Vitamin-mineral supplement use: association with dietary intake and iron status of adults

Although vitamin-mineral supplement use is increasing in the United States, few researchers have examined whether supplement users have better nutritional status than do nonusers. Data from 10,515 persons examined in the second National Health and Nutrition Examination Survey (NHANES II) were used to compare mean dietary intakes of several nutrients and food groups, hemoglobin, mean corpuscular volume, transferrin saturation, erythrocyte protoporphyrin, and serum ferritin between regular supplement users and nonusers aged 16 to 74 years. Prevalences of impaired iron status also were compared between user groups. Users consumed more vitamin C and ate fruits and vegetables more frequently than did nonusers in all age/sex groups. No significant differences in mean iron status indicators were observed except in the 65 to 74 year age/sex groups: transferrin saturation among men and mean corpuscular volume, erythrocyte protoporphyrin, and serum ferritin among women. In each case, users had higher values than nonusers in this age group. Prevalences of impaired iron status did not differ between users and nonusers in any age/sex group. In general, iron status was not associated with supplement use.     

Alpha-Tocopherol Distribution in Lipoproteins and Anti-Inflammatory Effects Differ between CHD-Patients and Healthy Subjects

Objective: The purpose of this study was to investigate the dose-dependent effects of RRR-α-tocopherol supplementation in coronary heart disease (CHD) patients and healthy subjects on plasma α-tocopherol levels, plasma lipoprotein distribution, LDL oxidation, and inflammatory plasma markers.

Methods: 12 patients with coronary heart disease and 12 healthy subjects were supplemented with increasing dosages of RRR-α-tocopherol at 100, 200 and 400 mg/day for a period of 3 weeks per dose. Lipoproteins were separated by FPLC and ultracentrifugation. α-Tocopherol was measured by HPLC. Resistance of LDL to oxidation was determined by reading the absorption at 234 nm after CuCl₂-induced oxidation. Clinical chemistry and inflammatory markers were measured on automated analysis systems.

Results: Plasma α-tocopherol concentrations at baseline were comparable between CHD-patients and healthy subjects (21.7 ± 4.7 μmol/L and 25.8 ± 7.6 μmol/L, respectively). CHD-patients showed a significant increase (59%) of plasma α-tocopherol concentrations to 34.6 ± 9.8 μmol/L at a dosage of 100 mg/day RRR-α-tocopherol, whereas healthy subjects showed a significant (54%) increase to 39.7 ± 6.1 μmol/L only with 400 mg/day RRR-α-tocopherol. In addition, CHD-patients showed a significantly increased enrichment of α-tocopherol in VLDL. Supplementation (200 mg/day) caused a significant decrease of the acute phase plasma proteins C-reactive protein (CRP) (?65%) and fibrinogen (?24%).

Conclusion: Our data demonstrate that CHD-patients require lower dosages of α-tocopherol supplementation than healthy subjects to exert biological effects on plasma lipoproteins and acute phase response.     

补充微量营养素对儿童营养状况的影响

【目的】　研究补充多种微量营养素对儿童营养状况的影响,为促进儿童健康成长提供理论依据。　【方法】　选择浙江省仙居县某所小学在校9~12岁小学儿童,经常规健康体检,将健康儿童220名,随机分成两组,一组为微量营养素补充组,服用多种微量营养素片,另一组为空白对照组,补充期为6个月。试验前和结束时,测定血清视黄醇和25 (OH)D3 含量,进行维生素B1、维生素B2 和维生素C的4 h尿负荷试验。　【结果】　干预试验前后,补充组与对照组儿童的血清视黄醇含量、维生素A缺乏的发生率差异均无显著性(P均> 0.05)。试验结束时,两组儿童的血清25 (OH)D3 水平都比干预试验前显著降低,但是对照组降低的幅度显著大于补充组(P<0.001),并且补充组试验后的降低值显著低于对照组(P<0.01);补充组儿童的4 h负荷尿中维生素B2 和维生素C排出量显著高于对照组(P<0.05),并且补充组维生素C的增加值非常显著高于对照组(P<0.01)。　【结论】　补充多种微量营养素能维持儿童的血清25 (OH)D3 水平在适宜范围,改善儿童的维生素B2 和维生素C营养状况。     

