ObjectiveTo investigate the status of undernutrition, nutritional risk as well as nutritional support in patients with gastrointestinal tumor. MethodsIn this prospective cohort study, patients with gastrointestinal tumor were recruited from Septemper 2009 to June 2011. Patients were screened by using Nutritional Risk Screening 2002 (NRS2002) at admission. Data of the nutritional risk, application of nutritional support, complications, and tumor staging were collected. ResultsNine hundred and sixty-one patients with gastrointestinal tumor were recruited, the overall prevalence of nutritional risk was 38.9% (374/961) at admission, 49.2% （176/358） in gastric tumor and 32.8% （198/603） in colorectal tumor, respectively. The highest prevalence was found in stage Ⅳ gastric tumor 〔87.3% (48/55)〕 and colorectal tumor 〔58.8% (50/85)〕 while the lowest prevalence was found in stage ⅡA gastric tumor 〔16.1% (5/31)〕 and stageⅠcolorectal tumor 〔9.8% (6/61)〕. 62.3% (152/244) of gastric tumor patients with nutritional risk while 48.6% (144/296) without nutritional risk received nutritional support. 37.7% (92/244) of colorectal tumor patients with nutritional risk while 51.4% (152/296) without nutritional risk received nutritional support. The ratio of parental nutrition and enteral nutrition was 1.251. The rate of complications in the gastrointestinal tumor patients with nutritional risk was higher than that in the patients without nutritional risk 〔32.4% (121/374) versus 20.4% (120/587), P=0.000 0〕. For the gastrointestinal tumor patients with nutritional risk, the complication rate of the patients with nutritional support was significantly lower than that of the patients without nutritional support 〔27.5% (67/244) versus 40.8% (53/130), P=0.008 6〕. For the gas trointestinal tumor patients without nutritional risk, the complication rate of gastric tumor patients with nutritional support was significantly lower than that of the patients without nutritional support (P=0.039 6), while the complication rate was not significantly different in the colorectal tumor patients with nutritional support or not (P=0.464 7). ConclusionsPatient with gastrointestinal tumor has a high nutritional risk which is related to tumor staging. Patients with nutritional risk have more complications, and nutritional support is beneficial to the patients with nutritional risk by a lower complication rate.
Objective To research the effect of ω-3 polyunsaturated fatty acid (PUFA) on inflammatory response and nutritional condition after operation for patients with gastrointestinal malignancies. Methods Forty patients with gastrointestinal malignancies were included in this study from February 1st, 2009 to June 1st, 2009. Forty cases were randomly allocated to experimental group (20 cases) and control group (20 cases). Parenteral nutrition was conducted in continuous 7 days after operation. Comparing with control group, a dose of 10 g of ω-3 PUFA was given to experimental group every day in 7 days after operation in addition. Blood samples were gained before operation, the 2nd and 8th day after operation respectively to measure relative indexes about inflammatory response (WBC, neutrophilic granulocyte and C-reaction protein) and nutrition (total protein, albumin, prealbumin, siderophilin and lymphocyte). Reduction of body mass was also recorded. Results The baseline between experimental group and control group was comparable (Pgt;0.05). The levels of indexes about inflammatory response (WBC, neutrophilic granulocytem and C-reaction protein) and nutrition (total protein, albumin, prealbumin, siderophilin and lymphocyte) between experimental and control group did not reach statistically significant difference in the 2nd day after operation (Pgt;0.05). The levels of neutrophilic granulocyte and C-reaction protein in experimental group were lower than those of control group, and the level of lymphocyte in experimental group was higher than that of control group in the 8th day after operation, and all of them reached statistical significance (Plt;0.05). There was no statistical different in reduction of body mass between experimentalgroupandcontrolgroup.Conclusion ω-3 PUFA can depress the excessively inflammatory reaction and improve the nutritional condition of patients with gastrointestinal malignancies after operation.
