[The impact factor of Nutrición Hospitalaria is 1.096]. / El factor de impacto de Nutrición Hospitalaria es 1,096.

The editors of Nutrición Hospitalaria (Nutr Hosp) analyze the journal from its foundation in 1979 to the present time, on occasion of the first publication of its impact factorby Journal Citation Reports (JCR). The actions taken along this thirty year period are described, including its incorporation to multiple web databases, the Open Access policy of the journal, its progressive internationality, and the bibliometric analysis made in 1999. A figure with the journal citation trends is included. Nutr Hosp, included in the "Nutrition & Dietetics" group of JCR, is in the position 42/59, i.e. in the third quartile. Among the Spanish journals included in JCR,Nutr Hosp is located in the 14/37 position. A few considerations are made related to the economical aspects of the journal, the number of articles received so far, the articles expected in the future, the rejection rate and the language (Spanish or English) in which Nutr Hosp should be published.

Intragastric balloon and multidisciplinary team.

BACKGROUND: The intragastric balloon is widely used for weight reduction in obese patients, but results are variable. We describe our results enhancing the importance of a Multidisciplinary Team (MT) taking part in the treatment. METHODS: A retrospective review was done concerning a total of 119 balloons , placed in 116 patients, under endoscopic control and conscious sedation, from May 2001 until August 2006. 49 patients were prepared and recommended to be followed by a MT in a physical unit, at least every 15 days during 6 months. 67 were indicated and followed by other colleagues, without MT. Removal was performed 6 months later. RESULTS: Concerning our 49 patients, mean age was 38, 1 years, 31 female and 18 males, with BMI ranged between 32 and 63, average of 42. The average decrease of weight excess was 31, 85% (-4, 45-80, 4%), and the BMI diminished 5,3 points (from 13,6 to gain of 0,9). The treatment failed in 34,6 % of our patients -including 4 patients lost of follow-up (8, 16%)-, compared with 53, 8% of patients without structured MT for selection and follow-up. Physical exercise enhanced markedly the results with 45, 8% of excess of weight loss in women and 39, 7% in males, compared with 14, 6 and 15, 6% in patients who didn't follow the program. The weight loss was mostly fat mass, 89,9% in men and 75,6% in women.- The results maintenance was obtained in 40% of patients one year later. There were no major complications; one balloon had to be removed at 3 weeks because of intolerance, another at 5 months because of gastroesophageal reflux. CONCLUSIONS: BIB is an effective help to achieve a short term weight loss in obese patients; nevertheless, good and long lasting results will depend on the modification of life style obtained by a multidisciplinary approach.

[Intragastric balloon in obesity treatment]. / Balón intragástrico en el tratamiento de la obesidad.

Obesity is considered a chronic and epidemic illness, hece difficult to treat. As conservative treatment has a high rate of failure, and considering morbimortality and sequels of surgery, less invasive techniques appeared to contribute to the treatment of this illness. The most implanted technique nowadays is the Intragastric Balloon, considered more efficient as conservative treatments and with less risks tan surgery, but having today a lack of consensus on indications and few information on his limitations, while its apparition in medias promote an important expansion in the 4 last years. In this publication, we do a critical revision, and describe limitations of this treatment, based on the evidences given by literature. We conclude this revision with some recommendations concerning the technique and indications, material and human requiring, need of a Multidisciplinary Team, as well as an adequate control and following.

Immunoenhanced enteral nutrition formulas in head and neck cancer surgery: a prospective, randomized clinical trial.

