低氮低热量营养支持在老年患者腹部术后应用的临床观察

目的 探讨低氮低热量营养支持在老年腹部手术后应用的临床效果.方法 对2005年1月至2010年6月52例腹部手术后预计超过5天不能进食患者分A、B两组,A组27例给予低氮低热量肠外营养支持,B组25例进行传统肠外营养支持,比较两组的血糖水平、血浆蛋白水平以及并发症的发生率、营养药品费用.结果 经过术后7天的营养支持治疗,低氮低热量组血糖、营养药品费用明显低于传统组.低热量组血糖均值为（5.58±1.34）mmol/L,传统组血糖均值为（7.17±1.52）mmol/L,两组比较差异有显著性（P〈0.05）.低热量组营养药品费用均值（1328.6±103）元,传统组为（2396.8±152）元,两组差异有极显著性（P〈0.01）.血浆蛋白水平、术后并发症的发生率无差异.结论 低氮低热量的肠外营养支持符合老年患者腹部术后患者其代谢特点,有利于全身炎症应激反应的恢复,减少感染并发症的发生,能够安全有效地促进老年腹部术后病人的恢复.     

The abstinence violation effect and very low calorie diet success.

This study evaluated the relationship between Marlatt and Gordon's (1985) Abstinence Violation Effect (AVE) and fasting outcomes of patients enrolled in a Very Low Calorie Diet (VLCD) and behavior education program. Within the first 11 weeks of the VLCD, 41 of 76 patients reported a fasting lapse and rated this lapse on an attribution scale. Patients reporting greater characterological attributions for their first lapse (i.e., a higher AVE) lost a smaller percentage of their excess weight during active fasting than patients reporting more situational attributions r(39) = -.36, p less than .025. First lapse AVE ratings did not distinguish between program dropout versus completer status, but high AVE dropouts did spend fewer weeks in the VLCD program than low AVE dropouts, r(12) = -.54, p less than .05. Although a faster's initial level of obesity accounted for the largest portion of weight loss outcome variance, the AVE accounted for a significant additional portion of outcome.     

Very low level environmental exposure to lead and prolactin levels during pregnancy

Lead (Pb) is a well-known poison interfering with calcium homeostasis and dopaminergic pathway. We hypothesized that environmental Pb exposure can interact with prolactin (PRL) secretion, regulated by calcium and dopamine, during pregnancy and in fetus. The objective of this longitudinal study was to determine the relationships between blood Pb concentration and serum PRL levels in 101 pregnant women recruited during pregnancy and their fetuses exposed to low environmental levels of Pb. We observed a significant negative relationship between maternal blood Pb concentrations and maternal serum PRL levels. Cord blood PRL was weakly correlated with blood Pb levels. Our results suggest that maternal physiological parameters in pregnancy can be modulated by low level of Pb exposure and indicate a particular susceptibility of pregnant women to its toxic effects.     

Influence of a very low calorie diet on the clearance of oxazepam and antipyrine in man

Summary A very low calorie diet (Prodi) was administered to eleven otherwise healthy obese subjects for fourteen days. The daily intake of protein was 52.7 g and carbohydrate 25.7 g, corresponding to 360 kcal. The clearance of oxazepam and antipyrine was investigated before and after the diet period.Total oxazepam clearance was 1.04 ml·min^–1·kg^–1 and it decreased 0.88-fold after the diet. The mean clearance of unbound oxazepam was correspondingly reduced 0.88-fold. The elimination half-life increased to 1.22-times the control value, 7.9 h.No significant change was found in the volume of distribution or protein binding of oxazepam. Antipyrine clearance, estimated by the one-sample technique, was 52.4 and 51.8 ml·min^–1, before and after the diet, respectively.It appears that a very low calorie diet with a sufficient protein and a very low carbohydrate content decreases the metabolism of oxazepam by glucuro-conjugation, whereas no effect was seen on the oxidative metabolism of antipyrine.     

