Effects of branched chain amino acid supplementation on patient care outcomes in adults and children with liver cirrhosis: A systematic review.

BACKGROUND & AIMS: Malnutrition is highly prevalent in chronic liver disease (CLD) due to alterations in nutrient utilization, malabsorption and poor intake. Low serum concentrations of branched chain amino acids (BCAA) in the presence of elevated aromatic acid concentrations is commonly observed in adult and children with liver cirrhosis and is associated with malnutrition and other adverse patient outcomes. The efficacy of BCAA supplementation has not been well established in adults and children with CLD. The purpose of this review was to critically evaluate the literature regarding the impact of BCAA supplementation related to changes in body composition, muscle strength, liver biomarkers, medical and hepatic complications (hepatic encephalopathy (HE), ascites, edema) and patient care outcomes (event free survival, health related quality of life, length of hospitalization). METHODS: A total of 40 articles retrieved from PubMed or Web of Science databases (1989-2017) were included. RESULTS: BCAA supplementation may be beneficial in improving muscle strength, ascites and edema with potential clinically significant improvements in HE in adult liver patients. In children, limited data have shown that BCAA supplementation may exert favourable effects on weight, fat mass, fat free mass and serum albumin level. CONCLUSIONS: Heterogeneity of study findings attributed to variability in BCAA dose (total, relative proportions), duration, disease severity and lack of uniformity in tools used for assessing patient outcomes limit overall conclusions. Longitudinal studies examining the efficacy of BCAA supplementation as a therapeutic treatment of malnutrition in chronic liver disease is warranted.

Effects of atrial natriuretic peptide on systemic haemodynamics and cardiac function in normal man.

Atrial natriuretic peptides (ANP) reduce blood pressure. Animal experiments suggest that this depressor action results from a reduction in cardiac output rather than peripheral vascular resistance but it is unresolved whether this is wholly due to their effect of reducing left ventricular filling or whether they have a negatively inotropic effect. We have therefore investigated the effects of ANP in normal man using Doppler measurements of ascending aortic blood flow. Six normal volunteers underwent infusions of placebo and incremental doses of ANP in the range 0.25 to 12 micrograms.min-1. Each infusion was given for 15 min and measurements made both in the supine and erect positions (passive tilt). In both positions ANP had dose dependent effects of increasing heart rate (HR) and maximal acceleration whilst lowering an index of systemic vascular resistance (ISVR). In the erect position ANP also lowered systolic blood pressure. In the 30 min after completion of the infusions there were significant decreases in peak velocity and cardiac output with increases in ISVR in both positions, but HR fell and diastolic pressure increased only when supine. During the course of the experiment mean haematocrit (SEM) increased from 43.9 (1.2) to 46.7 (1.0), indicating a mean reduction in plasma volume of 10.5%. This occurred despite a negative fluid balance of only 31(7) ml over the 2 h. These data suggest that ANP is not negatively inotropic and that, at pharmacological doses, it is an arteriolar dilator of rapid offset and reduces cardiac filling pressures by a mechanism of slower offset.

Outcome of hepatobiliary scanning in neonatal hepatitis syndrome.

UNLABELLED: To evaluate the diagnostic information gained from hepatobiliary scanning in infants, we reviewed 86 consecutive infants who were < or = 4 mo old and were treated for conjugated hyperbilirubinemia at the Hospital for Sick Children in Toronto between 1985 and 1993 and who had technetium iminodiacetic hepatobiliary scanning and a percutaneous liver biopsy performed in close temporal proximity. METHODS: Retrospective reviews of hospital charts and blinded reviews of hepatobiliary scans were performed. RESULTS: There were 58 male and 28 female infants (age range, 2-124 days; mean = 65 days). Hepatobiliary scanning failed to show biliary excretion into the gastrointestinal tract in 53 of 86 patients. Forty of these 53 had extrahepatic biliary atresia. The remaining 33 patients demonstrated biliary excretion into the gastrointestinal tract; 24 of 33 had neonatal hepatitis. Among 13 of the 53 patients who had no evidence of biliary excretion and who also did not have extrahepatic biliary atresia, 8 had idiopathic neonatal hepatitis, 4 had interlobular bile duct paucity and 1 had total parenteral nutrition-associated cholestasis. In this large series, no patient with extrahepatic biliary atresia showed bile drainage on hepatobiliary scanning. Fifty percent of patients with interlobular bile duct paucity but no extrahepatic obstruction failed to show biliary excretion of radionuclide. Twenty-five percent of patients (8 of 32) with idiopathic neonatal hepatitis demonstrated no biliary excretion. Hepatocellular extraction was examined by semiquantitative analysis in the nondraining, nonbiliary atresia patients (12 of 53). Four of these 12 patients demonstrated poor liver extraction. Three patients had idiopathic neonatal hepatitis, and one had bile duct paucity. Therefore, four of eight neonatal hepatitis patients had normal extraction, suggesting that poor versus good liver hepatocyte clearance cannot accurately identify neonatal hepatitis. CONCLUSION: Hepatobiliary scanning requires cautious interpretation. Nondraining scans may indicate severe neonatal hepatitis or the presence of interlobular bile duct paucity.

Control of cell number in the developing neocortex. I. Effects of early tectal ablation.

Target availability is an important factor in the early control of neuron number in many structures in the developing vertebrate nervous system. In early neocortical development, the role of target availability in the survival of subcortically projecting neurons is not yet understood, particularly because these cells' axons are widely distributed and highly branched. In this study, we have looked for alterations in the pattern of early cell death, adult cell density and adult morphology of pyramidal cells in layer V of visual cortex consequent to removal of one of their principal targets, the ipsilateral superior colliculus. After neonatal tectal ablation, there was no difference in the incidence of pyknotic cells in the cortex overall, or in layer V during the period of normal cell death in the cortex. Neither in adulthood, nor at any point in development did the density of layer V cells or cortical cell density overall differ from normal in Nissl material. Soma size of cells in layer V overall did not differ from normal in Nissl material. In addition, the soma size of the subpopulation of cells labelled with horseradish peroxidase (HRP) from midbrain injections was unaltered. In summary, this cell population appears unresponsive in both number and morphology to deletions of a major component of its target pool. This observation has some interesting implications for reasons of constancy of cell number in layer V across cytoarchitectonic areas.

The production of secondary caries-like lesions on cavity walls and the assessment of microleakage using an in vitro microbial caries system.

The aim of this study was to assess microleakage along restored cavity walls using a new in vitro microbial technique. Extracted human teeth containing cavities restored with a microfine posterior composite were incubated in broth inoculated with a single strain of Streptococcus mutans for 10 days, using a sequential batch culture technique. Each margin of the cavities was finished in one of three ways: butt joint and etching; butt joint and no etching, or; bevel joint and etching. The assessment of microleakage was achieved by examining sections of the teeth histologically using polarized light for the presence or absence of caries-like cavity wall lesions. Outer (surface) lesions were also examined and displayed the characteristic zones of early natural caries lesions. The cavity wall lesions were observed as a translucent zone in 31% of butt and unetched margins, 16% of butt and etched margins, and 5% of bevelled and etched margins.