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Advances in relationship between copper and cardiovascular diseases

Chinese Journal of Clinical Nutrition.2010;18(4):254-258. doi:10.3760/cma.j.issn.1674-635X.2010.04.013

Cardiovascular diseases (CVD) have become a major cause of death in urban Chinese residents.Numerous studies have found correlations between the occurrence and development of CVD and copper deficiency or excess. As an enzyme activator or inhibitor, copper regulates the metabolism and plays an especially important role in the process of CYD-related metabolism. In this paper, the relationship between copper and CVD will be reviewed.

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Benefits of perioperative fast-track surgery program on clinical outcome in patients with gastric cancer

Zhiguo HE ; Yun TANG ; Huiguo WU ; Bo WEI ; Lin CHEN ; Rong LI

Chinese Journal of Clinical Nutrition.2010;18(1):29-32. doi:10.3760/cma.j.issn.1674-635X.2010.01.008

Objective To evaluate the benefits of perioperative fast-track surgery (FTS) program on clinical outcome in patients with gastric cancer. Methods Totally, 82 patients were randomly allocated into FTS group (n = 41; received perioperative FTS program) and control group (n = 41; received a conventional therapy). The postoperative first defecation time, postoperative hospital stay, hospitalization expenditure, and postoperative complications were compared between the two groups. Results The postoperative first defecation time and postoperative hospital stay were (45.58 ± 26.91 ) h and (9.4 ± 3. 3 ) d in FT3 group and (58.01 ± 23.5 ) h and ( 12. 4 ±3.6 )d in control group (P = 0. 0287 and P = 0. 0002, respectively). Hospitalization expenditure was significantly lower in FTS group than that in control group [(2. 96 ± 0.44 ) yuan vs. ( 3.46 ± 0. 34 ) × 104 yuan, P ＜ 0. 0001 ).The complication was not significantly different between the two groups (7.3% vs. 17.1% , P =0. 232). Conclusion Perioperative FTS program can accelerate postoperative rehabilitation, shorten hospital stay, and decrease medical costs in patients with gastric cancer.

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Determination of energy expenditure in mechanically ventilated patients

Hong CHEN ; Fei LI ; Jianguo JIA ; Jiabang SUN

Chinese Journal of Clinical Nutrition.2010;18(2):91-94. doi:10.3760/cma.j.issn.1674-635X.2010.02.007

Objective To investigate the energy expenditure of mechanically ventilated patients,compare the measured energy expenditure (MREE) with the energy expenditure expected from the Harris-Benedict equation adjusted with correction factors (PREE). Methods Twenty-four critically ill adult patients who were mechanically ventilated in the intensive care unit were enrolled in this study. Data during the 72 hours of mechanical ventilation were collected for computation of severity of illness. Resting energy expenditures were derived at 72hours after mechanical ventilation by indirect calorimetry. Predicted basal energy expenditure was obtained at the same time using the Harris-Benedict equation and predicted resting energy expenditure was calculated using the Harris-Benedict value adjusted with correction factors for illness. Results The Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ)scores and Marshall scores were 14 ± 5 and 6 ± 3, respectively. MREE and PREE were (6 793.64 ± 1 197.15) and (8 041.02 ± 1 971.54) kJ/day, respectively. There was no correlation between MREE and PREE (r2 = 0. 28, P = 0. 07), and the difference between MREE and PREE was statistically significant (t = 7.62, P = 0.04). No statistically significant correlations were observed between both MREE or PREE and APACHE Ⅱ score or Marshall score (r2 = 0. 14, P = 0. 08; r2= 0. 08, P = 0. 63; r2 = 0. 05, P =0. 65; r2 = 0.03, P = 0. 87, respectively). Conclusions In mechanically ventilated patients, the energy expenditure is not correlated with the severity of illness. The Harris-Benedict prediction modified with correction factors for severity of illness systematically overestimates the total energy expenditure.

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Research advances in the pathogenesis of pediatric parenteral nutrition associated cholestasis

Jing LI ; Wei CAI

Chinese Journal of Clinical Nutrition.2010;18(1):48-51. doi:10.3760/cma.j.issn.1674-635X.2010.01.012

Parenteral nutrition associated cholestasis (PNAC) mainly occurs in children. Currently identified risk factors include premature infants, lack of enteral feeding, repeated infections, and toxicity or nutrient deficiency of parenteral nutrition solution. Recent studies have shown that nuclear receptor-mediated bile acid transporter may be the key site of PNAC pathogenesis, in which some cytokines play important roles. New anti-cholestatic therapy based on the regulation of expression of these molecules may prevent end-stage liver disease caused by PNAC.

