Application of metabonomics strategy in sepsis / 中国小儿急救医学

Sepsis is a heterogeneous disease with a complex pathogenesis and diverse clinical manifestations.Sepsis leads to disruption of biochemical homeostasis, which strongly promotes changes in metabolites in the body.Initial differences in metabolites may predict the severity of the disease, and changes in metabolites over time may useful in assessing treatment response, predicting progression of disease progression or clinical outcomes.This review focused on the studies related to the application of metabolomics strategy in sepsis, which could help to understand the potential value of sepsis metabolomics in the pathogenesis, diagnosis, prognosis and treatment of sepsis.

Complete response in metastatic breast cancer with visceral crisis using a combination of cyclin-dependent kinase 4/6 inhibitor and aromatase inhibitor: A case report from the eastern region of India

Patients with metastatic breast cancer (MBC) in visceral crisis require systemic chemotherapy. However, a coexisting cardiac failure that contradicts the use of systemic chemotherapy often demands an alternative treatment. Here, we report a case of hormone-receptor-positive MBC with cardiological comorbidities. She was treated with a combination treatment of tablet Ribociclib (600 mg once daily for 21 days followed by 7 days gap) and tablet Letrozole (2.5 mg once daily). The patient had a complete metabolic response in 18-Fluorodeoxyglucose Positron Emission tomography-Computed Tomography (18F-FDG PET/CT), after 6 months of treatment. Combination treatment with Ribociclib and Letrozole is beneficial in postmenopausal females with hormone receptor-positive and human epidermal growth factor receptor 2 neu-negative MBC in visceral crisis who have a contraindication to chemotherapy.

Starch and fibre intake and glucose postprandial response of dogs / Consumo de amido e fibra e a resposta pós-prandial de glicose de cães

ABSTRACT: Fibre has been studied to reduce the postprandial glucose response of dogs, but the results are inconsistent. Starch intake, however, was not properly considered in the published studies. The effects of starch and fibre intake on the postprandial glucose response were studied in non-obese adult dogs. Cellulose (CEL), carboxymethylcellulose (CMC), pea fibre (PE) and sugarcane fibre (SCF) were combined to form six diets with starch contents ranging from 33% to 42%: SCF+CEL and PE+CEL diets, both with high insoluble fibre (IF=22%) and low soluble fibre (SF=2.5%) content; SCF+CMC and PE+CMC diets with high SF (SF=4.5%; IF=19%) content; and CMC and CEL diets with low dietary fibre (14%) content. The diets were fed in two amounts, providing an intake of 9.5g or 12.5g of starch (kg0.75)-1 day-1, totaling 12 treatments. Each diet was fed to six dogs conditioned to consume all of the daily food in 10min. Their plasma glucose levels were measured before and during 480min after food intake. Results of fibre and starch intake and their interactions were compared by repeated measures ANOVA and the Tukey test (P<0.05). Fibre intake did not change the glucose postprandial responses (P>0.05). High-dose starch intake, however, induced a higher glycaemia at 180 and 240min after the meal and a greater maximal glycaemia and greater area under the glucose curve (P<0.05). A range in insoluble and soluble fibre intake does not change postprandial glucose response, and the amount of starch intake is a main factor for the postprandial glucose response of healthy non-obese dogs.

