Development of feeding information for infants with CHD.

INTRODUCTION: Infants with CHD often experience growth failure. Ensuring optimal growth before surgery is associated with improved outcomes and has emerged as a significant cause of parental stress. Parents have reported a perceived lack of accessible feeding information for infants with CHD. To address this gap, the aim of this study was to develop feeding information to better support parents. MATERIALS AND METHODS: A search for existing material on six electronic databases and an internet search for unpublished (grey) literature on feeding information for infants with CHD were carried out. Following the development of feeding information, semi-structured interview(s) with parents/health-care professionals were completed, focusing on whether the information was easy to understand, relevant, provided sufficient information around feeding/feeding difficulties, and whether there were any information gaps. Iterative changes were made to the information following each interview. The process was completed until thematic saturation was achieved. RESULTS: A total of 23 unique articles were identified of which 5 studies were included. From the grey literature, four web pages were reviewed. A total of 22 parents and 25 health-care professionals were interviewed. All parents/health-care professionals felt that the feeding information developed provided sufficient information; however, many wanted information on how to introduce complementary food, particularly if weaning was delayed. CONCLUSIONS: This study describes the development of feeding information for infants with CHD. From parent interviews, gaps identified focused on the introduction of complementary foods and uncertainty regarding the feeding journey beyond surgery.

Intestinal failure: the evolving demographic and patient outcomes on home parenteral nutrition.

AIM: We performed this study to examine and understand the evolving demographics and changing outcomes of intestinal failure (IF) and its implications for healthcare delivery. METHOD: We conducted a retrospective analysis of outcome data of children on home parenteral nutrition (HPN), over a 15-year period. RESULTS: A total of 31 patients received HPN: 15 for short bowel syndrome (SBS), eight neuromuscular disease (NMD) and eight for other causes. The HPN prevalence increased from 1.54 per million children in 2000 to 21.5 in 2016. The outcomes over last 5 years were better than those of previous 10 years. The rate of catheter-related bloodstream infection (CRBSI) had fallen from 4 to 1.3 and IF liver disease (IFALD) from 20% to 7.7%. The aetiology changed over years from SBS being the main cause to NMD contributing 43% to the total in 2016. This was especially relevant as NMD was associated with greater numbers of IFALD (38% vs 6.7%), CRBSI (1.51 vs 0.64/1000 PN days) and mortality. CONCLUSION: The outcome of long-term parenteral nutrition (PN) has improved. The increasing number of patients with NMD, coupled with their higher burden of care, results in an increasing health care burden, and the planning of intestinal rehabilitation services needs to reflect this.

The development of a consensus-based nutritional pathway for infants with CHD before surgery using a modified Delphi process.

IntroductionDespite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.Materials and methodsThe modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation. RESULTS: Paediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting. CONCLUSIONS: Nutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.

Key to sessile gnesiotrochan rotifers: Families, monospecific species in Flosculariidae, species of Atrochidae, Conochilidae, and Limnias.

Accurate identification of species is key to understanding their ecological roles and evolutionary history. It is also essential in cataloging biodiversity for comparisons among habitat types, responses to climate change, effective management practices, and more. The paucity of taxonomic expertise is increasing and with it the ability to competently identify species, this is particularly true for small taxa including rotifers. In an effort to improve this situation, we collated information on morphological characters from the literature on all valid species of sessile Gnesiotrocha (phylum Rotifera) currently assigned to two orders and four families. We review Order Collothecaceae, which comprises families Atrochidae (3 spp.) and Collothecidae (50 spp.) and Order Flosculariaceae, which includes families Conochilidae (7 spp.) and Flosculariidae (71 species). Based on that information, we provide dichotomous keys to the Families, monospecific species in Flosculariidae, and species of Atrochidae, Conochilidae, and Limnias. These keys will aid researchers to identify species in these families and lead to a better understanding of freshwater biodiversity and eco-evolutionary processes.

Single-Arm 8-Week Ad Libitum Self-Prepared Paleo Diet Reduces Cardiometabolic Disease Risk Factors in Overweight Adults.

