严重烧伤后超高代谢期的营养护理探讨

通过对 1 0例烧伤病人超高代谢期血浆儿茶酚胺 ,体重与补充热量变化的连续观察发现 ,病人体重逐日下降 ,伤后第 2 0天下降至 1 0 % ,虽然伤后热量的补充明显增加 ,但仍然不能满足高代谢的需要。而儿茶酚胺是机体维持高代谢状态的重要递质之一。作者认为 ,连续观察体重的变化是临床护理中判断病人营养状况的一种简便、易行的方法 ,作者还根据临床经验 ,对影响高代谢的环境、护理因素进行分析 ,并就改进营养的措施、方法 。

自体骨髓输注治疗艾滋病伴肝硬化失代谢期——访上海市公共卫生临床中心普外科刘保池教授

自2009年开始，刘保池教授在国内首创脾切除＋自体骨髓经门静脉输注治疗艾滋病伴肝硬化失代偿期取得良好的疗效，然后又为一般失代偿期肝硬化进行自体骨髓输注治疗，至今已治疗了150余例，为这些深陷生命“泥沼”中的人们带来了希望。2010年刘保池教授因此获得国际治疗倡导联盟（中国区）颁发的国内唯一的“先锋奖”。

Effects of Cadmium Stress on Key Enzymes Involved in Nitrogen Metabolism and Nitrogen,Phosphorus, Potassium Accumulation of Different Varieties of Rice

In this study, the pot experiment was used to explore the differences of activity of key enzymes involved in N metabolism and NPK accumulation under Cd stress during the til iering stage of differen varieties of rice. The results showed that：Cd stress could increase the NPK concentration of different rice type in the til ering stage, while Shen-Liangyou 5867,Yongyou 5550 and Wu-Yunjing 27 showed the highest amplification respectively. Morever, Cd stress can also contribute to the ac-tivity of NR,GS,GOGAT increasing.A s for NR,the Cd stress significantly contribute to NR activity increasing of Huang-Huazhan and Yongyou 538 but is not significant for Wu-Yunjing 27, Shen-Liangyou 5867 and Yongyou 5550, however, the difference among them is not obvious.However, for the activity of GS , Cd stress promote the GS activity. Huang-Huazhan and Wu-Yunjing 27 with low activity in Cd normal level are the most sensitive. Meanwhile the difference between two treatment is the most significant. To the contrary, restrain the GS activity of Shen-Liangyou 5867, Yongy-ou 5550 and the difference is not significant. And under Cd stress, either difference reached significant in GS activity. Cd stress also improve the activity of GOGAT, Wu-Yunjing 27 showed the highest inprovement which showed the lowest GOGAT activity under Cd normal level. Cd stress on rice growth and development of ad-verse, make its lower seed setting rate, 1 000 grain weight decreased, resulting in different degrees of reduction of output of rice.

怎样计算病人的能量需要？

答：临床病人的能量供给是一个很重要的复杂问题,病情较重的病人,大多有食欲减退、厌食的症状。同时,很多病人处于超高代谢状态,对能量需要增加,所以应十分重视病人营养支持问题。对能量的补充,不是越多越好,要恰到好处,其原则是病人处在分解代谢期,应坚持能量平衡,从而维持氮平衡;处在合成代谢期,

Effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing gastrectomy

AIM: To investigate the effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing radical distal gastrectomy. METHODS: Within 24 h of intensive care unit management, patients with gastric cancer were enrolled after written informed consent and randomized to the intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or the conventional insulin therapy (CIT) group to keep levels less than 10 mmol/L. Resting energy expenditure (REE), respiratory quotient (RQ), resting energy expenditure per kilogram (REE/kg), and the lipid oxidation rate were monitored by the indirect calorimeter of calcium citrate malate nutrition metabolism investigation system. The changes in body composition were analyzed by multi-frequency bioimpedance analysis. Blood fasting glucose and insulin concentration were measured for assessment of Homeostasis model assessment of insulin resistance. RESULTS: Sixty patients were enrolled. Compared with preoperative baseline, postoperative REE increased by over 22.15% and 11.07%; REE/kg rose up to 27.22 ± 1.33 kcal/kg and 24.72 ± 1.43 kcal/kg; RQ decreased to 0.759 ± 0.034 and 0.791 ± 0.037; the lipid oxidation ratio was up to 78.25% ± 17.74% and 67.13% ± 12.76% supported by parenteral nutrition solutions from 37.56% ± 11.64% at the baseline; the level of Ln-HOMA-IR went up dramatically (P < 0.05, respectively) on postoperative days 1 and 3 in the IIT group. Meanwhile the concentration of total protein, albumin and triglyceride declined significantly on postoperative days 1 and 3 compared with pre-operative levels (P < 0.05, respectively). Compared with the CIT group, IIT reduced the REE/kg level (27.22 ± 1.33 kcal/kg vs 29.97 ± 1.47 kcal/kg, P = 0.008; 24.72 ± 1.43 kcal/kg vs 25.66 ± 1.63 kcal/kg, P = 0.013); and decreased the Ln-HOMA-IR score (P = 0.019, 0.028) on postoperative days 1 and 3; IIT decreased the level of CRP on postoperative days 1 and 3 (P = 0.017, 0.006); the total protein and albumin concentrations in the IIT group were greater than those in the CIT group (P = 0.023, 0.009). Postoperative values of internal cell fluid (ICF), fat mass, protein mass (PM), muscle mass, free fat mass and body weight decreased obviously on postoperative 7th day compared with the preoperative baseline in the CIT group (P < 0.05, respectively). IIT reduced markedly consumption of fat mass, PM and ICF compared with CIT (P = 0.009 to 0.026). CONCLUSION: There were some benefits of IIT in decreasing the perioperative insulin resistance state, reducing energy expenditure and consumption of proteins and lipids tissue in patients undergoing gastrectomy.

MELD vs Child-Pugh and creatinine-modified Child-Pugh score for Dredicting survival in patients with decompensated cirrhosis

AIM: Model of End-stage Liver Disease (MELD) score has recently gained wide acceptance over the old Child-Pugh score in predicting survival in patients with decompensated cirrhosis, although it is more sophisticated. We compared the predictive values of MELD, Child-Pugh and creatinine modified Child-Pugh scores in decompensated cirrhosis. METHODS: A cohort of 102 patients with decompensated cirrhosis followed-up for a median of 6 mo was studied.Two types of modified Child-Pugh scores estimated by adding 0-4 points to the original score using creatinine levels as a sixth categorical variable were evaluated.RESULTS: The areas under the receiver operating characteristic curves did not differ significantly among the four scores, but none had excellent diagnostic accuracy (areas:0.71-0.79). Child-Pugh score appeared to be the worst, while the accuracy of MELD was almost identical with that of modified Child-Pugh in predicting short-term and slightly better in predicting medium-term survival. In Cox regression analysis, all four scores were significantly associated with survival, while MELD and creatinine-modified Child-Pugh scores had better predictive values (c-statistics: 0.73 and 0.69-0.70) than Child-Pugh score (c-statistics: 0.65). Adjustment for gamma-glutamate transpeptidase levels increased the predictive values of all systems (c-statistics: 0.77-0.81). Analysis of the expected and observed survival curves in patients subgroups according to their prognosis showed that all models fit the data reasonably well with MELD probably discriminating better the subgroups with worse prognosis. CONCLUSION: MELD compared to the old Child-Pugh and particularly to creatinine-modified Child-Pugh scores does not appear to offer a clear advantage in predicting survival in patients with decompensated cirrhosis in daily clinical practice.

Impact of a single bout of high-intensity interval exercise and short-term interval training on interleukin-6, FNDC5, and METRNL mRNA expression in human skeletal muscle

