Effects of intermittent fasting on health markers in those with type 2 diabetes:A pilot study

AIM To determine the short-term biochemical effects and clinical tolerability of intermittent fasting(IF) in adults with type 2 diabetes mellitus(T2DM).METHODS We describe a three-phase observational study(baseline 2 wk, intervention 2 wk, follow-up 2 wk) designed to determine the clinical, biochemical, and tolerability of IF in community-dwelling volunteer adults with T2DM. Biochemical, anthropometric, and physical activity measurements(using the Yale Physical Activity Survey) were taken at the end of each phase. Participants reported morning, afternoon and evening self-monitored blood glucose(SMBG) and fasting duration on a daily basis throughout all study stages, in addition to completing a remote food photography diary three times within each study phase. Fasting blood samples were collected on the final days of each study phase. RESULTS At baseline, the ten participants had a confirmed diagnosis of T2DM and were all taking metformin, and on average were obese [mean body mass index(BMI) 36.90 kg/m^2]. We report here that a short-term periodof IF in a small group of individuals with T2DM led to significant group decreases in weight(-1.395 kg, P = 0.009), BMI(-0.517, P = 0.013), and at-target morning glucose(SMBG). Although not a study requirement, all participants preferentially chose eating hours starting in the midafternoon. There was a significant increase(P < 0.001) in daily hours fasted in the IF phase(+5.22 h), although few attained the 18-20 h fasting goal(mean 16.82 ± 1.18). The increased fasting duration improved at-goal(< 7.0 mmol/L) morning SMBG to 34.1%, from a baseline of 13.8%. Ordinal Logistic Regression models revealed a positive relationship between the increase in hours fasted and fasting glucose reaching target values(χ~2 likelihood ratio = 8.36, P = 0.004) but not for afternoon or evening SMBG(all P > 0.1). Postprandial SMBGs were also improved during the IF phase, with 60.5% readings below 9.05 mmol/L, compared to 52.6% at baseline, and with less glucose variation. Neither insulin resistance(HOMAIR), nor inflammatory markers(C-reactive protein) normalized during the IF phase. IF led to an overall spontaneous decrease in caloric intake as measured by food photography(Remote Food Photography Method). The data demonstrated discernable trends during IF for lower energy, carbohydrate, and fat intake when compared to baseline. Physical activity, collected by a standardized measurement tool(Yale Physical Activity Survey), increased during the intervention phase and subsequently decreased in the follow-up phase. IF was well tolerated in the majority of individuals with 6/10 participants stating they would continue with the IF regimen after the completion of the study, in a full or modified capacity(i.e., every other day or reduced fasting hours).CONCLUSION The results from this pilot study indicate that shortterm daily IF may be a safe, tolerable, dietary intervention in T2DM patients that may improve key outcomes including body weight, fasting glucose and postprandial variability. These findings should be viewed as exploratory, and a larger, longer study is necessary to corroborate these findings.

Biomarkers of skin toxicity induced by anti-epidermal growthfactor receptor antibody treatment in colorectal cancer

Skin toxicity is a common symptom of anti-epidermal rowth factor receptor(EGFR) antibody treatment and is also a predictive marker of its efficacy in colorectal cancer patients. However, severe skin disorders induced by such antibodies negatively impact on the quality of life of patients and decreases drug compliance during treatment. If we can predict the high-risk group susceptible to severe skin toxicity before treatment, we can undertake the early management of any arising skin disorders and formulate a more accurate prognosis for anti-EGFR antibody treatment. Previous studies have identified molecular markers of skin toxicity induced by anti-EGFR antibody, such as EGFR polymorphisms, the expression of inflammatory chemokines and serum levels of EGFR ligands. A clinical trial was undertaken involving the escalation of cetuximab doses, guided by the grade of skin toxicity observed, such as no or low-grade, in metastatic colorectal cancer(the EVEREST study). The dose escalation of cetuximab was confirmed by a safety profile and had the tendency to achieve a higher response rate in KRAS wild-type patients. A large, prospective randomized trial is now ongoing(EVEREST 2) and the results of this trial may contribute to personalized medicine in KRAS wild-type colorectal cancer patients.

