Association between SMOF lipid and parenteral nutrition-associated cholestasis compared with Intralipid in extremely low birth weight infants: A retrospective cohort study.

BACKGROUND: There is limited evidence on benefits of SMOF lipids (mixed fatty acid emulsion of 30% soybean oil, 30% medium chain triglycerides, 25% olive oil, and 15% fish oil) in reducing parenteral nutrition-associated cholestasis in extremely low birth weight infants, compared with soybean oil-based Intralipid. AIM: To compare incidence of parenteral nutrition-associated cholestasis in preterm infants who received Intralipid vs SMOF lipid. METHODS: We conducted a retrospective study on infants with birth weight <1000 g, admitted between January 2013 to December 2022, who received parenteral nutrition for >14 days and divided them into two groups based on lipid emulsion received (Intralipid, n = 187, SMOF, n = 127). Primary outcome was incidence of parenteral nutrition-associated cholestasis, defined as direct bilirubin ≥2 mg/dl. RESULTS: Baseline characteristics did not differ between the two groups. No significant difference was noted in parenteral nutrition-associated cholestasis between the two groups on logistic regression, (adjusted odds ratio: 0.71, 95% confidence interval 0.35-1.42, P value 0.33) after adjusting for gestational age, parenteral nutrition days, lipid days, and late-onset sepsis. CONCLUSION: There was no difference in the rates of parenteral nutrition-associated cholestasis between preterm infants administered SMOF lipids and those given Intralipid.

The possible therapeutic role of intravenous lipid emulsion in acute aluminium phosphide poisoning: a randomized controlled clinical trial.

Introduction: Aluminum phosphide (ALP) is a highly toxic rodenticide and the mortality rates caused by it have been demonstrated up to 70-100% in various studies. Unfortunately, there is no specific antidote to manage its toxic effects. This study aimed to assess the biochemical and clinical efficacy and safety of intravenous lipid emulsion as an adjuvant therapy in acute aluminum phosphide poisoning. Patients and methods: Sixty-four cases with acute ALP poisoning were stratified according to severity by the Poison Severity Score into severe and moderate groups (32 patients each). Patients were then randomly allocated into either receiving intravenous lipid emulsion in addition to the conventional treatment or receiving the conventional treatment only by using block randomization. Results: Treatment by ILE resulted in a significant improvement in the survival time, the mean arterial blood pressure, arterial blood gases, and a significant reduction in serum lactate levels. The need for intubation and mechanical ventilation was insignificantly lower in the intervention groups compared to control groups. However, the reduction in mortality rate in the patients of intervention groups compared with control groups was found to be non-significant. Intravenous lipid emulsion use in acute ALP poisoning significantly prolonged the survival time, improved the metabolic acidosis, decreased the serum lactate levels and increased the mean arterial blood pressure and hospital stay in the intervention groups. And insignificantly decreased the mortality rate, need of intubation and mechanical ventilation, and the total dose of vasopressors.

Superprotonic Conductivity in a Metalloporphyrin-Based SMOF (Supramolecular Metal-Organic Framework).

Metal-organic frameworks and supramolecular metal-organic frameworks (SMOFs) exhibit great potential for a broad range of applications taking advantage of the high surface area and pore sizes and tunable chemistry. In particular, metalloporphyrin-based MOFs and SMOFs are becoming of great importance in many fields due to the bioessential functions of these macrocycles that are being mimicked. On the other hand, during the last years, proton-conducting materials have aroused much interest, and those presenting high conductivity values are potential candidates to play a key role in some solid-state electrochemical devices such as batteries and fuel cells. In this way, using metalloporphyrins as building units we have obtained a new crystalline material with formula [H(bipy)]2[(MnTPPS)(H2O)2]·2bipy·14H2O, where bipy is 4,4'-bipyidine and TPPS4- is the meso-tetra(4-sulfonatephenyl) porphyrin. The crystal structure shows a zig-zag water chain along the [100] direction located between the sulfonate groups of the porphyrin. Taking into account those structural features, the compound was tested for proton conduction by complex electrochemical impedance spectroscopy (EIS). The as-obtained conductivity is 1 × 10-2 S·cm-1 at 40 °C and 98% relative humidity, which is a remarkably high value.

Effects of SMOF on soil properties, root-zone microbial community structure, metabolites, and maize (Zea mays L.) response on a reclaimed barren mountainous land.

