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Background: Protein-calorie malnutrition is common in chronic hemodialysis patients and correlates with morbidity and mortality. There are limited trials evaluating the efficacy of oral nutritional supplementation in malnourished CHD patients. Aim of the Work: To evaluate the effect of 6-month-long intra-dialytic amino acids (AA) supplementation on selected nutritional variables in malnourished hemodialysis (HD) patients. Patients and Methods: This was prospective, intervention-controlled study, was conducted in haemodialysis unit Ahmed Maher Teaching Hospital, and other authorized hospitals nephrology clinics on 60 patients divided into 2 groups: (Group A); received oral formula, (Group B); the control group on their normal diet. Results: There were high statistically difference between the studied groups on nutritional markers. Conclusion: Malnutrition is common in incident and prevalent HD patients however enteral protein supplements can also help on increasing nutritional markers. [ABSTRACT FROM AUTHOR]

Objective: Tourette syndrome (TS) is a group of childhood-onset chronic neuropsychiatric disorders characterized by tics, i.e., repetitive, sudden, and involuntary movements or vocalizations, which is often associated with various psychopathological and/or behavioral comorbidities, including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, depression, and sleep disorders and have a worse prognosis. The mechanism of TS is still not clear. The relationship between immune activation, neuroinflammation, and neuropsychiatric disorders has attracted much attention in the past two decades. To explore the underlying mechanism in TS, the relationship between neuroinflammation and behavioral alterations in TS rats was investigated in this study. Methods: A total of 36 Sprague-Dawley male rats were divided into three groups randomly as follows: the TS, control (CON), and drug intervention groups. The TS rat group was treated with haloperidol (Hal) (the TS + Hal group). The TS rat model was established using 3,3-iminodipropionitrile (IDPN), which is a well-known animal model of TS. The behavioral syndromes, brain tissue cytokines, like interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α), and microglial activation of the three groups were assessed. Results: The behavioral scores of rats in the TS group and the TS + Hal group were higher than those in the CON group (P < 0.05), but the scores of behavioral tests in the TS + Hal group were lower than those in the TS group (P < 0.05). The levels of IL-6 and TNF-α in the rat brain tissue were significantly higher in the TS group than in the CON group (P < 0.05), while no significant differences were found between the CON group and the TS + Hal group (P > 0.05). The microglia was significantly activated in the TS group and slightly activated in the TS + Hal group, which was considerably less than that in the TS group. Conclusion: The IDPN-induced TS rats had significant neuroinflammation in the brain, and the interaction between dopamine (DA) dysregulation and immune dysfunction may play a vital role in the pathogenic mechanisms of TS. [ABSTRACT FROM AUTHOR]

ObjectiveTourette syndrome (TS) is a group of childhood-onset chronic neuropsychiatric disorders characterized by tics, i.e., repetitive, sudden, and involuntary movements or vocalizations, which is often associated with various psychopathological and/or behavioral comorbidities, including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, depression, and sleep disorders and have a worse prognosis. The mechanism of TS is still not clear. The relationship between immune activation, neuroinflammation, and neuropsychiatric disorders has attracted much attention in the past two decades. To explore the underlying mechanism in TS, the relationship between neuroinflammation and behavioral alterations in TS rats was investigated in this study.MethodsA total of 36 Sprague-Dawley male rats were divided into three groups randomly as follows: the TS, control (CON), and drug intervention groups. The TS rat group was treated with haloperidol (Hal) (the TS + Hal group). The TS rat model was established using 3,3-iminodipropionitrile (IDPN), which is a well-known animal model of TS. The behavioral syndromes, brain tissue cytokines, like interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α), and microglial activation of the three groups were assessed.ResultsThe behavioral scores of rats in the TS group and the TS + Hal group were higher than those in the CON group (P < 0.05), but the scores of behavioral tests in the TS + Hal group were lower than those in the TS group (P < 0.05). The levels of IL-6 and TNF-α in the rat brain tissue were significantly higher in the TS group than in the CON group (P < 0.05), while no significant differences were found between the CON group and the TS + Hal group (P > 0.05). The microglia was significantly activated in the TS group and slightly activated in the TS + Hal group, which was considerably less than that in the TS group.ConclusionThe IDPN-induced TS rats had significant neuroinflammation in the brain, and the interaction between dopamine (DA) dysregulation and immune dysfunction may play a vital role in the pathogenic mechanisms of TS.

