Ceramide in Lipid Emulsions Used in Parenteral Nutrition

Parenteral nutrition-associated liver disease is a prevalent and severe complication of long term parenteral nutrition. We present here for the first time data on the presence of ceramide, a bioactive compound involved in a variety of metabolic processes, in different lipid emulsions used in parenteral nutrition. Further research is needed to determine whether this potential harmful bioactive compound is involved in parenteral nutrition-associated liver disease.     

Toward the Development of Predictive Equations for Resting Metabolic Rate in Acutely Ill Spontaneously Breathing Patients

Background: There are many equations used for calculating energy needs of nutrition support patients but few developed specifically for the subset of spontaneously breathing acutely ill patients. The purpose of the current study was to validate existing equations and to start developing new equations for this cohort. Methods: Acutely ill patients not requiring mechanical ventilation had their resting metabolic rate measured using an indirect calorimeter. Metabolic rate was also calculated using the Mifflin–St Jeor equation, the Ireton‐Jones equation for spontaneously breathing patients, and a modification of the Penn State equation in which the minute ventilation‐dependent variable was removed. These calculated values were compared with measured expenditure and considered accurate if they fell within 10% of the measurement. Results: Fifty‐five patients were measured successfully. The modified Penn State equation was accurate in 71% of patients compared with 44% for Ireton‐Jones and 42% for Mifflin–St Jeor. Several forms of a new equation were outlined but not validated. The equation with the highest R² (0.82) was as follows: resting metabolic rate (kcal/d) = weight in kg (20) ? age in years (3) + male sex (197) + body mass index in kg/m² (25.9) + mean heart rate in beats/min (9.4) + 89. Conclusions: A modification of the Penn State equation for predicting resting metabolic rate was shown to accurately predict resting metabolic rate in acutely ill, spontaneously breathing patients if body mass index was ≥20.5 kg/m². A new set of population‐specific equations was outlined but should not be used until validated.     

肠内营养对重症急性胰腺炎患者肠屏障功能的影响

目的 观察肠内营养(EN)对重症急性胰腺炎(SAP)患者肠屏障功能的影响,并探讨其在SAP治疗中的临床应用价值.方法 收集2009年12月至2011年12月收治的SAP患者40例,按照营养支持方式分为全胃肠外营养(TPN)组20例和EN组20例.分析两组急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、血清内毒素、肠脂肪酸结合蛋白(IFABP)表达水平的差异.酶联免疫吸附试验方法检测血清内毒素和IFABP表达水平.结果 两组APACHEⅡ评分在治疗第1、7、14、21天呈逐渐降低趋势(P＜0.05),且EN组治疗第7、14、21天的APACHEⅡ评分显著低于TPN组[(7.03±1.86)分比(8.12±2.11)分、(5.32±1.14)分比(6.87±1.35)分、(3.49±0.83)分比(5.15±1.02)分,P＜ 0.05];两组血清内毒素表达水平在治疗第1、7、14、21天呈逐渐减低趋势(P＜ 0.05),且EN组治疗第7、14、21天血清内毒素表达水平显著低于TPN组[(48.18±15.48) EU/L比(60.12±18.16) EU/L、(33.46±12.04) EU/L比(51.32±14.66) EU/L、(22.15±7.81) EU/L比(35.62±12.53)EU/L,P＜0.05];两组血清IFABP表达水平在治疗第1、7、14、21天呈逐渐减低趋势(P＜0.05),且EN组治疗第7、14、21天血清IFABP表达水平显著低于TPN组[(18.47±3.55) ng/L比(22.57±4.14)ng/L、(10.32±2.68) ng/L比(18.11±3.62) ng/L、(6.39±2.26) ng/L比(12.16±3.06) ng/L,P＜0.05].相关性分析显示APACHEⅡ评分与血清内毒素(r=0.612,P＜0.05)和IFABP(r=0.634,P＜0.05)表达水平呈显著正相关,血清内毒素与IFABP表达水平亦呈显著正相关(r=0.627,P＜ 0.05).结论 EN治疗有助于SAP患者肠屏障功能的恢复,疗效优于TPN治疗,值得临床推广应用.     

Estimating treatment difference for binary responses in the presence of surrogate endpoints

Surrogate endpoint is chosen as a measure or indicator of a biological process that is obtained sooner, at less cost or less invasively than a true endpoint of health outcome, and is used to arrive at conclusions about the effect of intervention on the true endpoint. Following the work of Begg and Leung (J. R. Stat. Soc. Ser. A 2000; 163:15-28), we introduce a new motivation to analyse the surrogate and true endpoints together, to have a better estimate of the treatment difference where both the endpoints are binary. Several estimators are studied and compared. Some real data sets are analysed.     

六种辛辣食品的营养保健价值

介绍了六种辛辣食品(辣椒、生姜、大蒜、洋葱、花椒和胡椒)的营养特点。分别阐述了六种辛辣食品的营养成分和对人体的营养保健价值。     

TOTAL PARENTERAL NUTRITION AND CROHN'S DISEASE

Total parenteral nutrition (TPN) produced subjective and objective improvement in eight patients with Crohn's disease. TPN is useful in treating nutritional disorders caused by the disease and/or other treatment programs. Hypophosphatemia is a serious complication of TPN therapy requiring prompt attention.     

