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Role of CD4 + CD25 + regulatory T cells in the patients with ulcerative colitis

Chinese Journal of Clinical Nutrition.2010;18(4):224-229. doi:10.3760/cma.j.issn.1674-635X.2010.04.007

Objective To investigate the levels of CD4 + CD25 + regulatory T cells and the Foxp3 in the peripheral blood of patients with ulcerative colitis ( UC), and analyze its role in the pathogenesis of UC. Methods From February 2007 to December 2008, 40 UC patients (23 active and 17 remissive), 33 irritable bowel syndrome (IBS) patients, and 32 normal controls entered our study. CD4 + CD25 + T cells were detected with flow cytometric assay. The expression of Foxp3 mRNA in peripheral blood mononuclear cell (PBMC) was detected by RTPCR. Interleukin-10 (IL-10) and transforming growth factor-β (TGF-β) in the serum from the peripheral blood of UC patients, IBS patients, and normal controls were determined with ELISA. Results There were no significant differences of the peripheral CD4 +T cell numbers among the active, remissive UC and IBS patients, and normal control groups (P=0. 126). The positive rate of CD4+ CD25+ T cells in patients with active and remissive UC were significantly lower than those in IBS patients and normal controls ( both P ＜ 0. 01 ) it was more lower in the active UC patients than the remissive UC patients ( P ＜ 0. 001 ). However, the positive rate of CD4 + CD25 + T cells showed no significant difference between IBS patients and normal control groups ( P = 0. 343 ). The percentage of CD4 + CD25 + T cells was negatively correlated with UC disease activity index ( r = - 0. 660, P ＜ 0. 001 ) and with erythrocyte sedimentation rate (r = -0. 572, P =0. 001 ). The expressions of Foxp3 mRNA in PBMC from active and remissive UC patients were significantly lower than those in both IBS patients and normal controls ( both P ＜0. 001 ). There was no significant difference of the plasma levels of IL-10 or TGF-β among the active/remissive UC patients, IBS patients, and normal controls ( all P ＞ 0. 05 ). Conclusions CD4+ CD25 + regulatory T cells remarkably decline in the active UC and show certain increase in remissive UC, indicating that these cells may be involved in the pathogenesis of UC. The decreased expression of Foxp3 mRNA may be an important factor of the aberrant developmental disorder of CD4 + CD25 + regulatory T cells.

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Effects of branched-chain amino acids-enriched early parenteral and enteral nutrition on the liver function and serum aminograms in cirrhotic rats after partial hepatectomy

Jiaming LAI ; Wenjie HU ; Shutong WANG ; Yunpeng HUA ; Yuantao HAO ; Shimin LUO ; Yingrong LAI ; Lijian LIANG

Chinese Journal of Clinical Nutrition.2010;18(5):299-304. doi:10.3760/cma.j.issn.1674-635X.2010.05.010

Objective To evaluate the effects of branched-chain amino acids-enriched early parenteral and enteral nutrition on the liver function and serum aminograms in cirrhotic rats after partial hepatectomy. Methods In this prospective randomized controlled study, 24 cirrhotic rats, induced by thioacetamide, were randomized into three groups: enteral nutrition (EN) group, EN + branched-chain amino acid (BCAA) group, and parenteral nutrition (PN) + BCAA group. After receiving partial hepatectomy, rats in all three groups were nutritionally supported with equal amount of calorie and nitrogen contents from the 1st postoperative day ( PO day 1 ) to PO day 5. On PO day 6, parameters including body weight, liver functions, prealbumin, transferring, and serum aminograms were measured or determined, and the level of liver albumin mRNA was detected by reversal transcription-polymerase chain reaction and morphological examinations such as HE staining and immunohistochemical staining, which were assessed by index of Ki67 protein index. Results Body weight was significantly decreased in all three groups on PO day 6 (P ＜0.05 ). Compared with EN + BCAA group, serum aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase after partial hepatectomy were significantly higher in PN + BCAA group (P ＜0.05 ). Serum alkaline phosphatase level was significantly higher in PN + BCAA group than in EN group ( P ＜0. 05). The level of prealbumin was significantly lower in PN + BCAA group when compared with EN group or EN +BCAA group ( both P ＜ 0. 05 ), although no such significant difference was noted in terms of transferrin ( P ＞0. 05 ). The levels of leucine and isoleucine elevated while those of tyrosine, phenylalanine, arginine and tryptophan declined in PN + BCAA group or EN + BCAA group when compared with EN group ( P ＜ 0. 05 ). Aminograms were not significantly different between EN + BCAA group and PN + BCAA group ( P ＞ 0. 05 ). Levels of total amino acid and aromatic amino acid (AAA) were significantly lower while BCAA and ratio between BCAA and AAA (BCAA/AAA) were significantly higher in PN + BCAA group or EN + BCAA group than in EN group (P ＜ 0. 05 ).Significantly lower level of albumin mRNA and index of Ki67 were observed in PN + BCAA group than in EN group or EN + BCAA group (P ＜ 0.05 ) on PO day 6. Conclusions BCAA-enriched EN or PN reverses amino acid disequilibrium and restores BCAA/AAA in cirrhotic rats after partial hepatectomy. Compared with PN, EN is superior in improving postoperative liver function, promoting protein synthesis, and speed up tissue regeneration in the postoperative liver. However, it still can not restore serum albumin in a short term.