Hemodialysis (HD) and pressure injuries (PI) are both hypercatabolic states that may contribute to protein-energy wasting development. These conditions require increased energy and protein to prevent losses from HD and support wound healing. Nutrition support therapy using intradialytic parenteral nutrition (IDPN) with or without a combination of oral nutrition supplements has yielded positive outcomes among patients receiving HD with protein-energy wasting. However, IDPN is not a standard of care for patients with PI and receiving HD. No existing guidelines support its use with these combined complex medical conditions. We present a case of an older adult with PI receiving HD who required supplemental IDPN. This case demonstrated that IDPN helps wound healing, reduces the hospital length of stay, and enhances quality of life., (Copyright © 2023 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Abstract Background Cervical vestibular evoked myogenic potential (cVEMP) testing is a strong tool that enables objective determination of balance functions in humans. However, it remains unknown whether cVEMP correctly expresses vestibular disorder in mice. Objective In this study, correlations of cVEMP with scores for balance-related behavior tests including rotarod, beam, and air-righting reflex tests were determined in ICR mice with vestibular disorder induced by 3,3′-iminodipropiontrile (IDPN) as a mouse model of vestibular disorder. Methods Male ICR mice at 4 weeks of age were orally administered IDPN in saline (28 mmol/kg body weight) once. Rotarod, beam crossing, and air-righting reflex tests were performed before and 3–4 days after oral exposure one time to IDPN to determine balance functions. The saccule and utricles were labeled with fluorescein phalloidin. cVEMP measurements were performed for mice in the control and IDPN groups. Finally, the correlations between the scores of behavior tests and the amplitude or latency of cVEMP were determined with Spearman’s rank correlation coefficient. Two-tailed Student’s t test and Welch’s t test were used to determine a significant difference between the two groups. A difference with p

There may be immunologic alternations during Tourette syndrome (TS) development. This study aimed to determine the immune function changes in different aspects (spleen or thymus index, plasma cytokines, and T cell) in an 3,3′‐iminodipropionitrile (IDPN)‐induced rat model of TS. Male Sprague‐Dawley rats were assigned to control and TS groups. The control group received intraperitoneal infections of normal saline (5 ml kg−1 day−1), and the TS rats were injected with IDPN (150 mg kg−1 day−1). The spleen and thymus indices were calculated. The expression of anti‐inflammatory cytokines and inflammatory cytokines TNF‐α, in peripheral blood were measured by ELISA and Western blotting. The proportion of CD3+, CD4+, CD8+, Treg, Th1, and Th2 cells were determined by fluorescence‐activated cell sorting analysis. After 1 week of IDPN treatment, TS rats had decreased spleen and thymus weights versus control. The plasma levels of IL‐4, IL‐10, IL‐12, IFN‐γ, and TNF‐α were significantly increased, while no significant difference in TGF‐β was found. Flow cytometry analysis demonstrated that TS rats had significantly reduced CD3+ and CD4+ cells in spleen, without any change in the proportion of CD8+ cells. Furthermore, the ratio of Treg cells (CD4+/CD25+/FoxP3+) was decreased in TS rats; simultaneously, Th1 cells (CD4+/IFN‐γ+) and Th2 cells (CD4+/IL4+) were dramatically increased. Together, IDPN can trigger immune dysfunction through impairment of matured Th cells, in particular for the Treg subset. [ABSTRACT FROM AUTHOR]

