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Objectives: Obese Zucker rats display neurochemical modifications in the brain characteristic of dehydration, but are nevertheless hyperphagic. This suggests that the obese animals can be resistant to dehydration-induced anorexia. The aim of this study was to test the hypothesis by comparing the effects of dehydration on food intake and feeding pattern between obese and lean Zucker rats., Methods: Intracellular dehydration in obese (fa/fa) and lean (Fa/Fa) Zucker rats was induced by replacing drinking water with hyperosmotic sodium chloride solutions (1.8% and 2.7%, consecutively, 4 d each). Daily food intake, meal size, and meal number were measured using an automated computerized rat eater meter before, during, and after the dehydration., Results: After 8 d of hyperosmotic challenge, body weight decreased by 15% and 10% in lean and obese rats, respectively. Obese rats displayed higher food intake and meal size than lean rats before, during, and after the dehydration. Drinking 1.8% and 2.7% sodium chloride solutes decreased gradually food intake and meal size in both lean and obese rats; however, obese rats had a higher percentage of food intake than lean rats during the osmotic challenge. Higher ratios of food to water intake characterized obese rats and the percentage of such ratios in obese versus lean rats were increased during the 2.7% sodium chloride load. Meal number was not affected by dehydration in obese rats, but it was decreased in lean rats during the 2.7% sodium chloride load and remained low during refeeding after the dehydration, when the meal size was increased., Conclusion: Dehydration-induced anorexia is present in both obese and lean Zucker rats; however, obese rats are more resistant to dehydration by preserving their meal size and food intake. These results support a role for feeding-associated dehydration in the pathogenesis of hyperphagia and obesity., (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)

A complex role of the immune system has been highlighted in the development and progression of hepatocellular carcinoma (HCC). Natural Killer cells (NK) and natural killer T cells (NKT) cells are among the innate immune lymphocytes that predominate in the liver and can prevent tumor growth and metastasis. The aim of the study was to measure the percentages of NK and NKT cells among a sample of Egyptian patients with HCC and to find the association between their frequencies and disease progression. The study included 2 groups; the HCC patient group (n=40) and the healthy control group (n=20). Blood samples were drawn from all subjects for complete blood picture, liver enzymes and alpha fetoprotein serum level measurement. Flow cytometric analysis was performed for CD3 and CD16/56 for determining the percentages of NK and NKT cells. The frequencies of NK cells and NKT cells were significantly decreased in HCC patients (6.58± 1.76 and 5.26 ± 1.13 respectively) as compared to healthy controls (9.01±1.62 and 6.88 ± 1.88 respectively) (P < 0.001 and 0.0008 respectively) and in HCC patients with metastasis (6.01± 1.11 and 5.07± 1.10 respectively) than HCC patients without metastasis (7.75± 1.98 and 5.89± 0.88 respectively) (P= 0.004 and 0.03 respectively). We concluded that the reduced percentages of NK cells and NKT cells in HCC patients especially in those with metastasis point to their important roles in the occurrence and progression of HCC., (Copyright© by the Egyptian Association of Immunologists.)

Background: We tested the hypothesis that nebulized budesonide would improve lung mechanics and oxygenation in patients with early acute lung injury (ALI) and/or acute respiratory distress syndrome (ARDS) during protective mechanical ventilation strategy without adversely affecting systemic hemodynamics., Methods: Patients with ALI/ARDS were included and assigned into two groups; budesonide group (30 cases) in whom 1 mg-2 ml budesonide suspension was nebulized through the endotracheal tube and control group (30 cases) in whom 2 ml saline (placebo) were nebulized instead of budesonide. This regimen was repeated every 12 h for three successive days alongside with constant ventilator settings in both groups. Hemodynamics, airway pressures, and PaO 2 /FiO 2 were measured throughout the study period (72 h) with either nebulized budesonide or saline. Furthermore, tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6) were analyzed serologically as markers of inflammation at pre- and post-nebulization sessions., Results: We found a significant difference between the two groups regarding PaO 2 /FiO 2 ( P = 0.023), peak ( P = 0.021), and plateau ( P = 0.032) airway pressures. Furthermore, TNF-α, IL-1β, and IL-6 were significantly reduced after budesonide nebulizations. No significant difference was found between the two groups regarding hemodynamic variables., Conclusion: Nebulized budesonide improved oxygenation, peak, and plateau airway pressures and significantly reduced inflammatory markers (TNF-α, IL-1β and IL-6) without affecting hemodynamics., Trial Registry: Australian New Zealand Clinical Trial Registry (ANZCTR) at the number: ACTRN12615000373572., Competing Interests: There are no conflicts of interest.

There are no indications to prescribed special diets for postoperative patients. Low-sodium and low-fat or low-cholesterol diets are examples of restricted diets, especially in patients with heart disease and atherosclerosis. These restricted diets are unpalatable. Postoperative nausea, paralytic ileus, and vomiting caused by residual anesthetic effects and opioids used for pain control further contribute to the problem. Long-term adherence to these diets is necessary to derive benefits. Prescribing regular and palatable diets in the immediate postoperative period to meet protein and energy goals is important for wound healing and is commensurate with best clinical practices. In the following, we review the pertinent literature and offer clinical evidence that routine special diet orders for postoperative patients are not necessary., (Published by Elsevier Inc.)

We provide a practical approach to the complex management problem of chyle leaks that occur after surgical procedures or trauma, or when they occur spontaneously in association with malignancies. The volume of chyle loss causes significant problems due to loss of fluid, electrolytes, proteins, and lymphocytes, causing deleterious effects on wound healing and immunity. Enteral feeding is not always possible as long chain fatty acids are absorbed through the intestinal lacteals, the original source of chyle. Regular diets increase the leak and delay healing. Nutritional support involves coordinated care between healthcare providers to provide a combination of various modalities, including nil by mouth, parenteral nutrition, enteral feeding with formula modifications, and oral diet., (Published by Elsevier Inc.)

Objectives: Obesity is a significant quality of life-impairing health problem affecting industrialized nations. However, despite carrying a large fat mass, some very obese individuals exhibit normal metabolic profiles (metabolically healthy obesity). The physiological factors underlying their protective and favorable metabolic profiles remain poorly defined., Methods: A search of the National Library of Medicine PubMed database was performed using the following keywords: Metabolically healthy obese, metabolically normal obese, insulin resistance, metabolically unhealthy normal weight, and uncomplicated obesity., Results: This article reviewed factors associated with severe obesity that lacks complications, and suggests putative activities by which these obese individuals avoid developing the clinical features of metabolic syndrome, or the metabolic complications associated with severe obesity., Conclusions: Despite the knowledge that visceral fat deposition is the seminal factor that ultimately causes insulin resistance (IR) and the detrimental inflammatory and hormonal profile that contributes to increase risk for cardiovascular disease, it remains unknown whether metabolically healthy obesity (MHO) has genetic predisposing factors, and whether MHO ultimately succumbs to IR and the metabolic syndrome, indicating a need for prophylatic bariatric surgery., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Parenteral nutrition (PN) that includes lipid emulsion is considered to increase both bacterial and fungal central venous catheter-related bloodstream infections. This concept is based on several erroneous metrics: Reports in age-old literature at a time when preparing PN admixtures lacked stringent quality control, when its infusion, the techniques of insertion, maintenance of vascular access devices, and delivery systems were not well identified or enforced. Additionally, concepts of glucohomeostasis were different and higher glucose levels were accepted. We provide updated information with supporting literature to show that associating PN with lipids with an increase in bloodstream infections is not justified., (Published by Elsevier Inc.)