Plexin B2 tissue expression and related gene polymorphisms in psoriasis and their relation to NB-UVB and Acitretin therapy.

Psoriasis is a chronic, immune-mediated, hyperproliferative skin disease. Etiopathogenesis of psoriasis is not well understood. Plexin B2 was found to have effects on CD100-mediated T-cell morphology and expressed in the immune system. It may play a role in the pathogenesis of psoriasis. To assess the tissue level of plexin-B2 and plexin B2 related gene polymorphism which is signal regulatory protein gamma (SIRPγ-rs71212732) in psoriatic patients before and after NB-UVB, acitretin therapy alone or in combination and to detect correlation between level of tissue plexin B2 and disease severity and improvement. This single blinded randomized controlled trial was carried on 50 psoriatic patients and 50 healthy controls. Psoriasis Area and Severity Index score (PASI) was used to evaluate the disease severity. Tissue plexin-b2 level was measured using ELISA and SIRPγ-rs71212732 (T\C) was assessed using TaqMan™ assays and real-time PCR. A significant lower tissue plexin-B2 level was observed in control group (2.9 ± 0.6 pg/g) than cases (25.8 ± 2.8, pg/g) (p < 0.001). Also, a significantly higher tissue plexin-B2 level was observed in sever psoriasis (32.7 ± 3.8 pg/ml) in than moderate psoriasis (13.6 ± 2.1 pg/ml, p = 0.001). Tissue plexin B2 was positively correlated with diseases severity. Significantly higher (TC& TT) genotypes and mutant (C) allele among patients compared to the controls, p < 0.001 for all. Tissue plexin-b2 level was high in psoriasis vulgaris with positive correlation with disease severity and decreased after treatment. This may indicate a role of plexin-b2 in psoriasis vulgaris pathogenesis.

Nematocidal activity of chitosan nanoparticles conjugated with albendazole against the enteral and parenteral phases of trichinosis in experimentally infected mice.

Trichinosis is a serious parasitic zoonotic disease caused mainly by Trichinella spiralis. The used drugs for treatment of trichinosis showed limited bioavailability and high degree of resistance. Moreover, they have a very poor effect in treatment of encysted larvae. Therefore, there is a need for development of new agents which help in improving the bioavailability of the used drugs and enable them to reach different tissues. This study was designed to assess the use of chitosan nanoparticles (CSNPs) in conjugation with full and half dose albendazole (ABZ) in treatment of intestinal and muscular trichinosis. Albino mice (84 mice) were used to evaluate the efficacy of drugs and divided into seven groups; I: control, II: ABZ (50 mg/kg) treated, III: ABZ (25 mg/kg) treated, IV: ABZ (50 mg/kg) conjugated CSNPs treated, V: ABZ (25 mg/kg) conjugated CSNPs treated, VI: CS treated and VII: CSNPs treated. Parasitological and histopathological examinations were used to evaluate the therapeutic efficacy of the used drugs. Results showed significant reduction of adult Trichinella extracted from intestine of all ABZ treated groups either conjugated or not with the highest reduction rate in group IV followed by group V with percentage of reduction of 99.33% and 98.11%, respectively and marked improvement of histopathological examination. Also, results showed significant reduction of Trichinella larvae extracted from muscles of group IV, V and VII with the highest reduction rate in group IV with percentage of reduction of 100% in muscle larvae and marked improvement of histopathological examination. It was concluded that albendazole full dose conjugated chitosan nanoparticles can be a good candidate drug for treating both intestinal and muscular trichinosis.

Evaluation of the Effect of Oral Isotretinoin on the Level of Serum YKL40 in Acne Vulgaris Patients: A Cross-Sectional Case-Control.