The paleo diet is popular among the general population due to promoted weight loss and disease prevention benefits. We examined the effectiveness of a self-administered paleo diet in improving cardiometabolic disease risk factors. Overweight, physically inactive but otherwise healthy adults (males = 4, females = 3, age 32.7 ± 4.9 years, body mass index [BMI] 29.4 ± 2.4 kg/m2) habitually eating a traditional Western diet (1853.4 ± 441.2 kcal; 34.0% carbohydrate; 41.4% fat; 19.2% protein) completed an ad libitum self-administered paleo diet for 8 weeks. Height, weight, blood pressure, and a fasting blood sample were collected pre- and post-paleo dietary intervention. Blood samples were analyzed for fasting cardiometabolic disease biomarkers-including brain-derived neurotropic factor (BDNF), fibroblast growth factor (FGF) 21, and leptin. After 8 weeks, body mass (-5.3 kg, P = .008), BMI (-1.7 kg/m2, P = .002), serum leptin (-56.2%, P = .012), serum FGF21 (-26.7%, P = .002), and serum BDNF (-25.8%, P = .045) significantly decreased. Systolic and diastolic blood pressure were unchanged following the paleo dietary intervention (P > .05). Average energy intake (-412.6 kcal, P = .016) significantly decreased with the paleo dietary intervention mostly due to a reduction in carbohydrate consumption (-69.2 g; P = .003). An 8-week self-administered paleo dietary intervention was effective in improving cardiometabolic disease risk factors in a healthy, physically inactive overweight adult population.

A Short-Term Paleolithic Dietary Intervention Does Not Alter Adipokines Linked to Adiposity.

The Paleolithic diet, characterized by an emphasis on hunter-gatherer type foods accompanied by an exclusion of grains, dairy products, and highly processed food items, is often promoted for weight loss and a reduction in cardiometabolic disease risk factors. Specific adipokines, such as adiponectin, omentin, nesfatin, and vaspin are reported to be dysregulated with obesity and may respond favorably to diet-induced fat loss. We aimed to evaluate the effects of an eight-week Paleolithic dietary intervention on circulating adiponectin, omentin, nesfatin, and vaspin in a cohort of physically inactive, but otherwise healthy adults. METHODS: Seven inactive adults participated in eight weeks of adherence to the Paleolithic Diet. Fasting blood samples, anthropometric, and body composition data were collected from each participant pre-and post-intervention. Serum adiponectin, omentin, nesfatin, and vaspin were measured. RESULTS: After eight weeks of following the Paleolithic diet, there were reductions (p<0.05) in relative body fat (-4.4%), waist circumference (- 5.9 cm), and sum of skinfolds (-36.8 mm). No changes were observed in waist to hip ratio (WHR), or in adiponectin, omentin, and nesfatin (p>0.05), while serum vaspin levels for all participants were undetectable. CONCLUSIONS: It is possible that although eight weeks resulted in modest body composition changes, short-term fat loss will not induce changes in adiponectin, omentin, and nesfatin in apparently healthy adults. Larger, long-term intervention studies that examine Paleolithic diet-induced changes across sex, body composition, and in populations with metabolic dysregulation are warranted.

Improving growth of infants with congenital heart disease using a consensus-based nutritional pathway.

OBJECTIVE: Infants with congenital heart disease (CHD) often experience growth failure prior to surgery, which is associated with increased paediatric-intensive-care unit length of stay (PICU-LOS) and post-operative complications. This study assessed the impact of a pre-operative, consensus-based nutritional pathway (including support from a multi-disciplinary team) on growth and clinical outcome. DESIGN: Single-centre prospective pilot study. SETTING: Tertiary paediatric cardiology surgical centre. PATIENTS: Infants with CHD. INTERVENTION: Infants with CHD were followed for up to 4-months-of-age before cardiac surgery and then to 12-months-of-age following the implementation of the consensus-based nutritional-pathway (Intervention group: November 2017-August 2018), with outcomes compared to a historic control group. The nutrition pathway involved a dietitian contacting parents of infants with the highest risk of growth failure weekly; reviewing weight gain and providing feeding support. MAIN OUTCOME MEASURE: Growth (weight-for-age, WAZ, and height-for-age-z-score, HAZ) at 4 and 12 months-of-age. RESULTS: 44 infants in the intervention group were compared to 38 in the control group. Median (inter quartile range) change in WAZ from birth to 4 months-of-age (-0.9 (-1.5, 0.7)) and from birth to 12 months-of-age (-0.09 (-1.3, 1.1)) in the intervention group compared to the control group (-1.5 (-2.0, -0.4) (p = 0.04)) at 4 months-of age and at 12 months-of-age (-0.4 (1.9, 0.2) (p = 0.03)). HAZ at 4 months-of-age was -0.7 (-1.4, -0.1) vs. -1.0 (-1.9, -0.3) (p = 0.6) in the intervention and control groups respectively, and at 12 months-of-age HAZ was -0.7 (-1.9, -0.07) in the intervention group vs.-1.6 (-2.6, -0.4) in the control group (p = 0.04). Duration of PICU-LOS was 8.2 ± 11.6 days intervention vs. 18.3 ± 24.0 days control (p = 0.006). CONCLUSION: Overall weight was well maintained and growth improved in infants who followed the pre-operative nutritional-pathway. The duration of PICU-LOS was significantly lower in the intervention group, which may be due to improved nutritional status, although this requires further investigation.