Intradialytic parenteral nutrition (IDPN) remains a controversial nutrition support practice in hemodialysis. Multiple reviews and evidence-based clinical practice guidelines have been published in the past 20 years. Despite essentially looking at the same evidence, conclusions and recommendations vary significantly, leading to widespread uncertainty among clinicians on the value of and indications for IDPN. This paper aims to bring a clinical perspective to the current state of evidence and clinical practice, recognizing the strengths and weaknesses of current evidence and the clinical questions that remain unanswered, as well as providing guidance for using IDPN in clinical practice. IDPN should be considered a strategy to complement spontaneous oral intake in clinically stable patients receiving maintenance hemodialysis or who have or are at risk of malnutrition and who have substantial but not adequate protein and/or energy intake. There is a clear need for robust randomized controlled trials evaluating the impact of IDPN in appropriately selected patients. Additionally, future trials should include patient-centered outcome measures such as appetite, spontaneous oral intake, quality of life, and reliable measures of nutritional status., (Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.)

This study examines absolute hair cell numbers in the cristae of C57BL/6J mice and CBA/CaJ mice from weaning to adulthood as well as the dose required for 3,3'-iminodiproprionitrile (IDPN)-injury of the cristae in C57BL/6J mice and CBA/CaJ mice, the two mouse strains most commonly used by inner ear researchers. In cristae of CBA/CaJ and C57BL/6J mice, no loss of hair cells was observed up to 24 weeks. In both strains, dose-dependent loss of hair cells was observed 7 days after IDPN treatment of 2-month-old mice (IC50 = 16.1 mmol/kg in C57BL/6J mice vs. 25.21 mmol/kg in CBA/CaJ mice). Four-month-old C57BL/6J mice exposed to IDPN developed dose-dependent vestibular dysfunction as indicated by increased activity and circling behavior in open field tests and by failure to swim 7 days after treatment. IDPN-hair cell injury in C57BL/6J mice and CBA/CaJ mice represents a fast and predictable experimental model for the study of vestibular degeneration and a platform for the testing of vestibular therapies. [ABSTRACT FROM AUTHOR]

The nitrile 3,3--iminodipropionitrile (IDPN) causes a loss of hair cells in the vestibular epithelium of the inner ear in several species of both mammals and nonmammals. It is of interest as a model compound in ototoxicity and vestibular regeneration research, but its effects on the mouse, including the potential relevance of strain and sex differences for susceptibility, have not yet been thoroughly characterized. In this study, we compared the vestibular toxicity of IDPN in dose-response studies (0, 8, 12, 16, and 24 mmol/kg IDPN p.o.) in males and females of 2 different mouse strains (RjOrl:Swiss/CD-1 and 129S1/SvImJ). 3,3--Iminodipropionitrile caused a dose-dependent loss of vestibular function in all sex and strain groups, as assessed by a specific battery of behavioral tests. However, large differences in systemic toxicity were recorded, with high systemic toxicity in 129S1 mice of both sexes compared to limited effects on the Swiss mice. Both male and female Swiss mice showed a marked increase of hindlimb stride width after exposure. The Swiss, but not the 129S1, mice treated with IDPN showed hyperactivity in the open field. The dose-response relationships in the behavioral effects were matched by the extent of hair cell loss assessed by scanning electron microscopy. Altogether, the data demonstrated prominent strain-dependent differences in the systemic toxicity of IDPN between 129S1 and Swiss mice, in contrast to no differences between the strains and small differences between the sexes in its vestibular toxicity. These results support the use of Swiss mice exposed to IDPN as a mouse lesion model for research in vestibular therapy and regeneration. [ABSTRACT FROM AUTHOR]