Background: In the entire world, acne vulgaris (AV) is the most prevalent skin condition. Approximately 9.4% of people worldwide have acne vulgaris. This study compared the blood levels of chitinase 3-like protein 1 (YKL-40) in acne vulgaris patients before and after oral isotretinoin therapy. Patients and Methods: The design of the study was cross-sectional case-control. Forty patients with moderate to severe acne vulgaris and twenty healthy participants participated in this study. Using the Global Acne Grading System (GAGS) score, patients with acne vulgaris were evaluated both before and after concluding their treatment. Using the enzyme-linked immunosorbent assay (ELISA), the serum levels of YKL-40 were measured before and after oral isotretinoin therapy in healthy controls and acne patients. Results: Patients with acne vulgaris had considerably greater serum levels of YKL-40 than healthy control subjects (p 0.001) did. After three months of oral isotretinoin medication, the GAGS score and blood levels of YKL-40 in acne vulgaris patients both significantly decreased. Conclusion: The conclusion of this study was that reducing the blood levels of YKL-40 and the GAGS score in patients with acne vulgaris who took oral isotretinoin for three months was a crucial strategy.

Free Salt Dyeing by Treatment of Cotton Fabric Using Carboxyethyl Chitosan and Synthesized Direct Dyes to Enhance Dyeing Properties and Antibacterial Activity.

AIM: The purpose of this paper is to synthesize and characterize two new direct dyes based on chromenes derivatives. BACKGROUND: The synthesis of carboxyethyl chitosan (CECS) by the reaction of chitosan and acrylic acid via Michael's addition reaction was conducted. Cotton fabrics were treated with CECS to enhance the exhaustion of dye, fastness properties, and antimicrobial activity of dyed fabric. METHODS: Chitosan (CS) and acrylic acid were combined in Michael's addition process to successfully produce N-carboxyethylchitosan (CECS). Then, the cotton was treated with different concentrations of carboxyethyl chitosan (0.5-5 wt.%) and then dyed by synthesized mono azo and diazo direct dyes based on chromene derivatives. RESULTS AND DISCUSSION: The results regarding dyeing and antibacterial activity indicated highquality dyeing properties, However, direct dyes showed higher exhaustion and fixation values, fastness properties, and the colorimetric CIE L*a*b* C*h° data of the dyed cotton fabric. CONCLUSION: Cotton fabrics treated with carboxyethyl chitosan and dyed with direct dyes were found to have higher antibacterial activity upon a concentration of 2.5 wt.%. In addition, the antibacterial activity towards Gram-positive bacteria was reported to be more than Gram-negative bacteria.

Synthesis and characterization of polystyrene with embedded silver nanoparticle nanofibers to utilize as antibacterial and wound healing biomaterial.

Herein, silver nanoparticles (Ag) embedded in polystyrene (PS) nanofiber composites have been prepared by an electrospinning technique using N, N-dimethylformamide (DMF) as a solvent and safe reducing agent. Electrospinning of polystyrene (PS) solutions is conducted using different electrospinning parameters such as polymer concentration in the electrospinning solution; solution feed rate, and electrical field strength. Then silver nanoparticles (AgNPs) were embedded into PS nanofibers to obtain an AgNPs-PS nanofiber composite as a powerful, cheap, and nontoxic bioactive material. PS nanofibers and AgNPs-PS nanofibers composite were characterized by using thermogravimetric analysis (TGA), X-ray diffraction, and scanning electron microscopy (SEM). Also, AgNPs were characterized by UV-vis spectroscopy, transmission electron microscopy (TEM), and EDX analysis. Results showed that PS nanofibers were obtained with concentrations ranging from 10-30 wt.% in DMF solvent. Also, an AgNPs-PS nanofiber composite has been produced from its solutions by using DMF at the optimum value. The prepared AgNPs have a 21-40 nm particle size and a semi-spherical shape. In addition, the antibacterial activity of AgNPs-PS nanofibers towards both Gram-positive and Gram-negative bacteria has been increased. Therefore, this nanocomposite can be used as a powerful bioactive material in biomedical fields.

Synthesis, Application, and Antibacterial Activity of New Direct Dyes based on Chromene Derivatives.

