Progress in surgical techniques for scleral fixation of intraocular lens / 国际眼科杂志(Guoji Yanke Zazhi)

@#Patients with traumatic or congenital disease lead to lens dislocation and posterior capsule rupture after cataract surgery, <i>etc</i>, which cannot be routinely implanted with intraocular lens, can be implanted with different intraocular lenses according to the condition. This article will introduce a variety of surgical methods for posterior chamber intraocular lens scleral fixation, including sutured scleral fixation, sutureless intrascleral fixation and Fibrin glue-assisted sutureless haptic intrascleral fixation. In addition, the postoperative results and complications of the above procedures will be reported and analyzed.

Effect of Saropenia on Clinical Prognosis of Gastric Cancer Patients: A Prospective Cohort Study / 肠外与肠内营养

Objective: To investigate the effects of preoperative sarcopenia on postoperative clinical outcome in patients with gastric cancer. Methods: A prospective study was performed in 93 patients with gastric cancer and the skeletal muscle mass was examined by bioelectrical impedance. The primary outcome was postoperative complications. The secondary outcomes were postoperative length of stay, overall hospital costs, 60 days re-admission and mortality rate. Results: A significant difference (sarcopenia group vs. non-sarcopenia group) was observed in the rates of overall postoperative complications, incidence of pleural effusion and intra-abdominal infection, overall hospital stay and postoperative hospital stay (P ＜ 0. 05). The rates of 60 days readmission, 60 days mortality and hospital costs in sarcopenia group were not different between the two groups (P ＞ 0. 05). By univariate and multivariate analysis, preoperative sarcopenia and preoperative nutritional risk are the risk factors of postoperative complications. Conclusion: Sarcopenia is an independent risk factor for postoperative complications in patients with gastric cancer; preoperative patients with sarcopenia have a worse prognosis and should be screened and optimized before surgery.

Preparation of egg yolk antibodies against human isomaltase and determination of their biological activities / 医学研究生学报

Objective Antibody drugs are one of the hot topics in biomedical research.This study aims to develop egg yolk antibodies (IgYs) against human isomaltase and determine their biological activities.Methods The purified recombinant isomaltase protein was used as an antigen to immunize egg-laying hens in combination with complete Freund adjuvant (CFA).Anti-isomahase IgYs were extracted by water dilution-sodium sulfate extraction assay and further analyzed for their purity,specificity,titer and stability by SDS-PAGE,Western blot and ELISA respectively,and their inhibitory effect on human alpha-glycosidase enzymes was evaluated by the PNPG method.Results Anti-isomaltase IgYs were obtained,with a titer of 1 ∶ 12800,capable of specifically binding human isomaltase,and with a good thermal stability,acid/alkali stability and pepsin resistance.Conclusion Anti-human isomaltase IgYs were successfully prepared,which may provide an experimental ground for further investigation of oral antihyperglycemic agents for type Ⅱ diabetes mellitus.

Mucosal healing in different intestinal segments in patients receiving infliximab treatment for small bowel Crohn's disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the mucosal healing in the terminal ileum, colon and small bowel in patients receiving infliximab treatment for small bowel Crohn's disease (SBCD).</p><p><b>METHODS</b>The clinical data of 18 patients with SBCD treated with infliximab were analyzed for laboratory findings (routine blood tests, C-reative protein, and albumin), Crohn's disease activity index (CDAI), Lewis score (LS), Crohn's disease simplified endoscopic score (SES-CD) and adverse effects before and after 30 weeks of infliximab treatment.</p><p><b>RESULTS</b>SES-CD, LS, CDAI and CRP were all decreased significantly, but the body mass index and albumin were significantly increased in the 18 patients after 30 weeks of IFX treatment. Sixteen (88.9%) of the patients were in clinical remission, 10 (58.8%) showed terminal ileum and colonic mucosal healing, 4 (22.2%) showed small bowel mucosal healing, and 3 (17.6%) were in deep remission. The 4 patients with small bowel mucosal healing all showed terminal ileum and colon mucosal healing, and 6 patients with terminal ileum and colon mucosal healing did not show small bowel mucosal healing.</p><p><b>CONCLUSION</b>Infliximab treatment can effectively reduce inflammatory activity, induce and maintain clinical remission of SBCD and achieve mucosal healing; small bowel mucosal healing occurs later than terminal ileum and colonic mucosal healing, indicating the importance of small bowel mucosal healing in efficacy analysis of the treatment.</p>