Introduction: Maize is the largest crop produced in China. With the growing population and the rapid development of urbanization and industrialization, maize has been recently cultivated in reclaimed barren mountainous lands in Zhejiang Province, China. However, the soil is usually not suitable for cultivation because of its low pH and poor nutrient conditions. To improve soil quality for crop growth, various fertilizers, including inorganic, organic, and microbial fertilizers, were used in the field. Among them, organic fertilizer-based sheep manure greatly improved the soil quality and has been widely adopted in reclaimed barren mountainous lands. But the mechanism of action was not well clear. Methods: The field experiment (SMOF, COF, CCF and the control) was carried out on a reclaimed barren mountainous land in Dayang Village, Hangzhou City, Zhejiang Province, China. To systematically evaluate the effect of SMOF on reclaimed barren mountainous lands, soil properties, the root-zone microbial community structure, metabolites, and maize response were investigated. Results: Compared with the control, SMOF could not significantly affect the soil pH but caused 46.10%, 28.28%, 101.94%, 56.35%, 79.07%, and 76.07% increases in the OMC, total N, available P, available K, MBC, and MBN, respectively. Based on 16S amplicon sequencing of soil bacteria, compared with the control, SMOF caused a 11.06-334.85% increase in the RA of Ohtaekwangia, Sphingomonas, unclassified_Sphingomonadaceae, and Saccharibacteria and a 11.91-38.60% reduction in the RA of Spartobacteria, Gemmatimonas, Gp4, Flavisolibacter, Subdivision3, Gp6, and unclassified_Betaproteobacteria, respectively. Moreover, based on ITS amplicon sequencing of soil fungi, SMOF also caused a 42.52-330.86% increase in the RA of Podospora, Clitopilus, Ascobolus, Mortierella, and Sordaria and a 20.98-64.46% reduction in the RA of Knufia, Fusarium, Verticillium, and Gibberella, respectively, compared with the control. RDA of microbial communities and soil properties revealed that the main variables of bacterial and fungal communities included available K, OMC, available P, MBN, and available K, pH, and MBC, respectively. In addition, LC-MS analysis indicated that 15 significant DEMs belonged to benzenoids, lipids, organoheterocyclic compounds, organic acids, phenylpropanoids, polyketides, and organic nitrogen compounds in SMOF and the control group, among which four DEMs were significantly correlated with two genera of bacteria and 10 DEMs were significantly correlated with five genera of fungi. The results revealed complicated interactions between microbes and DEMs in the soil of the maize root zone. Furthermore, the results of field experiments demonstrated that SMOF could cause a significant increase in maize ears and plant biomass. Conclusions: Overall, the results of this study showed that the application of SMOF not only significantly modified the physical, chemical, and biological properties of reclaimed barren mountainous land but also promoted maize growth. SMOF can be used as a good amendment for maize production in reclaimed barren mountainous lands.

Effects of glutamine and n-3 polyunsaturated fatty acid mixed lipid emulsion supplementation of parenteral nutrition on sepsis score and bacterial clearance in early experimental sepsis.

INTRODUCTION: Glutamine (GLN) and n-3 polyunsaturated fatty acids (n-3PUFAs) have been shown to potentially possess immune-modulating and disease-modifying properties in experimental and clinical critical illness when given with parenteral nutrition (PN). However, we recently showed in experimental cancer models that combinations of GLN/n-3 PUFA may antagonize benefits of either nutrient alone. Thus, our aim was to explore the effects of PN-containing GLN and n-3PUFA mixed lipid emulsion (MLE) alone and in combination in experimental sepsis. METHODS: Adult male rats were exposed to cecal ligation and puncture (CLP) and sacrificed at 24 h. Rats were infused with either normal saline (NS); PN + Intralipid (PNcont); PN + GLN; PN + n-3PUFA MLE; or PN + GLN/n-3PUFA MLE after CLP-sepsis for 23 h. Animals were assessed at 24 h for sepsis score, Gram (+) and Gram (-) bacterial load in blood, peritoneum, and bronchoalveolar lavage fluid (BALF). RESULTS: Rats treated with PN + GLN or PN + n-3PUFA showed significantly lower sepsis scores compared to NS and PNcont (all p ≤ 0.016). Non-significant trends to improved sepsis scores was observed in rats treated with PN + GLN/n-3PUFA versus NS (p = 0.067) or PNcont (p = 0.093). Rats treated with PN + GLN, PN + n-3PUFA, or PN + GLN/n-3PUFA had significant improvement or trends to improved Gram (+) and Gram (-) bacterial loads in BALF versus NS (p ≤ 0.05, PN + GLN and PN + GLN/n-3PUFA for Gram (+); p = 0.057, PN + n-3PUFA for Gram (+); p ≤ 0.05, n-3PUFA and PN + GLN/n-3PUFA for Gram (-)). No differences between groups in blood or peritoneal bacterial counts observed. CONCLUSIONS: This data describes initial evidence that nutritional-doses of GLN, n-3PUFA MLE, and GLN + n-3PUFA MLE in PN can improve bacterial load/clearance in sepsis. Further, improvements of sepsis score by PN + n-3PUFA MLE and PN + GLN was observed. Previously observed antagonism of benefits of PN-containing GLN or n-3PUFAs alone by combinations of these nutrients was not observed in experimental sepsis. These results suggest further research is needed into PN-strategies using GLN and/or n-3PUFA at nutritional-doses in sepsis.