不同营养支持方式对重症急性胰腺炎患者肠道菌群失调的影响分析

目的 探讨不同营养支持方式对重症急性胰腺炎(SAP)患者肠道菌群失调的影响.方法 将2003年1月至2010年6月收治的66例SAP患者按随机数字表法分为研究组和对照组,每组33例,分别接受肠内营养和全胃肠外营养支持治疗,观察并比较两组患者肠道菌群失调的发生情况.结果 经营养支持治疗后,研究组大肠埃希菌和肠球菌的数量明显低于对照组,差异有统计学意义(P＜0.05);双歧杆菌和乳酸杆菌的数量则显著高于对照组,差异有统计学意义(P＜0.05).研究组肠道菌群失调的发生率为24.2%(8/33),显著低于对照组的51.5%(17/33),差异有统计学意义(P＜0.05).结论 肠内营养支持较单独全胃肠外营养支持能减少SAP患者肠道菌群失调的发生.

Abstract：

Objective To investigate the influence of different nutritional support ways on intestinal dysbacteriosis in patients with severe acute pancreatitis (SAP).Methods Sixty-six patients with SAP from January 2003 to June 2010 were divided into study group and control group according to random digits table,33 cases in each group,they were treated with enteral nutrition and total parenteral alimentation support treatment respectively and the incidence of intestinal dysbacteriosis was observed and compared.Results In 7 - 10 d after the onset of SAP,the number of escherichia coli and enterococci in study group were significantly lower than those in control group,the difference was statistically significant (P ＜ 0.05 );the number of bifidobacterium and lactobacillus were significantly higher than those in control group (P ＜ 0.05 ).A total of 25 patients in both groups occurred intestinal dysbacteriosis,the total incidence was 37.9%,the incidence in study group was 24.2% (8/33) and which was significantly lower than that in control group [51.5%( 17/33 )](P ＜ 0.05 ).Conclusion Enteral nutrition support treatment can reduce the incidence of intestinal dysbacteriosis in patients with SAP,its efficacy is better than parenteral nutrition.     

八省城乡0～5岁婴幼儿生长发育与家长喂养行为的调查分析

目的调查分析我国八省城乡0～5岁婴幼儿的营养和喂养现状。了解其中婴幼儿生长发育中存在的主要问题,为进一步制定营养改善措施提供依据。方法利用卫生部社妇司2004年在八省城乡开展的“0～5岁婴幼儿营养状况调查”,对我国八省城乡17081名0～5岁婴幼儿进行身高、体重的测量,并以问卷的形式对以上婴幼儿的家长进行了喂养行为的调查。结果城乡婴幼儿生长发育出现差异是从4月开始;农村1～2岁为营养不良的高发期,并以长期慢性营养不良为主;八省西部农村营养不良率高达20%以上,高于中、东部地区。结论在婴儿辅食添加中农村明显存在着添加时间、添加辅食在质量和数量上不科学合理的问题。分析原因除了经济的因素外,还与婴幼儿家长缺乏营养和保健知识关系。     

我国儿童营养的误区

在总结我国儿童营养现状的基础上，指出了我国儿童营养存在的6个误区，并认为误区主要归结于经济不发达、营养知识的缺乏、饮食习惯以及对儿童的教育，最后提出采取加强营养知识教育、加强儿童营养的研究和加强食品和农业科学的研究等措施来改善儿童营养状况。     

Zinc Deficiency With Dermatitis in a Parenteral Nutrition–Dependent Patient Due to National Shortage of Trace Minerals

The shortages of intravenous drugs remains critical, with sterile injectables accounting for 80% of the approximately 300 shortages. The impact is being felt in patients dependent on parenteral nutrition (PN), and severe deficiencies are becoming more commonplace. We report here a man who developed severe zinc deficiency, manifesting as a painful desquamative rash, due to an inability to obtain multi–trace element additives for his PN.     

Sensitivity in statistical evaluation of biomarkers

In clinical research and practice, biomarkers help in understanding disease progression and are useful when monitoring patients and making treatment decisions. Correct quantification of biomarkers in predicting the clinical outcome is important for better treatment of individual patients. Despite the rich literature in statistical validation, application of these validation methods in real data is not well studied. Specifically, the question is whether the change in a biomarker or the actual assessed value of the biomarker should be used. Contrary to most published papers in which the actual value of the biomarker is used, we showed through theory, simulation, and an example that it is more appropriate to use the change or the actual value in the marker with adjustment for the baseline value in evaluating a marker. Copyright © 2013 John Wiley & Sons, Ltd.     

Nutritional Treatment in Crohn’s Disease

Crohn’s disease (CD) is a chronic inflammatory bowel disease (IBD) which can affect any part of the whole gastrointestinal tract (from mouth to anus). Malnutrition affects 65–75% of CD patients, and it is now well acknowledged that diet is of paramount importance in the management of the disease. In this review, we would like to highlight the most recent findings in the field of nutrition for the treatment of CD. Our analysis will cover a wide range of topics, from the well-established diets to the new nutritional theories, along with the recent progress in emerging research fields, such as nutrigenomics.     