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Changes of some trace elements and nutritional proteins in children with acute lymphoblastic leukemia and acute myeloid leukemia at stages of onset

Jing WANG ; Ying WU ; Yijue CHEN ; Jian WANG ; Huaiyuan LI ; Qihua FU

Chinese Journal of Clinical Nutrition.2010;18(1):19-23. doi:10.3760/cma.j.issn.1674-635X.2010.01.006

Objective To investigate the changes of serum trace elements and nutritional proteins in children with acute lymphoblastic leukemia and acute myeloid leukemia at the stage of onset. Methods Serum levels of cuprum, zinc, iron, magnesium, phosphorus, calcium, ceruloplasmin, ferritin, transferrin, lactate dehydrogenase, total protein, albumin, hemoglobin, and erythrocytes were detected in 73 patients with acute lymphoblastic leukemia, 26 patients with acute myeloid leukemia at stages of onset, and 30 healthy controls using methods including atomic absorption spectrometry, nophelometry assay, dry chemical method, and/or chemiluminescence method. The differences of these indicators among these three groups were analyzed by t test. Results Serum levels of all detected elements except for zinc and phosphorus were significantly different between the onset groups and the control group (P ＜ 0.05 ). Serum levels of cuprum, magnesium, iron, ferritin, ceruloplasmin, and lactate dehydrogenase in the onset groups were significantly higher than those in control group ( all P ＜ 0.05 ). On the contrary, calcium, transferrin, total protein, albumin, hemoglobin, and erythrocyte count were significantly lower in the onset groups than those in control group (P ＜ 0.05). Serum iron, cuprum, zinc, and their metabolism were significantly different between acute lymphoblastic leukemia group and acute myeloid leukemia group ( P ＜ 0.05 ).Conclusion　Serum levels of some trace elements and nutritional proteins are disordered and out of balance in chil dren with acute lymphoblastic leukemia and acute myeloid leukemia at stages of onset.

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Influence factors of energy metabolism and nutritional risk screening in patients with newly diagnosed esophageal cancer

Cuihua HUANG ; Jiang WU ; Haibo XIAO ; Lina LU ; Wei CAI

Chinese Journal of Clinical Nutrition.2010;18(1):5-8. doi:10.3760/cma.j.issn.1674-635X.2010.01.002

Objective To evaluate the possible factors that may influence the resting energy expenditure (REE) in patients with newly diagnosed esophageal cancer. Methods Totally, 40 patients with newly diagnosed esophageal cancer were prospectively collected from November 2008 to June 2009 in Xinhua Hospital. Nutritional risk screening 2002 (NRS 2002) was performed. REE and body composition were measured using indirect calorimetry and bioeletrical impedence method, respectively. Results Twenty-seven (67.5%) patients were found with nutrition risk, and NRS score was negatively correlated with prealbumin ( r = - 0.444, P = 0.004) and albumin levels (r = - 0.386, P = 0.014). Measured REE and predicted REE values were ( 6770 ± 1360) and (6021 ± 841 ) kJ/d, respectively (P ＜ 0.001 ). Among all 40 patients, 57.5% of them were hypermetabolic,30.0% were normal, and 12.5% were hypometabolic. Stepwise linear regression analysis showed that fat free mass was the only significant determinant variable for REE (P ＜ 0.001 ). Conclusion Fat free mass is a factor than can influence the energy metabolism in patients with newly diagnosed esophageal cancer.

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Evaluation of preoperative undernutrition, nutritional risks, and nutritional support in general surgical wards

Dong PANG ; Fanfan ZHENG ; Yujie ZHOU ; Qian LU

Chinese Journal of Clinical Nutrition.2010;18(1):1-4. doi:10.3760/cma.j.issn.1674-635X.2010.01.001

Objective To evaluate the preoperative undernutrition, nutritional risks, and nutritional support in general surgical wards. Methods The nutritional risks of 217 new in-patients in general surgical wards in a Beijing-based hospital were assessed using nutrition risk screening 2002 ( NRS 2002 ) and the medical records were reviewed. Results The overall prevalence of preoperative undernutrition and nutritional risks was 7.4% and 14.7% respectively, most of which occurred in patients with gastrointestinal diseases and malignant diseases. Nutritional supports were provided to 18.8% of patients with undernutrition, 12.5% of patients with nutritional risks,3.0% of patients without undernutrition, and 2.7% of patients without nutritional risks. The enteral nutrition:The application of nutritional support should be further improved in general surgical wards.

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Effectiveness of aspirin in preventing peripherally inserted central venous catheter-related thrombosis

Xuying LI ; Zhenqiu SUN ; Yongyi CHEN ; Jinhua LI ; Zhong YUAN ; Yuhua WANG

Chinese Journal of Clinical Nutrition.2010;18(2):121-123. doi:10.3760/cma.j.issn.1674-635X.2010.02.013

Objective To evaluate the effectiveness of aspirin in preventing peripherally inserted central venous catheter (PICC) -related thrombosis. Methods Totally 360 cancer patients who had undergone routine PICC placement were equally randomized into aspirin group (receiving conventional PICC maintenance plus oral administration of aspirin; 100 mg/d, for consecutively 21 days) and control group (conventional PICC catheter maintenance). The incidences of phlebitis and thrombosis were observed in both two groups. Results The incidences of phlebitis and thrombosis were 3.3% and 0 in aspirin group, which were significantly lower than those in control group (8.9% , P = 0. 025; 1.7% , P = 0. 025). Conclusion The oral administration of aspirin after the PICC placement can reduce PICC-related thrombosis and phlebitis.