Effects of lipid emulsions on unbound bilirubin and response to phototherapy in preterm infants.

OBJECTIVE: Bilirubin-induced neurotoxicity is mediated by the fraction of total serum bilirubin (TSB) not bound to albumin (Bf). Unbound free fatty acids (FFAu) generated from lipid emulsions compete with bilirubin for albumin binding, increasing Bf. Soy-based (IL) and soy-MCT-olive-fish oil-based (SMOF) lipid emulsions contain different fatty acids with distinct albumin binding affinities. IL increases Bf in preterm infants, but the effects of SMOF on Bf are not known. Our objective was to compare changes in TSB, Bf, FFAu, and response to phototherapy in preterm infants receiving SMOF and IL. We hypothesized that SMOF would be associated with lower Bf and better response to phototherapy than IL. METHODS: Very preterm and low birth weight infants (<1500 g, <32 weeks) were infused with IL (n = 20) or SMOF (n = 20) as prescribed by providers. Phototherapy was prescribed using the standard care practice. FFAu profiles and levels, TSB, and Bf were measured on 0, 1, 2, and 3 g/kg/day of lipid infusion and at the initiation and termination of phototherapy. TSB was analyzed in the clinical laboratory using the diazo technique. FFAu and Bf were measured using fluorescent probes. RESULTS: Escalating doses of IL and SMOF increased FFAu levels and Bf, but not TSB. Phototherapy did not significantly decrease Bf for infants receiving either lipid. IL-treated infants had higher levels of unbound linoleic acid, and SMOF-treated infants had higher unbound arachidonic, oleic, and docosahexaenoic acids. CONCLUSIONS: IL and SMOF both increase Bf similarly, and phototherapy does not significantly affect Bf for infants receiving them.

Lipid Intake and Neurodevelopment in Preterm Infants.

Preterm infants are born before the critical period of lipid accretion and brain development that occurs during the third trimester of pregnancy. Dietary lipids serve as an important source of energy and are involved in complex processes that are essential for normal central nervous system development. In addition to traditional neurodevelopmental testing, novel quantitative magnetic resonance imaging (MRI) techniques are now available to evaluate the impact of nutritional interventions on early preterm brain development. Trials of long-chain polyunsaturated fatty acid supplementation have yielded inconsistent effects on neurodevelopmental outcomes and quantitative MRI findings. Recent studies using quantitative MRI suggest a positive impact of early lipid intake on brain volumes and white matter microstructural organization by term-equivalent age.

Intravenous lipid emulsion as an adjuvant therapy of acute clozapine poisoning.

INTRODUCTION: Clozapine is a frequently prescribed atypical antipsychotic drug. Various case reports documented the successful recovery of acute antipsychotics toxicity in association with the administration of intralipid emulsion (ILE). AIM: This study aimed to assess the adjuvant therapeutic role of SMOF Lipid administration on the outcomes of acute clozapine poisoning. METHODS: Forty patients with acute clozapine poisoning were randomly allocated into two equal groups. The control group received the standard supportive treatment only, whereas the intervention group received the standard supportive treatment plus SMOF Lipid 20% infusion. All patients were subjected to history taking, full clinical examination, and laboratory investigations. The study outcomes were evaluated. RESULTS: The mean Glasgow Coma Scale (GCS) at 6 hours (13.1 ± 2.3 vs 9.2 ± 2, p < 0.001) and 12 hours (14.3 ± 1.5 vs 9.6 ± 2, p < 0.001) after admission was significantly higher in the intervention group compared to the control group. The intervention group showed a significantly lower frequency of prolonged QTc interval 12 hours after admission (p = 0.003), as well as a significantly shorter hospital stay (p < 0.001). CONCLUSIONS: SMOF Lipid infusion seemed to have improved GCS, the prolonged QTc interval, and shortened the length of hospital stay. Furthermore, there were no adverse effects related to its administration.

Electrochemical investigations for COVID-19 detection-A comparison with other viral detection methods.

