Total parenteral nutrition during acute pancreatitis: Clinical experience with 156 Patients

Over a 3-year period, 156 of 815 patients admitted to a single institution with acute pancreatitis received total parenteral nutrition (TPN) for 2,572 patient days. Seventy had simple acute pancreatitis (group I) and 86 (group II) developed local complex disease (pseudocyst, abscess, or necrotic gland). In groups I and II, respectively, days without oral intake (NPO) were 13.6±1.5 (SEM) and 24.0±2.1 (p<0.005), hospital days were 19.8±1.7 and 35.8±3.2 (p<0.005), and duration of TPN was 10.9 ±1.0 and 21.0±2.3 days (p<0.005). Thirty-three patients in group I and 53 in group II required exogenous insulin. Alteration of standard formulas was necessary in 87 patients, but cessation of therapy was necessary in only one instance. Twenty catheters were removed for suspected sepsis with only 3 confirmed cases. Fat-based formulas were well tolerated in 15% of patients. During TPN, body weight rose from 95.0±2.4% to 97.4±4.3% of ideal in group I and remained at 90.5±1.8% in group II. Albumin rose from 3.36±0.10 to 3.50±0.08 g/dl in group I and from 3.01±0.07 to 3.35±0.07 g/dl in group II. The entire cohort differed from 10 randomly chosen patients who did not receive TPN in terms of days NPO (2.8±0.3) and hospital days (5.5±0.6). Variables associated with prolongation of hospital stay and time NPO were number of prognostic criteria, local complex disease, and underlying chronic pancreatitis only in select groups. We conclude that during acute pancreatitis, TPN can be administered safely but with careful monitoring and we recommend early aggressive therapy in the subgroups noted above and when underlying malnutrition exists. In the borderline patient, TPN may be administered by peripheral vein until the severity of disease is manifest.

---

Resumen En el curso de un período de 3 años, 156 de 815 pacientes hospitalizados en una sola institución por pancreatitis aguda recibieron nutrición parenteral total (NPT) durante 2,572 paciente-días. Setenta presentaban pancreatitis aguda simple (grupo I) y 86 (grupo II) desarrollaron enfermedad local complicada (pseudoquiste, absceso, o necrosis de la glándula). Las siguientes fueron las características de los grupos I y II, respectivamente: días sin ingesta oral (NPO) 13.6±1.5 (SEM) y 24.0±2.1 (p<0.005), días de hospitalización: 19.8±1.7 y 35.8±3.2 (p<0.005), y duración de la NPT: 10.9±1.0 y 21.0 ±2.3 días (p<0.005). Trienta y tres pacientes en el grupo I y 53 en el grupo II requirieron insulina exógena. Se requirió alterar la fórmula estándar en 87 pacientes, pero sólo fue necesario cesar la terapia en un caso. Veinte catéteres fueron retirados por sospecha de sepsis, pero sólo en 3 se confirmó. Las fórmulas a base de grasa fueron bien toleradas en 15% de los pacientes. En el curso de la NPT el peso corporal ascendió de 95.0±2.4% a 97.4±4.3% del peso ideal en el grupo I y se mantuvo a un 90.5±1.8% en el grupo II. La albúmina ascendió de 3.36±0.10 a 3.50±0.8 g/dl en el grupo I y de 3.01±0.07 a 3.35±0.07 g/dl en el grupo II. Toda la cohorte se diferenció de un grupo de 10 pacientes escogidos al azar que no recibieron NPT en términos del número de días NPO (2.8±0.3) y de días de hospitalización (5.5±0.6). Las variables que aparecieron asociadas con prolongación de la hospitalización y el tiempo NPO fueron el número de criterios de pronóstico, la enfermedad complicada, y la presencia de pancreatitis crónica subyacente sólo en grupos seleccionados. Nuestra conclusión es que en el curso de la pancreatitis aguda, la NPT puede ser administrada con seguridad pero bajo monitoría cuidadosa, y recomendamos terapia agresiva precoz en los subgrupos anotados anteriormente y cuando exista mal nutrición concomitante. En el paciente limitrofe se puede administrar la NPT por vía periférica hasta cuando la gravedad de la enfermedad se haga manifiesta.