Background: Exercise promotes numerous phenotypic adaptations in skeletal muscle that contribute to improved function and metabolic capacity. An emerging body of evidence suggests that skeletal muscle also releases a myriad of factors during exercise, termed "myokines". The purpose of this study was to examine the effects of high-intensity interval training(HIIT) on the acute regulation of the mRNA expression of several myokines, including the prototypical myokine interleukin-6(IL-6), and recently identified myokines fibronectin type III domain-containing protein 5(FNDC5)(irisin) and meteorin-like protein(METRNL).Methods: Both before and after a 20-day period of twice-daily high-volume HIIT, 9 healthy males(20.5 ± 1.5 years performed a standardized bout of high-intensity interval exercise(HIIE; 5 × 4 min at ~80% pretraining peak power output) with skeletal muscle biopsy samples(vastus lateralis) obtained at rest, immediately following exercise, and at 3 h recovery.Results: Before training, a single bout of HIIE increased IL-6(p < 0.05) and METRNL(p < 0.05) mRNA expression measured at 3 h recovery when compared to rest. Following 20 days of HIIT, IL-6 and FNDC5 mRNA were increased at 3 h recovery from the standardized HIIE bout when compared to rest(both p < 0.05). Resting METRNL and FNDC5 mRNA expression were higher following training(p < 0.05), and there was an overall increase in FNDC5 mRNA post-training(main effect of training, p < 0.05).Conclusion: In human skeletal muscle(1) an acute bout of HIIE can induce upregulation of skeletal muscle IL-6 mRNA both before and after a period of intensified HIIT;(2) Resting and overall FNDC5 mRNA expression is increased by 20 days of HIIT; and(3) METRNL mRNA expression is responsive to both acute HIIE and short-term intense HIIT. Future studies are needed to confirm these findings at the protein and secretion level in humans.

Growth, Metabolism and Physiological Response of the Sea Cucumber, Apostichopus japonicus Selenka During Periods of Inactivity

The growth, metabolism and physiological response of the sea cucumber, Apostichopus japonicus, were investigated during periods of inactivity. The body weight, oxygen consumption rate (OCR), activities of acidic phosphatase (ACP), alkaline phosphatase (AKP), catalase (CAT) and superoxide dismutase (SOD), and content of heat shock protein 70 (Hsp70) in the body wall and coelomic fluid of A. japonicus were measured during starvation, experimental aestivation and aestivation. The results showed that the body weight of sea cucumber in the three treatments decreased significantly during the experimental period (P < 0.05). The OCR of sea cucumber reduced in starvation and experimental aestivation treatments, but increased gradually in natural aestivation treatment. The activities of ACP and AKP of sea cucumber decreased gradually in all treatments, whereas those of SOD and CAT as well as Hsp70 content decreased in the starvation and experimental aestivation treatments and increased in natural aestivation treatment. The sea cucumber entered a state of aestivation at 24℃. To some extent, the animals in experimental aestivation were different from those in natural aestivation in metabolism and physiological response. These findings suggested that the aestivation mechanism of A. japonicus is complex and may not be attributed to the elevated temperature only.

Metabolic rates and biochemical compositions of Apostichopus japonicus (Selenka) tissue during periods of inactivity

Estivation, hibernation, and starvation are indispensable inactive states of sea cucumbers Apostichopusjaponicus in nature and in culture ponds. Generally, temperature is the principal factor that induces estivation or hibernation in the sea cucumber. The present study provided insight into the physiological adaptations ofA. japonicus during the three types of inactivity （hibernation, estivation, and starvation） by measuring the oxygen consumption rates （Vo2） and biochemical compositions under laboratory conditions of low （3℃）, normal （17℃） and high （24℃） temperature. The results show that the characteristics of A. japonicus in dormancy （hibernation and estivation） states were quite different from higher animals, such as fishes, amphibians, reptiles, and mammals, but more closely resembled a semi-dormant state. It was observed that the shift in the A. japonicus physiological state from normal to dormancy was a chronic rather than acute process, indicated by the gradual depression of metabolic rate. While metabolic rates declined 44.9% for the estivation group and 71.7% for the hibernation group, relative to initial rates, during the 36 d culture period, metabolic rates were not maintained at constant levels during these states. The metabolic depression processes for sea cucumbers in hibernation and estivation appeared to be a passive and an active metabolic suppression, respectively. In contrast, the metabolic rates （128.904-11.70 μg/g h） of estivating sea cucumbers were notably higher （107.85±6.31 μg/gh） than in starving sea cucumbers at 17℃, which indicated that the dormancy mechanism here, as a physiological inhibition, was not as efficient as in higher animals. Finally, the principle metabolic substrate or energy source of sea cucumbers in hibernation was lipid, whereas in estivation they mainly consumed protein in the early times and both protein and lipid thereafter.

