ABSTRACT
Oral transmucosal drug delivery can be defined as the administration of drug through the oral mucosa to achieve systemic effects. It has the advantages of high bioavailability and rapid drug response. In this review, we introduce the physiology of oral mucosa, and analyze the factors affecting the pharmacokinetic properties of oral transmucosal drug delivery in detail, such as physiological barriers, different administration sites, physicochemical properties of drugs, dosage forms, and formulation strategies. In addition, we describe the methods to evaluate the pharmacokinetic properties of this delivery systems, including in vitro permeability studies, buccal absorption studies, in vivo pharmacokinetic studies and physiologically based pharmacokinetics (PBPK) modeling, which provide methods and reference for the development of oral transmucosal drug delivery systems.
ABSTRACT
<p><b>OBJECTIVE</b>To demonstrate the changes of resting energy expenditure (REE), substrate metabolism and body composition in cancer patients.</p><p><b>METHODS</b>From September 2004 to March 2008, REE, carbohydrate oxidation (CO) and fat oxidation (FO) in 936 cancer patients and 840 control subjects were measured by indirect calorimetry. Bioelectrical impedance appliance was applied to assess intracellular fluid, extracellular fluid, fat mass (FM) and fat free mass (FFM) in the two groups.</p><p><b>RESULTS</b>No difference in REE was found between the cancer patients and non-cancer patients [(1452.2 +/- 196.4) kcal/d vs. (1429.5 +/- 182.6) kcal/d, P = 0.136]. But REE/FFM and REE/pREE were elevated in cancer patients than in controls (all P < 0.05). Of the cancer patients, 48.6% were hypermetabolic, 42.9% normal and 8.5% hypometabolic, while those were 22.5%, 58.5% and 19.0% in controls. Cancer patients had higher FO [(77.8 +/- 11.3) g/min vs. (67.1 +/- 12.1) g/min, P = 0.000], lower CO and npRQ [(68.7 +/- 10.5) g/min vs. (88.8 +/- 12.1) g/min, P = 0.000; 0.782 +/- 0.012 vs. 0.810 +/- 0.014, P = 0.000]. Cancer patients exhibited lower FM and FFM [(14.9 +/- 4.5) kg vs. (18.4 +/- 5.2) kg, P = 0.000; (44.4 +/- 7.2) kg vs. (46.1 +/- 8.1) kg, P = 0.008].</p><p><b>CONCLUSIONS</b>Elevated REE is common in cancer patients. Substrate metabolism of the cancer patients features in increased FO, decreased CO and npRQ, which is correlated with the elevated REE. FM and FFM loses in proportion in cancer patients.</p>
Subject(s)
Female , Humans , Male , Body Composition , Carbohydrate Metabolism , Energy Metabolism , Fats , Metabolism , Neoplasms , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To estimate prevalence of malnutrition on admission to hospital and the relationship between nutritional status and prognosis.</p><p><b>METHODS</b>Four thousand and twelve patients admitted to general surgery department were evaluated by a lot of nutrition indexes within 48 h. Operative morbidity and complications were recorded to identify the difference between malnourished and well-nourished patients.</p><p><b>RESULTS</b>Malnutrition rate of all patients according to BMI, TSF, MAC, AMC, albumin, prealbumin, and lymphocyte count was 21.3%, 50.6%, 20.5%, 21.2%, 24.2%, 35.4% and 55.8%, respectively. The prevalence of malnutrition as defined by SGA and MNA were 38.8% and 20.8%. The older patients (> 60 years old) were associated with a higher prevalence of malnutrition (47.6%) compared with those younger than 60 (31.5%). Malnutrition was more frequently occurred in cancer patients than non-oncologic patients (64.5% vs 22.4%). Patients with digestive tract disease had higher rates of malnutrition than those without digestive tract disease (52.6% vs 30.0%). There were large differences in the morbidity and complications between well nourished patients and malnourished patients (4.0% vs 1.1%, P < 0.01 for morbidity; 19.8% vs 5.9% for complications).</p><p><b>CONCLUSIONS</b>The prevalence of malnutrition in hospitalized surgical patients is high. Malnutrition was associated with increased length of stay, higher operative morbidity and complications.</p>