INTRODUCTION: Significant malnutrition exists in a high percentage of patients with head and neck cancer. Malnutrition is associated with defects in immune function that may impair the host response to malignancy. Malnutrition and immunosupression make patients highly susceptible to postoperative infections and complications. OBJECTIVES: Compare two immunoenhanced enteral nutritions with a control diet, and evaluate the effect in postoperative infections, length of stay and inflammatory markers. PATIENTS: A population of 44 patients with oral and laryngeal cancer was enrolled in a randomized trial. At surgery, patients were randomly allocated to three groups: (group I); patients receiving an arginine-enhanced formula (group II); patients receiving a standard polymeric formula, and (group III) patients receiving an arginine, RNA and omega-3 fatty acids enhanced formula, in an isonitrogenous way. RESULTS: The duration of enteral nutrition in the three groups was similar with an average duration of 14,5 +/- 8 days. The length of postoperative stay was similar, with an average of 19,8 +/- 8,5 days. Wound infections and general infections were more frequent in the control group. Fistula rates were not improved in the enhanced diet groups. No significant intergroup differences in the trend of the two plasma proteins (albumin, transferrin), lymphocytes, weight, IL-6, CPR and TNFalpha were detected. The control group showed the highest levels of TNFalpha at the fourteenth postoperative day. Gastrointestinal tolerance and diarrhoea rate were similar in all the patients. CONCLUSIONS: Immunoenhanced enteral nutrition formulas improved the infection rate in the postoperative of head and neck cancer patients. In the fistula rates, we observed that technical problems and nutritional status might have played an equally important role, and therefore the positive effect of immunonutrition in this parameter might have been overestimated.

[Bibliometric study of the Journal Nutrición Hospitalaria for the period 2001-2005: Part 1, Analysis of the scientific production]. / Estudio bibliométrico de la revista Nutrición Hospitalaria en el periodo 2001 a 2005: Parte I, Análisis de la producción científica.

OBJECTIVE: To assess the scientific activity and information production of the journal Nutrición Hospitalaria, for the period 2001-2005 by means of a Bibliometric study. METHOD: Cross-sectional descriptive study of the results obtained from the analysis of the articles published in the journal Nutrición Hospitalaria. The data were obtained by consulting the electronic version through the Web. In those cases in which there was a link breakdown, and thus, the inability to have access to the electronic document the printed version was consulted. All the documental possibilities were taken into account with the exception of communications to congresses. RESULTS: A total of 345 articles were published, 187 (54.20%) being original articles. The geographical distribution of the first author was Spanish in 287 articles (83.19%) and Latin American in 27 (7.83%). Most of the articles are from health care centers (172 articles (49.86%)), and the cooperation index being 4.15. Madrid is the most productive province, for both the absolute and adjusted frequencies. The median number of references per article is 18, the mean being 23.52 (95% CI 20.93 - 26.10). The predominant language was Spanish, with 308 articles (89.28%). CONCLUSION: Nutrición Hospitalaria may be considered as a reference journal regarding information and scientific communication on Nutrition for both the Spanish and Latin American communities. The bibliometric parameters studied compare with those verified for the remaining top of the list Spanish scientific journals on health sciences.

[Bibliometric study of the journal Nutrición Hospitalaria for the period 2001--2005: Part 2, consumption analysis; the bibliographic references]. / Estudio bibliométrico de la revista Nutrición Hospitalaria en el periodo 2001 a 2005: parte 2, análisis de consumo; las referencias bibliográficas.

OBJECTIVE: To describe and assess the consumption of the information consulted and cited in the articles published in the journal Nutrición Hospitalaria for the period 2001--2005 by means of bibliometric analysis. METHOD: Cross-sectional descriptive analysis of the results obtained from the analysis of the lists of bibliographic references of the articles published at Nutrición Hospitalaria. We studied the most cited journals, the signatures index, the type of document referred, the publication language, the distribution of geographical origin, and obsolescence and readiness index. We took into account all types of documents with the exception of Communications to Congresses. RESULTS: 345 articles were published at Nutr Hosp, containing 8,113 bibliographic references, with a median of 18, a maximum of 136 and minimum of 0 BR per article. The mean (rate of publications per published article during the specified period) is 23.52 (95% IC 20.93-26.10) and the mean at 5% is 20.66 per article. The 25th and 75th percentiles are 6 and 32, respectively, the interquartile interval being 26 BR per document. The semi-period of Burton and Kebler is 7 years and the Price Index is 38.18%. CONCLUSION: The bibliographic references, the consumption of information, of the articles published at Nutrición Hospitalaria present parameters similar to other journals on health science. However, good data on obsolescence are observed, which reveal the good validity of most of the references studied.

[Animal models of fulminant hepatic failure]. / Modelos animales de fallo hepático fulminante.