Summary Background & aims Protein-energy wasting (PEW) is increasingly becoming a clinical problem in maintenance hemodialysis patients and guidelines call for nutritional interventions. Serum prealbumin (transthyretin) represents a critical nutritional marker positively correlated with patient survival and negatively correlated with morbidity. Nutritional counseling, oral supplementation as well as intradialytic parenteral nutrition (IDPN) are recommended to fight PEW, however clinical trials on their use are scarce. Methods We conducted a prospective, multicenter, randomized, open-label, controlled, parallel-group Phase IV clinical trial in 107 maintenance hemodialysis patients suffering from PEW to assess the impact of IDPN on prealbumin and other biochemical and clinical parameters reflecting nutritional status. Patients randomized to the intervention group received standardized nutritional counseling plus IDPN three times weekly over 16 weeks followed by a treatment-free period of 12 weeks. The control group received standardized nutritional counseling only. Main trial inclusion criteria included moderate to severe malnutrition (SGA score B or C), maintenance hemodialysis therapy (3 times per week) for more than six months, and presence of two out of the following three criteria: albumin <35 g/L, prealbumin <250 mg/L, phase angle alpha <4.5° assessed by bioelectrical impedance analysis (BIA). Changes in serum prealbumin, albumin, transferrin, phase angle alpha, subjective global assessment (SGA) score and health-related quality of life using the 12-item short form health survey (SF-12) were investigated. Results IDPN significantly increased prealbumin (p < 0.05), showing rapid rise within 16 weeks of treatment and sustained response thereafter. In the full analysis set (n = 83), 41.0% of 39 patients receiving IDPN achieved a relevant (i.e., at least ≥15%) increase in prealbumin over baseline at week 4 compared to 20.5% of 44 patients in the control group. Considerably more patients with IDPN therapy achieved an increment of prealbumin >30 mg/L at week 16 (48.7% vs. 31.8%). Prealbumin response to IDPN therapy was more prominent in patients suffering from moderate malnutrition (SGA score B) compared to patients with severe malnutrition (SGA score C). Conclusions The results of this trial demonstrate for the first time that IDPN therapy, given three times weekly in a 16-week short-term intervention, results in a statistically significant and clinically relevant increase in mean serum prealbumin, a surrogate marker for outcome and survival in hemodialysis patients suffering from PEW, and is superior to nutritional counseling. Clinical trial registry: www.clinicaltrials.gov (NCT00501956). [ABSTRACT FROM AUTHOR]

Many long-term maintenance hemodialysis patients have symptoms of protein-energy wasting caused by malnutrition. Each session of hemodialysis removes about 10 to 12 g of amino acids and 200 to 480 kcal of energy. Patients receiving hemodialysis for chronic kidney disease may be undernourished for energy, protein consumption, or both. Non-diabetic hemodialysis patients were randomized to three treatment groups: oral supplementation, oral supplementation plus high-concentration glucose solution (250 mL containing 50% glucose) and these two interventions plus 8.5% amino acids solution. The post-treatment energy status of the glucose group was significantly higher than its baseline level, whereas the control group's status was significantly lower. The glucose group had significantly higher concentrations of asparagine, glutamine, glycine, alanine, and lysine after treatment. All treatment groups had significantly increased hemoglobin levels but significantly decreased transferrin levels after treatment compared to baseline. After treatment, the amino acid group had significantly higher albumin level compared to the glucose group (p = 0.001) and significantly higher prealbumin level compared to the control group (p = 0.017). In conclusion, long-term intervention with high-concentration glucose solution at each hemodialysis session is a simple and cheap method that replenished energy stores lost during hemodialysis of non-diabetic patients. [ABSTRACT FROM AUTHOR]