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Analysis and evaluation of the prescriptions of total parenteral nutrition

Zandong LI

Chinese Journal of Clinical Nutrition.2010;18(5):289-291. doi:10.3760/cma.j.issn.1674-635X.2010.05.008

Objective To analyze and evaluate the application of total parenteral nutrition in our hospital,with an attempt to improve the quality of total parenteral nutrition and provide a reference for clinical use. Method A total of 1386 prescriptions of total parenteral nutrition in our hospital from January 2008 to October 2009 were analyzed and evaluated according to the distribution of the departments and other drug uses. Results All these 1386 total parenteral nutrition prescriptions were mainly made by the departments of gastrointestinal pediatrics, oncology, hepatobiliary gland surgery, and ICU. The average time of use was 7.74 days. More than half of the prescriptions had a liquid volume less than 1500 ml. The volumes of vitamins and trace elements were basically appropriate in most prescriptions. However, problems such as incorrect glucose and lipid energy, low amino acid concentrations, and high Ca2+ or Mg2+ concentrations were also noted. Conclusions The prescriptions of total parenteral nutrition is basically appropriate in our hospital, although there is still space for improvement. More efforts should be made to carry our education and training on nutrition support to promote the reasonal application of total parenteral nutrition.

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Impact of nutrition support on the outcomes of patients at nutritional risks

Zhuming JIANG ; Kang YU ; Hailong LI

Chinese Journal of Clinical Nutrition.2010;18(5):263-267. doi:10.3760/cma.j.issn.1674-635X.2010.05.001

Nutrition support includes three parts: supplementation, support, and therapy. When? and how? to use nutrition support which should be related with clinical outcome of the patients. Parenteral nutrition became widely accepted in the States since the presentation at American College of Surgeons Congress 1967 by Dudrick et al. More detail study of baby growth and development receiving all nutrients exclusively by vein from Wilmore et al 1968. In China, it was Jiang et al reported the clinical applications of parenteral nutrition at Surgical Congress of Chinese Medical Association 1978. Enteral elemental diet and parenteral nutrition for intestinal fistulae illness by Jiang et al 1979 which enrolled by Medline. Although nutrition support has become a standardized technology in China, but evidences on improving the patients' outcomes were still insufficient. After Kondrup et al estsblished Nutritional Risk Screening 2002 tool, the nutrition support could use an evidence-based approaching with outcome. One prospective cohort study based on hospitals in Baltimore and Beijing, using Nutrition Risk Screening 2002 as the tool, have evaluated the impact of nutritional support (both parenteral and enteral nutrition) on the infective complications among patients at nutritional risk and demonstrated that the overall incidence of complications was significantly lower in patients who had received nutritional support, which was achieved mainly due to the decline of the incidence of infective complications. Therefore, support with appropriate nutrients being necessary for patients at nutritional risks or already with malnutrition. However, more cohort studies and randomized controlled studies with larger samples are still required.