Nutritional support therapy in patients with liver dysfunction undergoing gastrointestinal surgery / 中华胃肠外科杂志

Liver dysfunction by various reasons can cause metabolic disorders of a variety of nutrients and malnutrition, while malnutrition affects the recovery of liver function. Clinically patients undergoing gastrointestinal surgery are often accompanied with malnutrition, and these patients with liver dysfunction are easy to develop nutrient metabolic disorders. Therefore, improving the nutritional status of patients with liver dysfunction can improve the success rate of surgery and postoperative recovery. This article reviews the nutritional support in patients with liver dysfunction undergoing gastrointestinal surgery.

Pharmacological mechanisms and effects of amino acid nutrients / 中华胃肠外科杂志

Common amino acid nutrients mainly contain glutamine, arginine, leucine, methionine and cysteine, which are not only the components participating in body protein synthesis, but also regulate the patients' immune system and metabolism. Glutamine can improve the intestinal barrier, reduce inflammatory reaction, and promote immunity recovery, but the clinical effects of different patients with different diseases are still lack of clear conclusions. The catabolism of arginine can produce NO, promoting the inflammatory reaction, and can also generate ornithine, alleviating inflammatory reaction and promoting wound healing. Two competing ways coexist, but the specific effects on different diseases have no clear conclusions yet. Leucine promotes muscle protein synthesis mainly through mTOR pathway, however, the influence on metabolism is still debating. Sulfur-containing amino acids methionine and cysteine can promote the synthesis of connective tissue and collagen conducive to wound healing, and their beneficial effects on lipid metabolism are of value. The purpose of this review is to cover potential beneficial physiological mechanisms of amino acid nutrients, to describe their results of clinical applications and to evaluate the interactions among individual nutrients or between individual nutrients and body.

Genomic sequences of human infection of avian-origin influenza A(H7N9)virus in Zhejiang province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the etiology and genomic sequences of human infection of avian-origin influenza A(H7N9)virus from Zhejiang province.</p><p><b>METHODS</b>Viral RNA was extracted from patients of suspected H7N9 influenza virus infection and real-time RT-PCR was conducted for detection of viral RNA. All 8 segments of influenza virus were amplified by one-step RT-PCR and genomic sequences were assembled using the sequencing data. All the currently available HA and NA genes of the novel H7N9 virus, some other HAs from H7 subtype and NAs from N9 subtype were downloaded from public database for phylogenetic analysis, using the Mega 5.1 software. Mutations and variations were analyzed, using the genomic sequence data.</p><p><b>RESULTS</b>Reactions for influenza type A, subtype H7 and subtype N9 were all positive and all the genomic fragments were amplified for sequencing. After alignment, sequences were subjected for phylogenetic analysis. The results revealed highest homology with A/duck/Zhejiang/12/2011(H7N3)in HA gene and with A/wild bird/Korea/ A14/2011(H7N9)in NA gene of the H7N9 influenza virus. All 6 genes coding for internal proteins shared highest identities with H9N2 avian influenza which were circulated in the Chinese mainland, in the last two years. The sequenced virus showed Q226L mutation in HA protein, but E627K was not presented in PB2 protein of this virus. The E627K mutation was shared by all the other novel H7N9 viruses resulted in human infections through analysis on the currently available sequences.</p><p><b>CONCLUSION</b>Using the clinical samples, both detection of the viral genes and amplification of all 8 segments of the novel H7N9 influenza virus were accomplished. High homology of the novel H7N9 influenza viruses was observed by phylogenetic test, using the currently available sequences. The virus showed Q226L mutation on HA protein but E627K did not present on PB2 protein of this virus.</p>