AIMS: This study aimed at synthesizing, analyzing, and utilizing two new direct dyes based on chromene derivatives as the chromophoric moiety in dyeing wool, silk, and cotton, with good color strength, light fastness, and other desirable features. BACKGROUND: New direct dyes with antimicrobial activities for Gram-positive, Gram-negative bacteria, and fungus are being developed. These dyes are used on cotton, silk, and wool materials, which have excellent light fastness, washing, rubbing, and perspiration fastness. METHODS: All dyeing fabrics were tested for antibacterial activity. As a part of the experiment, parent structure 1 was previously synthesized. Then, diazotization and coupling reactions were used to prepare these dyes. RESULTS AND DISCUSSION: P-Aminobenzenesulfonic acid (C1) and 4-Aminoazobenzene-3,4'-disulfonic acid (C2) were diazotized in hydrochloric acid with sodium nitrite and then coupled with compound 1 in a molar ratio of 1:1 at 25 °C until the pH was fixed at 5. Finally, the monoazo and diazo direct dyes (D1 and D2) were prepared. CONCLUSION: Wool, silk, and cotton materials benefit from the increased antibacterial activities and dyeing qualities (exhaustion and fixing) of synthetic dyes. Furthermore, they offer excellent fastness qualities (light, rubbing, and perspiration).

Preparation of cellulose-based wipes treated with antimicrobial and antiviral silver nanoparticles as novel effective high-performance coronavirus fighter.

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). We succeeded in preparing disinfectant cellulose-based wipes treated with antimicrobial and antiviral silver nanoparticles to be used for prevention of contamination and transmission of several pathogenic viruses and microbes to human in critical areas such as hospitals and healthcare centers especially coronavirus. In this work, the antimicrobial and antiviral activities of silver nanoparticles (AgNPs) prepared with four different techniques were investigated for the utilization as a disinfectant for cellulose-based wipes. These four methods are namely; 1) trisodium citrate with cotton yarn as a reducing agent, 2) preparing AgNP's using aqueous solution of PVA in the presence of glucose, 3) trisodium citrate with cotton fabric as a reducing agent, and 4) photochemical reaction of polyacrylic acid and silver nitrate solution. Polyester/viscose blended spunlace nonwoven fabrics as cellulose based fabrics were treated with the prepared silver nanoparticles to be used as surfaces disinfection wipes. The properties of the nonwoven fabrics were examined including thickness, tensile strength in dry and wet conditions in both machine direction (MD) and cross-machine direction (CMD), bursting strength, air permeability, water permeability and surface wettability. Characterization of the AgNPs was carried out in terms of UV-VIS spectroscopy, TEM, SEM, and Zeta potential analysis. The assessment of AgNPs active solutions for antimicrobial and antiviral activities was evaluated. The results obtained from the analyses of the AgNPs samples prepared with different techniques showed good uniformity and stability of the particles, as well uniform coating of the AgNPs on the fibers. Additionally, there is a significant effect of the AgNPs preparation method on their disinfectant performance that proved its effectiveness against coronavirus (MERS-CoV), S. aureus and B. subtilis as Gram-positive bacteria, E. coli and P. mirabilis as Gram-negative bacteria, A. niger and C. albicans fungi.

Biochemical Assessments of Seminal Plasma Zinc, Testis-Expressed Sequence 101 and Free Amino Acids and Their Correlations with Reproductive Hormones in Male Infertility.