Fulminant hepatic failure (FHF) is a very serious clinical sindrome that, in spite of the important therapeutical advances that have taken place in the last years by means of bioartifical hepatic support devices and hepatic transplantation, is still associated to a high mortality. Knowledge and treatment of the FHF have been limited by the lack of satisfactory animal models. Among the attempts to develop a suitable model are surgical models, such as hepatectomy and total and/or partial devascularization, or the use of chemical substances with hepatic toxicity, such as acetaminophen, azoximethane, galactosamine or thioacetamide, among others. However, most of these models do not adequatly reflect the pattern of the human disease and all of them present important limitations. Although viral hepatitis is one of the most frequent causes of FHF, the use of viral agents to develop animal models has been little and unfortunate. Our group has recently developed a viral animal model of FHF by means of the inoculation of rabbits with the virus of the rabbit hemorrhagic disease. This model displays biochemical, and histological characteristics, and clinical signs that ressemble those in human FHF. In the present article, the most widely used animal models of FHF, together with their main advantages and disadvantages, are presented.

[Experimental models on hemorragic shock]. / Modelos experimentales sobre shock hemorrágico.

This review addresses the pathophysiology and treatment of hemorrhagic shock, a condition produced by rapid and significant loss of intravascular volume. Hemorrhagic shock may lead sequentially to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion and cellular hypoxia. Multiple organ failure, a systemic inflammatory process that leads to dysfunction of different vital organs, is a frequent complication after hemorrhagic shock and accounts for a high incidence of mortality. The pathogenesis of organ injury secondary to hypovolemic insults is still not completely understood, but both experimental studies and clinical observations indicate that macrophages are activated by translocated endotoxin-bacteria and ischemia/reperfusion. Activated Kupffer cells release pathologically active substances such as inflammatory cytokines, reactive oxygen species, and nitric oxide, all of which may participate in the mechanisms of hemorrhagic shock. Moreover, increased free radical production during hemorrhagic shock and resuscitation gives place to an increase in oxidative stress that would contribute to the organ damage. In the last few years, a number of experiments have been performed in an attempt to understand the pathophysiology and treatment of hemorrhagic shock. Different studies have shown positive effects on hemorrhagic shock treatment by antioxidant, amino acid, and lipid administration.

[Peripheral parenteral nutrition]. / Nutrición periférica.

The Target of this review is to provide an up-to-date overview of the advantages and disadvantages of Peripheral Parenteral Nutrition (PPN), including techniques, indications and results. The new generation catheters, together with a better knowledge of the intermediary metabolism, give us the opportunity to use PPN in many clinical situations for short periods of time. PPN is an alternative to Total Parenteral Nutrition (TPN) and is also a complement to enteral nutrition and to the oral route. Progress in the design of catheters and their materials, in infusion techniques and better knowledge of optimal nutrients has made PPN into an effective, safe and useful therapy in the treatment of patients for certain periods of time.

Identification of novel mutations in Spanish patients with muscle carnitine palmitoyltransferase II deficiency.

Carnitine palmitoyltransferase II (CPT II) deficiency is the most common recessively inherited disorder of lipid metabolism affecting skeletal muscle and the most frequent cause of hereditary myoglobinuria. We studied 5 Spanish patients with CPT II deficiency from four unrelated families. Four patients had the typical clinical phenotype of muscle CPT II deficiency with recurrent episodes of myoglobinuria, triggered by prolonged exercise, fasting, or fever, and marked elevation of creatine kinase values during metabolic crisis. One patient had exercise-related myalgia, cramps and moderate elevation of serum CK values, but had never had myoglobinuria. Molecular analysis showed that three patients were heterozygous for the S113L mutation and one patient heterozygous for the P50H substitution. To identify the mutations in the other alleles of our patients we amplified and sequenced genomic DNA fragments encompassing the entire coding region and intron/exon boundaries of the CPT2 gene. We found the recently reported 178 insT/del 25 bp in one patient. Three novel mutations were identified: a Y120C substitution that leads to a nonconservative amino acid replacement; a 36-38 insGC mutation that results in premature termination of the translation; and an I502T substitution that affects a conserved amino acid residue in the CPT II protein. Our data confirm the molecular heterogeneity of patients with CPT II deficiency, and suggest that the ethnic origin has to be taken into account before performing mutation analysis in these patients.

Dietary glycine inhibits activation of nuclear factor kappa B and prevents liver injury in hemorrhagic shock in the rat.