Influence of Lipoplus fat emulsion on postoperative nutritional status and early inflammatory response in patients with gastrointestinal malignancies / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Lipoplus on postoperative nutritional status and inflammatory response in patients with gastrointestinal malignancies.</p><p><b>METHODS</b>Sixty-four patients with gastrointestinal malignancies were randomized using random digit table to receive isonitrogenous, isocaloric total parenteral nutrition for 5 days including either Lipoplus or Lipofundin with 32 patients in each group. Blood samples were obtained before the surgery, postoperative days 1, 2, 3, and 6 to evaluate the nutritional status(prealbumin, retinol binding protein, and nitrogen balance) and inflammatory response [C-reaction protein(CRP), and leukotriene(LTB) 5, LTB4]. The incidence of postoperative systemic inflammatory response syndrome(SIRS), infection, postoperative complications, mortality, APACHEII score, length of hospital stay and other clinical indicators were recorded.</p><p><b>RESULTS</b>On postoperative day 1, prealbumin and retinol binding protein were significantly lower as compared to preoperative levels. These parameters increased significantly(P<0.05) on postoperative day 6 and the nitrogen balance was positive. On postoperative day 6, CRP was significantly lower in both groups as compared to postoperative day 3 (P<0.05), and the decrease was more prominent in Lipoplus than Lipofundin(P<0.05). There was a significant increase in LTB5/LTB4 as compared to postoperative day 1(P<0.05) in the Lipoplus group, however the increase was not statistically significant in the Lipofundin group(P>0.05). The incidence of postoperative infection was significantly lower in the Lipoplus group(3.1% vs. 6.3%, P<0.05), as was that of SIRS(9.4% vs. 15.6%, P<0.05). The APACHEII score was higher in the Lipoplus group but the difference was not statistically significant(3.6±2.0 vs. 3.3±2.1, P>0.05). The length of hospital stay was significantly shorter in Lipoplus group[(6.4±1.1) d vs. (8.2±1.3) d, P<0.05].</p><p><b>CONCLUSION</b>Lipoplus can improve the postoperative nutritional status and minimize the inflammatory response in patients with gastrointestinal malignancies.</p>

Effect of enteral nutrition on liver function and inflammatory response after abdominal operation in patients complicated with liver dysfunction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of enteral nutrition(EN) on liver function and inflammatory response after abdominal operation in patients with liver dysfunction.</p><p><b>METHODS</b>A prospective multicenter study was conducted. Patients requiring EN for at least 5 days after abdominal surgery with at least 1 abnormal liver function index were included. After operations, EN suspensions(TPF-FOS) were administered for 5 days after the return of bowel function with targeted content of 125.52 kJ(30 kcal)·kg(-1)·d(-1) maintained for a minimum of 3 days. Levels of serum pre-albumin, C-reaction protein(CRP), and liver function index were measured and the incidence of systemic inflammatory response syndrome(SIRS) was recorded before operation and 6 days after EN. Occurrence of gastrointestinal discomfort was monitored during the treatment.</p><p><b>RESULTS</b>No statistically significant difference was found in pre-albumin between preoperative level and post-EN level[(175.94±71.79) mg/L vs.(192.22±91.26) mg/L, P=0.162]. Patients with abnormal level of γ-glutamyl transpeptidase were less after EN compared to the preoperative period(30 vs. 40, P=0.041), as was total bilirubin (3 vs. 9, P=0.034). No significant differences in other indices of liver function were found. Total bilirubin and direct bilirubin decreased after EN support(P=0.000 and P=0.015, respectively). CRP was notably reduced after EN support [(48.74±65.16) mg/L vs.(25.79±23.63) mg/L, P=0.009] and the incidence of SIRS largely declined after EN support(19.0% vs. 10.3%, P=0.059). The incidence of gastrointestinal discomfort was 22.4% on postoperative day 1 and declined to 19.0% on postoperative day 5.</p><p><b>CONCLUSION</b>For patients with liver dysfunction, enteral nutrition support with TPF-FOS after abdominal operation can reduce inflammatory response, improve liver function, and maintain serum protein level.</p>

The study of resting energy expenditure equation for short bowel syndrome patients / 中华外科杂志