Virus-induced infection such as SARS-CoV-2 is a serious threat to human health and the economic setback of the world. Continued advances in the development of technologies are required before the viruses undergo mutation. The low concentration of viruses in environmental samples makes the detection extremely challenging; simple, accurate and rapid detection methods are in urgent need. Of all the analytical techniques, electrochemical methods have the established capabilities to address the issues. Particularly, the integration of nanotechnology would allow miniature devices to be made available at the point-of-care. This review outlines the capabilities of electrochemical methods in conjunction with nanotechnology for the detection of SARS-CoV-2. Future directions and challenges of the electrochemical biosensors for pathogen detection are covered including wearable and conformal biosensors, detection of plant pathogens, multiplexed detection, and reusable biosensors for on-site monitoring, thereby providing low-cost and disposable biosensors.

The effects of two mixed intravenous lipid emulsions on clinical outcomes in infants after gastrointestinal surgery: a prospective, randomized study.

BACKGROUND: There are many advantages of a SMOF emulsion (SMOF-lipid), such as liver-protective properties and anti-inflammatory effects. The objective of this study was to compare the clinical outcomes of SMOF-lipid with medium-chain triglycerides (MCT) /long-chain triglycerides (LCT) in infants after intestinal surgery. METHODS: This was a prospective, randomized study. Neonates receiving intravenous nutrient solution, including lipid emulsion after gastrointestinal surgery, were included in this study. The patients were randomly assigned to the SMOF-lipid or MCT/LCT groups. Infants who received intravenous lipid emulsion continuously for > 2 weeks were considered to have completed the study. Differences in weight gain, nutrition indices, alanine transaminase (ALT), aspartate transaminase (AST), and direct bilirubin (DB), and inflammation cytokine markers (interleukin [IL]-6 and tumor necrosis factor [TNF]-α) were measured. RESULTS: The final sample included 160 infants. One hundred fourteen infants received intravenous SMOF-lipid (74) or MCT/LCT (86) > 2 weeks and 46 infants received intravenous SMOF-lipid (22) or MCT/LCT (24) > 4 weeks. There were no significant differences in weight gain, nutrition indices, inflammation cytokine markers, and sepsis between the groups at the end of 2 and 4 weeks; however, in the SMOF group, the ALT, AST, and DB levels were significantly lower than the MCT/LCT group at the end of 4 weeks. CONCLUSION: The mixture and balanced emulsion of SMOF-lipid was well-tolerated in infants who have undergone gastrointestinal surgery, and liver-protective properties were demonstrated following long-term venous nutrition, especially > 4 weeks.

Comparative Study Between Conventional Fasting Versus Overnight Infusion of Lipid or Carbohydrate on Insulin and Free Fatty Acids in Obese Patients Undergoing Elective On-pump Coronary Artery Bypass Grafting. A Prospective Randomized Trial.

OBJECTIVES: Postoperative insulin resistance represents a major component of postoperative metabolic disorder. The authors compared the effects of preoperative infusion of lipid emulsion or carbohydrate to conventional preoperative fasting on postoperative insulin and free fatty acid (FFA) levels. DESIGN: A prospective randomized double-blinded study. SETTINGS: Tertiary university hospital. PARTICIPANTS: Sixty-three patients undergoing coronary artery bypass grafting. INTERVENTION: Participants were randomized into 3 equal groups. Group G received 500 mL of glucose 10% (50 g glucose). Group L received 100 mL of 2% lipid emulsion (soybean 30%, medium chain triglycerides (TG) 30%, olive oil 25%, fish oil 15%, and 20 mg vitamin E). Group C fasted overnight except for clear fluids allowed until 4 hours preoperatively. Serum insulin at the start of infusion (T1), 1-hour preinduction (T2), on admission to the intensive care unit (T3), after 24 hours of admission (T4), and after 48 hours of admission (T5), and FFA at T1 and T2 were measured. Serum very-low-density lipoprotein (VLDL), serum TG, and blood sugar were all measured (T1-T4). Bypass time, ischemic time, need for inotropic support, and length of intensive care unit stay also were measured. MEASUREMENTS AND MAIN RESULTS: At the end of infusion FFAs were significantly lower in the L group (1.1 ± 0.76 mg/dL) compared with G (1.64 ± 0.85 mg/dL) and C groups (1.48 ± 0.76 mg/dL). Insulin levels were significantly lower in the L group compared with levels in the G and C groups at T2, T3, and T4. Also, TG, VLDL, and random blood sugar levels decreased significantly at T2, T3, and T4 in the L group compared with the other 2 groups and compared with baseline value within the same group. CONCLUSION: Preoperative lipid infusion lowered postoperative FFA, insulin, TG, VLDL, and random blood sugar in obese patients undergoing coronary artery bypass grafting surgeries.