Efficacy of early lifestyle intervention on metabolic syndrome

Objective Intensive lifestyle intervention significantly reduces the progression to diabetes in high-risk individuals. This study aimed to investigate the efficacy of early lifestyle intervention on high-risk groups of metabolic syndrome. Methods In a two-arm randomized controlled 1-year trial, we compared the effectiveness of a general recommendation-based program of lifestyle intervention carded out by wained professionals versus standard unstructured information given by physicians at reducing the prevalence of multiple metabolic and inflammatory abnormalities in 306 adults aged 45-64 years in Xiaogan city, China. Results At baseline, clinical/ anthropometric/laboratory and lifestyle characteristics of the intervention （n= 153 ） and control （n= 153） groups were not significantly different. The former significantly reduced total/saturated fat intake and increased polyunsaturated fat/fiber intake and exercise level compared to the controls. Weight, waist circumference, high-sensitivity C-reactive protein, and most of the metabolic syndrome components decreased in the intervention group and increased in the controls after 12 months. Lifestyle intervention significantly reduced metabolic syndrome （OR=0.28; 95% CI 0.18-0.44）, with a 31% （95% C121-41） absolute risk reduction, corresponding to 3.2 （95% CI, 2-5） patients needing to be treated to prevent 1 case after 12 months. The intervention significantly reduced the prevalence of central obesity （OR=0.33; 95% CI, 0.20-0.56）, and hypertriglyceridemia （OR=0.48; 95% CI, 0.31-0.75） and the incidence of diabetes （OR=0.23; 95% CI, 0.06-0.85）. Conclusions A lifestyle intervention based on general recommendations was effective in reducing multiple metabolic/inflammatory abnormalities. The usual care by clinical physicians was ineffective at modifying progressive metabolic deterioration in high-risk individuals （J Geriatr Cardio12010; 7：10-16）.

Metabolic Disorders of Transitional Low Production Dairy Cow

The objective of this study was to assess the occurrence of metabolic disorders in periparturient low milk production （〈 15 kg/d） dairy cows. Data were collected between April 2009 and April 2010 from randomly selected Holstein crossed breed dairy cow and heifer （30 cows ＇,and 10 heifers） on faculty farm of faculty of Natural Resources Rajamangala University of Technology Isan, Skon-nakon Campus. Blood samples were collected weekly from each cow, starting 2 weeks before expected calving until 4 weeks postpartum. Serum was analyzed for NEFA and BHBA. The critical threshold for [NEFA] was defined as： 〉 0.4 mmol/L when 〈 -7 to 0 DIM, and 〉 0.7 mmol/L when 3 DIM. Postpartum sub-clinical ketosis （SK） was defined using [BHBA] 〉 14.4 mg/dl. The prevalence of elevated NEFA was 82.5%, 27.5%, 27.5% 7.5% and 7.5% in the dry period, 1st, 2nd 3rd and 5th weeks of lactation, respectively. The prevalence of SK was 12.5% at 2nd weeks of lactation. High prevalence of elevated NEFA during dry period through first 2 weeks of postpartum indicated that periparturient dairy cows suffered some degree of negative energy balance （NEB）. These resulted indicated that though, milk yield of these cows were not that high, NEB and ketosis are still major nutrient-related problems.