<p><b>OBJECTIVES</b>To determine the accuracy of resting energy expenditure (REE) calculated by using the Harris-Benedict (HB) equation, Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU) equations (FAO equations), Shizgal-Rosa (SR) equation and the LIU equation in patients with short bowel syndrome (SBS). In addition, to explore the relationship between measured REE and body weight, fat free mass, body cell mass, fat mass and fat mass percent.</p><p><b>METHODS</b>Fourty-one SBS patients including 30 male and 11 female, aged from 18 to 60 years admitted between January 2001 and October 2010 were enrolled in this study. All patients required long-term parenteral or enteral plus parenteral nutrition support. Their mean age and mean stature were (37 ± 16) years and (164.3 ± 9.0) cm, and the average body weight and residual small intestine was (47.4 ± 9.3) kg and (52 ± 45) cm. Measured REEs and calculated REEs of SBS patients were estimated respectively by indirect calorimetry and REE equations, and then defined the difference of them. And body mass were metered by body composition analyzer.</p><p><b>RESULTS</b>A significant correlation was found between measured REEs (1218 ± 293) Kcal and calculated REEs from the HB equation (r = 0.588, P < 0.01), the SR equations (r = 0.591, P < 0.01), the FAO equations (r = 0.411, P < 0.01) and the LIU equation (r = 0.585, P < 0.01). In the total sample, the paired t test between measured REEs and REEs derived from the HB equation, SR equation and FAO equation showed no significant difference (P > 0.05). However, measured REEs were significantly higher than REEs calculated using the LIU equations by 14.17% (P < 0.01). There was also a significant correlation between measured REEs and body weight, fat free mass and body cell mass (r = 0.548, 0.641 and 0.581).</p><p><b>CONCLUSIONS</b>Indirect calorimetry is preferred when an accurate REE estimate of SBS patients is necessary. However, if this machine is not available, SR equation is recommended to use and LIU equation must be avoided. Fat free mass may be more useful than body weight in REE calculation.</p>

Diagnosis of a dengue fever outbreak in Yiwu city, Zhejiang province in 2009 and its molecular tracing of the pathogen / 中华预防医学杂志

<p><b>OBJECTIVE</b>To determine a dengue fever outbreak in Yiwu city, Zhejiang Province in 2009 and to trace the origin of the pathogen.</p><p><b>METHODS</b>The dengue virus IgM, IgG antibodies and viral nucleic acid were detected and virus was isolated using 40 serum samples from the suspected patients. The viral RNA of the isolated virus strains was extracted and the E gene was amplified by RT-PCR. The amplicons were sequenced and the phylogenetic and homological analyses were also constructed.</p><p><b>RESULTS</b>Among 40 serum samples from dengue fever suspected patients, 17 were positive from for dengue IgM (42.5%); 4 were IgG positive (10.0%); 34 samples were dengue virus RNA positive (85.0%), 28 dengue virus type 3 (D3) strains were isolated (70.0%). The complete coding region of envelope genes (E) from 13 D3 strains was all 1479 nt without any insertion or deletion, which encoded with 493 amino acids (aa). E gene from the 13 D3 strains from Zhejiang in 2009 (D3/ZJ/2009) was 100.0% identical. The strain from Saudi Arabia shared the highest similarity with the D3 strain, 99.3% and 100.0% of their E genes and deduced amino acids were identical, respectively, whereas they were 93.4% and 97.4% between D3/ZJ/2009 strain and its prototype strain (D3/H87/1956), and 93.6% and 97.4% between D3/ZJ/2009 and a D3 strain isolated in Guangxi Province in 1980. The phylogenetic tree of E genes also indicated that D3/ZJ/2009 had maximum similarity with the D3/Saudi Arabia/2004. They all belonged to the D3/GIII branch, which was originated from Indian Subcontinent.</p><p><b>CONCLUSION</b>The outbreak of dengue fever in Zhejiang in 2009 was caused by type 3 dengue virus III genotype. The virus was most likely originated from Saudi Arabia.</p>

The clinical effectiveness of percutaneous drainage and laparotomy for patients with infective pancreatic necrosis / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the clinical effectiveness of percutaneous US- or CT-guided drainage and laparotomy for patients with infective pancreatic necrosis.</p><p><b>METHODS</b>Data of 90 infective pancreatic necrosis patients admitted from January 2008 to December 2009 were included. They were divided into two groups by the different treatment choices. Twenty-seven patients in the percutaneous group received percutaneous US- or CT-guided drainage as first choice. After that a sump suction apparatus was applied for controlled drainage. If no improvement was achieved after 3 days, they would received operation soon. While patients in the laparotomy group received surgical drainage at the time when the diagnosis of infected pancreatic necrosis was confirmed. Continuous drainage was also applied for these ones.</p><p><b>RESULTS</b>The percutaneous group had a significant low rate of reoperation (7.1% vs. 14.3%, P < 0.05) and postoperative residual abscesses (7.1% vs. 28.6%, P < 0.05). Furthermore, 48.1% of patients in percutaneous group successfully avoid laparotomy. In the regard of complications, the percutaneous group presented lower incidence of both single organ dysfunction (7.4% vs. 28.6%, P < 0.05), intestinal fistula (7.4% vs. 27.0%, P < 0.05) and long-term complications (3.7% vs. 22.2%, P < 0.05). In addition, the percutaneous group costed less medical resources as evidenced by shorter ICU duration (21.2 ± 9.7 vs. 28.7 ± 12.1, P < 0.01), shorter hospital duration (48.2 ± 12.5 vs. 59.6 ± 17.5, P < 0.05) and less expenditure (191 762 ± 5892 vs. 341 689 ± 10 854, P < 0.05).</p><p><b>CONCLUSIONS</b>Percutaneous drainage can effectively lower the surgical rates and the rates of complications and reoperations in patients with infective pancreatic necrosis. Besides that, it could also reduce the cost of medical resources.</p>

