octreotide、Ranitidlne、Cimetidine、Nizatidine、Famotidine　Amikacin、Gentamiein、Tobramycin、PeniciUins and Vancomycin added into total parenteral nutritions, respeclwel. The methods we used was to inspect visually, measure the pH, particle size distribution and concentrations after storage for various duration in different temperatures. The results some drugs were stable in total parenteral nutritions,and the others are not.

53 cases who underwent major and moderate abdominal surgery were administered total paraenteral nutrition(TPN) by double energy resources and "all in one" irffusion way since December 1998. Non-protein energy was 105～150KJ/kg·d. Nitrogen was 0.16 ～0.35g/kg·d, Fat was 30%～40% of total energy. Serum protein of the cases were approximately or exceeded preoperative level. Body weight remained stable or increased (0.5～3kg). Positive nitrogen equilibrium was achieved 5～7d postoperatively. TPN improved the patients nutritional status, facilitated postoperative recovery and reduced the occurence of complications. We have the experience: (1) Appropriate nutrition support helps the critical patients of abdominal surgery tide over the long critical course and enhance curative rate. (2) It is necessary for the patients of obvious malnutrition and poor tolerance for operation to receive nutritional support for 5～7d. Postoperative TPN support should not be less than 1 week. (3)Infusion of nutritional ingredients should follow the principle of "metabolic support". (4)TPN can improve not only nutritional condition and immunity,but anticaneerous function of patients with gastrointestinal tract tumor combined with chemotherapy. (5)TPN support can reduce intestinal fluid leakage, facilitae fistua healing and prevent infection for patients with intestinal fistula. (6)TPN support can supply appropriately body needed nutrition and reduce exocrine secretion of pancreas for patients with severe pancreatitis.

Objective To evaluate the effects of application of MgCI2, ATP, and ATP-MgCl2 on the funcrions of liver, kidney, heart and lung in experimontelly ischemic injuried animals, and to study the therapeutic role of exogenous Mg2+ and energy on repairmat of this injuny ming. Freeze etching, Histochemistry, Atomic Absorhtion Spectrum (AAS) and combine LM and EM. The experiment showed that MgCl2 and ATP protectived functions damnify organic (P>0.01) ,ATP-MgCl2 protected effect it notable results (P<0.01 ). Cell membrance was complete, glycogen became enriched in the cytoplasm, the uniform-distributed protein granule on Pside of plasma membtance of cell was found. There were positive material in the membrances and similar to normal group, cell michondia calcium decreased. Conclusions The exogenous application of ATP-MgCl was beneficial to the critical patient.

To study the stability of fal emulsion in all types of AU-in-One nutrient admixtures prepared from on morket fat emnlsions and new MCT/LCTs. Admixtures were prepared from domestic fat emulstions and MCT/LCTs separately with amino acids,dextrose,vitamins, electrolyltes and trace elements. They were stored for one day at 25℃ followed by one day at 25℃ and eight days at 4℃. Admixtures of control group were prepared with fat emulsions and MCT/LCTs of other manufacturers and stored under the same conditions. Particle size and distribution, mass percentage of larger particles to theroretical total iol volume were measured by using light seattering spectrophotometer and coulter multisizer accucomp. Osmolality and pH of the samples were also measured. Stability of the all-in-one admixtures was monitored. The results showe that, compare with the control products, the particle size and distribution of domestic fat emulsions and MCT/LCTs, pH and osmolality of the admixtures remained stable during observation.

Abstracts Experience in total parenteral nutrition (TPN) support for 27 patients with acute severe panereatitis is presented. Most patients were seriously ill, and the course were long and complicated with a mean duration of 64 days, and the longest one was 179 days. Metabolic disturbance and malnutrition were very conspicuous. The mean duration of TPN support for each patient was 24 days, and the longest one maintained for 72 days. TPN began from the early stage and cover the whole period of alimentary dysfunction until the patient could take food by mouth in most patients. Combined treatment was important, ineluding: early operation in 19 patients, intra-and/or postoperative lavage of pancreatic bed and and peritoneal cavity in 13 patients, and as well as appropriated conservative management. Late operative drainage for pancreatic abscess was done in 7 cases. Results Were satisfactory with 22 (81. 5% ) were cured and 5 (18. 5% ) died. In the latter, 3 were died of pancreatic sepsis complicated with infective shock, 2 died of exhaustion, together with pneumonia and multiple system organ filure. None of early died.