Browning formation markers of subcutaneous adipose tissue in relation to resting energy expenditure, physical activity and diet in humans.

Background Regular exercise and diet may contribute to white adipose tissue (WAT) conversion into a brown adipose-like phenotype that may increase resting energy expenditure (REE), leading to weight loss. We examined the relationship between REE, physical activity (PA) participation and diet with browning formation markers of subcutaneous WAT in healthy men. Materials and methods We assessed REE, diet and body composition of 32 healthy men [age (years): 36.06 ± 7.36, body mass index (BMI): 27.06 ± 4.62 (kg/m2)]. Participants also underwent measurements of PA [metabolic equivalent (MET)-min/week] using the International Physical Activity Questionnaire (IPAQ), while they undertook a subcutaneous fat biopsy from the abdominal region to assess the mRNA expressions of uncoupling protein 1 (UCP1), peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), peroxisome proliferator-activated receptor alpha (PPARα) and peroxisome proliferator-activated receptor gamma (PPARγ). Results We found no associations between the UCP1, PGC-1α, PPARα and PPARγ mRNAs with REE, PA levels and diet (p > 0.05). However, the PGC-1α, PPARα and PPARγ mRNAs were more expressed in individuals displaying moderate rather than low PA levels (p < 0.05). Furthermore, PGC-1α, PPARα and PPARγ mRNAs were negatively correlated with fat mass percentage (p < 0.05). PGC-1α and PPARα mRNAs were also negatively correlated with BMI, while PGC-1α mRNA was inversely associated with waist-to-hip ratio (p < 0.05). Conclusion REE, PA levels and diet are not associated with browning formation indices of subcutaneous adipose tissue in healthy adult men.

Chloride channel gene expression in the rabbit cornea.

PURPOSE: The maintenance of stromal hydration by the corneal endothelium relies on active transendothelial anion transport, with bicarbonate and chloride the major anions carrying the current. However, the ion transport pathways that operate to maintain stromal hydration have yet to be fully elucidated. METHODS: We used RT-PCR to identify the gene expression profile of members of the ClC family of chloride channels in freshly isolated samples of rabbit corneal endothelium, stroma, and epithelium. The expression of a separate group of genes was also examined to confirm the purity of the sample collection protocol. The expression of the ClC-2 and ClC-3 channel protein in the cornea was also evaluated by light and electron microscopic immunolabelling. RESULTS: The mRNA for ClC-2, ClC-3, ClC-5, ClC-6, and ClC-7 were expressed in both the corneal epithelium and endothelium, and in the stroma. The mRNA for the skeletal muscle specific channel ClC-1 and the kidney specific chloride channel ClC-Ka were not detectable. ClC-4 mRNA was not detected in any rabbit tissue examined. The expression pattern of the mRNAs for collagens V, VI, VII, and VIII demonstrated the absence of contamination in epithelial and endothelial samples. ClC-2 and ClC-3 immunolabelling confirmed the presence of these proteins in corneal endothelium, stroma, and epithelium. CONCLUSIONS: Together with cystic fibrosis transmembrane conductance regulator (CFTR) and calcium activated chloride channel-1 (CLCA1), these results bring the number of chloride channel genes known to be expressed in the corneal endothelium and epithelium to seven. These channels are likely to be important for the maintenance of corneal transparency.

Carer's education groups for relatives with a first episode of psychosis: an evaluation of an eight-week education group.

AIM: This study aimed to evaluate an eight-week carers group for people with first episode of psychosis receiving services from the Gloucestershire Recovery in Psychosis Early Intervention Team. Potential benefits for carers were assessed including changes in feelings of stress, isolation, recognition, and of being appreciated and valued. METHODS: Following completion of the group, all 12 carers participated in an independently facilitated focus group to evaluate the course. Transcripts were imported into the QSR NVivo 8 (QSR International, Doncaster, Victoria, Australia) software package for thematic analysis. An independent coding and correlational analysis of data was used to identify any common themes. RESULTS: Results identified five key themes reported by carers: the emotional impacts of being a carer (loss, grief, guilt, shock, acceptance), the wider impacts of mental illness within a family (isolation, stigma), the caring role and how this affected relationships (improved relationships), the design of the group (barriers, course content, timing of invitations, moving forward) and the wider impacts of participation (carer education, importance of sharing real-life experiences, navigating the National Health Service). CONCLUSIONS: Carers reported less isolation, improved confidence, greater understanding of psychosis, reduction in guilt and increased coping in their caring role after the group. Carers reported that they gained new knowledge, obtained support from staff and graduate carers, increased the recognition of their caring role and had improved relationships with their relative with mental illness.