Mechanism of glutamine downregulates the cytokine expression in lipopolysaccharide-stimulated human peripheral blood mononuclear cells / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the mechanism that glutamine (Gln) downregulates the cytokine expression in lipopolysaccharide (LPS)-stimulated human peripheral blood mononuclear cells (PMBCs).</p><p><b>METHODS</b>PMBCs were extracted from healthy volunteer by density gradient centrifugation, the cells were divided into two parts. The first part of PMBCs was pretreated with Gln of the concentration of 0, 8, 15 mmol/L for 0.5 h and 2.0 h respectively, then stimulated by LPS for 4.0 h. Cells and supernatants were collected. The second part of PBMCs was divided into group A, B and C. Group A and B were pretreated with HSP70 blocker (Quercetin) for 1.0 h, then were stimulated by LPS for 4.0 h. Cells and supernatants were also collected. The release of TNF-alpha and IL-10 was analyzed via enzyme-linked immunosorbent assay (ELISA) and HSP70 via Western Blot. In this experiment, the effect of Quercetin on TNF-alpha, IL-10 and HSP70 expression in human PBMCs was assessed.</p><p><b>RESULTS</b>Gln led to an increase in HSP70 expression, and decreased TNF-alpha, IL-10 release at 4.0 h after LPS stimulation when 8 mmol/L glutamine pretreated for 0.5 h and 2.0 h, 15 mmol/L glutamine pretreated for 0.5 h (P < 0.05). The expression level of HSP70 was significantly decreased, however, the expression of TNF-alpha and IL-10 was enhanced in Quercetin group (P < 0.05).</p><p><b>CONCLUSION</b>The effect of glutamine attenuating cytokine release in PBMCs is related to the enhancement of HSP70 expression.</p>

Treatment experience of severe acute pancreatitis on 1033 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To summary the treatment experience of severe acute pancreatitis (SAP).</p><p><b>METHODS</b>From January 1997 to March 2009, a total of 1033 patients suffered SAP were admitted with a mean APACHE II score 12.0 +/- 4.3. There were 622 males and 411 females, aged from 13 to 98 years old. All patients were cared by the multidisciplinary team with intensivist, endoscopists, gastroenterologists, radiologist, nephrologist and surgeons.Patients treated in SICU in the early phase of the disease. In these 1033 patients, 365 cases received mechanical ventilation, 218 with tracheotomy, 159 cases received high-volume continuous venovenous hemofiltration (CVVH), 179 received nasobiliary drainage, 513 were treated with early enteral nutrition. CT-guided percutaneous catheter drainge for peripancreatic fluid collection was pefromed for 477 times and 438 patients received surgical debridement for infected pancreatic necrosis.</p><p><b>RESULTS</b>In all these 1033 cases, 975 patients (94.4%) survived, and 38 patients died (3.7%). The mortality of patients who received surgical debridement for infected pancreatic necrosis was 7.1% (31/438).</p><p><b>CONCLUSION</b>The muti-discipline management of severe acute pancreatitis can remarkably improve the prognosis of patients.</p>