The role of the male factors in the couple's infertility has been significantly increased in recent years due to a sententious assessment of male reproductive functions and enhanced diagnostic tools. We investigated the correlations among the seminal plasma (SP) levels of each of zinc, testis-expressed sequence 101 (TEX101), and free amino acids levels with reproductive hormones in adult fertile and infertile men. The study included 100 infertile men categorized into 50 non-obstructive azoospermic patients and 50 patients with idiopathic oligoasthenoteratozoospermia (iOAT), in addition to 50 fertile controls. Semen analyses, serum ELISA assays for male reproductive hormones (follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone, and prolactin), colorimetric assays of SP zinc and total proteins, SP free amino acids using high-performance liquid chromatography (HPLC), and ELISA assays of SP TEX101 were performed for all subjects. Infertile men with azoospermia had significantly lower SP median levels of zinc, TEX101, and many SP free amino acids compared to both men with iOAT and fertile controls (P Ë‚ 0.05 for all). There were lower SP levels of zinc and some free amino acids among men with iOAT compared to the fertile controls (P Ë‚ 0.05 for all) with non-significant difference regarding to SP TEX101 (P Ëƒ 0.05). Azoospermic men exhibited negative correlations between FSH, LH, and prolactin with some SP free amino acids (P Ë‚ 0.05 for all), and a positive correlation between glycine with total testosterone (P Ë‚ 0.05). Among iOAT patients, LH and FSH were positively correlated with SP zinc, TEX101, and some measured free amino acids (P Ë‚ 0.05 for all). Total testosterone was positively correlated with some amino acids, while prolactin was negatively correlated with glycine (P Ë‚ 0.05 for all). iOAT and azoospermic men exhibited low SP zinc and some free amino acids levels that were more pronounced in azoospermic men and were significantly associated with the reproductive hormones. TEX101 could be a helpful confirmatory test for azoospermia.

Relations between vitamin D3, total and specific IgE for house dust mites in atopic dermatitis patients.

Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease. There are a lot of evidences on the importance of vitamin D and house dust mite (HDM) allergens in the etiology and course of AD. The objectives of this study are to evaluate the relation between vitamin D3 level and house dust mites (HDM) Dermatophagoidspecies sensitization in pathogenesis of atopic dermatitis. Cross-sectional design study was conducted on 50 atopic dermatitis patients. Blood analysis were done to determine level of vitamin D3, total IgE by fluorescent immunoassay & specific IgE for HDM (d1, d2) & other inhalant allergens by ELISA test. There was significant high negative correlation with the specific IgE for HDM (r = -0. 62, p < 0.001) and vitamin D3. & there was non-significant minimal negative correlation with the specific IgE and other inhalant allergens (r = - 0.10, p > 0.05). There was a statistically significant relation between level of vitamin D3 and atopic dermatitis severity and sensitization to HDM and other allergens.

Preparation of biocompatible chitosan nanoparticles loaded by tetracycline, gentamycin and ciprofloxacin as novel drug delivery system for improvement the antibacterial properties of cellulose based fabrics.

The main aim of this research work was to develop controlled drug delivery systems based on nanotechnology. Chitosan nanoparticles (CSNPs) were selected as a nanocarrier for the selected antibiotic drugs tetracycline, gentamycin and ciprofloxacin. CSNPs were prepared from chitosan solution by using tripolyphosphate (TPP) via ionic gelation method. Then the prepared high performance CSNPs were loaded with three different antibiotics to form nanocomposite from antibiotic loaded chitosan nanoparticles. Then the prepared nanocomposite used as superior antibacterial materials with minimum toxicity. Samples of cotton (100%) and (50:50) cotton/polyester blended fabrics were treated with different concentrations of this composite to impart antibacterial activity. Results showed that the treated fabrics with chitosan nanoparticles and its nanocomposite with different antibiotics were inhibited the growth of both Gram-positive and Gram-negative bacteria. The Fourier Transform Infrared spectroscopy (FTIR) and Scanning Electron Microscope (SEM) analysis exposed the embedding of chitosan nanoparticles into fabrics and their antibiotics loaded.

Seminal and serum leptin levels in male patients with varicocele and isolated asthenozoospermia before and after repair.