Off-pump coronary artery bypass grafting: Misperceptions and misconceptions

Coronary artery bypass grafting (CABG) continues to be one of the most commonly performed cardiac surgical procedures worldwide. Conventional CABG performed on cardiopulmonary bypass termed on-pump CABG is regarded as the gold standard. However, on-pump CABG results in several physiologic derangements including but not limited to thrombocytopenia, activation of complement factors, immune suppression, and inflammatory responses leading to organ dysfunction. Furthermore, manipulating an atherosclerotic ascending aorta during cannulation and cross-clamping can predispose to embolization and stroke risk. Recognition of these detrimental effects of on-pump CABG resulted in resurgence of off-pump CABG nearly two decades ago. Off-pump CABG since its resurgence has been a subject of intensive scrutiny and speculation. Despite numerous retrospective nonrandomized studies, prospective randomized trials, and meta-analyses validating the safety and efficacy of off-pump CABG, opponents of the technique have persistently demanded abandonment of off-pump CABG. Several misconceptions and misperceptions are used as an excuse for such demands. This review article examines published scientific evidence to evaluate these misperceptions and misconceptions about off-pump CABG.     

冠状动脉搭桥术患者并发精神障碍的影响因素分析

目的：探讨冠状动脉搭桥术后患者并发精神障碍的影响因素。方法收集自2012年1月至2013年1月于本科室行冠状动脉搭桥术的患者资料,按术后有无发生精神障碍分为两组,结果用SPSS 19．0软件进行t检验,χ2检验。结果冠状动脉搭桥术后精神障碍发生率为16．67％,主要表现为抑郁、意识障碍、认知障碍。结论冠状动脉搭桥术后发生精神障碍是多种因素共同作用的结果,医护人员应采取综合护理措施,以改善疾病预后。     

冠状动脉搭桥术后ICU临床路径的变异分析与改进

目的探讨冠状动脉搭桥（CABG）术后ICU临床路径（Clinical pathway，CP）管理的变异情况及如何持续改进。方法连续观察了实施临床路径管理的择期冠脉搭桥术后在ICU监护治疗的患者100例。在临床路径表单标记每日目标完成情况，对于偏离路径的情况在变异记录单上记录并说明原因。结果按变异原因分析，发生医护相关性变异（45％）、患者相关性变异（28％）、系统相关性变异（5％）；接变异种类分析，发生负性变异（20％）、正性变异（30％）、可控性变异（15％）。结论通过对冠状动脉搭桥病人术后ICU临床路径变异情况的记录与分析，有利于医疗质量持续改进，并为科学制定临床路径提供依据。     

冠状动脉旁路手术、优化药物治疗和经皮冠状动脉介入治疗的全因死亡率的对比

目的比较评估冠状动脉旁路移植术(CABG)、优化药物治疗(OMT)和经皮冠状动脉支架植入术(PCI)的治疗效果。方法连续入选2008~2014年在解放军总医院第一医学中心心内科住院的冠状动脉造影(CAG)住院患者,按治疗方式的不同将入选患者分成CABG组,OTM组和PCI组,采用电话、门诊和查阅病历确定患者的存活状态,采用Kaplan-Meier方法进行生存分析,采用二元逻辑回归分析死亡的危险因素。结果共入选患者1 643例,其中CABG 283例,OTM 425例,PCI 935例。CABG组年龄最大,合并疾病脑卒中、高血压、既往心肌梗死最多,冠状动脉病变最严重,Syntax积分和血管狭窄积分最高,其次为PCI,再其次为OMT,差异有统计学意义(P <0.05)。OMT左室射血分数最低,其次为PCI,再其次为CABG,差异有统计学意义(P=0.004)。PCI组肌钙蛋白T最高,其次为CABG,再其次为OMT,差异有统计学意义(P=0.014)。OMT和PCI红细胞低于CABG,差异有统计学意义(P=0.026)。CABG组死亡27例(9.5%),OTM组死亡22例(5.2%),PCI为组死亡63例(6.7%),CABG的死亡率偏高(P=0.063)。CABG与OTM两两比较差异显著,差异有统计学意义(P=0.018)。男性、高龄、SYNTAX积分、红细胞降低,EF降低,右冠状动脉近端病变是老年患者死亡的危险因素(P <0.05)。结论远期随访显示CABG,OMT和PCI的死亡率大致相似,但CABG死亡率略高。男性、高龄、复杂病变、LAD近端病变、射血分数降低是老年患者死亡的危险因素。     