Development and validation of RP-HPLC method for determination of acetazolamide, furosemide and phenytoin extemporaneous suspensions

The development of the extemporaneous preparations allows physicians to adjust the dose for pediatric patients and provides for a more convenient dosage vehicle for those patients with difficulty swallowing tablets[1].As such,the production unit of pharmacy division,Sappasit Prasong Hospital,Ubon Ratchathani province,prepared the extemporaneous formulations such as Acetazolamide(AM),Furosemide(FM)and Phenytoin(PT)powder for suspensions.The extemporaneous suspensions of 10 mg/mL AM,2 mg/mL FM and 10 mg/mL PT were prepared from 250 mg Diamox?,40 mg Lasix?and 50 mg Dilantin?tablets,respectively and diluted with syrup vehicle.

Effects of Size and Surface Charge of Polymeric Nanoparticles on in Vitro and in Vivo Applications

Biodegradable polymeric materials are the most common carriers for use in drug delivery systems. With this trend, newer drug delivery systems using targeted and controlled release polymeric nanoparticles (NPs) are being developed to manipulate their navigation in complex in vivo environment. However, a clear understanding of the interactions between biological systems and these nanoparticulates is still unexplored. Different studies have been performed to correlate the physicochemical properties of polymeric NPs with the biological responses. Size and surface charge are the two fundamental physicochemical properties that provide a key direction to design an effective NP formulation. In this critical review, our goal is to provide a brief overview on the influences of size and surface charge of different polymeric NPs in vitro and to highlight the challenges involved with in vivo trials.

Application of a Rapid ESI-MS/MS Method for Quantitative Analysis of Docetaxel in Polymeric Matrices of PLGA and PLGA-PEG Nanoparticles through Direct Injection to Mass Spectrometer

Docetaxel is a member of taxan family of antineoplastic agents widely used in cancer chemotherapy. However, application of conventional chemotherapy with commercial formulation has been accompanied with matters of concern regarding drug’s biodistribution, pharmacokinetics, and pharmacodynamics. Polymeric nanoparticles have been widely used as unique drug delivery vehicles to circumvent such problems. Docetaxel-loaded poly (lactide-co-glycolide) (PLGA) and poly (lactide-co-glycolide)-poly (ethylene glycol) (PLGA-PEG) nanoparticles fit well in modifying drug’s pharmacokinetic characteristics as intravenous (IV) sustained-release delivery vehicles. In such circumstances, characterization of nanoparticles in terms of their drug-payload would be a necessary step. The majority of studies have used HPLC analysis method for docetaxel quantitation in polymeric nanoparticles. Herein, a rapid ESI-MS/MS method for quantitative analysis of docetaxel in polymeric matrices of PLGA and PLGA-PEG nanoparticles through direct injection to mass spectrometer has been developed and validated. The assay was validated over a range of 3.9 - 1000 ng/ml and 125 - 16,000 ng/ml. Samples were directly injected to the instrument through an isocratic elution (0.1% formic acid in methanol) and detection was performed on a Hybrid Triple Quadrupole/Linear Ion trap mass spectrometer with multiple reaction monitoring (MRM) mode via positive electrospray ionization (ESI) source. The run time and retention time were 2 and 0.6 minutes respectively. The method demonstrated acceptable level of accuracy and precision and was successfully applied for quantitative analysis of docetaxel in polymeric nanoparticles of PLGA and PLGA-PEG.

Characterisation of colonic dysplasia-like epithelial atypia in murine colitis

AIM To determine if exacerbation of pre-existing chronic colitis in Winnie(Muc2 mutant) mice induces colonic dysplasia.METHODS Winnie mice and C57BL6 as a genotype control, were administered 1% w/v dextran sulphate sodium(DSS) orally, followed by drinking water alone in weeklong cycles for a total of three cycles. After the third cycle, mice were killed and colonic tissue collected for histological and immunohistochemical evaluation. Inflammation and severity of dysplasia in the colonic mucosa were assessed in H&E sections of the colon. Epithelial cell proliferation was assessed using Ki67 and aberrant β-catenin signalling assessed with enzyme-based immunohistochemistry. Extracted RNA from colonic segments was used for the analysis of gene expression using real-time quantitative PCR. Finally, the distribution of Cxcl5 was visualised using immunohistochemistry.RESULTS Compared to controls, Winnie mice exposed to three cycles of DSS displayed inflammation mostly confined to the distal-mid colon with extensive mucosal hyperplasia and regenerative atypia resembling epithelial dysplasia. Dysplasia-like changes were observed in 100% of Winnie mice exposed to DSS, with 55% of these animals displaying changes similar to high-grade dysplasia, whereas high-grade changes were absent in wild-type mice. Occasional penetration of the muscularis mucosae by atypical crypts was observed in 27% of Winnie mice after DSS. Atypical crypts however displayed no evidence of oncogenic nuclear β-catenin accumulation, regardless of histological severity. Expression of Cav1, Trp53 was differentially regulated in the distal colon of Winnie relative to wild-type mice. Expression of Myc and Ccl5 was increased by DSS treatment in Winnie only. Furthermore, increased Ccl5 expression correlated with increased complexity in abnormal crypts. While no overall difference in Cxcl5 mucosal expression was observed between treatment groups, epithelial Cxcl5 protein appeared to be diminished in the atypical epithelium. CONCLUSION Alterations to the expression of Cav1, Ccl5, Myc and Trp53 in the chronically inflamed Winnie colon may influence the transition to dysplasia.

