A randomized, double blind, and controlled clinical trial of the non-addictive propacetamol in postoperative analgesia / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the postoperative analgesic efficacy and safety of the non-addictive propacetamol hydrochloride (Pro-Bufferin) injection and dolantin in a prospective, randomized, double blind and controlled clinical trial.</p><p><b>METHODS</b>After the pain intensity was assessed when the patients were undergone thoracic and abdominal selective surgery became fully conscious, 40 consecutive patients with moderate to severe postoperative pain (equivalent to Pain Grade I and II of American Anesthesia Association classification) were randomized into the study against the control groups. The two groups were similar for age, sex, height/weight, disease categories, operation categories, anesthesia methods and duration, vital signs, hepatorenal function, and blood cell count (P = 0.06-0.93). In the study group, 2 g propacetamol in 100 ml normal saline (NS) intravenously with 1.0 ml NS intramuscularly as the placebo control to dolantin were administered. In the control group, 1.6 g mannitose in 100 ml NS intravenously as the placebo control to propacetamol with 50 mg dolantin (1.0 ml) intramuscularly as the positive control to propacetamol were administered. The intensity change of postoperative pain was then evaluated 10 times with visual analog scale and verbal describing scale during 6 h from the beginning of propacetamol infusion. Vital signs and adverse reactions were also documented. After all data were put into the computer, the blinding codes were decoded and the statistic analysis was then made.</p><p><b>RESULTS</b>There was no significant difference (P = 0.93) about the area under the curve of "Pain Relieve Score vs. Time". The "starting to effect" time (15-30 min), analgesic duration (6 h) and the percentage of excellent or good analgesic effect (90%) in the two groups were the same. Adverse reactions didn't reached the statistic different level (P = 0.35).</p><p><b>CONCLUSIONS</b>Propacetamol HCL injection 2 g intravenously could be an alternative to dolantin 50 mg intramuscularly for moderate to severe postoperative pain with its advantage of being non-addictive.</p>

An appraisal of immunonutrition for clinical nutritional support with a systematic review of English and Chinese documents / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the efficacy, safty and economical values of immunonutrition for clinical nutritional support.</p><p><b>METHODS</b>The following electronic databases were searched: Chinese Biomedicine database (CBM), MEDLINE, EMBASE, Cochrane Library and SCI. Data were extracted by two reviewers. RevMan 4.1 was applied for statistical analysis.</p><p><b>RESULTS</b>Seventeen randomised trials comparing the use of immunonutrition which comprises nucleotides, omega-3 fatty acids and arginine with standard enteral nutrition in surgical, trauma/burn and critical illness patients. Combined analysis indicated that the use of immunonutrition decreased infectious events (pooled OR was 0.51, 95%CI [0.38, 0.67], P = 0.00001), length of hospitalization, and the cost. In sensitivity analysis for mortality, we found an increased tendency in immunonutrition (pooled OR was 1.94, 95%CI [1.05, 3.57], P = 0.03). Further sub-group analysis indicated that the effects of immunonutrition were various in different patient types.</p><p><b>CONCLUSIONS</b>Immunonutrition is associated with decreasing of infectious rates, length of hospitalization and cost in selective operation patients. But current evidence can't affirm the role of immunonutrition on critical illness patients. Further studies are urgently needed to clarify the reliability of immunonutrition in this group.</p>

The role of nutritional status on serum immunoglobulins, body weight and postoperative infectious-related complications in patients with Crohn's disease receiving perioperative parenteral nutrition / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the role of nutritional status on serum immunoglobulins, body weight and postoperative infectious-related complications in patients with Crohn's disease receiving perioperative parenteral nutrition (PN).</p><p><b>METHODS</b>32 patients with Crohn's disease receiving perioperative parenteral nutrition in our department between 1984 and 1994 were enrolled in this survey. 16 patients with loss of body weight in the range of 15%-30% were assigned to the malnutrition group, the other 16 patients with normal weight or loss of body weight less than 15% to the control group. Serum IgM, IgG and IgA levels were measured before and after PN by enzyme-linked immunosorbent assays. Liver function, body weight changes and postoperative complications were also analyzed.</p><p><b>RESULTS</b>IgM levels were elevated before PN in both groups [control group: (133 +/- 16) mg/dl, malnutrition group: (139 +/- 41) mg/dl; normal value: (110 +/- 35) mg/dl; P = 0.04], decreased to normal value [(105 +/- 29) mg/dl, P = 0.02] in the malnutrition group while having no obvious changes in the control group [(129 +/- 13) mg/dl, P = 0.34]. No significant changes in concentrations of IgG and IgA were found (P in the range of 0.20-0.57). The average weight gain was 1.862 kg in malnutrition group [before PN: (45.8 +/- 8.9) kg, after PN: (48.0 +/- 8.8) kg; P = 0.005] and no significant changes in the control group [before PN: (55.6 +/- 6.1) kg, after PN: (56.3 +/- 6.0) kg; P = 0.46]. There was an increase in infectious complications in the control group (control group: 4 cases, 25%, malnourished group: 2 cases, 12.5%; P = 0.13).</p><p><b>CONCLUSIONS</b>Perioperative parenteral nutrition ameliorated the humoral immunity, increased the body weight in patients with obvious malnutrition, whereas it had little value for those without or with mild malnutrition.</p>

Assay of carnitine in plasma and urine of healthy adults / 中国医学科学院学报

<p><b>OBJECTIVE</b>To determine the levels of carnitine in plasma and daily excretion of carnitine in urine of healthy adults so as to provide the reference standard for studying the changes of carnitine in patients.</p><p><b>METHODS</b>Carnitine in plasma and urine was assayed with high performance liquid chromatography (HPLC). The levels of total carnitine (TC), free carnitine (FC) and acetyl-carnitine (AC) in fasting plasma and the daily excretion of TC, FC and AC in urine were assayed in 40 healthy adults (20 men and 20 women) with standard diet.</p><p><b>RESULTS</b>Good linearity (r 2 > or = 0.999) was observed in assaying TC, FC and AC. The relative standard deviation (RSD) was lower than 9.1% and bias lower than 5.6%. It was showed that the plasmatic levels of TC, FC and AC in healthy men [(53.1 +/- 8.5), (41.2 +/- 6.1), (6.2 +/- 0.6) mumol/L] were significantly higher than those in healthy women [(45.4 +/- 5.6), (35.2 +/- 4.9), (5.7 +/- 0.7) mumol/L] (P = 0.002, 0.002, 0.035). The daily urinary excretion of TC, FC and AC in healthy men [(386.1 +/- 22.9), (180.5 +/- 31.8), (33.8 +/- 3.3) mumol] were also significantly higher than those in healthy women [(240.1 +/- 35.6), (112.7 +/- 22.6), (29.3 +/- 4.3) mumol] (P < 0.0005, < 0.0005, < 0.0005) when the adults were given standard diet. Both the plasmatic levels and the daily urinary excretion of TC, FC and AC were of significantly positive correlation with lean body mass (LBM) (r = 0.501-0.856). The (TC-FC)/FC ratios in plasma were 0.29 +/- 0.05 for male and 0.29 +/- 0.04 for female.</p><p><b>CONCLUSION</b>Good precision and accuracy were observed in assaying carnitine with HPLC. After standard diet, both the level of carnitine in fasting plasma and the daily urinary carnitine excretion of healthy adults were positively correlated with LBM.</p>