Combined effect of Controlling Nutritional Status and Acute Kidney Injury on severe COVID-19 short-term outcomes

Introduction/ObjectivesAcute kidney injury (AKI) and malnutrition are two complications commonly reported in severe forms of COVID-19, their combined effect on short-term mortality is, however, not yet investigated. The objective of this study is to determine both their individual and combined effects on short-term prognosis.Materials and methodsThis is a prospective, uni-centric study, including 247 severe COVID-19 patients, admitted between April 25th and June 20th, 2020, at the University Hospital of Blida. AKI was defined according to the KDIGO-2012 guidelines. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score. The association with in-hospital mortality was assessed using the Kaplan-Meier method and proportional Cox regression.ResultsAmong the 247 severely affected COVID-19 patients included in this study, 34.4% developed AKI, 30.4 and 1.2%, respectively, had moderate and severe CONUT scores, 17.7% worsened and progressed to a critical state and 26.7% did not survive. Both AKI and CONUT score were significantly associated with mortality in a dose-response manner (pLog-Rank < 0.0001). Their relative risks are respectively (HR = 3.25 CI 95% [1.99–5.3] and HR = 2.42 CI 95% [1.5–3.9], p < 0.0001). In multivariate analysis, the highest risk was observed for the AKI-CONUT-high combination (HR = 3.0, 95% CI [1.5–6.1], p = 0.002).ConclusionA possible synergistic interaction between AKI and CONUT score for COVID-19 short-term mortality has been highlighted. Monitoring of renal function associated with assessment of nutritional status should be performed routinely and systematically from the early stages of admission.     

肠内营养剂治疗小儿营养不良效果

应用肠内营养剂对小儿营养不良进行治疗。营养剂治疗组13例,平均年龄5．4岁,其中结核性脑膜炎昏迷5例,慢性腹泻8例,计算出每人每日所需营养素,摄入量为21～42ml·kg-1·d-1,一日3次。对照组15例,平均年龄5．2岁,供给自制混合奶。结果治疗组体重（WT）,三头肌皮褶厚度（TSF）,上臂肌围（MAMC）,血红蛋白（Hb）,血清白蛋白（AL）有明显增加,而对照组无明显改变。证明肠内营养剂应用简便,无副作用,能较快恢复人体测量指标和生化指标,改善营养不良。     

合肥郊区0—6岁儿童营养状况分析

目的：了解合肥郊区儿童的营养状况,评价农村儿保工作的质量。方法：于1990－1995年按既定诊断标准逐年调查全区0－6岁儿童佝偻病、缺铁性贫血（IDA）及营养不良的患病情况。结果;全区儿童营养不良、佝楼病及IDA的患病率分别为0.25％－1.06％,5.72％－18.44％及8．33％－42.9％;1992－1995年营养不良患病率有逐年下降的趋势,而佝偻病及贫血则相反;婴幼儿较学龄前儿童佝偻病患病情况严重,而贫血则相反;男女童营养状况无差异;经济状况较好的近郊儿童的营养状况明显好于经济状况较差的远郊儿童。结论：农村儿保工作的重点仍应放在营养缺乏病的防治上．对婴幼儿重点在佝偻病,学龄前儿童重点在IDA。     

肠外营养在不能手术肝癌治疗中的应用

目的:观察肠外营养在肝癌治疗中的作用.方法:38例体重下降超过10%不能手术的肝癌患者随机分成A、B两组,A组接受肝动脉插管化疗栓塞(TACE)前给予肠外营养(PN)支持;B组单接受TACE.结果:A组有效率及一年存活率均显著高于B组.结论:TACE前给予PN支持可以提高伴有营养不良的不能手术肝癌的治疗效果.     

Immunohistochemical examination of the INK4 and Cip inhibitors in the rat neonatal cerebellum: cellular localization and the impact of protein calorie malnutrition

Expression of the cyclin-dependent kinase inhibitors (CKIs) has been linked to the inhibition of cellular proliferation and the induction of differentiation. Based on structure function analysis, two distinct families of CDKIs, the INK4 and the Cip/Kip family have been identified. The INK4 family member p16(Ink4), and the Cip/Kip protein p27(Kip1) have been implicated in normal development of the CNS and cerebellum. Recent studies have suggested a functional inter-dependence between the CKI and the abundance of cyclin D1 in orchestrating growth factor-induced cellular proliferation. The neonatal rat cerebellum undergoes proliferative growth and differentiation, localized to distinct topographical regions and cell types. The cell type and the temporal profile of CKI expression during postnatal cerebellar development had not been described. The current studies determined the specific cerebellar cell types in which the CKIs were expressed during post natal development by co-staining for cell-type specific markers. p16(Ink4a) and p27(Kip1) immunostaining was identified in both neurons and glial cells, increasing progressively between postnatal days 6 to 13 into adulthood. By contrast, neuronal and glial cell p21(Cip1) staining was prominent at days 6-11 and decreased thereafter. Cyclin D1 was expressed in the proliferating external granular cells, with occassional staining in the molecular, and internal granular layers. Dual immunostaining demonstrated cyclin D1 within cells expressing CKI (p16(Ink4a), p21(Cip1),p27(Kip1)). Cerebellar cellular growth arrest, induced by protein-calorie malnutrition, inhibited cyclin D1 protein levels without affecting CKI immunostaining suggesting CKI do not mediate the developmental arrest. These results demonstrate that the CKIs are induced by differentiation cues in specific cell types with distinct kinetics in the developing cerebellum in vivo.     

