Preoperative vs Intraoperative Initiation of Parenteral Nutrition is Associated with Increased Postoperative Synthesis of Albumin but not Fibrinogen in Patients Undergoing Colorectal Surgery and Receiving Epidural Analgesia
Bibliographic record
Abstract
Hypocaloric parenteral nutrition (PN) promotes an anabolic response at the whole body level after major abdominal surgery if effective pain relief is provided by epidural analgesia. Hypothesis. Avoiding preoperative fasting by initiating PN before surgery promotes whole body anabolism and synthesis of plasma proteins in patients receiving epidural analgesia. Methods. Twelve metabolically healthy patients (ASA class I and II) undergoing resection for colorectal carcinoma were randomized to receive PN (glucose 2.5 g/kg.d, amino acids 1.0 g/kg.d) starting 24h before surgery (PreOp) or at skin incision (IntraOp). Whole body leucine balance was determined by [1‐ 13 C]leucine infusions 24h before and 48h after surgery. Fractional (FSR %/d) and absolute (ASR umol/kg.d) synthesis of albumin, fibrinogen, and the total plasma protein pool (TPP) were determined 48h post surgery by [ring‐ 2 H 5 ]phenylalanine tracer. Results. The postoperative increase in leucine balance was greater with PreOp than Intra‐Op PN initiation (17.4 ±2 vs. 4.1±2 umol/kg.h, p<0.001). image Conclusion . Avoiding preoperative fasting, by initiating hypocaloric PN before surgery in the presence of optimal postoperative pain relief by epidural analgesia improves whole body protein balance and albumin synthesis after colorectal surgery. (Supported by CIHR)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".