严重烧伤家兔不同病理期丙泊酚的药代动力学差异

目的了解严重烧伤家兔在休克期与高代谢期丙泊酚的药代动力学特征和差异。方法将20只新西兰大白兔按随机数字表法分为烧伤组和假伤组，每组10只。将烧伤组家兔造成30％TBSA的Ⅲ度烫伤（以下称烧伤），伤后即刻复苏；6h后静脉注射5．1mg／kg丙泊酚，分别于注药后1、3、5、10、15、20、30、45、60、90min于左侧颈外静脉取血1，5mL；1周后重复上述注药及标本采集过程。假伤组家兔除致假伤外，其他处理同烧伤组。用高效液相色谱仪集中检测2组家兔血浆丙泊酚浓度，采用3P97实用药代动力学计算程序处理血浆药物浓度一时间数据，拟合药代动力学模型并求算参数。结果烧伤组家兔药物浓度一时间数据符合二房室模型，假伤组符合三房室模型。休克期，与假伤组家兔中央室分布容积[Vc，（3．1±1．5）L／kg]、曲线下面积[AUC，（25±7）mg·min·L^-1]、消除相半衰期[t1／2β，（113±93）min]、总清除率[CLs，（110±50）mL·kg^-1·min^-1]比较，烧伤组Vc[（8．8±4．2）L／kg]与AUC[（44±10）mg·min·L^-1]增大（t值分别为3．191与3．668，P值均小于0．01），t1／2β[（339±258）min]延长（t=2．932，P〈0．05），CLs[（40±30）mL·kg^-1·min^-1]降低（t=-3．013，P〈0．05）。高代谢期，烧伤组家兔CLs[（180±40）mL·kg^-1·min^-1]显著高于假伤组[（90±30）mL·kg^-1·min^-1，t=-3．013，P〈0．05]。与本组休克期比较，烧伤组家兔高代谢期Vc[（4．1±1．3）L／kg]与AUC[（24±5）mg·min·L^-1]显著减小（t值分别为2．979与3．766，P值均小于0．01），分布相半衰期[t1／2α，休克期为（16．1±13．1）min、高代谢期为（8．3±2．5）min]、t1／2β[（55±19）min]明显缩短（t值分别为9．065与8．795，P值均小于0．01），而CLs则显著增加（t=4．238，P〈0．01）。结论严重烧伤家兔休克期与高代谢期丙泊酚药代动力学差异较大，休克期以Ve、AUC增大，t1／2α、t1／2β延长，CLs降低为特点；高代谢期以CLs显著增加为特点。

Bariatric surgery proves long-term benefit in patients with cirrhosis

Background:Obesity is commonly observed in patients with cirrhosis,especially with the increasing prevalence of nonalcoholic steatohepatitis(NASH).Bariatric surgery has been avoided in these patients given concerns about increased perioperative risk;therefore,data are lacking regarding long-term outcomes.In this study,we aimed to evaluate the long-term outcomes of patients with cirrhosis who underwent bariatric surgery.Methods:We reviewed the charts of adult patients with compensated cirrhosis who underwent bariatric surgery after they were prospectively enrolled between February 23,2009 and November 9,2011,and followed in a pilot study for evaluation of bariatric surgery outcomes.Only patients with more than 4 years of follow-up were included in the analysis.Data regarding their liver disease,metabolic status,and survival were collected.A descriptive analysis was performed.Results:The cohort consisted of 10 patients,of whom 7 were females.The median post-surgical follow-up was 8.7 years(61.4 years).All patients had biopsy-proven NASH;two patients had concurrent,untreated hepatitis C infection.During the observation period,there was a mean weight loss of 24 kg(19.2%of total body weight pre surgery,P<0.001)and only one patient regained weight to the baseline pre-surgical measurement.One patient who was not eligible for transplant developed hepatic encephalopathy 3 years after surgery and later died.The remainder of the patients did not have any hepatic decompensation,cardiovascular event,or mortality.Except for one patient with Gilbert syndrome,bilirubin was normal in all patients at last follow-up.Conclusions:Bariatric surgery in patients with compensated cirrhosis can lead to sustained weight loss and stable hepatic function on long-termfollow-up.

Short-term captivity influences maximal cold-induced metabolic rates and their repeatability in summer-acclimatized American goldfinches Spinus tristis

Studies of metabolic variation in birds have involved both wild and captive individuals, but few studies have investi- gated whether captivity directly influences metabolic rates, despite such variation potentially confounding conclusions regarding how metabolic rates respond to the conditions under study. In addition, whether short-term captivity influences metabolic rate re- peatability in birds is currently uninvestigated. In this study, we measured Msum （maximal cold-induced metabolic rates） in sum- mer acclimatized American goldfinches Spinus tristis directly after capture from wild populations, after approximately 2 weeks of indoor captivity （Captive 1）, and again after an additional 1-2 weeks of captivity （Captive 2）. M~ increased significantly （16.9%） following the initial captive period, but remained stable thereafter. Body mass （Mb） also increased significantly （9.2%） during the initial captive period but remained stable thereafter, suggesting that muscle growth and/or remodeling of body composition pro- duced the observed metabolic variation. Mb and Msum were not significantly repeatable between wild and Captive 1 birds, but were significantly repeatable between Captive 1 and Captive 2 groups. These data suggest that caution must be exercised when extrapolating metabolic rates from short-term captive to wild populations. In addition, Msum was a repeatable trait for birds under conditions where mean metabolic rates remained stable, but Msum repeatability disappeared during acclimation to conditions pro- moting phenotypically flexible metabolic responses. This suggests that the capacity for phenotypic flexibility varies among indi- viduals, and such variation could have fitness consequences