Association of fliR gene in Leptospira interrogans with adhesion and pathogenicity to host cells / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the pathogenicity of Leptospira interrogans fliR gene to J774A.1 cells.</p><p><b>METHODS</b>fliR gene from L. interrogans serogroup Icterohaemorrhagiae serovar lai strain 56601 and kana gene from plasmid pET42a were amplified by PCR. Suicide plasmid of fliR gene was constructed; and specific siRNA for fliR gene was designed and synthesized. fliR gene mutants were constructed by gene knock-out with suicide plasmid (56601fliR-Kana) and gene silencing with siRNA (56601siRNA-R2). The mutants were identified by PCR, sequencing and semi-quantitative RT-PCR. Adhesion to mouse mononuclear-macrophage J774A.1 and induction of cell necrosis and apoptosis by 56601fliR-Kana and 56601siRNA-R2 were examined by adhesion test and flow cytometry, respectively.</p><p><b>RESULT</b>The nucleotide and putative amino acid sequences of cloned fliR gene had 99.9% and 100% similarities to those of reported sequences in GenBank. The nucleotide sequence of the cloned kana gene was identical to the corresponding sequence in pET42a map. The results of PCR and sequencing confirmed that kana gene was inserted in the sequence of 56601fliR-Kana fliR gene. The mRNA level of fliR gene in 56601fliR-Kana was remarkably decreased (P<0.01) while the mRNA level of fliR gene in 56601siRNA-R2 was much lower than that in wild strain 56601 (P<0.05). 56601fliR-Kana and 56601siRNA-R2 lost the ability to adhere J774A.1 cells; and their ability to induce cell necrosis and apoptosis was markedly weakened (P<0.01).</p><p><b>CONCLUSION</b>fliR is a virulence-associated gene of L. interrogans and the function of the gene is closely related to adhesion, induction of cell necrosis and apoptosis of the microbe.</p>

Enteral nutrition support in 21 patients after opening abdomen / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and efficacy of enteral nutrition (EN) in patients underwent open-abdomen managements.</p><p><b>METHODS</b>Twenty-one patients who received at least 3 days of EN after opening the peritoneal cavity between January 2003 and November 2006 were included in this study. Energy expenditure and actual caloric and protein intake were determined in some patients. The levels of serum protein and nitrogen balance before and after the EN were analyzed. Other related complications were also evaluated.</p><p><b>RESULTS</b>Average daily total caloric intake was 93% - 95% of estimated needs. The EN support was administered (8.8 +/- 5.5) d after opening the abdominal cavity and lasted for (51.5 +/- 33.6) d. Initial serum protein levels were low and below normal but increased in all of the patients after the EN. The average nitrogen balance was (-28.6 +/- 5.4) g/d. Diarrhea, gastric reflux, vomiting and abdominal distention occurred in 67%, 23%, 9.5% and 23% of the patients, respectively. All the complications were managed well.</p><p><b>CONCLUSIONS</b>EN support could be effectively and safely given in patients requiring opening peritoneal cavity management.</p>

Effect of high amounts of medium chain triglyceride and protein enteral nutrition on nutritional status in patients after major abdominal operation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Nutrition MCT and Nutrition MF enteral nutrition on nutritional status of patients after major abdominal operation.</p><p><b>METHODS</b>In a double- blinded and randomized cross- cover study, Nutrition MCT and Nutrition MF enteral nutrition were fed in patients when the gut function restored after operation. The total calorie was 104.6 kJ(25 kcal) x kg(-1) x d(-1) and the period of full dose of enteral nutrition was 5 days. The blood samples were collected before operation,before enteral nutrition and the sixth day after full dose of enteral nutrition for the measurement of pre- albumin, total protein,albumin, transferrin and triglyceride. The urine, stool and drainage fluid were collected to analyze nitrogen balance.</p><p><b>RESULTS</b>The plasma protein and fat were obviously dropped in patients after abdominal operation and improved after the enteral nutrition support in two groups. However, the pre- albumin level increased more in patients of Nutrition MCT than Nutrition MF.</p><p><b>CONCLUSION</b>Nutrition MCT can obviously improve the nutritional status of patients after major abdominal operation.</p>

