Use of Conditionally Essential Amino Acids and the Economic Burden of Postoperative Complications After Fracture Fixation: Results from a Cost Utility Analysis.

Objective: To measure the economic impact of conditionally essential amino acids (CEAA) among patients with operative treatment for fractures.

Methods: A decision tree model was created to estimate changes in annual health care costs and quality of life impact due to complications after patients underwent operative treatment to address a traumatic fracture. The intervention of interest was the use of CEAA alongside standard of care as compared to standard of care alone.

Obesity and critical care nutrition: current practice gaps and directions for future research.

Background: This review has been developed following a panel discussion with an international group of experts in the care of patients with obesity in the critical care setting and focuses on current best practices in malnutrition screening and assessment, estimation of energy needs for patients with obesity, the risks and management of sarcopenic obesity, the value of tailored nutrition recommendations, and the emerging role of immunonutrition. Patients admitted to the intensive care unit (ICU) increasingly present with overweight and obesity that require individualized nutrition considerations due to underlying comorbidities, immunological factors such as inflammation, and changes in energy expenditure and other aspects of metabolism. While research continues to accumulate, important knowledge gaps persist in recognizing and managing the complex nutritional needs in ICU patients with obesity.

Using Nurse-Driven Protocols to Eliminate Routine Gastric Residual Volume Measurements: A Retrospective Study.

Background: Multiple critical care guidelines support the elimination of routine gastric residual volume monitoring in patients receiving enteral nutrition. However, transitioning nursing practice away from routine gastric residual volume assessments has proved challenging.

Objective: To evaluate outcomes after the elimination of routine gastric residual volume monitoring in a 14-bed adult intensive care unit at a large teaching hospital in the southeastern United States.

Preoperative carbohydrate loading in surgical patients with type 2 diabetes: Are concerns supported by data?

Currently, there is a lack of consensus on the provision of preoperative carbohydrate loading in patients with type 2 diabetes mellitus (T2DM) due to theoretical concerns including the possibility of delayed gastric emptying, perioperative hyperglycemia, and poor surgical outcomes. This narrative review summarizes the accumulating evidence on preoperative carbohydrate loading in this population and whether these concerns are supported by preliminary evidence. In general, the available research suggests that carbohydrate loading may be implemented in those with T2DM without increased risk for intra- and postoperative hyperglycemia or surgical complications.

THE ROLE OF HETEROPLASMY IN THE DIAGNOSIS AND MANAGEMENT OF MATERNALLY INHERITED DIABETES AND DEAFNESS.

Maternally inherited diabetes and deafness (MIDD) is a rare diabetic syndrome mainly caused by a point mutation in the mitochondrial DNA (mtDNA), mt3243 adenine to guanine (A>G). The objective of this paper is to review the genetic inheritance, clinical manifestations, and treatment of patients with MIDD. The current review used a literature search of scientific papers on this rare syndrome.

Larger omental adipocytes correlate with greater Fetuin-A reduction following sleeve gastrectomy.

Background: Shortly after bariatric surgery, insulin sensitivity improves and circulating Fetuin-A (FetA) declines. Elevated FetA may decrease insulin sensitivity by inhibiting insulin receptor autophosphorylation. FetA also mediates inflammation through toll-like receptor 4 and influences monocyte migration and macrophage polarization in the adipocyte.

Circulating Triglycerides and the Association of Triglycerides with Dietary Intake Are Altered by Alpha-2-Heremans-Schmid Glycoprotein Polymorphisms.

Background: Circulating fetuin-A (FetA) inhibits insulin receptor signaling and activates the toll-like receptor 4 proinflammatory cascade; thus, it may contribute to metabolic syndrome. Polymorphisms in alpha-2-Heremans-Schmid glycoprotein (AHSG), the gene which codes FetA, may influence metabolic syndrome progression in higher-risk ethnic groups. We aimed to identify whether individual variation in AHSG influences biomarkers of metabolic disease and obesity in young Mexican adults.

From infancy to aging: Biological and behavioral modifiers of Fetuin-A.

Fetuin-A is a multifunctional protein which inhibits ectopic calcification and insulin receptor phosphorylation. It may also promote insulin resistance by activation of toll-like receptor 4 pro-inflammatory cascade. Increased levels of Fetuin-A have been associated with obesity and related comorbidities such as type 2 diabetes and cardiovascular disease, therefore, it has been suggested as a potential therapeutic target for intervention.