Ante la alta prevalencia de la situación de malnutrición en pacientes en hemodiálisis y conociendo que ello implica un aumento de la tasa de infecciones, hospitalización y estancia lo que se traduce en un incremento de la morbimortalidad global, la Sociedad Española de Nefrología (SEN) y la Sociedad Española de Nutrición Parenteral y Enteral (SENPE) realizan un consenso sobre las indicaciones, contraindicaciones y límites de la Nutrición Parenteral Intra Diálisis (NPID). En este consenso se considera a la NPID como una alternativa válida a otros tipos de soporte nutricional cuando estos demuestran su ineficacia. Se sientan las bases del momento de intervención nutricional con NPID, su composición ideal, el tiempo de administración, los controles, las pautas de seguimiento y el momento en que este soporte nutricional debe de ser discontinuado.Given the high prevalence of the hyponutrition state among haemodialysis patients and knowing that this implies an increase in the rates of infection, hospitalisation and hospital stay, which translates into an increase in global morbid-mortality, the Spanish Society of Nephrology (SEN) and the Spanish Society of Parenteral and Enteral Nutrition (SENPE) have reached a consensus on the indications, contraindications, and limitations of Intra-Dialysis Parenteral Nutrition (IDPN.) This consensus considers IDPN as a valid alternative to other types of nutritional support when these show their lack of efficacy. The bases are set regarding the timing of nutritional intervention with IDPN, its ideal composition, the time of administration, its controls, follow-up schedules, and the time at which the nutritional support has to be discontinued.

Many long-term maintenance hemodialysis patients have symptoms of protein-energy wasting caused by malnutrition. Each session of hemodialysis removes about 10 to 12 g of amino acids and 200 to 480 kcal of energy. Patients receiving hemodialysis for chronic kidney disease may be undernourished for energy, protein consumption, or both. Non-diabetic hemodialysis patients were randomized to three treatment groups: oral supplementation, oral supplementation plus high-concentration glucose solution (250 mL containing 50% glucose) and these two interventions plus 8.5% amino acids solution. The post-treatment energy status of the glucose group was significantly higher than its baseline level, whereas the control group’s status was significantly lower. The glucose group had significantly higher concentrations of asparagine, glutamine, glycine, alanine, and lysine after treatment. All treatment groups had significantly increased hemoglobin levels but significantly decreased transferrin levels after treatment compared to baseline. After treatment, the amino acid group had significantly higher albumin level compared to the glucose group (p = 0.001) and significantly higher prealbumin level compared to the control group (p = 0.017). In conclusion, long-term intervention with high-concentration glucose solution at each hemodialysis session is a simple and cheap method that replenished energy stores lost during hemodialysis of non-diabetic patients.

Abstract: Developmental neurotoxicity (DNT) testing assesses potentially adverse effects on the developing nervous system. The present DNT study was conducted to generate historical data with the Wistar Han (WH) and Sprague Dawley (SD) rat strains, commonly used in Europe and the US, respectively. Potential differences between these strains in DNT endpoints have not been extensively investigated. Motor activity, startle response, learning and memory testing, and neurological (quantitative and qualitative) examinations were conducted using three groups of control, prenatally exposed (to Methylazoxymethanol [MAM] on gestation Day 15) and acutely treated (with IDPN, MK-801 or Chlorpromazine) animals for each strain. The positive controls produced clear effects in most endpoints investigated, with limited functional differences in baseline behavior and positive control sensitivity. However, SD rats were considerably more susceptible to MAM-induced learning and memory impairments and neurological damage. These data highlight differential sensitivity between the strains, which may require risk assessment consideration for developmental neurotoxicants. [Copyright &y& Elsevier]

Summary: Among patients with renal failure, those with ARF and critical illness represent by far the largest group undergoing artificial nutrition. ARF, especially in the ICU, seldom occurs as isolated organ failure but rather is a component of a much more complex metabolic environment, in the setting of the multiple organ failure. Nutritional programs for ARF patients must consider not only the metabolic derangements peculiar to renal failure and with the underlying disease process/associated complications, but also the relevant derangements in nutrient balance due to renal replacement therapies, especially when highly efficient renal replacement therapies (RRT) are used, such as continuous veno-venous hemofiltration (CVVH), or prolonged intermittent modalities such as sustained low-efficiency dialysis (SLED). Finally it is to be taken into account that nutrient requirements can change considerably during the course of illness itself (see also guidelines on PN in intensive care). From a metabolic point of view, patients with CKD or on chronic HD who develop a superimposed acute illness should be considered to be similar to patients with ARF. The same principles in respect of PN should therefore be applied. [Copyright &y& Elsevier]