Objective To investigate the effect of short-term administration of growth hormone (GH) on serum insulin-like growth factor-1 (IGF-1) level and nutritional status in patients after gastrointestinal operation, and evaluate whether postoperative application of GH rise the risk of tumor recurrence. Methods Forty-eight patients undergoing major gastrointestinal operation were randomly divided into two groups: GH group （n=24） and control group （n=24）. The two groups received isocaloric isonitrogenous nutrition with daily injection of either GH 0.15 U/kg or placebo for a period of day 3-9 postoperatively. Serum albumin, fibronectin, and IGF-1 were measured before operation as a baseline, and day 3 and 10 after operation using standard laboratory techniques. Nitrogen balance was measured daily from day 3 to day 9 after operation. Postoperative complications and adverse reaction were observed. All cancer patients received regular abdominal B-type ultrasonography and chest X-ray examination during 2 years of follow-up. Results Compared with control group, GH treatment did not influence serum IGF-1 and serum albumin level （Pgt;0.05）, but improved significantly the rise from day 3 to day 10 of serum fibronectin level 〔(22.8±5.8) mg/L vs.（9.6±3.6） mg/L， P＜0.05〕 and the cumulative nitrogen balance 〔（11.37±16.82） g vs.（－9.11±17.52） g， P＜0.01〕 postoperatively. There was no severe adverse effects and complications during GH treatment. The tumor-recurrence rates were not statistically different between two groups during follow-up. Conclusions Short-term administration of low-dose GH combined with early nutrition support can improve total nitrogen retention and protein metabolism, but not influence serum IGF-1 level after major abdominal surgery. Short-term administration of low-dose GH may not cause the tumor-recurrence.
Objective To investigate the role of rehabilitation therapy both on nutritional status and intestinal adaptation of patients with short bowel syndrome (SBS). Methods The literatures about rehabilitation therapy for SBS were reviewed. Results Intestinal rehabilitation refers to the process of restoring enteral autonomy, in order to get rid of parenteral nutrition, usually by means of dietary, medical, and surgical treatment. Recent researches showed that medication and the use of specific nutrients and growth factors could stimulate intestinal absorption and might be useful in the medical management of SBS. Conclusion Intestinal rehabilitation is of benefit in the treatment of SBS and would play a greater role in the future.
This study was disigned to determine the effect of nutritional status on the energy metabolism of liver. Rat liver of four nutritional groups (Group Ⅰ： fasting; Group Ⅱ: surgar feeding diet; Group Ⅲ: normal feeding diet; Group Ⅳ: group Ⅰ and group Ⅱ accepted patenteral nutrition) were removed for study. The adenosine triphosphate (ATP) level, total addenosine nucleotides (TAN) level, and adenylaty energy charge (EC) of liver decreased in group Ⅰ and group Ⅱ in contrasted with group Ⅲ (Plt;0.001), result of group Ⅳ was similar to that of group Ⅲ when the liver specimens were collected. The rusults indicate that a short period of starvation and low sugar intake will result in the malnutrition of liver and derangement of hapatic energy metabolism and material metabolism. But this status can be corrected by a short perios of parenteral nutrition.
Objective To study the influencing factors for duration of mechanical ventilation in chronic obstructive pulmonary disease ( COPD) patients with type II respiratory failure. Methods Twenty-eight cases of mechanical ventilated COPD patients with type II respiratory failure were enrolled from March 2006 to March 2008 in Beijing Shunyi Hospital. They were divided into two groups based on their duration of ventilation: ≤7 d group as group I, and gt; 7 d as group II. Data of heart rate and blood pressure were recorded before the trachea intubation. Clinical data of blood routine, blood gas analysis and serum biochemistry were collected and analyzed. Previous history, smoking history and subsequent complications were also recorded. Results Heart rate in the group II were significantly higher than which in the group I[ ( 121. 50 ±17. 20) /min vs ( 103. 08 ±19. 97) /min, P lt;0. 05] . The incidences of upper gastrointestinal hemorrhage and blood pressure fall immediately after intubation were 63% and 88% respectively in the group II, which were significantly higher than the group I ( 0 and 25% ) . The levels of albumin, pre-albumin, Na+ , PaO2 were ( 29. 06 ±5. 00) g /L, ( 66. 36 ±17. 72) mg/L,( 138. 45 ±4. 74) mmol /L and ( 49. 06 ±20. 11) mm Hg respectively in the group II. While in the group I, those were ( 37. 11 ±2. 73) g /L, ( 127. 70 ±35. 84) mg/L, ( 143. 29 ±3. 42) mmol /L and ( 72. 25 ±38. 69) mm Hg respectively, which showed significant differences compared with the grouop II. The incidence of previous concomitant cerebral infarction showed significant difference between the group I and group II( 33. 33% vs 0) .Conclusion The levels of albumin, pre-albumin, heart rate before the intubation, upper gastrointestinal hemorrhage and blood pressure fall immediately after the intubation are associated with duration of mechanical ventilation and may indicate the prognosis in COPD patients with type II respiratory failure.