Comparison of Measured Trough Values after Deriving the Initial Dose Setting of Vancomycin with a Conventional Computer Software and a Nomogram Based on the Revised Japanese 2016 Therapeutic Drug Monitoring Guidelines for Antimicrobial Agents

Background: Due to the relatively high renal toxicity of vancomycin injection (VCM), setting an initial dose that achieves a trough that ranges between 10 and 20 μg/mL on day 3 is important to ensure safety and minimize side-effects, especially for patients with low renal function. To address these issues, the revised 2016 Therapeutic Drug Monitoring (TDM) Guidelines for Antimicrobial Agents (GL2016) proposed the use of a renal function-based, estimate glomerular filtration rate (eGFR) nomogram for setting the dose of VCM in Japan. Methods: Our hospital introduced the use of the GL2016 in September 2016 for the patients administered VCM. After setting the initial VCM dose using 1) a conventional VCM analysis software and 2) the GL2016 eGFR nomogram, the measured trough values on day 3 were compared and evaluated in this study. Results: With the VCM analysis software, the mean measured trough value in the a-total group (n = 53) was 12.8 ± 4.7 μg/mL. With the eGFR nomogram, the mean measured trough value in the b-total group (n = 13) was 9.6 ± 4.6 μg/mL. However, when the different severities of renal function were compared, the mean measured trough value was more significantly lower in the b-1 group than in the a-1 group among subjects with G2 and above (eGFR ≥ 60 mL/min/1.73 m2), but it was similar between the a-2 group and the b-2 group among subjects with G3 and below (eGFR 60 mL/min/1.73 m2). The proportion of subjects reaching the various trough ranges shows similar tendency. Conclusions: These data suggested that the measured trough value on day 3 was generally lower when the initial dose was established using the eGFR nomogram based on the GL2016, and this was especially prominent among patients with normal renal function. As for subjects with low renal function, the trough values were relatively high while ensuring safety.

Off-label use of targeted therapies in oncology

Off-label use is defined by the prescription of a marketed drug outside the conditions described in the summary of product characteristics.In oncology,off-label prescribing of targeted therapies may occur in patients with other tumor types expressing the same target.Agents associated to phenotypic approaches such as therapies against the tumoral vasculature(anti-angiogenic drugs) and new immunotherapies(checkpoint inhibitors) also carry the potential of alternative indications or combinations.Off-label use of targeted therapies is little documented and appears to be in the same range than that regarding older drugs with wide variations among agents.When compared with older agents,off-label use of targeted therapies is probably more rational through tumoral genotyping but is faced with a limited clinical support,reimbursement challenges related to the very high pricing and the cost of genotyping or molecular profiling,when applicable.

Winston-Lutz-Gao Test on the True Beam STx Linear Accelerator

In the linear accelerator-based stereotactic radio surgery (SRS) and stereotactic body radiotherapy (SBRT) programs, single isocenter-multiple metastases’ treatment has become more and more popular due to their high efficiency in treatment time. However, the absence of a comprehensive quality assurance program is still the challenge for medical physicists. The Winston-Lutz-Gao test, which we developed two years ago, was performed for the first time on a True Beam STx (Varian Medical System) linear accelerator in this study. Beams were designed by Eclipse with gantry, collimator, and couch full rotations, and a 200-pound weight was placed on the couch to mimic real treatment. The “frameless SRS QA target pointer” from the Brainlab company, with a 3.5-mm metallic ball embedded in the center, was used as a phantom. Images were acquired by the portal imager built-in linear accelerator and analyzed directly by the Image browser in ARIA. We found that the farther the metastases were from the linac isocenter, the worse the congruence was between the beam mechanical and the radiation center. The farthest metastases should be within 6 cm from the linac isocenter per the AAPM TG-142 and American Society for Radiation Oncology (ASTRO) white paper criteria. To the best of our knowledge, this is the first off-isocenter Winston-Lutz test performed on a True Beam STx linear accelerator.