Children with end-stage renal disease (ESRD) have rates of mortality estimated to be 30-times higher than expected for age compared with those of healthy children. Physical manifestations of under-nutrition, such as body mass index (BMI) and low height standard deviation score (SDS), have been associated with increased risk of mortality. Traditional measures, such as height, weight and serum albumin concentration, may not be accurate indicators to assess the nutritional status of children receiving maintenance hemodialysis. Normalized protein catabolic rate (nPCR) has emerged as a better marker of nutritional status of such children. Meeting the special nutritional needs of these children often requires nutritional supplementation, by either the enteral or the parenteral route. Recently, in children receiving maintenance hemodialysis who are malnourished, intradialytic parenteral nutrition (IDPN) has been utilized as a means to provide additional protein and calories. This article is a state-of-the-art review of malnutrition in children receiving maintenance hemodialysis, with special focus on outcome, nPCR and IDPN. [ABSTRACT FROM AUTHOR]

Summary: Because of the number of factors affecting the nutritional and metabolic status in patients with advanced chronic kidney disease or who are on maintenance dialysis, the prevention and treatment of protein-energy wasting (PEW) of chronic kidney disease should involve a comprehensive combination of maneuvers to diminish protein and energy depletion, in addition to therapies that will avoid further losses. The available evidence suggests that nutritional supplementation, administered orally or parenterally, is effective in the treatment of maintenance dialysis patients with PEW in whom oral dietary intake from regular meals cannot maintain adequate nutritional status. Increased oral nutrient intake during dialysis and at home is the ideal choice for this intervention. In clinical practice, the advantages of intradialytic oral nutritional supplements include proven efficacy and compliance. Therefore, at a minimum, oral nutritional supplementation given intradialytically should be attempted in maintenance dialysis patients with PEW, accompanied by individualized dietary advice for appropriate intake at home. In ones who cannot tolerate oral feeding, other forms of nutritional supplementation including intradialytic parenteral nutritional are a reasonable strategy. Although not proven conclusively, nutritional interventions in the form of supplementation may lead to considerable improvements in mortality, hospitalization, and treatment costs. [ABSTRACT FROM AUTHOR]

β,β′-Iminodipropionitrile (IDPN) is known to produce permanent motor behavioral abnormalities in rats. This behavior syndrome is also termed as “ECC Syndrome”, the animal model for Gilles de la Tourette syndrome in humans. Some reports showed that these behavioral abnormalities are caused by monoamine changes. However, there was little research on the relation between IDPN-induced behavioral abnormalities and free radical. 3-Methyl-1-phenyl-2-pyrazolin-5-one (MCI-186), a newly synthesized free radical scavenger, exerts beneficial free radical scavenging and antioxidant characteristics. We investigated that MCI-186 inhibited the process of hydroxyl radical formation induced by IDPN administration in the rat brain. In the group of IDPN administration, hydroxyl radical levels exhibited predominant increase in most parts of the rat brain. In the group of IDPN and MCI-186 administration, hydroxyl radical levels marked significant decrease compared with those in the group of IDPN administration. Therefore, MCI-186 inhibited production of hydroxyl radical and might prove to be effective against ECC syndrome induced by IDPN. [Copyright &y& Elsevier]

The Golgi apparatus (GA) of anterior horn neurons of rats chronically intoxicated with β,β′-iminodipropionitrile (IDPN) in drinking water was examined with an organelle-specific antibody. The neuropile of the anterior horns contained the typical axonal spheroids associated with IDPN toxicity while the perikarya of approximately one-third of the neurons contained phosphorylated neurofilaments, which are not found in the perikarya of control rat neurons. By serial or double immunostaining with the SMI-31 and anti-MG 160 antibodies, there were no morphological changes of the GA in the majority of neurons including neurons with a mild to moderate degree of neurofilamentous accumulation. However, a few neurons with a massive accumulation of phosphorylated neurofilaments contained abnormal profiles of the GA which consisted of focal clustering, reduction in size and fragmentation. The results suggest that masses of phosphorylated neurofilaments are associated with struc-tural abnormalities of the GA. [ABSTRACT FROM AUTHOR]