营养状况及血清尿酸水平与慢性阻塞性肺疾病的关系

目的测定慢性阻塞性肺疾病(COPD)患者实际体重与标准体重的百分比(IBM%)及血清尿酸 (UA)水平,以探讨其与COPD严重程度的关系。方法测定187例稳定期COPD患者的IBM%、血清UA、肺功能[第1秒用力呼气容积的实测值占预计值的百分比(FEV1%)、第1秒用力呼气容积占用力肺活量的百分比 (FEV1/FVC)、用力呼气中期流速(MMEF)、最大呼气峰流速(PEF)、75%肺活量时的最大呼气流速(FEF25)、 50%肺活量时的最大呼气流速(FEF50)]及心电图,根据气流受限程度分为ⅡA、ⅡB、Ⅲ级COPD,根据心电图检查结果分成伴肺源性心脏病(肺心病)组和不伴肺心病组。结果ⅡA级COPD组的血清IBM%为1．03±0．15, ⅡB级COPD组为0．95±0．15,Ⅲ级COPD组为0．93±0．14,ⅡA级COPD组与ⅡB级COPD组和Ⅲ级COPD 组的差异有显著性(P<0．05和<0．01)。ⅡA级COPD组血清UA水平为(380．54±77．62)μmol／L,ⅡB级 COPD组为(356．32±65．33)μmol/L,Ⅲ级COPD组为(335．06±57．97)μmol／L,各组间比较差异均有显著性 (P值均<0．05)。伴肺心病组的血清IBM%为0．92±0．15,不伴肺心病组为1．01±0．14,两组间差异有显著性 (P<0．05)。伴肺心病组的血清UA为(340．36±65．46)μmol／L,不伴肺心病组为(366．28±68．78)μmol／L,两组间差异有显著性(P<0．01)。在控制年龄、营养等因素后,UA与FEV1%呈显著正相关(标准化回归系数= 0．217,P<0．01)。结论营养不良是COPD独立的预后因子;血清UA降低是COPD的独立危险因子之一。     

中国5岁以下儿童营养不良的社会决定因素研究

目的： 了解中国5岁以下儿童营养不良与社会决定因素的关联程度，为制定进一步改善儿童营养不良的社会政策提供依据。方法： 从中国居民健康和营养调查（China Health and Nutrition Survey, CHNS）1991-2011年的纵向数据中提取2 434名5岁以下儿童，使用世界卫生组织igrowup软件计算儿童营养不良率，使用多因素非条件Logistic回归分析营养不良与社会决定因素的关联。结果： 20年间儿童整体低体重率和生长迟缓率分别下降了64.8%和67.8%，儿童低体重和生长迟缓得到显著改善。消瘦率一直维持在较低水平，女童营养不良率的降低幅度大于男童。非社会经济因素中，母亲身高低、儿童蛋白质摄入不足是营养不良的危险因素。社会决定因素中，居住在西部和中部、居住地城市化水平低、家庭收入低、母亲教育水平低是儿童营养不良的危险因素。结论： 为进一步改善儿童营养不良和缓解儿童健康不公平，需要重视儿童营养不良背后的社会决定因素，完善并实施改善儿童营养相关的社会政策，包括关注孕产妇和儿童的膳食营养、提高家庭生活水平和母亲教育水平、平衡地区间发展差距和资源分配等。     

晚期肿瘤患者营养状况与焦虑、抑郁的相关性分析

目的 研究晚期肿瘤患者营养状况与焦虑、抑郁不良情绪的相关性。方法 筛选2019年1月至2020年1月在重庆市 巴南区人民医院肿瘤科住院的晚期肿瘤患者，调查营养风险筛查2002（NRS 2002）评分、体质指数（BMI）、血液学指标（总蛋白、 白蛋白、血红蛋白）；用住院患者焦虑抑郁量表（HADS）对患者的焦虑、抑郁情况进行评估；分析晚期肿瘤患者营养状况与焦 虑、抑郁之间的关系。结果 1501例晚期肿瘤患者中 22.39%（336/1501）的患者 BMI<18.5 kg/m2，NRS 2002≥3 分发生率为 56.70%（851/1501）。存在营养风险患者总蛋白、白蛋白、血红蛋白以及BMI更低；比较不同癌种，晚期消化道肿瘤患者营养不 足及存在营养风险比例最高。焦虑症状阳性率为78.61%（1180/1501），抑郁症状阳性率为69.62%（1045/1501），NRS 2002评分 与焦虑、抑郁呈正相关；BMI与焦虑、抑郁呈负相关。结论 晚期肿瘤患者营养不足、营养风险发生率高，焦虑、抑郁不良情绪普 遍，NRS 2002评分越高，BMI越低，焦虑抑郁程度越重。针对营养风险高、营养不足的晚期肿瘤患者我们应加强营养治疗以及 对焦虑、抑郁不良情绪的干预。