Risk Factors for Gastrointestinal Injuries in Acute Coronary Syndrome Patients with Double Antiplatelet Therapy in One-Year Follow-Up

Background: The goal is to determine the incidence of symptomatic gastrointestinal (GI) injuries in acute coronary syndrome (ACS) patients receiving double antiplatelet therapy (DAPT). The risk factors for serious GI complications are also evaluated. Methods: 603 eligible patients from the Department of Cardiology at Zhongda Hospital between January 2014 and August 2015 were enrolled and the occurrence of GI injuries within one year assessed. The risk factors for serious GI complications were identified using cox regression analysis. Results: After one-year follow-up, 108 (17.9%) out of 603 patients developed symptomatic GI injuries: 22 (3.65%) with serious GI complications and 86 (14.2%) with GI symptoms. Drinking habit (95% CI: 1.512 - 8.796;P = 0.004) and previous peptic injury (95% CI: 2.307 - 18.080;P = 0.001) are independent predictors of serious GI complications, while proton pump inhibitor (PPI) was protective (95% CI: 0.120 - 0.699;P = 0.006) per cox regression analysis. Additionally, GI injuries of both serious GI complications and GI symptoms peaked in the first three months. Conclusions: Symptomatic GI injuries were relatively common in ACS patients with DAPT, especially in the first three months. Previous peptic injury and drinking habit were significant independent risk factors for serious GI complications, while PPI played a protective role in ACS with DAPT.

妊娠晚期应用奈韦拉平的毒性研究

Objective: Nevirapine-based therapy is associated with increased frequency of adverse events among women with CD4+cell count of 250 cells/μL or greater. We evaluated the safety of nevirapine-based antiretroviral therapy in human immunodeficiency virus (HIV)-1-infected pregnant women. METHODS: We retrospectively evaluated 23 pregnancies managed with nevirapine-based regimens from July 2001 to April 2005. The incidence of adverse events was determined and analyzed by CD4+cell count of either less than or greater than or equal to 250 cells/μL, and gestational age when nevirapine was initiated. Liver function abnormality was graded according to the National Institute of Allergy and Infectious Diseases Division of AIDS toxicity guidelines. RESULTS: Five of 23 patients (21.7%) started nevirapine-based therapy after 27 weeks of gestation. All 3 cases of adverse events occurred in this group within 6 weeks of initiating therapy and with CD4+cell count greater than 250 cells/μL. A significant difference was noted in the proportion of patients who developed toxicity while starting nevirapine in the third trimester (3/5, 60%; 95%confidence interval 14.66-94.73%) compared with those starting nevirapine earlier in pregnancy (0/18, 0%; 95%confidence interval 0.0-18.53%; P < .006). Two patients developed rash, eosinophilia, and liver function abnormality, with one developing clinical hepatitis and renal failure. A third patient had abnormal elevation of liver enzymes but was asymptomatic. CONCLUSION: The incidence of adverse events with nevirapine may be lower than previously reported (13%versus 29%) and may be primarily noted with initiating the drug late in pregnancy. Further study of nevirapine in larger cohorts of HIV-infected pregnant women is warranted to determine the relationship between nevirapine hepatotoxicity and trimester use.

