Our work concerned 15 patients (9 males, 6 females) with a mean age of 29.5 years, having a hematologic malignant disease and undergoing allogenic bone marrow transplantation.We studied :
1. The metabolic disorders induced by the conditioning regimen (chemotherapy and total body irradiation) pregraft accompanying cytolysis (day −7, −5, −2).
2. The corrective effect of a total parenteral nutrition introduced 2 days before the transplantation and pursued during 30 days post-graft (day −2 to day 30).
3. The interest of a high calorie intake (BEE × 2) and, after randomisation, of a variable nitrogen intake (24% of the total calorie intake for group A [8 patients] and 14% for group B [7 patients]). The patient characteristics of these two groups were closely comparable. Urinary parameters were studied daily (3-methylhistidine, cratinine, nitrogen) and blood parameters weekly (transferrin, pre-albumin, albumin, retinol binding protein).
We observed globally :
-- An excellent result of the nutritional support without significant weight loss;
-- protein catabolism stopped with a recovery of synthesis of RBP after day 7 and pre-albumin from day 7;
-- a decrease in muscle catabolism.
The randomized study showed :
-- a significant difference in nitrogen excretion between group A and group B;
-- earlier and better protein synthesis recovery in group A, particularly with regard to RBP and pre-albumin.
In conclusion, we recommend for the patients undergoing bone marrow transplantation :
-- nutritional support should be introduced before the conditioning regimen;
-- a high calorie intake (BEE × 2) with a nitrogen intake between 14% and 24% of the total calorie intake;
-- cyclic parenteral nutrition should be pursued during the second and third month post-graft.
Résumé
Nous avons étudié chez 15 malades (9 hommes, 6 femmes) d'âge moyen 29,5 ans, présentant une hémopathie maligne et nécessitant une greffe de moelle osseuse allogénique :
1. Les désordres métaboliques induits par la chimiothérapie et l'irradiation corporelle totale en période de prégreffe au cours de la cytolyse (J −7, J −5, J −2).
2. L'effet correcteur d'une nutrition parentérale introduite deux jours avant la greffe et exclusive durant les 30 jours post-greffe (J −2, J + 30).
3. L'intérêt d'un apport calorique élevé (BEE × 2) et, par randomisation, d'un apport azoté variable (24 % de l'apport calorique total pour le groupe A et 14 % pour le groupe B).
Nous avons étudié quotidiennement certains paramètres urinaires (3MeH, créatinine, azote) et les paramètres sanguins (transferrine, préalbumine, albumine, RBP) l'ont été de façon hebdomadaire.Nous avons constaté globalement un excellent résultat du support nutritif sans perte de poids significative, un arrêt du processus catabolique protéique avec reprise de synthèse après J +7 pour la RBP et pour la préalbumine et une réduction du catabolisme musculaire.L'étude randomisée a mis en évidence :
-- une différence statistique dans l'excrétion axotée, plus intense dans le groupe A,
-- une reprise des synthèses protéiques, plus précoce et plus performante dans ce même groupe pour la RBP et la préalbumine.
En conclusion et compte tenu de l'ensemble des éléments, nous préconisons chez ces malades devant subir une greffe de moelle osseuse allogénique :
-- une attitude préventive en ce qui concerne la nutrition à débuter avant le conditionnement,
-- un apport calorique élevé (BEE × 2) et un apport azoté situé entre 14 % et 24 % de l'apport calorique total,
-- une étude prospective quant à l'intérêt de certains acides aminés et d'une nutrition parentérale cyclique poursuivie au 2e et au 3e mois post-greffe.