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Effect of ω-3 polyunsaturated fatty acids on intestinal ischemiareperfusion injury and lymphatic duct ligation

Guizhen HE ; Liangguang DONG ; Kaiguo ZHOU ; Xuefeng CHEN

Chinese Journal of Clinical Nutrition.2010;18(2):95-100. doi:10.3760/cma.j.issn.1674-635X.2010.02.008

Objective To investigate the effect of intestinal lymphatic duct ligation and ω-3 polyun saturated fatty acids on intestinal and distant organ in intestinal ischemia-reperfusion injury. Methods Totally 40Sprague-Dawley (SD) male rats (SPF grade)after gastrostomy were equally randomized into sham group (Sham), enteral nutrition (EN) group, enteral nutrition and lymphatic duct ligation (EN + L) group, ω-3 polyunsaturated fatty acids (ω-3PUFA) group, and ω-3PUFA and lymphatic duct ligation (ω-3PUFA + L) group. After 7 days of nutritional intervention, rats were subjected to 60 minutes of intestinal ischemia, ischemia plus mesenteric lymph duct ligation, or sham procedures. After 3 days of continuous nutrition intervention using the original nutrient, lymph nodes, lung, intestine, liver, and blood specimens were harvested. Intestinal permeability and morphology, results of bacterial cultures, and serum cytokines were observed or detected. Result After 3 days of intestinal ischemia-reperfusion (I/R), the body weights of rats in EN group significantly decreased when com pared with the pre-I/R levels (P ＜ 0.05), while the body weights of rats in EN + L group were significantly lower than those in ω-PUFA group and ω-PUFA + L group (P ＜ 0. 05). After one day of intestinal ischemia-reperfusion (I/R), the L/M significantly increased in each group (P ＜0.05 or P ＜0. 01). After 3 days of intestinal ischemiareperfusion (I/R) , the L/M were significantly lower than the level one day after ischemia- reperfusion in EN + L group, ω-PUFA group, and ω-PUFA + L group (P ＜ 0.05). The L/M in EN group and EN + L group were significantly higher than that in ω-PUFA + L group (P ＜ 0. 05). The mucosa thickness and villus height of jejunum in ω-PUFA group and ω-PUFA + L group were significantly higher than those in Sham group, EN group, and EN + L group (P ＜ 0. 01 or P ＜ 0. 05). The mucosa thickness and villus height of ileum in ω-PUFA group and ω-PUFA +L group were also significantly higher than those in EN group (P ＜ 0.05). In ω-PUFA + L group, the serum endotoxin level and tumor necrosis factor-α level were significantly lower than those in EN group (P ＜ 0.05), interleukin (IL) -6 level was significantly lower than that in the ω-PUFA group (P ＜ 0.05), and IL-1 β level was significantly lower than those in other groups (P ＜ 0. 05). In EN group, the lung cell apoptosis index was significantly higher than those in other groups (P ＜ 0.05)and the levels of inducible nitric oxide synthase (iNOS)and myeloperoxidase (MPO) were significantly higher than those in ω-PUFA + L group (P ＜ 0. 05). The level of iNOS was also significantly higher in EN + L group than that in ω-PUFA + L group (P ＜ 0.05). Conclusions Sixty minutes of intestinal ischemia can cause intestinal injury, intestinal barrier dysfunction, and increased permeability of intestine. After 72 h of reperfusion, the intestinal injury can be partially recovered and the permeability can be lower than the post-ischemia level; however, bacterial endotoxin translocation and lung apoptotic cells still exist. Intestinal lymphatic ligation can alleviate the lung damage, promote repair of intestinal mucosa, reduce endotoxin translocation, and attenuate the systemic inflammatory response. EN added with ω-3PUFA is remarkably superior to conventional EN.

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Application of continuous subcutaneous insulin infusion in desensitization for allergy to recombinant human insulin

Naishi LI ; Weigang ZHAO ; Hongbo YANG ; Wenhui LI ; Xiaoling ZOU ; Hui PAN ; Lianglu WANG ; Hongding XIANG

Chinese Journal of Clinical Nutrition.2010;18(2):84-86. doi:10.3760/cma.j.issn.1674-635X.2010.02.005

Objective To evaluate the values of continuous subcutaneous insulin/rapid insulin analoguc infusion in desensitization for allergy to recombinant human insulin. Methods Two patients allergic to recombinant human insulin received desensitization therapy by continuous subcutaneous insulin lispro infusion. The diluted insulin lispro solution was pumped with initial basal rate of O. O1 U/h, and the basal rate and insulin lispro concentration increased gradually until the insulin dosage for clinical treatment was reached. After that, continuous subcutaneous insulin lispro infusion was replaced by regimen of insulin lispro subcutaneous injection plus oral hypoglycemic agents. Results Local wheals were not observed in both two patients during continuous subcutaneous insulin lispro infusion or during bolus subcutaneous injection of insulin lispro after desensitization. Conclusion The desensitization therapy by continuous subcutaneous insulin/rapid insulin analogue infusion can be applied for allergy to recombinant human insulin.

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