---

Résumé Pendant une période de 3 ans, 156 des 815 patients admis pour pancréatite aiguë ont reçu une alimentation parentérale totale (APT), soit en tout 2,572 jours patient. Soixante dix patients (groupe I) avaient une pancréatite simple et 86 (groupe II) avaient aussi une maladie locale complexe (pseudokyste, abcès ou nécrose du pancréas). La durée du jeûne était respectivement de 13.6±1.5 (ET) et de 24.0±2.1 (p<0.005), la durée moyenne de séjour était respectivement de 19.8±1.7 et de 35.8 ±3.2 (p<0.005) alors que la durée d'APT était respectivement de 10.9±1.0 et de 21.0±2.3 jours (p<0.005). Trente-trois patients dans le groupe I et 53 dans le groupe II avaient besoin d'insuline exogène. Un changement dans la formule standard a été nécessaire chez 87 patients mais l'APT n'a du être arrêté complètement que chez un patient seul. Vingt cathéters ont été enlevés avec suspicion de sepsis, confirmée cependant dans 3 cas seulement. Les compositions à base de lipides ont été bien tolérées chez 15% des patients. Pendant l'APT, le poids du corps s'est élevé de 95.0±2.4% à 97.4±4.3% du poids idéal chez les patients du groupe I et est resté à 90.5±1.8% chez ceux du groupe II. L'albumine s'est élevée de 3.36±0.10 à 3.50 ±0.08 g/dl dans le groupe I et de 3.01±0.07 à 3.35±0.07 g/dl dans le groupe II. La durée du jeûne (2.8±0.3) et la durée moyenne de séjour (5.5±0.6) de l'ensemble des patients différaient de ces mêmes données chez 10 autres patients choisis au hasard. Les facteurs associés avec un séjour hospitalier prolongé et sans alimentation orale étaient le nombre de critères pronostiques, l'existence de complications locales, et de pancréatite chronique sous-jacente chez certains patients. Nous concluons que pendant la pancréatite aiguë, l'APT peut être administrée sans danger sous contrôle permanent et nous conseillons un traitement agressif et précoce dans le sous groupe mentionné plus haut ou quand existe un état de nutrition déficient. Chez le patient limite, on peut se contenter d'APT par une veine périphérique tant que des signes de gravité ne se manifestent pas.

---

---

Presented at the Société Internationale de Chirurgie in Toronto, Ontario, Canada, September, 1989.     

Effect of low dose radiation on subpopulations of lymphocytes and T cell subsets in mice

<正> The effect of radiation on lymphocyte subpopulations and T cell subsets of peripheral blood was studied in mice after X- and y-irradiation.lt was found that (1) there were neither marked changes in the percentage and absolute number of acid alpha-naphthol acetyl esterase "positive(ANAE + )cells of different granular patterns, nor significant lowering of the T11/Ts ratio after single whole body X-irradiation in the dose range of 25-250 mGy with a dose rate of 12.5mGy/min. At the same time no significant changes were found at different time intervals after irradiation. After continuous low level irradiation with 60Co γ-rays with a dose rate of 5.4 mGy/6h.d,the ANAE grauular pattern of lymphocytes showed no significant changes with cumulative doses of 32.4 -520 mGy. (3)There was no decrease in the "splenocyte Ts index in Kunming mice after low dose X-irradiation. The results suggest that the stimulatory effect of low dose radiation on the PFC reaction can not be explained on the basis of a decrease in num     

丝光沸石催化剂上正己烷异构化反应机理

以轻质烷烃异构化中试放大用的丝光沸石催化剂为研究对象,运用“原位”红外反应技术和催化剂活性评价手段,并结合反应动力学参数计算,探讨了正已烷异构化反应机理。结果表明,可用五配位反应中间物种机理解释正碳离子的生成。用双分子六元环反应中间物机理能较好地解释正已烷在氢型丝光沸石(HM)上的异构化过程。对正已烷在Pd/HM上的反应过程也可用正碳离子机理结合双分子六元环中间物机理解释。     

电针巨刺对中风偏瘫患者甲皱微循环的影响

<正> 《灵枢·官针篇》说:“巨刺者,左取右,右取左”。巨刺治疗中风偏瘫早在元代就有记载。《济生拔粹·针经摘英集》曰:“治中风手足不遂,针百会、听会、肩髃、曲池、三里、悬钟、风市,其七穴左治右,右治左”。巨刺历来受到各家重视,但其依据何在?与针刺瘫痪侧肢体(下称瘫刺)是否有差异?作者试用电针巨刺对中风偏瘫患者甲皱微循环的影响进行了观察。     

Immune responses to the expressed products of the CSP antige n gene of Plasmodium falciparum southern China isolate FCC1/HN in Hela cell