Chemistry-led investigations into the mode of action of NAMPT activators,resulting in the discovery of non-pyridyl class NAMPT activators

The cofactor nicotinamide adenine dinucleotide(NAD+)plays a key role in a wide range of physiological processes and maintaining or enhancing NAD+levels is an established approach to enhancing healthy aging.Recently,several classes of nicotinamide phosphoribosyl transferase(NAMPT)activators have been shown to increase NAD+levels in vitro and in vivo and to demonstrate beneficial effects in animal models.The best validated of these compounds are structurally related to known urea-type NAMPT inhibitors,however the basis for the switch from inhibitory activity to activation is not well understood.Here we report an evaluation of the structure activity relationships of NAMPT activators by designing,synthesising and testing compounds from other NAMPT ligand chemotypes and mimetics of putative phosphoribosylated adducts of known activators.The results of these studies led us to hypothesise that these activators act via a through-water interaction in the NAMPT active site,resulting in the design of the first known urea-class NAMPT activator that does not utilise a pyridine-like warhead,which shows similar or greater activity as a NAMPT activator in biochemical and cellular assays relative to known analogues.

Improvement of Quality of Nonanesthetic Colonoscopy by Preoperative Administration of Pinaverium Bromide

Background： Nonanesthetic colonoscopy is popular in clinical practice in China. However, intestinal spasms often result in a prolonged examination time, increased operating difficulties, decreased polyp detection rate, and failure to complete the procedure clinically. Therefore, exploring alternative approaches that can reduce the pain in patients during colonoscopy is of utmost importance, and finding the optimal preoperative administration to improve the quality of nonanesthetic colonoscopy is also necessary. This study aimed to investigate the effects of the prophylactic administration of pinaverium bromide before colonoscopy and the effects of pinaverium bromide alone at different time points or combined with scopolamine butylbromide. Methods： A randomized controlled trial was performed on a cohort of 1000 patients who underwent colonoscopy in outpatient clinic of Wuhan Union Hospital. The patients were randomly assigned to the following groups： Group A, given oral pinaverium bromide （100 mg, three times a day） one day before examination combined with intramuscular injection of scopolamine butylbromide （20 mg） 10 min before colonoscopy; Group B0, given pinaverium bromide alone on the day ofcolonoscopy （ 100 mg, three times a day）; Group B1, given pinaverium bromide alone （100 mg, three times a day） one day before colonoscopy; Group B2, given pinaverium bromide alone （100 mg, three times a day） two days before colonoscopy; and Group C, given scopolamine butylbromide alone （20 mg） before colonoscopy. The successful rate of colonoscopy, procedure time, degree of abdominal pain, and polyp detection rate were recorded and compared among all groups. Results： The successful rate of colonoscopy in Group B1 （82.0%） and Group B2 （83.0%） was significantly higher than that in Group B1 （62.0%, all P 〈 0.01 ）. The time to reach the ileocecal region in Group B1 and Group B, were lower than those in Group B0 （all P 〈 0.05）. However, no significant differences were observed in polyp detection rate between Group B1（24.0%） or Group B2 （26.0%）, and Group Bo （22.4%, all P 〉 0.05）. Furthermore, there were no significant differences in the various parameters examined between Group B1 and Group B2 （P 〉 0.05）. The successful rate of colonoscopy in Group A （92.0%） was significantly higher than that in Group B2 （82.0%） and Group C （80.0%; both P 〈 0.05）. Moreover, the time for the colonoscope to reach the ileocecal region in Group A were markedly shorter as compared to those in Group B1 and Group C （P 〈 0.05）. The polyp detection rate in Group A was 32.0%, significantly higher than that in Group B1 （24.0%, P 〈 0.05） and Group C （24.2%, P 〈 0.05）. Conclusion： Administration of pinaverium bromide alone one day before examination was beneficial to relieve symptoms of abdominal pain during nonanesthetic colonoscopy. In addition, therapeutic effects were improved when pinaverium bromide administration was combined with intramuscular injection of scopolamine butylbromide. Therefore, the combined use ofpinaverium bromide with scopolamine butylbromide might have great application value to improve the quality of nonanesthetic colonoscopy in the preoperative preparation.