Mots clés: greffe de moelle osseuse; nutrition parentérale totale; apport azotéKey-words: bone marrow transplantation; total parenteral nutrition; nitrogen intake 相似文献
The advent of systems biology necessitates the cloning of nearly entire sets of protein-encoding open reading frames (ORFs), or ORFeomes, to allow functional studies of the corresponding proteomes. Here, we describe the generation of a first version of the human ORFeome using a newly improved Gateway recombinational cloning approach. Using the Mammalian Gene Collection (MGC) resource as a starting point, we report the successful cloning of 8076 human ORFs, representing at least 7263 human genes, as mini-pools of PCR-amplified products. These were assembled into the human ORFeome version 1.1 (hORFeome v1.1) collection. After assessing the overall quality of this version, we describe the use of hORFeome v1.1 for heterologous protein expression in two different expression systems at proteome scale. The hORFeome v1.1 represents a central resource for the cloning of large sets of human ORFs in various settings for functional proteomics of many types, and will serve as the foundation for subsequent improved versions of the human ORFeome. 相似文献
The effectiveness of galactomannan detection with the Platelia test was evaluated in a prospective study of 3,327 sera from 807 patients. The specificity was 99.6% (748 of 751 cases). For the groups of patients with proven and probable invasive aspergillosis, the sensitivity was 50.0% (17 of 34 cases). The disappointing sensitivity associated with the presence of rare false-positive cases underlines the limits of this test. 相似文献
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Very-low-level methicillin-resistant Staphylococcus aureus (MRSA), or class 1 MRSA, is often misdiagnosed as methicillin-susceptible S. aureus (MSSA). We evaluated the performances of three methods for detection of low-level methicillin resistance: the disk diffusion method using the cephamycin antibiotics cefoxitin and moxalactam, the Vitek 2 system (bioMérieux), and the MRSA-screen test (Denka). Detection of the mecA gene by PCR was considered to be the "gold standard." We also determined the sensitivity of the oxacillin disk diffusion method with 5- and 1-microg disks and that of the Oxascreen agar assay with 6 mg of oxacillin liter(-1) for detection of MRSA. We compared the distributions of MICs of oxacillin and cefoxitin by the E-test (AB Biodisk), and those of moxalactam by dilutions in agar, for MRSA and MSSA isolates. The 152 clinical isolates of S. aureus studied were divided into 69 MSSA (mecA-negative) and 83 MRSA (mecA-positive) isolates, including 63 heterogeneous isolates and 26 class 1 isolates (low-level resistance). The cefoxitin and moxalactam disk diffusion tests detected 100% of all the MRSA classes: cefoxitin inhibition zone diameters were <27 mm, and moxalactam inhibition zone diameters were <24 mm. The Vitek 2 system and the MRSA-screen test detected 94 and 97.6% of all MRSA isolates, respectively. The sensitivities of the 5- and 1-microg oxacillin disks were 95.2 and 96.4%, respectively, whereas that of the Oxascreen agar screen assay was 94%. All of the tests except the 1-microg oxacillin disk test were 100% specific. For the class 1 MRSA isolates, the sensitivity of the Vitek 2 test was 92.3%, whereas those of the MRSA-screen test and the disk diffusion method with cefoxitin and moxalactam were 100%. Therefore, the cefoxitin and moxalactam disk diffusion methods were the best-performing tests for routine detection of all classes of MRSA. 相似文献
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Kinetics of solution homopolymerization of p-formylstyrene
1 System name: 4-vinylbenzaldehyde.
(A) and copolymerization with styrene (S) have been examined at 60°C in N,N-dimethylformamide with 2,2′-azoisobutyronitrile as initiator. For p-formylstyrene, kp/k = 0,135 L1/2 · mol?1/2 · s?1/2 was estimated from the plot of monomer consumption versus time, i.e. a value greater than that for styrene (Kp and Kt are the rate constants of propagation and termination and termination, respectively). Reactivity ratios have been determined to be rA = 3,0 and rS = 0.2, indicating the reactivity of p-formylstyrene to be higher than that of styrene. Moreover, from initial copolymerization rates, the cross termination factor was calculated and found to depend upon the copolymer composition. Some solution properties of the homo- and copolymers have been analysed: solubility of (co)polymers, their molecular weight and its distribution (by gel permeation chromatography), and their composition and monomer sequence distribution (using 1H and 13C NMR spectroscopy). 相似文献
This study characterizes antigen-induced phenotypic and functional aspects of major histocompatibility complex (MHC) class II expression on recirculating T cells in efferent lymph. In vivo secondary, but not primary challenge is associated with both kinetic and phenotypic alterations in class II expression by T cells. All three major T cell subsets, CD4+, CD8+ and T19+ (γδ T cell receptor), show an approximate four fold increase in the level of MHC class II expression during secondary responses. No changes in B cell expression of class II were seen. Resting efferent lymph T cells are predominantly either class II? or DR+DQ? but this changes to DR+DQ+ after antigenic challenge. The antigen-presenting function of these class II+ T cells was investigated at daily intervals after in vivo antigenic challenge. T cells from non-activated lymph nodes could not induce proliferation of antigen-specific T cells with soluble antigen but were weakly stimulatory in allo-mixed lymphocyte reaction (MLR) at high (> 2:1) stimulator cell ratios. Activated T cells isolated during secondary in vivo responses, and expressing increased quantities of MHC class II, were positive stimulator cells in the MLR. In contrast these cells could not present soluble antigen or trypsin-digested antigen to the T cell lines. In the MLR assays, the relative stimulation by class II+ T cells correlates with the levels of class II expression. We conclude from these experiments that both quantitative and qualitative changes in MHC class II, induced on T cells under physiological conditions, play a role in the regulation of the immune response in vivo but that that role is not simply one of presentation of soluble antigen. 相似文献