Very low doses of ethanol induce behavioral changes involving dopamine D2 receptors

In male rats, pretreatment for 20 days with very low (0.5, 1%, v/v) but not with high (5, 10%, v/v) oral doses of ethanol delayed the initiation and reduced the duration of narcosis induced by an acute high intraperitoneal (i.p.) dose of the drug (3 g/kg in 25% saline solution). Furthermore, the treatment improved the acquisition of shuttle-box active avoidance response but did not affect the emission of ultrasonic calls, an index of emotional state of animals. These effects were inhibited by peripheral administration of the dopamine D2 receptor antagonist, sulpiride (1 mg/kg). A higher dose of sulpiride (10 mg/kg) prolonged the duration of narcosis in rats pretreated with high-dose ethanol and reduced the number of conditioned avoidance responses in the shuttle-box paradigm. The pretreatment with the dopamine D2 receptor agonist, (+/-)-2-(N-phenethyl-N-propylamino)-5-hydroxytetralin (PPHT, 0.1 mg/kg), enhanced the effects of ethanol very low doses in delaying the initiation and reducing the duration of narcosis induced by an acute i.p. dose of the drug. A pharmacokinetic study in ethanol-pretreated animals revealed that administration of 0.5% or 1% ethanol for 20 days did not modify significantly the bioavailability of acute ethanol administered i.p. in a dose of 3 g/kg in 25% saline solution. Thus, repeated administration of ethanol very low doses may have affected the sensitivity of presynaptic dopamine D2 receptors. The influence on dopamine release through an action on presynaptic receptors may be involved in these effects of small doses of ethanol.     

肠内给予谷氨酰胺在极低出生体重早产儿中的应用研究

目的 探讨肠内给予极低出生体重儿谷氨酰胺(G1n)对其生长发育,胃肠功能及感染发生率的影响.方法 将34例极低出生体重儿随机分为治疗组和对照组,治疗组在给予PN的同时,经肠道给予Gln,对照组常规PN、监测两组生长发育、喂养耐受情况,胃肠功能及感染发生率.结果 治疗组生后4周时,尿素氮(BUN)水平较对照组高(P＜0.05),但仍在正常范围内.平均PN时间及平均住院时间均短于对照组(P＜0.0 5).感染发生率较对照组明显减少(P＜0.01).结论 初步观察提示,经肠道给予极低出生体重儿Gln,对其生长发育,胃肠功能的成熟及减少院内感染的发生是有益的.     

Protein calorie malnutrition and cancer therapy.

Anorexia and cachexia frequently complicate the late stages of malignancy and may be a prominent feature of early disease. The resulting weight loss often becomes a major focus of concern for the patient and the family and may significantly add to the morbidity and mortality of cancer. Factors which contribute to the wasting syndrome include the effects of the tumour, effects of chemotherapy, abnormalities of carbohydrate, fat and protein metabolism and the cytokine response. Administration of total parenteral nutrition (TPN) is an important method of addressing malnutrition, particularly in patients with nonfunctioning gastrointestinal tracts. A critical review of the TPN cancer literature is provided along with a discussion of new approaches and future directions in the nutritional support of patients with malignant disease, such as anabolic agents, hydrazine sulfate and megestrol.     

Very low doses of delta 8-THC increase food consumption and alter neurotransmitter levels following weight loss

We have investigated the effect of 0.001 mg/kg delta(8)-tetrahydrocannabinol (THC) on food consumption, cognitive function, and neurotransmitters in mice. Sabra mice were treated with vehicle, THC, or THC+CB1 antagonist (SR141716A). The mice were fed for 2.5 h a day for 9 or 50 days. In the 9-day schedule, THC-treated mice showed a 16% increase in food intake compared with controls (P<.001). This effect was reversed by the antagonist (P<.01). In the long-term schedule a 22% increase in intake (P<.05) was recorded. During the course of the 9- and 50-day experimental protocol, all mice lost about 20% and 10% of their original weight, respectively, to reach approximately the same weights, which were not significantly different between the different treatment groups. In addition, THC caused an increase in activity (P<.05). Cognitive function showed a tendency to improve (P<.06) in the THC-treated mice, which was reversed by the antagonist for Days 4 and 5 of the maze (P<.01, and P<.05, respectively). Significant decreases in dopamine and serotonin (5-HT) levels were found both in the hypothalamus (P<.01) and the hippocampus (P<.01, P<.05), respectively, while norepinephrine (NE) levels showed tendency to increase in both the hypothalamus and hippocampus. Delta(8)-THC increased food intake significantly more (P<.05) than did delta(9)-THC, while performance and activity were similar. Thus, delta(8)-THC (0.001 mg/kg) caused increased food consumption and tendency to improve cognitive function, without cannabimimetic side effects. Hence, a low dose of THC might be a potential therapeutic agent in the treatment of weight disorders.     