Effects of drug-polymer dispersions on solubility and in vitro diffusion of artemisinin across a polydimethylsiloxane membrane

Artemisinin(ART) is a sesquiterpene lactone with an endo-peroxide bridge that is thought to be responsible for its antimalarial activity.It has low oral bioavailability because of aqueous insolubility,which leads to local toxicity at the site of aggregation.The present work focused on increasing its solubility and evaluating its permeation across a model membrane to mimic transdermal delivery that bypasses the hepatic metabolism.For this purpose,physical mixtures(PM),solid dispersions(SD) and lyophilized dispersions(LD) with different drug-polymer ratios(1:0.5,1:1,1:2,1:4 and 1:9) were prepared using the hydrophilic polymer polyvinylpyrrolidone(PVP).Drug-polymer dispersions were characterized using X-ray diffraction(XRD) and Fourier transform infrared spectroscopy(FTIR).Solubility was measured in three solvents:de-ionized water,phosphate buffered saline(PBS) and methanol.The toluene-water partition coefficient was evaluated and compared with the literature and calculated logP values.In vitro diffusion of ART was studied across a polydimethylsiloxane membrane from a saturated solution of drug-polymer dispersions.XRD patterns showed a gradual decrease in crystallinity of ART with increasing polymer concentration,while FTIR confirmed no interactions between ART and PVP.Solubility was increased up to 4-,5-and 8-fold for LD in water,PBS and methanol,respectively.The logP for toluene-water was 2.65 ± 0.3,which is in good agreement with literature and calculated logP values.Permeation was enhanced,which is attributed to the decrease in crystallinity and increase in wettability of the drug.The ART flux was significantly higher than that of pure ART(0.12 ± 0.01) with increasing PVP concentration for SD and LD formulations.In conclusion,drug-polymer dispersions with PVP improve the pharmaceutical properties of ART in the order LD>SD>PM.

Large-area burns with pandrug-resistant Pseudomonas aeruginosa infection and respiratory failure

Background Infection due to pandrug-resistant Pseudomonas aeruginosa （PDRPA） has become a challenge in clinical practice. The aim of this research was to summarize the treatment of large-area burns （60%-80%） with PDRPA infection and respiratory failure in our hospital over the last two years, and to explore a feasible treatment protocol for such patients.Methods We retrospectively analyzed the treatment of five patients with large-area burns accompanied by PDRPA infection and respiratory failure transferred to our hospital from burn units in hospitals in other Chinese cities from January 2008 to February 2010. Before PDRPA infection occurred, all five patients had open wounds with large areas of granulation because of the failure of surgery and dissolving of scar tissue; they had also undergone long-term administration of carbapenems. This therapy included ventilatory support, rigorous repair of wounds, and combined antibiotic therapy targeted at drug-resistance mechanisms, including carbapenems, ciprofloxacin, macrolide antibiotics and β-lactamase inhibitors.Results Four patients recovered from bums and one died after therapy.Conclusions First, compromised immunity caused by delayed healing of burn wounds in patients with large-area bums and long-term administration of carbapenems may be the important factors in the initiation and progression of PDRPA infection. Second, if targeted at drug-resistance mechanisms, combined antibiotic therapy using carbapenems,ciprofloxacin, macrolide antibiotics and β-lactamase inhibitors could effectively control PDRPA infection. Third, although patients with large-area burns suffered respiratory failure and had high risks from anesthesia and surgery, only aggressive skin grafting with ventilatory support could control the infection and save lives. Patients may not be able to tolerate a long surgical procedure, so the duration of surgery should be minimized, and the frequency of surgery increased.

体质量稳定及肠外营养特征与结直肠癌患者预后的相关性

背景:代谢紊乱及肠外营养(PN)特征对接受肠外营养的癌症患者生存的影响,目前所知有限。本研究旨在评估临床方法:研究纳入美国MD Anderson癌症中心2008-2013年接受肠外营养支持的572例结直肠癌患者。记录病例特征、体质指数、体质量、药物/手术治疗史、PN适应证、PN相关数据及生存情况。分析临床及PN特征与患者生存的相关性。结果:437例患者纳入最终分析,平均年龄57岁,81%为进展期结直肠癌。经多因素校正后,PN开始前体质量不稳定(变化≥2.5%)与生存负相关(HR=1.41,P=0.023)。肠梗阻作为PN适应证者较无肠梗者预后更差(HR=1.75,P=0.017)。PN配方中每千克理想体质量的氨基酸含量(g/kg)更高者,其生存时间更长(HR=0.59,P=0.029);而非PN配方中的静脉卡路里摄入量更高者,其生存时间更短(HR=1.04,P=0.011)。结论:体质指数和体质量稳定可能是预测接受PN支持的结直肠癌患者预后的有效营养学指标。制定PN计划时应考虑到非PN卡路里的摄入量,从而获得最佳的能量支持和能量平衡。进一步研究需明确PN配方中最优的氨基酸需求量和能量平衡。