EVALUATION OF AMINO ACID MIXTURES FOR TOTAL PARENTERAL NUTRITION

Blood aminograms can effectively supplement nitrogen balance in the design of amino acid mixtures for parenteral nutrition. A well-designed mixture of amino acids given parenterally is used efficiently.     

Serum Transthyretin Level Is Associated With Clinical Severity Rather Than Nutrition Status in Massively Burned Patients

Background: The purpose of this study is to clarify the clinical significance of serum transthyretin (TTR) in massively burned patients in nutrition support and clinical severity. Methods: A retrospective study was performed with 204 patients admitted to Hangang Sacred Heart Hospital's Burn Center September 2010‐September 2012 with burn wounds > 20% of total body surface area (TBSA) burned. Serum TTR, C‐reactive protein (CRP), lactic acid, and an NST index (calculated by dividing real caloric intake by estimated caloric need for 7 days) were analyzed on a weekly basis for 5 weeks after admission. Results: When we classified patients with severity according to mortality, percentage of TBSA burned, serum lactic acid, and CRP, mean serum TTR level was significantly higher in the less severe patient group than in the severe patient group in each week for every severity index. And the serum TTR level did not show significant differences by NST index in both the severe patient group and the less severe patient group. In a multivariate logistic regression, percentage TBSA burned, TTR, and lactic acid had an independent association with mortality. Conclusion: Serum TTR did not show a significant difference by nutrition support in massively burned patients with >20% of TBSA burned. But serum TTR was significantly different by the severity of the patient and independently associated with mortality. Hence, serum TTR level can be 1 of the useful biomarkers for comprehending the severity of the illness in massively burned patients.     

食品营养标签的实施——对营养学理论和应用的挑战

我国食品营养标签管理办法,经过专家、管理者和应用者多层次的讨论研究,2004年10月～12月已在网上公布。从国际环境和国内需求来看,对我国食品营养标签实施管理已势在必行。食品营养标签表达了一个食品的基本营养特性和信息,是消费者了解食品的营养组成和特征的来源,也是保证消     

A model for immunological correlates of protection

Immunological assays measure characteristics of the immune system, such as antibody levels, specific to certain diseases. High assay values are often associated with protection from disease. A question of interest is how the relationship between assay values and subsequent development of disease should be quantitatively modelled. Existing approaches successfully model the relationship for high assay values, where the probability of developing disease is low. However at low assay values, the probability of developing disease is more closely associated with factors such as disease prevalence rates and an individual's chance of exposure to infection; these are less well captured by existing models. This paper presents a model that accommodates both assay values and factors independent of assay values, enabling protection from disease to be modelled over the whole range of assay values and proposing a method for predicting the efficacy of a vaccine from the assays of vaccinees and non-vaccinees.     

一种大鼠肠内营养管长期固定的简易方法

目的:建立一种长期可靠的大鼠肠内营养(EN)管固定方法. 方法:将20只大鼠随机分为EN组(实验组)和假手术组(对照组),每组10只.行大鼠近端空肠置管术,并将营养管进行多水平固定,然后将防咬弹簧固定在髂骨上.营养管固定后,使用电子输液泵进行EN液匀速输注,每周监测大鼠体重,并全程观察大鼠对EN的耐受情况. 结果:所有...     

Parenteral Nutrition–Associated Cholestasis in Premature Infants

Purpose: To evaluate whether intravenous lipid (IL) intake is associated with the development of parenteral nutrition–associated cholestasis (PNAC) in infants younger than 32 weeks gestational age (GA). Methods: A retrospective matched case‐control study (1:1) was performed including infants younger than 32 weeks GA admitted to the neonatal intensive care unit within 48 hours after birth. Infants with a chromosomal disorder, TORCH infection (toxoplasmosis, syphilis, rubella, cytomegalovirus, herpes, human immunodeficiency virus, and parvovirus), metabolic disorder, and/or surgical abnormality of the hepatobiliary system were excluded. Infants with PNAC (direct bilirubin 2 mg/dL or higher) comprised the case group, while infants without PNAC comprised the control group. Duration of parenteral nutrition, intravenous fluid intake on the day of development of PNAC, and GA were used as matching criteria. Results: A total of 46 subjects were studied. Daily average intravenous dextrose (ID) intake was significantly higher in infants with PNAC compared with infants without PNAC (12.72 ± 2.5 g/kg/d and 10.64 ± 2.1 g/kg/d, respectively, P = .004). On comparison of receiver operating characteristic curves, the area under the curve for ID intake (0.74) was significantly higher (P = .01) compared with the area under the curve for IL intake (0.59) and intravenous protein (IP) intake (0.52). On logistic regression, daily ID intake was associated with PNAC (odds ratio 1.7; 95% CI, 1.04–2.9, P = .03) after controlling for daily IP and IL intake. Conclusions: ID intake may be associated with the development of PNAC in premature infants. Our findings suggest that limiting ID intake may be more useful than limiting IL intake in reducing the incidence of PNAC in premature infants.