Tauroursodeoxycholic acid (TUDCA) increases the influx of primary bile acids into the gut. Results obtained on animal models suggested that Firmicutes and Proteobacteria phyla are more resistant to bile acids in rats. As part of a pilot study investigating the role of probiotics supplementation in elderly people with home enteral nutrition (HEN), a case of a 92-year-old woman with HEN is reported in the present study. She lives in a nursing home and suffers from Alzheimer\'s disease (AD); the patient had been prescribed TUDCA for lithiasis cholangitis. The aim of this case report is therefore to investigate whether long-term TUDCA administration may play a role in altering the patient\'s gut microbiota (GM) and the impact of an antibiotic therapy on the diversity of microbial species. Using next generation sequencing (NGS) analysis of the bacterial 16S ribosomal RNA (rRNA) gene a dominant shift toward Firmicutes and a remodeling in Proteobacteria abundance was observed in the woman\'s gut microbiota. Considering the patient\'s age, health status and type of diet, we would have expected to find a GM with a prevalence of Bacteroidetes phylum. This represents the first study investigating the possible TUDCA\'s effect on human GM.

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UNASSIGNED: to investigate the ability of mandibular distraction osteogenesis (MDO) to avoid gastrostomy tube (G-tube).
UNASSIGNED: PubMed, EBSCOhost, Cochrane, and Embase.
UNASSIGNED: We retrospectively reviewed the number of MDO cases performed at our institution for patients with Robin Sequence (RS) over the past 10 years. In our institutional review, patients were excluded if they had a G-tube already placed at the time of surgery. We also performed a systematic review of the literature. Articles were excluded if they did not detail feeding outcomes after MDO, or if MDO was performed on patients that did not have RS.
UNASSIGNED: In our systematic review, 12 articles were included that comprised a total of 209 neonates with RS that underwent MDO. A total of 174 (83.3%) patients avoided a G-tube once MDO was performed. A total of 14 patients met the inclusion criteria at our institution. Of the 14 RS patients, 9 (64%) avoided having a G-tube placed and all (14/14) avoided tracheostomy. The average birth weight of patients avoiding a G-tube was 3.11 kg compared to 2.25 kg (P = .045) in the group requiring a G-tube. In the group avoiding a G-tube, the average weight at time of operation was 3.46 kg compared to 2.83 kg (P = .037) in the group requiring a G-tube.
UNASSIGNED: MDO may be considered as a surgical option to prevent G-tube placement for neonates with non-syndromic RS who have difficulty with PO feeding but whose airway obstruction is not severe enough to require respiratory support. Based on our institutional experience, a minimum weight of 3.00 kg correlated with higher success rates of PO intake and avoiding a G-tube.

UNASSIGNED: Caustic injuries remain a major public health concern. Nutritional status plays a pivotal role in determining the outcome. Unfortunately, nutritional care guidelines are not widely implemented in clinical practice, and decisions are often based on prior experience and local policies.
UNASSIGNED: We present the case of an 83-year-old man who accidentally ingested alkali, resulting in severe caustic injury and subsequent complications that further deteriorated his nutritional status. The management of esophageal strictures necessitated constant adjustments to the nutritional strategies employed. The clinical evaluation revealed protein and energy malnutrition, accompanied by type 2 intestinal failure. However, with individually tailored parenteral nutritional therapy, a significant improvement in the patient\'s nutritional status was observed.
UNASSIGNED: Recognizing that caustic injuries increase metabolic demands, a comprehensive and active nutritional assessment is crucial, focusing on the need for adequate energy, high protein intake, and an appropriate feeding route. In cases of acute or prolonged type 2 intestinal failure with insufficient oral or enteral nutrition, parenteral feeding should be the primary therapy. Effective management of caustic injuries requires a multidisciplinary and multicenter approach, integrating nutritional evaluation, including body composition measurements, into the clinical algorithm. Early initiation of nutritional therapy is vital to prevent chronic intestinal failure.

OBJECTIVE: This study aimed to investigate the incidence of enteral nutrition intolerance (ENI) in patients with sepsis and explore potential risk factors.
METHODS: A case-control study was conducted in patients with sepsis who were receiving enteral nutrition (EN) at a tertiary hospital in China. The included patients were divided into the ENI group and the non-ENI group. Univariate and multivariate analyses were performed to identify the risk factors for ENI.
RESULTS: A total of 859 patients were included in the study. Among them, 288 (33.53%) patients experienced symptoms of ENI, including diarrhea, vomiting, bloating, and gastric retention. Logistic regression analysis revealed that the Acute Physiology and Chronic Health Evaluation H (APACHE H) score, thoracocentesis, and usage of cardiotonic drugs (namely, inotropes) were independent predictors of the ENI.
CONCLUSIONS: The incidence of ENI is relatively high in patients with sepsis, especially in those who have higher APACHE H scores, have undergone thoracocentesis, and have received inotropes.