Leaching of plasticizers from polyvinylchloride perfusion lines by different lipid emulsions for premature infants under clinical conditions.

Plasticizers migrate from polyvinylchloride (PVC) infusion systems into lipid emulsions. The aim of this study was to investigate the leaching of different plasticizers from PVC perfusion lines by a selection of lipid emulsions under clinical conditions. Seven PVC perfusion lines with an equal length of 150cm and three internal diameters were perfused with three lipid emulsions: Intralipid® 20%, ClinOleic® 20% and SMOFlipid® 20%, mimicking clinical conditions. The concentrations of the plasticizers were measured directly in the emulsions by gas chromatography - mass spectrometry. Of the four plasticizers examined in this study, di (2-ethylhexyl) phthalate (DEHP) leached the most and was found, on average, at 46.5µg/ml in the emulsions - around one order of magnitude higher than the other plasticizers. This study demonstrates that the leaching of DEHP by lipid emulsions in conditions of total parenteral nutrition is many times higher than should be accepted and higher when compared to the other plasticizers. There was no significant difference in leaching of plasticizers in relation to the type of lipid emulsion. The influence of tube diameter on the leaching rate of plasticizers should be taken into account especially in particular exposed patients.

Pathophysiology, prevention, treatment, and outcomes of intestinal failure-associated liver disease.

BACKGROUND: Intestinal failure-associated liver disease (IFALD) remains a serious problem in the treatment of infants with nutritional problems and short bowel syndrome. METHODS: A review of the recent literature from 2010 to 2016, concentrating on articles related to the pathophysiology of IFALD and to outcomes of novel nutritional and pharmacological therapies for neonatal cholestasis in the post-surgical neonate. RESULTS: The pathophysiology of IFALD relates to an increase sensitivity of the neonatal liver to cholestasis in the non-fed state; prolonged cholestasis almost inevitably results in liver damage which will progress from fibrosis to cirrhosis. Clinically discerned risk factors include premature birth, inflammation, sepsis, disruption of the enterohepatic circulation by creation of a proximal stoma, and the duration and type of parenteral nutritional support. Within the hepatocyte, the regulatory enzyme farsanoid receptor X (FXR) appears to play a pivotal role in the development of cholestasis. Recent studies have shown that its activity is suppressed by sepsis, and by plant phytosterols found in soy-based lipid preparations. This paradigm is reflected in the emerging consensus for the care of post-surgical neonates, which is based around a multi-disciplinary team approach. Using an algorithm-driven approach, an appropriate balance between caloric support and prevention of IFALD can be achieved. CONCLUSIONS: Further prospective studies are required to further refine the optimal sequence of use of these therapies and the long-term effects on neurological development and hepatic function. However, with optimal care, the number of IF patients progressing to end-stage liver disease because of IFALD should be very low.

Comparison of Formulas Based on Lipid Emulsions of Olive Oil, Soybean Oil, or Several Oils for Parenteral Nutrition: A Systematic Review and Meta-Analysis.

Many studies have reported that olive oil-based lipid emulsion (LE) formulas of soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOF) may be a viable alternative for parenteral nutrition. However, some randomized controlled clinical trials (RCTs) have raised concerns regarding the nutritional benefits and safety of SMOFs. We searched principally the MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials databases from inception to March 2014 for the relevant literature and conducted a meta-analysis of 15 selected RCTs that 1) compared either olive oil- or SMOF-based LEs with soybean oil-based LEs and 2) reported plasma concentrations of α-tocopherol, oleic acid, and ω-6 (n-6) and ω-3 (n-3) long-chain polyunsaturated fatty acids (PUFAs) and liver concentrations of total bilirubin and the enzymes alanine transaminase, aspartate transaminase, alkaline phosphatase, and γ-glutamyl transferase. The meta-analysis suggested that SMOF-based LEs were associated with higher plasma concentrations of plasma α-tocopherol, oleic acid, and the ω-3 PUFAs eicosapentaenoic and docosahexaenoic acid. Olive oil- and SMOF-based LEs correlated with lower plasma concentrations of long-chain ω-6 PUFAs and were similar to soybean oil-based LEs with regard to their effects on liver function indicators. In summary, olive oil- and SMOF-based LEs have nutritional advantages over soybean oil-based LEs and are similarly safe. However, their performance in clinical settings requires further investigation.