Objective Patients with chronic renal failure (CRF) are frequently malnourished, skeletal muscle atrophy and protein depleted. Insulin-like growth factor 1 (IGF-1) is an anabolic hormone. The actions of IGF-1 on protein turnover were examined in skeletal muscle of rats with CRF and sham operated (SO), pair-fed controls. IGF-1 was extracted from serum and skeletal muscle and then measured by radio-immunoassay (RIA). Total tyrosine in the supernatant from the medium was measured fluorometrically and then basal protein synthesis rate and degradation rate in skeletal muscle were calculated. The results showed that IGF-1 levels in serum and in skeletal muscle in the CRF rats were 170.3 ± 16.4 ng/ml and 4.22 ± 1.03ng/grams respectively. These values were significantly lower than in the SO rats (410.4 ± 49.3ng/ml in serum and 6.93 + 1.41ng/grams in muscle, respectively, P<0.001 for each comparison). The basal protein synthesis rate in epitrochlearis muscle of the CRF rats (24.0 ± 2.1 nmol Tyr/grams per hour ) was significantly lower, by 22%, than that of SO, pair-fed rats (30.8 ± 2.4nmol Tyr/grams per hour,P<0.05). In contrast, the basal protein degradation rate in the epitrochlearis muscle of the CRF rats (234.4 ± 13.8nmol Tyr/grams per hour) was increased by 78% in comparison to SO rats (131.7 ± 8.4nmol Tyr/grams per hour, P< 0.001). Dose response curves of rhIGF-1 showed that the effects of rhIGF-1 On muscle protein synthesis and degradation in CRF rats were markedly attenuated as compared to their SO pair-fed controls. The enhancement in protein synthesis induced by increasing concentrations of rhIGF-1 (ranging from 25 to 500ng/ml) in CRF rats was only 25 to 44% of that in SO rats. Similarly, the suppressive effects of the various concentrations of rhlGF-1 on protein degradation in muscle from CRF rats were only 15 to 42% of those found in SO rats. These data indicate that there are impaired actions of rhIGF-1 on protein synthesis and degradation in skeletal muscle of rats with CRF. These findings suggest that the decreased IGF-1 levels in serum and in skeletal muscle, the resistance to the anabolie effects of IGF-1 on protein metabolism may be the main causes of reduced protein synthesis and enhaneed protein degradation in muscle, muscle atrophy and malnutrition in patients with CRF.

Suppressor of cytokine sigaling (SOCS) genes encode a family of protein recently identified as negative feedback inhibitors of signaling by eytokine receptors. We have previously shown that endotoxin markedly stimulates SOCS gene expression in rat liver, that correlates with observed resistance to growth hormone-signaling during endotoxemia. The objective of this study was to determine the expression of SOCS genes in state of fasting that have been shown to cause altered responses in pro-inflammatory cytokines and anzbolic hormones. Male Sprague-Dawley rats (～200g) were fasted for 1, 2 or 3 days, or refed for 3 days following a 3-day period of fasting. Liver and muscle mRNAs were determinedby Northern blotting using specific rat cDNA probes cloned in our laboratory. In liver, after a l-day lag period, there was a progressive 2-fold increase in SOCS-3 and 75% decrease in SOCS-2 mRNA afte 2 and 3 of fasting. Both SOCS mRNAs were normalized by 3 days of refeeding. There was no measurable changes in tyrosine phosphorylation of STAT1, STAT3, STAT5a or STAT5b, nor activation of MAP kinases including ERK 1/2, p38, and JUNK 1/2 in liver by 3 days of fasting. In muscle, there was a similar 75% decrease in SOCS-2 mRNA, but no change in SOCS-3 mRNA following 3 days of fasting. These data suggest that malnutrition regulates SOCS-2 and SOCS-3 in a different way, and this regulation is tissue specific. The changes of SOCS mRANs are independent of measurable phosphoryiation of multiple STATs and activation of MAP kinasea. The altered SOCS expressions during fasting may explain the changes of biological effects of multiple cytokines and anabolie hormones in malnutrition states.

Objective To evaluate the safety and effect of enteral nutrition support at early period after gastroenteric operation. Methods 62 patients with gastrointestinal cancer were divided into three groups randomly: control group, TPN group, and TEN group. Patients in TPN and TEN groups received 7 days nutritional support in isonitrogenous and isocaloric. The peripheral vein blood was sampled before operation and 7 day after that to observe nutritional status and T lymphocyte subsets, NK cells, and NK cell activity. Resalts There were no significant difference in the three groups in albumin and anthropomentric measurement, visceral proteins decreased in three groups in postoperative period, but the values of control group was more seriously than TPN or TEN groups (P<0.05). Mean nitrogen balance: - 8.6 ± 3.12g/day in control group, - 4.22 ± 2.02g/day in TPN group, - 3.88 ± 2.35g/day in TEN group (P<0.05). CD3 ,CD4 ,CD4/CD8, NK cells and NK cell activity decreased in postoperative period in three groups, but there are no significant ditference in three groups. Conelasions Enteral nutrition support at early period after gastroenteric operation is safety and effective.