BACKGROUND: Exomphalos anomaly is defined as the herniation of abdominal viscera into the base of the umbilical cord, with only a membranous sac covering these contents. It has an incidence of approximately 1 in 4000-6000 births. Management of exomphalos major (EM) remains controversial and limited, with very few studies to guide decision-making.
METHODS: This is a case series of four neonates with EM treated at a tertiary paediatric referral centre between 2018 and 2021 with a gradual compression dressing technique.
RESULTS: Four neonates were diagnosed with EM. The average gestational age was 38 + 5 (range 38 + 2 - 39 + 2), and the average birth weight was 3.1 kg (range 2.56 - 3.49 kg). The defect size ranged between 5 and 7 cm. All patients were commenced on gradual compression dressing between days 1 and 3 of life. Dressings were applied at the bedside in the general neonatal ward. The average time taken to reach full feeds was 1 week; only one patient required parenteral nutrition. Three underwent surgical repair at two and 16 weeks of age; one had delayed repair at the age of 1 year because of the COVID-19 pandemic. None required patch repair. None required prolonged ventilation after repair.
CONCLUSIONS: This case series describes a successful compression dressing technique that reduces sac content without the need for general anaesthetic or respiratory compromise, whereby simultaneous enteral feeding is tolerated.

Nutritional support in critically ill patients is an essential aspect of treatment. In particular, the benefits of enteral nutrition (EN) are well recognized, and various guidelines recommend early EN within 48 hours in critically ill patients. However, there is still controversy regarding EN in critically ill patients with septic shock requiring vasopressors. Therefore, this case report aims to provide basic data for the safe and effective nutritional support in septic shock patients who require vasopressors. A 62-year-old male patient was admitted to the intensive care unit with a deep neck infection and mediastinitis that progressed to a septic condition. Mechanical ventilation was initiated after intubation due to progression of respiratory acidosis and deterioration of mental status, and severe hypotension required the initiation of norepinephrine. Due to hemodynamic instability, the patient was kept nil per os. Subsequently, trophic feeding was initiated at the time of norepinephrine dose tapering and was gradually increased to achieve 75% of the energy requirement through EN by the 7th day of enteral feeding initiation. Although there were signs of feeding intolerance during the increasing phase of EN, adjusting the rate of EN resolved the issue. This case report demonstrates the gradual progression and adherence to EN in septic shock patient requiring vasopressors, and the progression observed was relatively consistent with existing studies and guidelines. In the future, further case reports and continuous research will be deemed necessary for safe and effective nutritional support in critically ill patients with septic shock requiring vasopressors.

We reported a case of an advanced gastric cancer patient with gastric outlet obstruction and malnutrition who successfully underwent neoadjuvant chemotherapy with enteral feeding. The patient is a 72-year-old man. The diagnosis was advanced gastric cancer with pyloric stenosis. Both decompression and enteral nutrition was performed with a W-ED®. Chemotherapy was markedly effective and nutritional status improved. He underwent robot-assisted distal gastrectomy(D2)and Billroth Ⅱ reconstruction under good nutritional status after neoadjuvant chemotherapy with intragastric decompression and nutritional management using a W-ED® tube. W-ED® tube is a useful tool for the proper nutritional management of patients with advanced gastric cancer who have pyloric stenosis by adequate decompression and enteral feeding.

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UNASSIGNED: The goal of palliative care is to preserve the quality of life or patient \"comfort\" in patients with serious diseases. Palliative care providers serve a wide range of patients: from those who seek curative treatment to those who are actively dying. Given this range, palliative care must mirror the dynamic goals of the patient at different stages of life and treatment. Throughout these stages, a goal of the palliative care provider would be to avoid hastening death; however, this often leads to clinical decisions that directly pit the patient\'s comfort against the patient\'s life span. This is most salient with clinical decisions of withdrawing treatments that prolong life even at the expense of comfort. An example of this dichotomy can be seen when providers use enteral nutrition to treat head and neck cancer patients.
UNASSIGNED: We describe a patient with stage IV pancreatic cancer with metastases to her head and neck. The patient was experiencing increased morbidity related to her percutaneous endoscopic gastrostomy (PEG) tube feeding. These complications included tube-related concerns such as infection, leakage, and diarrhea but also decreased intended benefits as she lost weight and functionality while maintaining enteral feeding. Despite the patient experiencing a common and expected disease course, she remained unsure and was fearful about considering discontinuation of her enteral feeding. However, the care team who understood the risks, benefits, and harms related to withdrawal provided a foundation of discussion and mitigated patient fears, allowing for the successful removal of her PEG tube and increased quality of life at the end of life.
UNASSIGNED: To care for a patient in their entirety is also to care for them at all stages of disease. Care is not limited to those who might be cured of disease, but should also consider those who continue to live with disease and the downstream effects of medical interventions used to support them. Discontinuing treatments whose harms outweigh the benefits to patients is a moral imperative to providers; yet, how providers approach discontinuing life-prolonging treatment is seen as morally distressing. Our patient did not see the discussion as morally distressing and continued to benefit from active discussions even at the end of her life.