RESUMO: Fibras têm sido estudadas como opção para reduzir a resposta glicêmica pós-prandial de cães, mas os resultados obtidos têm sido inconsistentes. A ingestão de amido, no entanto, não tem sido adequadamente considerada na interpretação dos resultados de algumas dessas pesquisas. O presente estudo investigou, em cães adultos não obesos, os efeitos da ingestão de amido e fibra sobre a resposta pós-prandial. Celulose (CEL), carboximetilcelulose (CMC), fibra de ervilha (PE) e fibra de cana-de-açúcar (SCF) foram combinadas, gerando seis dietas com 33% a 42% de amido: dietas SCF+CEL e PE+CEL com alta fibra insolúvel (IF=22%) e baixa fibra solúvel (SF=2,5%); dietas SCF+CMC e PE+CMC com alta fibra solúvel (SF=4,5%; IF=19%); dietas CMC e CEL como controles baixa fibra (14%). As dietas foram fornecidas aos cães em duas quantidades, resultando na ingestão de 9,5g ou 12,5g de amido (kg0,75)-1 dia-1, gerando um total de 12 tratamentos. Cada tratamento foi fornecido a seis cães, condicionados a ingerir todo o alimento do dia num período de 10min. A glicose plasmática foi medida em jejum e durante 480min após a refeição. Os resultados foram analisados por análise de variância de medidas repetidas, considerando-se os feitos da ingestão de amido e fibra, e suas interações, sendo as médias comparadas pelo teste de Tukey (P<0,05). A ingestão de fibra não alterou a resposta pós-prandial de glicose (P>0,05). O consumo da dose elevada de amido, no entanto, resultou em maiores glicemias aos 180 e 240min, maior glicemia máxima e maior área abaixo da curva de glicose (P<0,05). Verificou-se que a quantidade ingerida de amido é mais importante que o consumo de fibra para a resposta glicêmica pós-prandial de cães não obesos.

Efecto del consumo de bebidas dietéticas sobre los niveles de glucosa e insulina plasmática en jóvenes estudiantes de la Universidad del Norte / Effect of the consumption of diet sodas in plasmatic levels of glucose and insulin in young students at Universidad del Norte

Objetivo: Determinar el efecto de las bebidas dietéticas en los niveles de glucosa e insulina en jóvenes estudiantes de medicina de la Universidad del Norte. Materiales y métodos: Se realizó un estudio experimental aleatorizado con una muestra de 16 estudiantes de sexo femenino de tercer semestre del programa de Medicina de la Universidad del Norte. Su participación fue voluntaria, previa firma del consentimiento informado. Se determinaron las variables antropométricas: peso, talla e índice cintura/ cadera. Se extrajo muestras para la determinación de la glucosa e insulina en ayunas. Posteriormente se distribuyeron aleatoriamente en dos grupos. Al grupo control se le suministró una gaseosa normal de 600cc y al grupo experimental, una gaseosa dietética de igual volumen. Al término de 2 horas se extrajeron nuevas muestras para determinar niveles de glucosa e insulina postprandiales. Se recolectaron los datos y se realizó el análisis estadístico utilizando el software IBM SPSS v22.0. Resultados: Se encontró una relación lineal positiva estadísticamente significativa entre los niveles de insulina (r = 0,908; p=0,002) y entre los índices HOMA (r= 0,913; p=0,002), HOMAR (r= 0,920;p=0,001), HOMA beta (r= 0,838;p=0,009)y OUICKI (r= 0,996;p=0,001) pre- y postprandial en el grupo que recibió la bebida dietética. Conclusiones: Los datos demuestran que los niveles de glucosa, insulina y el índice HOMA se comportan de forma lineal según el tipo de gaseosa consumido. No obstante se necesitan más estudios para determinar la interrelación entre dichas variables.

Objective: To determine the effect of diet sodas in glucose and insulin levels in young medical students from the Universidad del Norte. Materials and methods: A randomized experimental study with a sample of 16 female students with an average age of 18 years, belonging to the third semester of Medicine pro-gram at Universidad del Norte. The subject's participation was voluntary prior signature of informed consent. We assed the following anthropometric variables: weight, height, waist / hip ratio. Blood samples were obtainedfor determination of fasting glucose. We randomly divided the sample into two groups. The control group was provided a 600 cc of a regular soda, and the group experimental, an equal volume of diet soda. After 2 hours, new blood samples were taken in order to determine postprandial glucose and insulin levels. Data was collected and statistical analysis was performed using SPSS v22.0 software. Results: A statistically significant positive linear relationship between the levels of basal and postprandial insulin (r = 0.908; p = 0.002) and between pre and post-prandial HOMA index (r = 0.913;p = 0.002), HOMAR (r= 0,920;p=0,001), HOMA beta (r= 0,838;p=0,009), y OUICKI (r= 0,996; p=0,001) was found in the group receiving dietary drink. Conclusions: Data from this study show that the levels of glucose, insulin and HOMA index behave in lineal ways according to the type of soda consumed, however further studies are needed to determine the inter-relationship between these variables.