We investigated the effects of a glycine-containing diet (5%) on liver injury caused by hemorrhagic shock and resuscitation in rats. Anesthetized rats were bled to a mean arterial blood pressure of 35-40 mm Hg for 1 h and then resuscitated with 60% of shed blood and lactated Ringer's solution. Feeding the rats glycine significantly reduced mortality, the elevation of plasma transaminase levels and hepatic necrosis. The increase in plasma TNFalpha and nitric oxide (NO) was also blunted by glycine feeding. Hemorrhagic shock resulted in oxidative stress (significant elevations in TBARS and in the oxidized/reduced glutathione ratio) and was accompanied by a reduced activity of the antioxidant enzymes Mn- and Cu,Zn-superoxide dismutase, glutathione peroxidase and catalase, overexpression of inducible NO synthase (iNOS), and activation of nuclear factor kappa B (NF-kappaB). Glycine ameliorated oxidative stress and the impairment in antioxidant enzyme activities, inhibited NF-kappaB activation, and prevented expression of iNOS. Dietary glycine blocks activation of different mediators involved in the pathophysiology of liver injury after shock.

McArdle's disease associated with homozygosity for the missense mutation Gly204Ser of the myophosphorylase gene in a Spanish patient.

We studied a pateint whose clinical, morphological and biochemical findings were consistent with McArdle's disease. Molecular genetic studies revealed that the patient did not harbor the common Arg49Stop mutation and was homozygous for the Gly204Ser mutation. Until now, no patient having the missense mutation in the two alleles has been documented.

Cholestasis and alterations of glutathione metabolism induced by tacrolimus (FK506) in the rat.

BACKGROUND: Tacrolimus (FK506) is an immunosuppressive agent used for the prevention of allograft rejection after organ transplantation. The aim of this study was to investigate the effects of chronic tacrolimus treatment on bile secretion in rats. METHODS: Tacrolimus was administered intraperitoneally at doses of 0.2, 0.5, and 0.8 mg/kg/day for 6 weeks. RESULTS: Bile flow was significantly reduced at doses of 0.5 mg/kg and 0.8 mg/kg (-25% and -32%, respectively). Bile acid secretion was not significantly modified, but bicarbonate secretion decreased at doses of 0.5 mg/kg and 0.8 mg/kg (-23% and -29%, respectively). Glutathione secretion was significantly reduced at doses of 0.5 mg/kg (-29%) and 0.8 mg/kg (-49%). Liver glutathione concentration was reduced at the higher dose (-17%). Liver gamma-glutamyl-cysteinyl synthetase activity was elevated (+22%, +10, and +15%) and gamma-glutamyl transpeptidase activity was reduced (-18%, -40%, and -25%) at all doses. Dichlorofluorescein and thiobarbituric acid-reactive substance concentrations were not significantly modified. Liver glutathione peroxidase activity increased at doses of 0.5 mg/kg (+65%) and 0.8 mg/kg (+56%). Kidney concentration of thiobarbituric acid-reactive substances was significantly increased at doses of 0.5 mg/kg (+17%) and 0.8 mg/kg (+12%). CONCLUSIONS: Our data indicate that tacrolimus at high doses induces cholestasis by inhibiting primarily biliary excretion of glutathione and, to a lesser extent, bicarbonate. The decrease in biliary glutathione secretion is not due to a lower synthesis or degradation and could be related to its increased sinusoidal efflux.

The effects of glucagon on protein metabolism in normal man.

Plasma glucagon rises after major injury and could act to increase gluconeogenesis and ureagenesis in the post-traumatic state. This study documents the effect of prolonged glucagon infusion on ureagenesis and nitrogen excretion, as well as possible sources of the increased ureagenesis, in normal man. Four healthy men fasted for 6 days during intravenous infusion of glucose (750 gmday), establishing a steady state of minimal ureagenesis. Glucagon (1 mg/day) then was added to the infusion for 5 days. Glucose alone was given for the final 2 days. Forearm muscle flux of metabolites was determined by standard arterial-deep venous sampling and capacitance plethysmography. Glucagon concentration was suppressed during glucose infusion (11 +/- 13 pg/ml) and rose to levels seen in subjects with major trauma during glucagon infusion (669 +/- 138 pg/ml). Glucose infusion stabilized urine nitrogen excretion at 1.54 +/- 0.42 gm of N/sq m/day. Nitrogen excretion increased to 2.40 +/- 0.53 gm of N/sq m/day with glucagon infusion, with urea accounting for the increased excretion. Excretion of 3-methylhistidine was unchanged. Plasma amino acid concentration was strikingly reduced on the first day of glucagon infusion, where it stabilized. Forearm flux showed a slight net release of amino acid nitrogen during glucose infusion. Addition of glucagon to the glucose infusion resulted in a net uptake of nitrogen by forearm skeletal muscle. These evidences strong suggest that glucagon infusion in normal man increases ureagenesis, not only at the expense of the free amino acid pool, but by the hydrolysis of visceral protein as well, with muscle protein being maintained.