Magnetic resonance imaging in coronary artery bypass surgery--improvement of global and segmental function in patients with severely compromized left ventricular function

Objectives

In the present study, patients with severely compromized left ventricular function underwent magnetic resonance imaging (MRI) before and after coronary artery bypass grafting (CABG). Although improvement of global myocardial contractile function has been shown before, we sought to evaluate whether a functional contractile improvement may be determinable on a myocardial segmental basis after CABG surgery.

Methods

Thirty-three CABG patients with left ventricular ejection fraction (LVEF) ≤30% prospectively underwent MRI to compare pre- and postoperative functional data. At follow-up, all survivors underwent clinical assessment. In 16 patients (three patients died perioperatively, 13 could were lost to MRI follow-up because of cardiac resynchronization therapy and other reasons) postoperative MRI scanning was performed.

Results

In-hospital mortality was 9%. At 20 ± 2 months after surgery, New York Heart Association class improved from 3.0 ± 0.1 to 2.2 ± 0.2 (p < 0.01). Left ventricular end-diastolic volumes decreased significantly from 229 ± 14 mL to 189 ± 19 mL (p < 0.05). LV end-systolic volumes decreased significantly from 163 ± 13 mL to 126 ± 17 mL (p < 0.05). LVEF improved from 30 ± 2% to 36 ± 3% (p < 0.05). On a segmental basis, 42 out of 875 segments (4.8%) had normal function before surgery, at follow-up, 177 segments (20.4%) had normal regional function (p < 0.05).

Conclusions

Patients who undergo CABG surgery with severely compromized left ventricular function, postoperative MRI shows improved global and segmental cardiac function at mid-term follow-up. At the same time there is considerable clinical improvement.     

Uricogenic potential of selected cooked foods in rats.

Samples of beefsteak, beef liver, haddock, and mushrooms were cooked by two methods: boiling and broiling. Growth and purine metabolism in rats fed diets containing 20% protein (N × 6.25) were studied for a period of 26 days. The cooked meats and fish were used as the sole source of dietary protein, while cooked mushrooms provided 5% protein in mushroom-casein diets. Body weight, and food and water intakes were recorded weekly while total urine was collected during the last 6 days of the feeding period. Levels of purine metabolites (uric acid and allantoin) in blood and urine were determined by enzymatic methods and reverse-phase HPLC techniques. Dietary treatments had no significant effects on weight gain and food consumption. Compared with animals fed the casein control diet, rats fed the broiled liver, broiled haddock, and boiled mushroom diets had significantly (p less than 0.05) higher concentrations of serum allantoin, suggesting that uricogenicity of these foods was influenced by the method of cooking. The renal excretion of purine metabolites was significantly correlated with purine intake, the renal excretion of allantoin and uric acid being the highest in rats fed the liver diets.     

妊娠期妇女营养状况与新生儿生长发育的关联分析

目的调查杭州市上城区妊娠期妇女体内营养状况以及与新生儿生长发育的关联性。方法选取2018年1月至2019年1月于杭州市妇幼保健院妇女营养门诊进行妊娠期保健的277例孕早期女性为研究对象,对所有研究对象进行孕早期铁(Fe)、锌(Zn)、铜(Cu)、镁(Mg)、维生素A(VA)、维生素B12(VB12)、叶酸以及整个孕期血红蛋白(Hb)水平测定,并随访妊娠结局以及新生儿体格指标,采用多因素线性回归分析营养状况与新生儿生长发育的关系。结果孕早期Zn缺乏率最高(16.97%),其次为VA(10.83%),叶酸无缺乏情况发生;孕早期母体内Mg含量、叶酸水平与新生儿体重存在关联性,其线性回归系数(β)及95%CI分别为1456.051(384.638~2529.481)、0.213(0.101~0.479),均P<0.05;孕早期母体内Fe含量、叶酸水平与新生儿身长存在关联性,其β值及95%CI分别为0.057(0.004~0.153)、0.002(0.000~0.198),均P<0.05;孕早期和孕中期Hb水平与新生儿身长存在关联性,其β值及95%CI分别为0.087(0.053~0.125)、0.112(0.072~0.153),均P<0.05。结论孕产妇体内营养状况与新生儿生长发育指标存在相关性,该地区妊娠期妇女仍存在部分营养元素缺乏,应合理膳食,平衡营养。     

