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Parents of children with intestinal failure, dependent on Home Parenteral Nutrition (HPN), may experience psychosocial problems due to the illness and intensive treatment of their child. Literature concerning psychosocial problems is scarce. Therefore, we aimed to investigate Health-Related Quality of Life (HRQOL), levels of anxiety, depression, distress and everyday problems of these mothers and fathers. A multicenter study was conducted among 37 mothers and 25 fathers of 37 children on HPN (response-rate 37/49 = 76%, mean age children = 5.1 years, SD = 4.6). Parents completed three questionnaires to measure different outcomes on the KLIK website (www.hetklikt.nu): the TNO-AZL QOL Questionnaire (TAAQOL) to measure HRQOL, the Hospital Anxiety and Depression Scale (HADS) to measure anxiety and depression, and the Distress Thermometer for Parents (DT-P) to measure distress. Scores were compared to Dutch reference mothers and fathers using Mann–Whitney U-tests. No differences were found in HRQOL, measured by the TAAQOL, between HPN parents compared to the reference groups, except for the subscale 'depressive emotions' for mothers (p =.01) and 'daily activities' for fathers (p =.04). HPN mothers reported higher levels of depression compared to reference mothers (p =.001). In addition, HPN mothers and fathers reported higher levels of distress than reference mothers (p =.001) and fathers (p =.03). HPN mothers reported significantly more problems in the practical, emotional, cognitive and parenting domains, fathers in the social, emotional and parenting domains. On HRQOL, anxiety and depression, HPN parents generally did not show much differences compared to reference parents. However, when asked about parental distress and everyday problems, HPN treatment of their child seems highly stressful for some parents and influences daily functioning. Therefore, structural screening for parental psychosocial problems in clinical practice, e.g. using the DT-P, is necessary in order to improve the well-being of both these parents and their children dependent on HPN. [ABSTRACT FROM AUTHOR]

Summary: Background & aims: Central venous catheter occlusion is a frequently occurring complication during home parenteral nutrition (HPN). The aim of the study was to investigate the effectiveness of sodium hydroxide (NaOH) administration to clear an occluded central venous catheter especially in HPN. Method: Retrospective study to the use of NaOH in partially occluded central venous catheters. About 45 patients with HPN treated in the Academic Medical Center of the University of Amsterdam (AMC) were included in this study between January 1997 and April 2003. Excluded from the study were patients under the age of 18 at the start of HPN and/or patients who use parenteral nutrition for less than 3 months. Partial catheter occlusion was defined as a spontaneous flow less than 60 drops/min. Results: In total, 130 occlusions were registered in 29 HPN patients. The other 16 HPN patients did not report any occlusion. The incidence of occlusions in fat containing total parenteral nutrition (TPN) was 1 occlusion in 167 feeding days. TPN without fat showed only one occlusion (incidence 1 in 7126 feeding days). The use of a lipid emulsion proved an important risk factor for catheter occlusion in this study (, RR=43). Ninety-five central venous catheter occlusions were treated with NaOH 0.1M. The remaining occlusions were total or mechanical occlusions making NaOH treatment impossible. In 73 out of 95 partial occlusions treatment with NaOH was effective . Using NaOH extended the use of 32 catheters (range 7–1592 days, mean 328). Twenty-one out of 32 catheters could be used for more than 3 months after using NaOH . Conclusion: We conclude that perfusion of a partial occluded central venous catheter (defined as 25–60 drops/min) used for parenteral nutrition with 0.1N NaOH is safe and shows a significant long term improvement in catheter care, by preventing total occlusion and operative removal. [Copyright &y& Elsevier]

Abstract: This study examined the modulatory influence exerted by GABAB receptors on the transmission of cutaneous afferent input to cuneate nucleus neurons in anesthetized cats. Electrical stimulation at the center of a receptive field activated cuneate nucleus cells at latencies of ≤7 ms whereas stimulation at neighboring sites (receptive field edge) increased the response latency. Extracellular recording combined with microiontophoresis demonstrated that GABAB receptors are tonically active. Blockade of GABAB receptors prolonged sensory-evoked response durations and decreased times of occurrence of successive bursts whereas the agonist baclofen suppressed both these effects. Ejection of baclofen delayed the evoked response from the receptive field edge with respect to the receptive field center response and inhibited responses from the receptive field edge more effectively than responses from the receptive field center. From these results it is concluded that activation of GABAB receptors precludes cuneate cells from reaching firing threshold when afferent inputs are weak, spatially modulate cuneate nucleus excitability, play a major role in temporal pattern of discharges, and shape cutaneous receptive fields. [Copyright &y& Elsevier]

Stunted children with cystic fibrosis (CF) have less net protein anabolism than do children without CF, and the result is retarded growth in the CF patients. It is not known whether protein intake above that recommended by the Cystic Fibrosis Foundation would further stimulate whole-body protein synthesis. Objective: We studied the effects of 3 amounts of protein intake on whole-body protein synthesis and breakdown by using isotopic infusion of [1-13C]valine and [15N2]urea in children with stable CF who required tube feeding. Design: In 8 pediatric CF patients, we administered 3 randomly allocated isocaloric diets with normal (NP), intermediate (IP), and high (HP) amounts of protein (1.5, 3, and 5 g · kg-1 · d-1, respectively) by continuous drip feeding during a 4-d period at 6-wk intervals. Each patient acted as his or her own control. On the fourth day of feeding, whole-body protein synthesis and breakdown were measured. Results: Protein synthesis was significantly higher in the HP group (x ± SEM: 1.78 ± 0.07 μmol · kg-1 · min-1) than in the IP (1.57 ± 0.08 μmol · kg -1 · min-1; P < 0.001) and NP (1.37 ± 0.07 ±mol ± kg-1 · min -1; P< 0.001) groups. There were no significant differences in protein breakdown. Net retention of nitrogen was significantly higher in the HP group (12.93 ± 1.42 μmol · kg-1 · min-1) than in the IP (7.61 < 1.40 μmol · kg-1 min-1; P=0.01) and HP (2.48 - 0.20 μmol · kg-1 · min-1; P = 0.001) groups. Conclusion: In stunted children with CF requiring tube feeding, the highest stimulation of whole-body protein synthesis was achieved with a short-term dietary protein intake of 5 g · kg-1 · d-1. [ABSTRACT FROM AUTHOR]