Objective To construct a eukaryotic expression system with pcDNA3-PfCSP/Hela for the Circ umsporozoite protein (CSP) gene of Plasmodium falciparum (P.falciparum), t o observe the immune responses in BALB/c mice induced by the expressed proteins .Methods The recombinant plasmid pcDNA3-PfCSP was transformed into the Hela cell line. The expressed protein was isolated and analyzed by using SDS-PAGE and used for immunization of BALB/c mice by subcutaneous, intravenous, and intraperitone al adminstration.Enzyme-linked immunosorbent assay(ELISA), Dot-ELISA, Wester n blot, T lymphocyte proliferation test, natural killer cell(NKC) activity assay , and CD4(+) and CD8(+) T cell detection were used for observation of humoral an d cellular immune responses.Results Immune sera strongly reacted with the expressed protein, antibody titer was up to 1∶6400 as detected by ELISA.Western blot analysis revealed a specific b and at 38.3 Kda.When the spleen cells of normal and immunized BALB/c mice we re specifically stimulated with expressed protein, the optical densities were 0 .12±0.03 and 0.34±0.04, respectively.The latter were significantly highe r than the former (P&lt;0.01).We used the MTT colorimetric assay to measure NKC activity of mice spleen.The results showed that the NKC activity of immuni zed BALB/c mice was remarkably higher than that of the controls (P&lt;0.05). CD4(+) and CD8(+) T cells were detected by using monoclonal antibody immunofluor escence methods.The results showed that the percentage of CD4(+) and CD8(+) T cells of immunized group were significantly higher than that of control group ( P&lt;0.05).Conclusions The humoral and cell-mediated immune responses and elevated NKC activity to pr oducts made with a eukaryotic expression system could be specifically detected i n BALB/c mice.These findings indicate that the expressed protein could enhance the immune function in mice.     

Long-term mortality in patients with myocardial infarction: impact of early treatment with captopril for 4 weeks

目的　中国心脏研究 Ⅰ (CCS 1)入选 150 0 0例急性心肌梗塞 (AMI) (发病 36小时内 )患者 ,随机口服卡托普利或安慰剂治疗 4周。结果卡托普利治疗组 4周病死率 (9 12 % )较安慰剂对照组 (9 74 % )轻微下降 (P =0 19) ,但对其远期病死率的影响尚不知晓。本研究目的是了解卡托普利早期治疗 4周 ,对远期病死率的影响。方法　选择急性期试验完成 2 0例以上的CCS 1单位进行随访 ,计划随访 80 0 0例 (MI)病人 ,实际随访 6 74 9例 ,随访率 84 4 %。结果　治疗组 (n =3391)与对照组 (n =3358)随访病人基本临床特征是可比的。平均年龄 6 3 6± 10 6岁 ;平均随访时间 2 3 4± 16 9个月 ;男性占 76 2 %。治疗组与对照组随访时心功能 (NYHA分级 )Ⅲ Ⅳ级者分别为 9 0 %与9 9% ;再梗塞发生率为 5 6 %与 6 0 % ;总心血管事件为 32 9与 34 3%。治疗组总病死率 (11 9% ;n =4 0 4 )明显低于对照组 (13 8% ;n =4 6 3) (P =0 0 3) ;心血管性死亡 (10 0 %vs 11 8% )明显减少 (P =0 0 2 ) ,其中心衰死亡(4 1%vs 5 5% )差异更显著 (P =0 0 1)。早期用卡托普利治疗 4周 ,远期可挽救生命 19/ 10 0 0人。随机前收缩压≥ 10 0mmHg者 ,治疗组远期病死率 (12 4 % )较对照组 (13 8% )明显减少 (P =0 0 4 ) ;基础心率≥     

Studies on association between lipoprotein lipase gene polymorphisms of Pvu Ⅱ site and hypertriglyceridemics in Chinese

Objective To explore whether Pvu Ⅱ restriction fragment length polymorphisms (RFLP) in the lipoprotein lipase (LPL) gene are associated with hypertriglyceridemics (HTG).Methods Pvu Ⅱ restriction fragment length polymorphisms in the lipoprotein lipase gene on a sample of 135 HTG patients and 193 age-matched healthy individuals in Chengdu area were detected with the method of PCR-RFLP.Results The P+P+ genotype frequency and P+ allelic frequency of LPL gene for HTG cases are higher than those for control groups (0.460 vs 0.337, P<0.05; 0.689 vs 0.565, P<0.01). The serum levels of TG, apoC Ⅱ, apoC Ⅲ, apoE and TG/HDL-C in P+P+ genotype are higher than those in P-P- genotype (P<0.05).Conclusion The results suggest that P+P+ genotype in the lipoprotein lipase gene is associated with susceptibility to hypertriglyceridemics in Chinese population.     

51例闭经的临床分析和治疗探讨

目的 探讨闭经的病因、治疗方法及疗效。方法 对1989年2月－2001年2月间我院妇科内分泌治疗的51例闭经患者的临床资料进行回顾性分析,并根据患者的临床症状及血清激素水平特征归类讨论。结果 51例闭经患者,未婚8例,女婚43例,其中3例结婚时间短于半年,37例为不孕症者,占72．5％。多囊卵巢综合征（PCOS）21例（41．2％）;卵巢早衰（POF）18例（35．3％）;高催乳素血症（HPRL）6例;垂体微腺瘤4例;高雄激素血症（HT）2例。通过内分泌药物治疗后观察,PCOS患者的妊娠率为58．8％;POF患者中仅有1例妊娠;HPRL6例患者中有5例妊娠;垂体微腺瘤3例（已婚）中有2例妊娠;高雄激素血症的2例患者中1例妊娠。结论 闭经患者经过适当的治疗,除POF外其妊娠率效果较为满意。