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Research advances in gene expressions and related signal transduction in the tight junction of intestinal epithelium

Zhihua LIU ; Huanlong QIN

Chinese Journal of Clinical Nutrition.2010;18(5):310-316. doi:10.3760/cma.j.issn.1674-635X.2010.05.012

The tight junction of intestinal epithelium plays an important role in maintaining the function of intestinal barrier and regulating the cell differentiation. The intestinal epithelial cells interact with neighboring cells and the extracellular matrix and then affect the epithelial barrier as well as the proliferation, polarization, and apoptosis of cells. As an important cell junction, the tight junction of intestinal epithelium participates in a series of signal transduction pathways including the classic cyclic adenosine monophosphate-protein kinase A-cyclic adenosine monophosphate response element-binding, inositol trisphosphate, Ras-mitogen-activated protein kinase, phosphatidylinositol 3-kinase, and in some special pathways including zonula occludents protein 1-associated Y-box factor,cyclin related protein, phosphorylation, and methylation. Furthermore, regulations of gene and protein expression of the tight junction are also complex, while disorders of such regulations may lead to clinical diseases, such as disruption of the intestinal barrier, refractory infection, and even cancers. This article reviews the research advances in gene expressions, related signal transduction, and self-regulation in the tight junction of intestinal epithelium.

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Resting energy expenditure in patients with well controlled type 2 diabetes mellitus

Zhenhe HUANG ; Shuxin Lü ; Liping LI ; Yanfang MAO ; Ying JIANG ; Hongling WU ; Zhuoqin JIANG

Chinese Journal of Clinical Nutrition.2010;18(5):284-288. doi:10.3760/cma.j.issn.1674-635X.2010.05.007

Objective To investigate the features of resting energy expenditure (REE) in patients with well controlled type 2 diabetes mellitus (T2DM). Methods Totally 45 T2DM patients with stable blood glucose were enrolled. The general conditions, biochemical indicators, measurements of REE ( MREE), and basal energy expenditure (BEE) calculated with Harris-Benedict formula (HBEE) and Owen formula (OBEE) were recorded and compared. Results MREE had no significant difference with HBEE or OBEE in T2DM patients with stable blood glucose (P ＞ 0. 05). Correlation analysis showed that REE was significantly correlated with gender, age, body weight, body height, body surface area, and fat-free mass ( all P ＜ 0.05 ), but was not correlated with body mass index, fat mass, fasting plasma glucose, postprandial plasma glucose, haemoglobin Alc, total cholesterol, triglyceride, total protein, albumin, and haemoglobin (P ＞ 0. 05 ). Multiple regression analysis showed that fat free mass and age had the closest correlation with REE. Conclusions REE does not increase in T2DM patients with well controlled blood glucose. Factors that influence their REE are similar with healthy individuals. Determi nation of REE can provide useful information for the nutrition treatment of T2DM.

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Nutritional risk screening and nutritional support among inpatients in a middle hospital and a small hospital in Shijiazhuang

Zhenfu LI ; Yubin ZHANG ; Jianbin GU ; Yan WANG ; Jingcheng ZHANG ; Yunfeng GENG

Chinese Journal of Clinical Nutrition.2010;18(5):282-283. doi:10.3760/cma.j.issn.1674-635X.2010.05.006

Objective To investigate the hospitalized patients incidence of nutritional risk and nutritional support in six departments (general surgery, thoracic surgery, gastroenterology, neurology, urology and respirology) in a middle hospital and in the medical/surgical departments in a small hospital, so provide reference for rational nutritional support for patients. Method Nutritional Risk Screening 2002 was used to assess the existence of nutritional risk and the necessity of nutritional support. Results The overall prevalence of the nutrition risk was 25% in the six departments in the middle hospital; more specifically, the prevalence of nutrition risk arranged from 18% to 31% in these six departments: 31% in the department of respiratory medicine, 29% in the department of neurology, 27% in the department of urology, 23% in the department of thoracicsurgery, 22% in the department of gastroenterology, and 18% in the department of general surgery. For those at nutritional risk, the nutritional support rate was 24%. For non-risky patients, 9% received nutritional support. The overall prevalence of nutrition risk was 18% in the small hospital; more specifically, the prevalence of nutrition risk was 29% in the department of internal medicine and 7% in the department of surgery. For those at nutritional risk, the nutritional support rate was 24%.For non-risky patients, the nutritional support rate was 4%. Conclusions Certain nutritional risk and malnutrition exist in inpatients in the middle and small hospitals in Shijiazhuang. The applications of parenteral and enteral nutritions still have some problems. It is of particular importance to further promote the application of evidence-based parenteral/enteral nutrition guidelines in middle and small hospitals to standardize the application of nutritional support.