BACKGROUND AND AIM: Varicocele is one of the most common causes of male infertility. Leptin that has a role in sperm motility may have a role of varicocele. We aimed to study the effect of varicocelectomy on the serum and seminal leptin in patients with asthenozoospermia and the correlation between leptin levels, sperm parameters and varicocele grade. METHODS: Thirty-six male patients with varicocele having isolated asthenozoospermia were included in this study. Thirty normal fertile controls were included. Semen analysis, serum and seminal leptin measurements were performed for all participants at baseline and for patients three months after varicocelectomy. Microsurgical varicocelectomy has been performed for patients. RESULTS: Seminal and serum leptin levels were significantly higher in patients than controls. Seminal leptin was positively correlated with varicocele grade (r = 0.357, p < .05) while no correlation was found between serum leptin varicocele grade (r = 0.056, p = .37). Both seminal and serum leptin were inversely correlated with sperm motility (r = -0.92 and r = -0.87, p < .001; respectively). Seminal and serum leptin were significantly improved after varicocelectomy. CONCLUSION: Varicocele is associated with higher levels of seminal and serum leptin especially in higher grads and this was correlated with negative effects on sperm motility. Leptin levels were significantly decreased after repair.

25-Hydroxy cholecalciferol, anti-Müllerian hormone, and thyroid profiles among infertile men.

BACKGROUND AND AIM: We examined the relationship among vit.D3, AMH, FT3, FT4, and TSH, in addition to the serum levels of reproductive hormones (FSH, LH, prolactin, and free testosterone), in oligoasthenoteratozoospermia and azoospermia patients in a cohort of infertile men from Egypt to establish a clinical marker/cause-effect relationship. METHODS: This cross-sectional cohort study was carried out on 301 men (105 males with oligoasthenoteratozoospermia and 96 males with azoospermia), in addition to 100 controls. Measurements of serum vit.D3, AMH, FT3, FT4, and TSH levels, in addition to reproductive hormone assays, were performed on all included subjects, using ELISA kits. RESULTS: Overall, results showed significantly lower serum levels of vit.D3 in infertile men than in the controls, with a greater decrease observed in men with azoospermia than in oligoasthenoteratozoospermia patients, (p < .05 for all). Significantly higher serum TSH and FSH levels and significantly lower serum free testosterone levels were observed in males with azoospermia than in males with oligoasthenoteratozoospermia and the controls (p < .05 for both). There were no significant differences between the studied groups in terms of AMH, FT3 or FT4 levels. LH levels were negatively correlated with TSH levels and positively correlated with AMH levels among men with oligoasthenoteratozoospermia, while among men with azoospermia, LH levels were positively correlated with vit.D3 levels (p < .05 for all). CONCLUSION: Decreased Vit.D3 could play a role in male infertility, in addition to abnormal thyroid function, which needs further investigation.

Diagnosis of onychomycosis clinically by nail dermoscopy versus microbiological diagnosis.

Diagnosis of onychomycosis requires microbiological studies, which are time-consuming. Dermoscopy is non invasive, easy and coastless method. To evaluate the diagnostic role of dermoscopy in onychomycosis and comparing its findings with microbiological results. Eighty patients with onychomycosis and 40 controls were studied for nail dermoscopic finding, and microbiological examinations in the form of microscopic examination by 20% KOH, Sabouraud dextrose agar (SDA), and HiCrome Candida Differential Agar. 72.5% of the patients were females. Most of the patient were presented with one finger (35%) and two fingers (35%). 85% of the patient were presented clinically with distal lateral subungual onychomycosis followed by total dystrophic onychomycosis (12.5%) and lastly with superficial white onychomycosis (2.5%). 52.5% and 75% of the patients were positive by direct microscopic examination with 20%KOH and SDA, respectively. Dermatophytes isolated from 7.5% of the patient, non-dermatophytes (Aspergillus) was isolated from 2.5%, and 65% had Candida by SDA. C. albicans was the commonest species (75%), followed by C. tropicalis (17.3%), and lastly C. krusei (7.7%). Dermoscopic examinations of patients showed nail spikes, longitudinal striations, and color changes in 75%, 82.5%, and 95%, respectively, with statistically significant P value (P < 0.001). There was significant difference regarding long striations and yellow coloration dermoscopic finding with positive KOH patients. All patients with positive culture showed nail spikes on dermoscopic examination. Dermoscopy is a rapid tool for diagnosis of onychomycosis. Longitudinal striations is the best diagnostic dermoscopic finding. Microbiological test are still needed for accurate and reliable diagnosis.