Objective To investigate the effect of early postoperative enteral nutrition support on the balance of free amino acid spectrum in plasma for patients with cardiac valve replacement during perioperative period. Methods (Forty-seven) patients undergoing cardiac valve replacement were divided into two groups randomly, the routine diet group and the Nutrison Fibre group. The levels of free amino acids in plasma were measured with pre-column derivatization of high-performance liquid chromatography. Results During perioperative period most free amino acids in plasma decreased significantly in the routine diet group (Plt;0.05). Despite some free amino acids in plasma decreased significantly in the Nutrison Fibre group(Plt;0.05), all free amino acids in plasma returned to (Pgt;05) or were higher than the preoperative levels in the postoperative sixth day (Plt;0.05). At the same postoperative points, most free amino acids in plasma in the Nutrison Fibre group were higher than that of the routine diet group (Plt;0.05). Conclusions The levels of free amino acids in plasma decrease significantly in patients with cardiac valve replacement after operation. Early postoperative Nutrison Fibre enteral nutrition support is helpful for keeping the balance of free amino acids in plasma for patients with cardiac valve replacement.
【Abstract】 Objective To detect the expression of Bcl-2/adenovirus E1B 19-kDa-interacting protein 3 (BNIP3)in cell death induced by nutrition deprivation in nucleus pulposus cells so as to further understand the mechanism of deathin nucleus pulposus cells. Methods Two adult Sprague Dawley rats, male or female, weighing 150-200 g, were involvedin this experiment. The cells isolated from rat caudal disc were cultured under the condition of L-DMEM culture media,10%FBS, and 21%O2 (control group) and under the condition of DMEM-free glucose culture media, no serum, and 1% O2(experimental group). The expressions of BNIP3 gene and protein were detected by real-time fluorescent quantitative PCR,immunofluorescence staining, and Western blot. The cell apoptosis rate and mitochondrial membrane potential were measuredby flow cytometry at 24, 48, and 72 hours after culture. Results The expression of BNIP3 decreased in the control group;the expressions of BNIP3 showed an increasing tendency with time in the experimental group, and BNIP3 combined withmitochondria. Significant differences were observed in the expressions of BNIP3 gene and protein between 2 groups at the othertime (P lt; 0.05) except that no significant difference was observed in the expression of BNIP3 gene at 24 hours (P gt; 0.05). Thecell apoptosis rate and mitochondrial membrane potential were significantly lower in the experimental group than those in thecontrol group (P lt; 0.05). Conclusion Upregulation of BNIP3 and translocation to mitochondria may be involved in nucleuspulposus cell death in nutrition deprivation.
Objective To investigatethe anatomic structure of the compound flap of distally-based saphenous nervegreat saphenous vein nutritional vessels so as to provide anatomic basis for the clinical operation. Methods The origin, branches, anastomosis of nutritional vessels of sural nerve-great saphenous vein, and the relationof blood supply of tibia and soleus muscle were observed on 30 low limb specimens of adult cadaver, which were perfused with red gelatin to dissect from the artery. Results The nutritional vessels of sural nerve-great saphenous vein originated from: the saphenous artery 3-5 branches with a diameter of 0.7±0.4 mm；the cutaneous branches of medial inferior genicular artery, diameter of 0.7±0.2 mm；the intermuscular space perforating branches of posterior tibial artery 2-7 branches with a diameter of 1.0±0.2 mm，the internus halfside of the muscular branches nutrient soleus muscle；the perforating osteoseptocutaneous 1-2 branches with a diameter of 1.3±0.3 mm; the perforating branches of superior malleolus with a diameter of 0.6±0.2 mm; the perforating branches of medial anterior malleolus with a diameter of 0.8±0.3 mm. A vascularnetwork of 3 layers, which included periosteum, deep artery, and fascia nerve and superficial vein, was formed by those branches of deep artery, fascia branches, periosteum branches, and nerve-vein nutrition branches. Conclusion The nutritional vessels of saphenous nerve-great saphenous vein has the same origin as muscles, bones, and cutaneous nutritional vessels. It provides anatomic basis for the compound flap of distally-based saphenous nerve nutritional vessels.
One of the most difficult problems on tendon surgery is adhesion formation during the process of tendon healing, which causes functional interference. This pathophysiologic pcocess is closely related to the ways of tendon nourishment and types of tendon healing. In order to understand whether the sutured tendon couldheal without blood circulation, the process and types of tendon healing in the synovial fluid were studied by in vivo culture modle. Flexor digitorum profundus (FDP) segments from the front paw of 50 New Zedland white rabbits were cut inthe middle and sutured with microsurgical technique, and then, preserved in thesynovial cavitied of both knees of the rabbits. After 1, 2, 4, 6 weeks, the specimens from the synovial cavities were studied by gross observation, light microscope, scanning and transmission electron microscope, and biochemical determination. The results showed that the tendon which was nourished by synovial fluid not only could survive, but also could heal. Healing of the tendon was completed by activation and proliferation of both peritendon cells and cells in the tendon.The healing could be devided into 3 periods: malnutrition period (less than 1 week), reparative period (2-4 week) and rebuilding period (more than 4 week).