Observation of the efficacy and safety of the Song-Relaxing and Zhen-Vibrating abdomen manipulation for patients with prediabetes

Objective:To observe the safety of the Song-Relaxing and Zhen-Vibrating abdomen manipulation in treating patients with prediabetes and its effects on blood glucose and lipid metabolism.Methods:One hundred and two patients with prediabetes were divided into a manipulation group and a control group according to the random number table method,with 51 cases in each group.All patients received the general behavioral intervention for prediabetes,with additional Song-Relaxing and Zhen-Vibrating abdomen manipulation in the manipulation group and oral metformin hydrochloride tablets in the control group.Both groups received the intervention for six months.Results:Fourteen patients dropped out during the treatment,and a total of 88 patients completed the trial,including 45 cases in the manipulation group and 43 cases in the control group.After the treatment,the prediabetes control rate was 93.3%in the manipulation group and 74.4%in the control group,and the difference between the two groups was statistically significant(P<0.05);no patient in the manipulation group progressed to diabetes,while the rate of conversion to diabetes in the control group was 6.9%,with a significant difference between the two groups(P<0.05).After the treatment,the body mass index(BMI),glycosylated hemoglobin A1c(HbA1c),fasting plasma glucose(FPG),2-hour postload plasma glucose(2hPG)level during an oral glucose tolerance test(OGTT),fasting insulin(FINS),homeostasis model assessment-2 of insulin resistance(HOMA2-IR),total cholesterol(TC),and triglycerides(TG)decreased in both groups versus baseline,with significant differences within the groups;the levels of all indicators were lower in the manipulation group than in the control group(P<0.05),and the differences between the two groups were more prominent at the sixth month(P<0.01).At the sixth month,the high-density lipoprotein cholesterol(HDL-C)in the manipulation group was increased,while there was no significant change in the control group.In the control group,three patients reported mild gastrointestinal reactions at the initial dosing,which improved after medication adjustment.No other adverse events were observed in either group.Conclusion:Both metformin hydrochloride tablets and the Song-Relaxing and Zhen-Vibrating abdomen manipulation can improve blood glucose and lipid metabolism and reduce insulin resistance and clinical discomfort in patients with prediabetes,but the Song-Relaxing and Zhen-Vibrating abdomen manipulation has higher efficacy and safety.

Elevated CO_2 Accelerates Phosphorus Depletion by Common Bean(Phaseolus vulgaris) in Association with Altered Leaf Biochemical Properties

Phosphorus （P） is a major limiting factor for plant productivity in many ecosystems and agriculture. The projected increase in atmospheric CO2 is likely to result in changes in plant mineral consumption and growth. We studied P depletion by common bean （Phaseolus vulgaris） cultured hydroponically under ambient （377±77μmol mol^-1） or elevated （650±32 μmol mol^-1） CO2 in media of low or high P. Under elevated CO2 compared to ambient CO2, the maximum P depletion rate increased by 98% at low P and 250% at high P, and P was depleted about 2-5 weeks sooner; leaf acid phosphatase （APase） activity and chlorophyll content both increased significantly; root-to-shoot ratio increased significantly at high P, although it was unaffected at low P; lateral root respiration rate showed no change, suggesting that COs did not affect P depletion via metabolic changes to the roots; the total biomass at final harvest was significantly higher at both low and high P. Our data showed that the increased rate and amount of P depletion during plant growth under elevated CO2 occurred in association with alterations in leaf biochemical properties, i.e., enhanced activities of leaf APase and increased leaf chlorophyll content.