Variation in purchasing for the invasive management of coronary heartdisease

This paper reports the results of a postal questionnaire survey of Directors of Public Health in all health authorities in the United Kingdom (as at March 1994). Our aim was to examine variations in the purchasing of coronary artery bypass grafting, percutaneous transluminal coronary angioplasty and coronary angiography. Information on planned service developments in cardiology was also sought. The response rate was 62%. The mean rate of CABG was 374 per million total population (range 162–710); PTCA 183 (range: 18–648); and coronary angiography 1,010 (range 581–2,334). The mean ratio of invasive treatment to angiography was 1 : 2. Variations in provision were not related to mortality from coronary heart disease or the availability of a local provider. Those districts purchasing higher levels of CABG tended to purchase higher levels of PTCA (Spearman's r=0.52). Observed variations in purchasing of invasive treatments and investigation for coronary heart disease do not relate to population ‘need’ as defined by mortality rates from CHD. The greatest variations are seen in the purchasing of PTCA, an intervention whose place in the management of CHD is as yet not fully defined. Consensus guidelines on the appropriate use of these interventions and on population needs are required.     

Epidemiological study of coronary artery disease and its risk factors in an elderly urban population of north India.

In view of the rapid increase in the prevalence of coronary artery disease (CAD) in developing countries, our aim was to determine the prevalence of CAD and its risk factors and lifestyle factors in an elderly population from north India.

A random sample of 595 elderly subjects between 50 to 84 years of age was obtained from the urban population of Moradabad. The response rate was 90.1%. The survey methods included a questionnaire containing information on 7-day food intake, other lifestyle factors, Rose questionnaire for diagnosis of angina pectoris, a standard 12-lead electrocardiogram, blood pressure measurements and blood examination.

The total prevalence of CAD based on clinical history and electrocardiogram was 121/1000 (95% CI 72 to 165). The prevalence rate was slightly higher in males (130/1000) than in females (110/1000). The prevalence of CAD based on the Rose questionnaire was 57/1000 and based on electrocardiogram in 561 asymptomatic subjects was 67/1000. CAD was significantly higher in the elderly (65 to 84 years) group than in the middle-aged (50 to 64 years) group (168 vs. 97 per 1000), respectively. While the prevalence of hypertension was significantly higher in the elderly than middle-aged group respectively (214 vs. 168 per 1000), the prevalence of central obesity was significantly higher in the middle-aged than elderly group (674 vs. 632 per 1000). Other risk factors including smoking were comparable in the two subgroups. Prevalence of major risk factors and central obesity were significantly higher among patients with CAD than in the rest of the subjects. Prevalence of CAD was significantly higher in the middle and higher socio-economic groups compared to the lower income group. These higher income groups were also eating significantly higher amounts of visible fat and had a higher prevalence of physical inactivity (93.3%) compared to the lower income group.

CAD and its risk factors such as hypertension, hypercholesterolemia, diabetes and central obesity are of sufficient magnitude in the elderly population of India to be a major public health problem. The findings also indicate that CAD is more commonly associated with middle and higher socio-economic status which may be due to greater consumption of dietary fat and more sedentariness compared to lower socioeconomic groups.     

胎膜早破孕妇血清氧化应激状态分析

目的　通过对胎膜早破孕妇血清氧化应激指标—超氧化物歧化酶、丙二醛及维生素E的测定,分析其氧化应激状态。方法　用化学比色法对30例正常未孕妇女、30例正常孕足月妇女及2 0例胎膜早破孕妇血清中超氧化物歧化酶、丙二醛及维生素E进行测定。结果　与未孕妇女相比,正常孕足月妇女血清丙二醛升高(P <0 .0 5 ) ,超氧化物歧化酶和维生素E也显著升高(P <0 .0 5 ) ;与正常孕足月妇女相比,胎膜早破孕妇血清丙二醛水平升高(P <0 .0 5 ) ,超氧化物歧化酶、维生素E水平却下降(P <0 .0 5 ,P <0 .0 5 )。结论　胎膜早破孕妇处于氧化应激状态中。     

Dietary and biochemical indices of nutritional status in male athletes and controls.