Fractional Erbium-YAG Laser and Platelet-Rich Plasma as Single or Combined Treatment for Atrophic Acne Scars: A Randomized Clinical Trial.

INTRODUCTION: Acne scarring is a common undesirable complication of acne vulgaris. Fractional erbium-yttrium aluminum garnet (YAG) 2940 nm laser and platelet-rich plasma have been used in treating acne scars with variable outcomes. The objective of this study is to assess the efficacy of fractional erbium-YAG 2940 nm laser and platelet-rich plasma as a single line of treatment in comparison with combined treatment in atrophic postacne scars. METHODS: Seventy-five patients were included in this trial and randomized into three equal groups (25 each). Group A was subjected to six sessions of erbium-YAG laser for 6 months, group B was treated with 12 sessions of platelet-rich plasma over the same period, and group C was subjected to six sessions of erbium-YAG laser plus 12 sessions of platelet-rich plasma over the same period. Each subject was evaluated by acne scar grading, photography, and subjective evaluation. RESULTS: Both treatment modalities showed improvement of acne scars, but the improvement with combined treatment was better than that with erbium-YAG laser or platelet-rich plasma alone regarding scar grade improvement (P = 0.007 and 0.001), clinical improvement (P = 0.001 and 0.001), and patient satisfaction (P = 0.005 and 0.001), respectively. CONCLUSIONS: The combination of platelet-rich plasma plus erbium-YAG laser is superior to either treatment alone for acne scars, with trivial side effects for all treatment modalities. TRIAL REGISTRATION: ClinicalTrials.gov identifier; NCT03933033.

Topical calcipotriol vs narrowband ultraviolet B in treatment of alopecia areata: a randomized-controlled trial.

Alopecia areata is a chronic relapsing autoimmune inflammatory hair disorder with no novel therapy. The objectives of this study are to compare the efficacy of topical calcipotriol vs narrow band ultraviolet B phototherapy (NB-UVB) in the treatment of alopecia areata and its correlation with serum vitamin D3 levels. A randomized-controlled trial has been conducted on 60 patients with scalp alopecia areata randomized into four groups; topical calcipotriol, NB-UVB, both and placebo. All patients were evaluated by assessment of severity of alopecia areata by severity of alopecia tool (SALT) score at baseline and 3 months after treatment and vitamin D3 levels at baseline and after 3 months. SALT score and vitamin D3 levels were significantly improved in all groups except placebo after treatment with (P = 0.026, P = 0.005, P = 0.004, P = 0.140) and (P = 0.028, P = 0.011, P = 0.003, P = 0.725), respectively. Combined therapy showed non-significant improvement in SALT score (P = 0.530, P = 0.643), respectively, and significant improvement in serum vitamin D3 levels than each line alone with (P = 0.021, P = 0.044), respectively. Both topical calcipotriol and NB-UVB are effective therapies in the treatment of AA and associated with improvement of SALT score and vitamin D3 levels.

Vitamin D levels in acne vulgaris patients treated with oral isotretinoin.