Serum CK-BB as a tumor marker in patients with carcinoma confirmed histologically.

We determined serum CK-BB mass concentration using a specific RIA method, in 267 patients with carcinoma confirmed histologically distributed as follows: 46 prostatic adenocarcinoma, 52 lung neoplasies, 70 colon carcinoma, 52 breast carcinoma and 41 gastric carcinoma; and also in 135 patients with histologically proved non-neoplastic diseases distributed as follows: 28 prostatic hyperplasy, 31 lung tuberculosis, 29 inflammatory bowel disease, 27 fibrocystic mastopathy and 20 gastroduodenal ulcer. Reference values in healthy subjects (n = 360) were 5.46 +/- 2.68 (SD) ng/ml. We found that serum CK-BB mass concentration is not a specific tumor marker but it is a valuable indicator of responsing to therapy and metastatic widespread. However, in prostatic carcinoma--prevalence 0.25, predictive positive value (PPV) 0.51 and predictive negative value (PNV) 0.88--and breast carcinoma--prevalence 0.32, PPV 0.60 and PNV 0.87--serum CK-BB can be used as a tumor marker. Only 12 over 268 patients with different neoplastic disease (4.47%) showed detectable serum CK-BB catalytic concentrations.

Cancer of the pancreas. Palliative operation, Whipple procedure, or total pancreatectomy?

The choice of operation for ductal carcinoma of the pancreas is as yet not clear. Failure to make an early diagnosis still stands out as the major problem in the treatment of this disease and as a result the resectability rate is exceedingly low. Between 1964 and 1973, nineteen total pancreatectomies were performed at Peter Bent Brigham Hospital for all tumors of the pancreas. Sixteen of these were for ductal carcinoma. The mortality was 12.5 per cent. When total pancreatectomy is compared with the Whipple procedure and a simple bypass procedure and when the tumor disease encountered is corrected for stage of disease, it is apparent that total pancreatectomy carries a statistically significant longer survival for patients with Stages I and II disease (no lymph node involvement) than the other two procedures. For Stages III and IV, there is no difference in survival between the three different operations. We therefore conclude that total pancreatectomy carries a better survival prognosis than other procedures performed for Stage I and II ductal carcinoma of the pancreas.

Influence of nutrition on liver oxidative metabolism.

The liver plays a major role in the disposition of the majority of drugs. This is due to the presence of several drug-metabolizing enzyme systems, including a group of membrane-bound mixed-function oxidative enzymes, mainly the cytochrome P450 system. Hepatic oxidative capacity can be assessed by changes in antipyrine metabolism. Different drugs and other factors may induce or inhibit the cytochrome P450-dependent system. This effect is important in terms of the efficacy or toxicity of drugs that are substrates for the system. Microsomal oxidation in animals fed with protein-deficient diets is depressed. The mixed-function oxidase activity recovers after a hyperproteic diet or the addition of lipids. Similar findings have been reported in patients with protein-calorie malnutrition, although results in the elderly are conflicting. Different studies have revealed that microsomal oxidation is impaired by total parenteral nutrition and that this effect is absent when changing the caloric source from carbohydrates to a conventional amino acid solution or after lipid addition, especially when administered as medium-chain/long-chain triglyceride mixtures. Peripheral parenteral nutrition appears to increase antipyrine clearance.

Nutritional and metabolic support: converging concepts.