To determine whether physical exercise affects biochemical indices of nutritional status, we compared four groups of male athletes (total n = 427) with two control groups (n = 150). Data about their nutrient intake for 1 month were obtained from a 122-item food frequency questionnaire. An estimate for leisure energy expenditure (EE) was calculated from a 15-item physical activity questionnaire. Athletes were grouped according to their EE (ModEE and HighEE athletes) and weight (light = less than 75 kg; heavy = greater than or equal to 75 kg), and controls according to their weight. Mean energy intake in ModEE and HighEE athletes was 2805-3260 kcal/day. Leisure EE significantly (p less than 0.0001) affected energy and nutrient intakes. Energy, riboflavin and calcium intakes were also higher in heavy subjects (P = 0.0006-0.03). The estimated percentage of subjects with deficient dietary intakes, calculated from probability analyses, was 0-6, depending on group and nutrient. Erythrocyte transketolase activation coefficient (E-TKAC) was highest in controls (1.17 +/- 0.0008; p = 0.001). Serum magnesium was highest (p = 0.01) in ModEE athletes (0.85 +/- 0.006 mmol/L). No intergroup differences were found for plasma ascorbic acid, serum zinc or serum ferritin concentration, whereas blood hemoglobin was lowest (p less than 0.001) in HighEE athletes (149 +/- 0.5 g/L). Ten percent of the control subjects had E-TKAC greater than 1.24. Percentage of other values outside reference range was 0-4, depending on group and indicator. Since lowered blood hemoglobin concentration can be explained by hemodilution, we conclude that sports training did not have a negative effect on biochemical indices of thiamin, vitamin C, magnesium, iron, or zinc status in Finnish male athletes.     

循证护理对冠状动脉搭桥术患者负性情绪及并发症的影响

目的 探究循证护理对冠状动脉搭桥术患者负性情绪及并发症的影响。方法 本研究对象为2018年4月—2019年2月就诊于我院的80例冠状动脉搭桥术患者,按随机数字表法分为两组。对照组40例采取常规护理,研究组40例采取循证护理。比较两组负性情绪和并发症情况。结果 研究组护理后的抑郁自评量表(SDS)评分(46.55±5.02)分、焦虑自评量表(SAS)评分(43.58±6.52)分均低于对照组(52.51±4.80)分、(53.55±6.34)分,差异有统计学意义(t=5.427,t=6.934,P<0.001);研究组并发症发生率(7.50%)低于对照组(27.50%),差异有统计学意义(χ2=5.541,P=0.019)。结论 循证护理可以有效减少冠状动脉搭桥术患者的抑郁、焦虑情绪,降低并发症发生率,促进患者康复。     

冠状动脉旁路移植术后患者生存质量分析

目的 了解非体外循环冠状动脉旁路移植术(OPCABG)和经典体外循环冠状动脉旁路移植术(CCABG)术后患者生命质量状况及导致生命质量受限的原因.方法 选取解放军总医院心血管外科进行冠状动脉旁路移植术(CABG)患者,其中OPCABG病例150例,CCABG100例;采用欧洲5维生命质量量表(EQ-5D)问卷调查对比OP-CABG和CCABG术后生命质量,分析导致生命质量下降的原因.结果 CABG术后患者生命质量较满意,在行动、自我照顾、日常活动、疼痛/不适和焦虑/沮丧方面,完全不受限的比例分别为82.0%,93.9%,94.7%,80.7%和78.9%;OPCABG和CCABG术后患者生命质量无明显差别;导致CABG术后生命质量下降的主要原因是桥血管病变和心律失常.结论 CABG术后患者生命质量较满意,OPCABG和CCABG术后患者生命质量无明显差别.CABG术后生命质量下降的主要原因是桥血管病变和心律失常.     

