteoporosis and bone reconstruction.