β-β′-iminodipropionitrile (IDPN)-induced monoamine and hydroxyl radical changes in the rat brains were studied. IDPN caused decreases in 5-HT and 5-HIAA levels in all brain regions, strongly indicating that IDPN's neurotoxicity primarily affects 5-HT containing neurons. Dopamine and its metabolites' levels decreased in the some regions, most likely due to depression of dopamine metabolic turnover. Our results more clearly demonstrate IDPN-induced monoamine alterations in the rat brain more than previous reports. To clarify one of the pathogenesis of IDPN-induced neurological disorders, we measured hydroxyl radical levels. 2,3-DHBA increased at 1st day, and decreased in some regions at 7th days after discontinuing IDPN. We conclude, hydroxyl radical formation causes neuronal damage, and monoamine changes contribute to IDPN-induced neurological disorder. [ABSTRACT FROM AUTHOR]

Given the high prevalence of the hyponutrition state among haemodialysis patients and knowing that this implies an increase in the rates of infection, hospitalisation and hospital stay, which translates into an increase in global morbid-mortality, the Spanish Society of Nephrology (SEN) and the Spanish Society of Parenteral and Enteral Nutrition (SENPE) have reached a consensus on the indications, contraindications, and limitations of Intra- Dialysis Parenteral Nutrition (IDPN.) This consensus considers IDPN as a valid alternative to other types of nutritional support when these show their lack of efficacy. The bases are set regarding the timing of nutritional intervention with IDPN, its ideal composition, the time of administration, its controls, follow-up schedules, and the time at which the nutritional support has to be discontinued. [ABSTRACT FROM AUTHOR]

This study examines absolute hair cell numbers in the cristae of C57BL/6J mice and CBA/CaJ mice from weaning to adulthood as well as the dose required for 3,3'-iminodiproprionitrile (IDPN)-injury of the cristae in C57BL/6J mice and CBA/CaJ mice, the two mouse strains most commonly used by inner ear researchers. In cristae of CBA/CaJ and C57BL/6J mice, no loss of hair cells was observed up to 24 weeks. In both strains, dose-dependent loss of hair cells was observed 7 days after IDPN treatment of 2-month-old mice (IC 50  = 16.1 mmol/kg in C57BL/6J mice vs. 25.21 mmol/kg in CBA/CaJ mice). Four-month-old C57BL/6J mice exposed to IDPN developed dose-dependent vestibular dysfunction as indicated by increased activity and circling behavior in open field tests and by failure to swim 7 days after treatment. IDPN-hair cell injury in C57BL/6J mice and CBA/CaJ mice represents a fast and predictable experimental model for the study of vestibular degeneration and a platform for the testing of vestibular therapies.

Many long-term maintenance hemodialysis patients have symptoms of protein-energy wasting caused by malnutrition. Each session of hemodialysis removes about 10 to 12 g of amino acids and 200 to 480 kcal of energy. Patients receiving hemodialysis for chronic kidney disease may be undernourished for energy, protein consumption, or both. Non-diabetic hemodialysis patients were randomized to three treatment groups: oral supplementation, oral supplementation plus high-concentration glucose solution (250 mL containing 50% glucose) and these two interventions plus 8.5% amino acids solution. The post-treatment energy status of the glucose group was significantly higher than its baseline level, whereas the control group's status was significantly lower. The glucose group had significantly higher concentrations of asparagine, glutamine, glycine, alanine, and lysine after treatment. All treatment groups had significantly increased hemoglobin levels but significantly decreased transferrin levels after treatment compared to baseline. After treatment, the amino acid group had significantly higher albumin level compared to the glucose group (p = 0.001) and significantly higher prealbumin level compared to the control group (p = 0.017). In conclusion, long-term intervention with high-concentration glucose solution at each hemodialysis session is a simple and cheap method that replenished energy stores lost during hemodialysis of non-diabetic patients.