冠状动脉旁路移植手术与经皮冠状动脉介入治疗多支血管病变合并糖尿病患者的预后比较

目的比较冠状动脉旁路移植手术(CABG)与经皮冠状动脉介入(PCI)治疗多支血管病变(MVD)合并糖尿病(DM)患者的预后结果。方法连续收集2010年1月至2012年12月于咸阳市中心医院住院接受CABG和PCI的MVD合并DM患者入组。收集并获取患者基线资料,包括性别、年龄、既往病史、左心室射血分数、血生化指标、住院天数、住院费用、出院诊断等信息,并进行术后定期随访。结果本研究共收集MVD合并DM患者625例,其中接受CABG的共205例,接受PCI的共420例。与PCI组相比,CABG患者冠状动脉狭窄程度及左主干狭窄程度更严重(P<0.001),患者遭受的并发症更多(P<0.001);CABG组的主动脉内球囊反搏使用率高,住院总花费也显著偏高(P<0.001);CABG组患者的住院死亡率(1.5%)略高于PCI组患者(0.5%),但差异不显著(P>0.05);CABG组的五年生存率(98.0%)显著高于PCI组(74.5%);CABG组患者的预后显著优于PCI组,五年内发生心梗和心脑血管不良事件的概率也更低(P<0.05)。结论对于MVD合并DM患者,CABG手术的长期预后结局优于PCI手术。     

慢性冠状动脉完全闭塞病变血运重建术后QTd、QTcd变化的研究

目的探讨慢性冠状动脉完全闭塞病变患者血运重建（CRY）术前、术后的QT间期离散度（QTd）及校正QT间期离散度（QTcd）的变化。方法20例慢性冠状动脉完全闭塞病变患者行经皮冠状动脉介入（PCI）治疗和24例患者行冠状动脉搭桥术（CABG），利用标准同步12导联心电图，对术前、术后1d、术后1周及术后1个月的QTd及QTcd进行测量计算。结果慢性冠状动脉完全闭塞病变患者行PCI治疗与CABG术后的QTd及QTcd较术前均显著缩短（P〈0．01），两组QTd及QTcd缩短程度及时间差异无统计学意义（P〉0．05）。结论慢性冠状动脉完全闭塞病变仍存在存活冬眠心肌或顿抑心肌。血运重建后再灌注心肌可恢复电生理功能，且两种血运重建方法术后1个月内至少在改善心肌电活动程度和时间上是一致的。     

非体外循环冠状动脉搭桥术治疗冠心病患者的临床疗效观察

目的观察非体外循环冠状动脉搭桥术治疗冠心病患者的临床疗效。方法将我院2016年3月至2019年3月收治的100例冠心病患者随机分为两组各50例。对照组采用传统体外循环冠状动脉搭桥术治疗,观察组采用非体外循环冠状动脉搭桥术治疗。比较两组的相关围术期指标、术后心功能及不良反应。结果观察组的术中出血量、输血量、手术时间、住院时间均显著少于对照组(P<0.05)。术后,观察组的心脏指数(CI)、左心室收缩压(LVSP)、左室做功指数(LVSWI)、右室做功指数(RVSWI)均显著高于对照组(P<0.05)。观察组的不良反应发生率为4.00%,显著低于对照组的22.00%(P<0.05)。结论非体外循环冠状动脉搭桥术可显著改善冠心病患者的心功能,不良反应发生率较低。     

Associations between Nutrition and Cataract

Blindness due to opacification of the lens, or cataract, afflicts 50 million persons worldwide. In the United States over 541,000 cataract extractions are done annually at a cost of over $3.8 billion. Conservative estimates indicate that the prevalences of cataracts in Americans aged 65-75 and 75-85 years are 18% and 46%, respectively. Cataracts are even more prevalent in some other populations. It is estimated that the need for cataract extractions would be diminished by half if onset of cataract could be delayed by only ten years. Hypotheses regarding the etiology of cataract include oxidative perturbations of protein metabolism, diverse pathologic conditions, and perhaps glycation of lens proteins. Epidemiologic data indicate that elevated plasma levels of specific nutrients (i.e., carotenoids, ascorbate, tocopherol, and taurine) are associated with diminished incidence of certain types of cataract. Biochemical evidence suggests that each of these compounds can delay photooxidative damage to lens proteins. Roles in lens metabolism for selenium and tryptophan have been suggested. Elucidation of mechanisms by which caloric restriction delays cataract development is a promising area of current research.