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Application of Nutritional Risk Screening 2002 in the investigation of nutritional risks, undernutrition, and nutritional support among inpatients in tertiary hospitals in Tianjin

Yan CHANG ; Wenyu ZHENG ; Yanjin CHEN ; Qingjie GUO ; Junhong MA ; Ping ZHAO

Chinese Journal of Clinical Nutrition.2010;18(5):272-275. doi:10.3760/cma.j.issn.1674-635X.2010.05.003

Objective To investigate the nutritional risks, undernutrition, and nutritional support among inpatients in tertiary hospitals in Tianjin using Nutritional Risk Screening 2002 (NRS2002). Methods Inpatients in six departments in two tertiary hospitals in Tianjin (Tianjin Nankai Hospital and Tianjin Chest Hospital ) were consecutively enrolled from March 2005 to March 2006. Their nutritional risks were screened using NRS 2002, and the nutritional support was investigated. Results A total of 1200 inpatients received nutritional screening, and 93.0% of them underwent NRS 2002 scoring. The prevalence of undernutrition was 9. 8% and the prevalence of nutritional risk was 42. 8%. Of these patients, 241 patients (46.4%) with NRS2002≥3 received nutrition support, and 244 patients (35.9%) with NRS2002 ＜3 received nutritional support Conclusions NRS2002 is suitable for nutritional risk screening among inpatients. Inpatients usually have nutritional risks or undernutrition. However, physicians at different levels in different regions have different awareness of such risks or conditions, and the clinical application of nutritional supports sometimes are inappropriate.

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Incidences of nutrition risks, malnutrition ( undernutrition), overweight, and obesity, and nutrition support in tertiary hospitals in Xinjiang Uigur Autonomous Region

Li LI ; Guoli XU ; Kuanqian TUO ; Hongliang ZHANG ; Xiangmei ZHANG ; Yi WANG

Chinese Journal of Clinical Nutrition.2010;18(5):268-271. doi:10.3760/cma.j.issn.1674-635X.2010.05.002

Objective To investigate the incidences of nutrition risks, malnutrition ( undernutrition),overweight, and obesity, and nutrition support in tertiary hospitals in Xinjiang Uigur Autonomous Region. Methods Using fixed-point consecutive sampling, we collected the clinical data of inpatients in 6 departments of five tertiary hospitals in Xinjiang. According to the Nutrition Risk Screening 2002 (NRS 2002 ) published by European Society for Parenteral and Enteral Nutrition, patients were graded as at nutritional risk when their NRS 2002 scores ≥3 and as malnutrition when the body mass index (BMI) was ＜ 18.5 kg/m2 (or albumin ＜ 30 g/L). NRS 2002 screening was performed on the next morning after a patient was admitted. The nutrition supports within 2 weeks after admission were also investigated. The relationship between nutrition risks and nutrition support was analyzed.Results A total of 4036 inpatients were investigated, among them 3913 patients received NRS 2002 screening.The malnutrition (undernutrition) rate and the proportion of patients at nutritional risk were 8.4% and 34. 2%, respectively. The percentage of nutrition support was 10. 2%, which included parenteral nutrition (8. 5% ) and ena simple, fast and convenient tool for the investigation of nutrition risks and can provide a basis for reasonable nutrition support Therefore, it should be widely applied in clinical practice.

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Role of Toll-like receptor 4 in intestinal ischemia-reperfusion and the interventional role of ω-3 polyunsaturated fatty acids

Kaiguo ZHOU ; Guizhen HE

Chinese Journal of Clinical Nutrition.2010;18(5):317-320. doi:10.3760/cma.j.issn.1674-635X.2010.05.013

Toll-like receptors is a super-family of pathogen recognition-receptors discovered in recent years.During the process of ischemia-reperfusion, the Toll-like receptor 4 (TLR4) combines with lipopolysaccharide and many endogenous ligands such as high mobility group protein B1, heparan sulfate, and fibrinogen. Through the myeloid differentiation protein 88 -dependent and -independent signaling pathways, the products induce the release of inflammatory cytokine-mediated inflammatory response, leading to injuries. ω-3 polyunsaturated fatty acids, by inhibiting the signal pathway activation and target gene expression of TLR4, can influence the function of many immune cells and regulate the body's inflammatory response and immune function. This article reviews the function of TLR4 during ischemia-reperfusion injury and the possible interventional role of ω-3 polyunsaturated fatty acids.

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