The response to injury and infection can be viewed as a mobilization of body protein, fat, and carbohydrate stores to ensure normal or above-normal circulating levels of substrate in the absence of dietary intake. The situation does not readily yield to nutritional manipulation, and inappropriate nutritional support can cause additional stress. Artificial nutrition is mainly a form of nutrient administration and not nutrient utilization. Modulation of neurohumoral and wound responses to trauma due to starvation and refeeding has not been delineated. The provision of adequate substrates alone does not necessarily guarantee their efficient use in metabolism. With a clear knowledge of the role of cellular mediators in the pathophysiology of disease, it may be possible to develop more rational therapeutic approaches during critical illness. Determination of appropriate and optimal substrate support through parenteral and enteral nutrition remains of great clinical importance. The clinical application of branched-chain amino acids, dispensable amino acids, acetylated amino acids, dipeptides or tripeptides, cysteine, glutamine, and arginine has been explored in recent years. The idea that lipids are deleterious in sepsis and organ failure should be revised and documented, and recent studies suggest that fish oils as a lipid source may also favorably affect immune responses. Under stressful conditions, total parenteral nutrition can require large amounts of energy at a time when there are marked disturbances in glucose utilization. In this area, the use of nonglucose carbohydrates or oligosaccharides can be appropriate, despite the lack of broad acceptance. Existing conventional substrates should be studied beyond mere provision of energy and metabolic pathway support.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of parenteral nutrition supplemented with glutamine or glutamine dipeptides on liver antioxidant and detoxication systems in rats.

Our aim was to determine the effects of glutamine or alanyl glutamine parenteral supplementation on the liver oxidant/antioxidant balance and on cytochrome-P450-mediated detoxication in rats. Animals were infused for 5 d with standard total parenteral nutrition (TPN), glutamine-enriched TPN, or alanyl glutamine-enriched TPN. The hepatic concentration of glutathione was reduced, and the levels of thiobarbituric-acid-reactive substances (TBARS) were increased in animals receiving standard TPN. Both glutamine and alanyl glutamine supplementation normalized glutathione, but thiobarbituric-acid-reactive substance concentration was only decreased by ananyl glutamine. This effect was parallel to a partial recovery of the activity of antioxidant enzymes. Cytochrome-P450 liver content, cytochrome-P450-dependent monooxygenases, and antipyrine clearance were not modified by glutamine or alanyl glutamine. Our data suggest a better protection against free radicals by alanyl glutamine supplementation and an absence of effects of both glutamine and alanyl glutamine on liver oxidative metabolism.

Antipyrine clearance in surgical patients maintained on hypocaloric peripheral parenteral nutrition.

BACKGROUND: Antipyrine clearance (CLAP) constitutes a sensitive indicator of hepatic microsomal enzyme activity providing specific information on hepatic function. The purpose of this study was to evaluate the influence of hypocaloric peripheral parenteral nutrition on CLAP in patients receiving nutrition support after elective surgery. METHODS: CLAP was measured in 15 patients before elective gastrointestinal surgery and 6 days after the surgery. Antipyrine (1 g) was administered orally, and CLAP was determined by the one-sample method. Subjects received a postoperative 786 kcal/d regimen providing 66 g of amino acid per day and 133 g of glucose per day for 5 days. Nutritional status was evaluated by anthropometric parameters. A control group of 15 patients received no postoperative hypocaloric peripheral parenteral nutrition but received conventional fluid therapy. RESULTS: Mean CLAP was increased by 61% (0.66 +/- 0.06 mL/min.kg-1 body wt vs 0.41 +/- 0.05 mL/min.kg-1 body wt in the preoperative period; p < .001), and antipyrine half-life was reduced by 42% (10.9 +/- 1.0 hours vs 18.9 +/- 2.0 hours; p < .001) after 5 days of hypocaloric peripheral parenteral nutrition. No significant modification was shown among control patients in CLAP (0.54 +/- 0.07 mL/min.kg-1 body wt vs 0.46 +/- 0.05 mL/min.kg-1 body wt in the preoperative period) or in antipyrine half-life (14.0 +/- 1.4 hours vs 16.5 +/- 1.8 hours). No significant correlation was observed between CLAP changes and those for the nutritional status of the patients. CONCLUSIONS: The results of our study indicate that oxidative drug-metabolizing capacity is increased in surgical patients maintained on hypocaloric peripheral parenteral nutrition. Clinicians should be conscious of the potential of this effect for altering the efficacy or toxicity of many therapeutic agents.