Treatment response in obese binge eaters: preliminary results using a very low calorie diet (VLCD) and behavior therapy.

The present study compared the treatment response of male and female obese binge eaters and nonbinge eaters attending a university-based weight reduction program employing a very low calorie diet (VLCD) and concurrent behavior therapy. Twenty-nine percent of female patients (n = 19) and 22% of male patients (n = 6) were characterized as binge eaters based on their scores on the Binge Eating Scale. No significant differences were found between binge and nonbinge groups on measures of weight loss, adherence to the diet, or drop-out rate, although a trend towards greater attrition in the binge group (32%) relative to the nonbinge group (17%) was noted. However, binge eaters had significantly higher pretreatment levels of trait anxiety, state anxiety, and depression as well as higher within treatment levels of anxiety and depression despite significant reductions in depression over the course of treatment. Further examination revealed a binge status X sex interaction effect on state anxiety. Binge-eating females had significantly higher anxiety levels pretreatment and throughout the 10 weeks of the study. No differences between binge and nonbinge males on levels of anxiety were found. These preliminary results tentatively suggest that a VLCD in conjunction with behavior therapy may be an effective method of weight loss for this segment of the obese population, but that elevated levels of anxiety persist in female patients. Future studies must address the long-term maintenance of weight loss in this population as well as other treatment strategies.     

Very low density lipoprotein receptor promotes adipocyte differentiation and mediates the proadipogenic effect of peroxisome proliferator-activated receptor gamma agonists

Very low density lipoprotein receptor (VLDLR) is a member of the low density receptor family, expressed mostly in adipose tissue, heart, and skeletal muscles. VLDLR binds apolipoprotein-E-triglyceride-rich lipoproteins and plays a key role in lipid metabolism. In adipocytes, VLDLR expression increases with differentiation but it is not known whether it plays a role in the adipogenesis. Here we report that VLDLR expression in 3T3-L1 adipocytes is upregulated by PPARγ agonist 15-deoxy-delta^12,14-prostaglandin J₂ (15d-PGJ₂) in dose- and time-dependant manners. Knockdown of peroxisome proliferator-activated receptor-γ (PPARγ) with siRNA abolished pioglitazone- and 15d-PGJ₂-induced VLDLR expression and simultaneously reduced VLDL uptake in adipocytes. In addition, PPARγ-agonist treatment of control mouse adipocytes (vldlr^+/+) enhanced adipogenesis and VLDL uptake concurrently with the induction of VLDLR expression. However, vldlr deficiency (vldlr^−/−) significantly blunted the proadipogenic effects of PPARγ agonists. Sequence analysis revealed the presence of a putative PPARγ responsive sequence (PPRE) within the vldlr promoter, which is responsive to natural (15d-PGJ₂) and synthetic (pioglitazone) PPARγ agonists. Reporter gene assays using serial deletion of the 5′-flanking region showed that this putative PPRE site induced promoter transactivation, while a site-targeted mutation abolished transactivation. Moreover, electrophoresis mobility shift assay (EMSA) and chromatic immunoprecipitation (ChIP) assays showed the specific binding of PPARγ to the PPRE sequence.Together, these results support a crucial function for VLDLR in adipocyte differentiation and mediation of the proadipogenic effect of PPARγ.