Background. Postoperative muscle protein catabolism reflected by diminished muscle protein synthesis, reduced glutamine levels and increased nitrogenlosses has in many studies been shown to be reduced by the addition of growth hormone and by the addition of glutamine. The combination of growth hormone and insulin like growth factor (IGF-I, a growth factor which may explain some of the effects of growth hormone) and the addition of glutamina together with growth hormone has so far not been studied postoperatively on muscle protein metabolism. This was the aim of this study. Patients and methods. Metabolic healthy patients undergoing elective colonic resection because of non-spread colonic malignancy were included in the study. The patients were preoperatively weight stable and their BMI were within the normal range. They were given isocaloric (28 kcal/kg/24h) and isonitrogenous TPN (0.15 gN/kg/24h) during 3 days following operation. In three groups TPN was given as a continuous infusion during the study. One group served as a control group (n = 10), another group was given GH postoperatively (GH; n = 7) twice a day subcutaneously (0.15E/kg/injection) and a third group (GH-IGF-I, n = 9) was given the same amount of GH and IGF-I twice a day (40mikrog/kg/24h). Two other groups were given glutamine-containing TPN (0.28g glutamine/kg/24h) during 3 days postoperatively either with addition of growth hormone (GH-GLN; n =8) at a dose of 0.3E/kg/24h, or without growth hormone (GLN; n = 8). In the latter two groups the patients were given TPN during 16 hours per day. Preoperatively and on the third postoperative day a muscle biopsy was taken for analysis of muscle amino acids and determination of the ribosomal patttern reflecting protein synthesis. Urine was sampled during the whole study and the cumulated nitrogen balance was calculated by measuring the total nitrogen content in urine, estimating the extrarenal losses to be 1.5g per day. Results Postoperatively the muscle glutamine was reduced with 22.9 ± 5.6 96 in the control, in the GH group with 22.6 ± 6.5 % and in the GH-IGF-I group with 22.2 ± 4.5 %, all groups given continuous Pn during the study the muscle glutamine level unaltered while a 47.5 ± 6.3 % decline was seen in the GLN group. The concentrations of polyribosomes and ribosomes decreased in a similar way by about 30 % in the control group, in the GH-group and in the GH-IGF-I group indicating a decrease in protein synthesis postoperatively. However, these parameters were unchanged in the two groups given glutamine either with or without growth hormone. In the groups given continuous nutrition during the postoperative period the cumulated nitrogen balance was positive, 6.8 ± 1.6g in the control group, 10.7 ± 1.3 in the GH group and 9.4 ± 2.8 in the GH-IGF-I group. The combination of GH and glutamine reduced nitrogen-losses compared with glutamine alone, -5.8 ± 1.4g vs - 10.6 ± 1. 1g. The two latter groups were not given PN continuously. Conclusion The combination of GH and IGF-I did not in this study improve the parameters reflecting postoperative protein catabolism when PN was given continuously. In both groups a decrease in muscle glutamine and ribosome paramenters reflecting a decrease in protein synthesis were seen. When TPN was given continuously without interruption the cumulated nitrogen balance was improved and positive indicating a beneficial effect on nitrogen metabolism. This effect of the administration of nutrition may be of larger importance than the effect of growth factors in high doses. When glutamine is added a synergistic effect with growth hormone is seen on postoperative glutamine levels which were unaltered compared with glutamine administration alone. When glutamine is adcled the decrease in ribosome parameters reflecting protein synthesis is prevented. The continnous infusion of nutrients and thereby optimizing the whole body nitrogen metabolism may explain the results in this study. It is also plausible that when the metabolid response to trauma is marginal the effects of th

Objective It has been demonstrated that para-operative fasting often induce gastrointestinal mucosal atrophy, that, together with the surgically-stress effects, deteriorate the intestinal harrier structure and may further cause gut-origin infection. Parenteral nutrition has been widely employed in the patients undergone surgery or with trauma as a standard nutritional support in many hospitals. It can provide sufficient nutrients, including calories, nitrogen, and minerals for the daily and extra needs during the stress. However, numbers of investigations have proven that long term parenteral nutrition support has no effects on preventing intestinal mucosa atrophy, but indeed, consistently result in down-regulation of mucosal structure. It has been widely accepted in the clinic that enteral nutrition should be chosen as a priority mean, as to parenteral nutrition, to support the patients whenever they can tolerant. However, there are few reports concerning earlier use of enteral nutrition in post-operative patients. The purpose of this study was to evaluate the effects of postoperative earlier enteral nutrition support (24～36 hours) on the patients undergone major surgery. The cases with earlier enteral nutrition feeding during last three years were reviewed and the feeding method, the effectiveness, and the complications of earlier feeding were investigated. In five cases, with two of proximal small intestine fistula, three of pancreas, duodenal injury, the total effectiveness was satisfactory. All patients gained wight and the nutritional states were much improved. The initial disease of the patients with earlier feeding were all cured within the time periods which were significantly shorter than those who had ordinary post-operative feeding. Only one case among five had mild nausea during the feeding, and was settled after anti-nauseas medications. Two cases with proximal small intestine fistula were recovered in four weeks time. We thus conclude that earlier enteral feeding post-operatively is a safe and effective method for those who have major surgery. It benefits bowel barrier function and further improves the recovery after surgery. Besides, earlier enteral feeding is less costly compared to parenteral nutrition, and easy to operate. A more case-based, prospective controlled clinical study should be organized in the future to further evaluate the usefulness of earlier enteral feeding in the patients with surgery.