BACKGROUND/OBJECTIVES: Acne vulgaris is a common inflammatory skin disease. Vitamin D deficiency plays a role in many inflammatory skin diseases. It may play a role in pathogenesis of acne vulgaris. This study aimed to assess serum levels of 25 hydroxy vitamin D in patients with acne vulgaris before and after treatment with isotretinoin and its relation with acne vulgaris severity. METHODS: Ninety patients with acne vulgaris and 60 age-sex matched healthy subject as controls have been recruited in this study. Patients were treated with 0.75 mg/kg/d isotretinoin for 3 months. Serum level of 25 hydroxy vitamin D has been measured at baseline and after treatment. RESULTS: Serum levels of 25 hydroxy vitamin D were significantly higher in patients with acne vulgaris than healthy controls (P = .001). There was a significant inverse relation between level of 25 hydroxy vitamin D and severity of acne vulgaris before treatment (P = .001). Serum levels of 25 hydroxy vitamin D were significantly increased after isotretinoin treatment in patients with acne vulgaris (P = .001). CONCLUSION: This study concluded that vitamin D may play a potential role in pathogenesis of acne vulgaris or acne vulgaris may have a negative effect on vitamin D synthesis. Further studies are needed to confirm these potential relations.

Impregnation of silver nanoparticles into polysaccharide substrates and their properties.

A method to impregnate silver nanoparticles (AgNPs) into different polysaccharides substrates (cellulose powder (CP), microcrystalline cellulose (MCC), carboxymethyl cellulose (CMC) and chitosan (Chit)) by using glucose as reducing agent, is presented. X-ray diffraction analyses of polysaccharides coated with AgNPs showed the formation of silver particle sizes in the range of 3.7-5.6 nm and have almost spherical shape. The entire prepared composite shows antimicrobial effect. The antibacterial activity of polysaccharides loaded with silver nanoparticles was evaluated against Gram-negative Escherichia coli (E. coli) and Gram-positive Staphylococcus aureus (S. aureus) bacteria. The results suggest excellent antibacterial activity.

Aggressive early total parental nutrition in low-birth-weight infants.

OBJECTIVE: This study aimed to compare nitrogen balance and biochemical tolerance of early aggressive versus late total parenteral nutrition in very-low-birth-weight (VLBW) infants over the first week of life. STUDY DESIGN: In all, 32 ventilator-dependent preterm infants were prospectively randomized into two groups. The Early Total Parenteral Nutrition (ETPN) group received 3.5 g/kilo-day amino acids (AA), and 3 g/kilo-day of 20% Intralipid (IL), starting within 1 hour after birth. The Late Total Parenteral Nutrition group (LTPN), started on a solution containing glucose during the first 48 hours of life, followed by 2 g/kilo-day of AA and 0.5 g/kilo-day of IL. For the LTPN group AA and IL were each increased by 0.5 g/kilo-day to a maximum of 3.5 and 3 g/kilo-day, respectively. RESULTS: Nitrogen retention was significantly greater in all infants in the ETPN group throughout the 7-day study period. All infants in the LTPN group were in negative nitrogen balance during the first 48 hours of life, while those in the ETPN group were in positive nitrogen balance throughout. The mean (+/-SD) nitrogen retention in the ETPN was 384.5 mg/kilo-day (+/-20.2), compared to 203.4 mg/kilo-day (+/-20.9) in the LTPN group (p <0.001). In each of the first 5 days of life, energy intake was significantly greater in the ETPN group compared to the LTPN group (p <0.001). Mean fluid intake during the study period was similar between, the ETPN and the LTPN groups (162 and 165 cm3/kilo-day, respectively). The mean weight gain was similar in the ETPN and LTPN groups. Plasma levels of cholesterol, triglycerides, bicarbonate, blood urea nitrogen, creatinine, and pH were similar in both groups during the study period. Mean (+/-SD) serum glucose in the LTPN group was higher, but remained in normal range (101.1+/-5.2 and 80.8+/-5.4 mg/kilo-day, respectively). The mean peak serum bilirubin was significantly higher in the ETPN group, compared to The LTPN group (7.7 and 6.2 mg/dl). CONCLUSION: This study shows that aggressive intake of AA and IL can be tolerated immediately after birth by VLBW infants. Also, ETPN significantly increased positive nitrogen balance and caloric intake, without increasing the risk of metabolic acidosis, hypercholesterolemia, or hypertriglyceridemia.