Advances in metabolic response to stress during critical illness / 中华危重病急救医学

The metabolic response to stress plays a key role in the adaptive response during critical illness.Multiple mechanisms including the stimulation of the sympathetic nervous system,inflammation,and immune responses were involved.Insulin resistance is one of the main features in metabolic response to stress.Metabolic response to stress was manifested by disorders of energy consumption,such as glucose,lactic acid,lipids,and proteins.The decrease in fat-free body mass and cell mass,relative excess of adipose tissues,and increased extracellular fluid volumes were also involved.Therapeutic interventions,including hormone supplementation,enhanced protein intake,and early mobilization,are considered for prevention and therapy of metabolic response to stress.The review aims to summarize the pathophysiological mechanisms,clinical consequences,and therapeutic implications of metabolic response to stress in critical illness.

Respuesta metabólica en el trauma / Metabolic response in trauma

La agresión traumática da lugar a importantes procesos metabólicos, proporcionales con la intensidad de la agresión sufrida, y aunque estos son más evidentes en las dos primeras semanas tras el trauma, suelen persistir y exigen un adecuado soporte nutricional. Se describen las características y las diferentes fases de la respuesta sistémica al trauma. También se hace referencia a la interacción neuro-endocrino-inmunitaria en la respuesta y a las consecuencias metabólicas posteriores a la lesión, que fueron determinadas mediante la revisión actualizada de documentos y revistas nacionales e internacionales, con el objetivo de profundizar en el estudio de las principales alteraciones metabólicas que desencadena el trauma. Las capacidades del organismo para poder sobrevivir, cuando ocurre un trauma importante, pueden ser insuficientes, de ahí la necesidad de apoyo, que resulta decisiva. Comprender los elementos descritos en la respuesta inmunometabólica y la complicación séptica, se consideran vitales, así como el control de las alteraciones posteriores a la injuria

Traumatic aggression leads to significant metabolic processes, in proportion to the intensity of the aggression suffered, and although these are more obvious in the first weeks after trauma, they remain and demand an appropriate nutritional support. The characteristics and the different phases of systemic response to trauma are described. Also, authors make reference to the interaction neuro-endocrine-immune in the response and to the metabolic consequences after injury, determined by means of the updated revision of documents and of national and international journals to deepen in the study of the major metabolic alterations triggering the trauma. The abilities of the organism to survive, when occur a significant trauma, may be enough, hence the need of support which is decisive. To understand the elements described in the immuno-metabolic response and the septic complication, are vital, as well as the control of alterations after injury

Effectiveness of Aerobic Exercise in Cardiac Patients

OBJECTIVE: The purpose of this study is to evaluate the effectiveness and safety of aerobic exercise program in cardiac patients. METHOD: Twenty patients participated in 6 weeks of aerobic exercise with telemetry monitoring as an outpatient rehabilitation program. For the comparison of physiologic changes, we used graded exercise test (GXT) by means of modified Bruce protocol before and in 6 weeks after aerobic exercise training. Exercise prescription for cardiac rehabilitation was composed of intensity, mode, frequency and duration. By use of EKG telemetry and monitoring of blood pressure and Borg RPE (ratings of perceived exertion) scale, we were monitored patients status during exercise. RESULTS: In six weeks after aerobic exercise training, the hemodynamic and metabolic responses were improved and statistically significant parameters were as follows: exercise time, maximal METs, resting heart rate, maximal heart rate, submaximal rate pressure product, maximal expired volume, maximal oxygen consumption rate and anaerobic threshold. CONCLUSION: We concluded that six week cardiac rehabilitation program is useful and safe to improve the aerobic capacity for cardiac patients.