Mechanism of reduction of albumin expression induced by lipopolysaccharide in rat hepatocytes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The severity of hypoalbuminemia has been shown to be related to morbidity and mortality in some critical illnesses, illustrating the need for better understanding of molecular mechanism of hypoalbuminemia. Lipopolysaccharide (LPS) is a key mediator inducing hypoalbuminemia in sepsis and septic shock. The present study was designed to identify if the reduction of albumin expression is directly induced by LPS and modulated by activated extracellular signal-regulated protein kinase (ERK) and p38 mitogen-activated protein kinase (MAPK) in rat hepatocytes.</p><p><b>METHODS</b>Primary rat hepatocytes were divided into five groups. In two of them, hepatocytes were treated with normal saline or 1 microg/ml LPS, then albumin mRNA expression was observed at 0, 2, 8, 12 and 24 hours after treatment. In another group, hepatocytes were pretreated with 100, 40 or 20 micromol/L of cycloheximide (CHX, an inhibitor of protein synthesis) for 30 minutes followed by 1 microg/ml LPS for 24 hours. Then the RNA was extracted from the cells for RT-PCR to detect the expression of albumin. The other two groups were administered 1 micromol/L, 10 micromol/L and 50 micromol/L of SB203580 (p38 MAPK inhibitor) or PD98059 (ERK inhibitor) 30 minutes prior to 1 microg/ml LPS treatment. After 24 hours of LPS treatment, the supernatant was collected and assayed for albumin concentrations. Data were analyzed by one-way analysis of variance, followed by the Newman-Keul test; a P<0.05 was considered significant.</p><p><b>RESULTS</b>There was no marked change in albumin mRNA expression in the control group during 24-hours treatment with normal saline. The reduction did not occur until 24 hours after LPS treatment, and albumin mRNA decreased by 30% approximately compared to the control group at 24 hours (0.587 vs 0.832, P=0.007). CHX could inhibit the decline of albumin mRNA induced by LPS and the effect was correlated with the dose of CHX. The ERK inhibitor PD98059 caused a significant increase in LPS-induced albumin production at the three concentrations (119.7, 111.4 and 80.0 ng/ml vs 44.4 ng/ml, P=0.0013, 0.0025 and 0.009, respectively), whereas SB203580 obviously blocked albumin reduction in LPS-treated cells at the concentrations of 10 and 50 micromol/L (87.5 and 93.6 ng/ml vs 44.4 ng/ml, P=0.0076 and 0.0049, respectively).</p><p><b>CONCLUSIONS</b>LPS can induce the reduction of albumin expression by new synthesized proteins indirectly, and the process may be related to the signal proteins of ERK and p38 kinase. The ERK and p38 kinase are critical signaling pathways in LPS-induced hypoalbuminemia which is worthwhile to understand in studying the molecular mechanism of hypoalbuminemia in sepsis and septic shock.</p>

Potential mechanism underlying down-regulation of albumin expression induced by lipopolysaccharide in rat hepatocytes / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the potential molecular mechanism underlying down-regulation of albumin expression induced by lipopolysaccharide (LPS) in rat hepatocytes.</p><p><b>METHODS</b>The albumin mRNA expression and albumin protein levels in the supernatant were observed at 0, 2, 8, 12 and 24 hours after 1 micro g/ml LPS treatment. The albumin mRNA expression was determined by RT-PCR, and albumin protein levels were assayed with EIA in the supernatant of hepatocytes pretreated with specific inhibitors of extracellular signal-regulated kinase (PD98059) and p38 kinase (SB203580).</p><p><b>RESULTS</b>The albumin mRNA expression was reduced to 70% of baseline value, meanwhile, the albumin protein concentration in the supernatant was reduced by 50% compared with the controls after 24 hours of LPS treatment. Pretreatment with PD98059 and SB203580 did significantly inhibit the reduction of albumin by LPS at the given dose.</p><p><b>CONCLUSION</b>The results indicate that LPS can induce the reduction of albumin synthesis by down-regulation of albumin mRNA expression at transcription level, and the process may be related to the signal transducation of extracellular signal-regulated kinase and p38 kinase.</p>

Albumin kinetics in patients with severe sepsis / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the mechanism of hypoalbuminemia in patients with severe sepsis.</p><p><b>METHODS</b>I(125)-labeled albumin was administered intravenously to 10 health volunteers and 10 patients with severe sepsis. Blood samples were taken at 0, 1, 2, 4, 8, 12, 24 hours and 2, 3, 4, 5, 6, 7, 9, 11, 13, 15, 18, 22, 25 days for the measurement of the dose of gamma-radiation and the curve of concentration and time. Then the half-life time (t(1/2)), apparent volume of distribution (V(d)) and transportation rate (K(12)) from center compartment to side compartment of albumin were calculated.</p><p><b>RESULTS</b>The half-life time in septic group was obviously shorter than that in control group (8.2 +/- 1.4 vs. 12.5 +/- 1.7, P < 0.01). The transportation rate in the septic group was higher than that in the control group [(4.4 +/- 1.9) x 10(-2)/h vs. (2.4 +/- 0.6) x 10(-2)/h, P < 0.05]. There was no significant difference in apparent volume of distribution between the two groups.</p><p><b>CONCLUSIONS</b>In patients with severe sepsis, the distribution rate of albumin from vessel to tissue was obviously increased and the decomposition rate of albumin was markedly improved.</p>