ABSTRACT
Objective To investigate the effects of different early enteral nutrient (EN) emulsions of TPF-T and TP on nutritional status and intestinal mucosal barrier in patients with septic shock. Methods From May 2017 to May 2018, 112 patients with septic shock were continuously enrolled in the Department of Intensive Care Unit of the First People's Hospital of Taizhou, and they were randomly divided into a TPF-T group and TP group, each group with 56 cases. After admission, the patients in both groups were all treated according to the 2016 Saving Sepsis Campaign (SSC) Guidelines for septic shock. Both groups were supported with EN, TPT-T group was given TPF-T EN emulsion rich in fish oil, while TP group was supported with standard TP EN emulsion, and the therapeutic course was consecutive 7 days in both groups. The differences in nutritional status, inflammatory response, immune function, intestinal mucosal barrier, gastrointestinal symptoms and prognosis were compared between the two groups. Results After EN, the nutrition indicators such as albumin (Alb), prealbumin (PA), transferrin (TRF) and immune indexes (IgA, IgG), human leukocyte DR antigens (HLA-DR) and D-lactic acid were increased in both groups, reaching the peaks on the 7th day after EN application, Alb, PA, TRF, IgA, IgG, HLA-DR in the TPF-T group were significantly higher than those in the TP group [Alb (g/L): 34.43±5.81 vs. 33.59±5.34, PA (mg/L): 269.83±47.56 vs. 252.67±41.92, TRF (g/L): 3.43±0.64 vs. 3.32±0.81, IgA (mg/L): 159.45±34.56 vs. 143.31±33.81, IgG (mg/L): 4 947.68±871.66 vs. 4 583.75±841.54, HLA-DR: (68.22±9.11)% vs. (62.21±9.69)%], and after EN, the D-lactic acid in the TPF-T group was significantly lower than that in the TP group (mg/L: 30.42±6.79 vs. 33.34±7.31). The inflammatory indicators of tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), procalcitonin (PCT), endotoxin and diamine oxidase (DAO) were all gradually reduced in two groups, reached the lowest levels on the 7th day after EN application, and all the above-mentioned indicators in the TPF-T group were significantly lower than those in the TP group [TNF-α (ng/L):95.43±20.69 vs. 109.59±23.45, CRP (mg/L): 21.33±16.35 vs. 32.36±17.83, PCT (μg/L): 1.24±1.21 vs. 4.18±1.32, endotoxin (U/L): 10.32±2.31 vs. 11.54±2.69, DAO (g/L): 19.45±8.49 vs. 25.47±9.41]. The incidences of gastric retention, diarrhea and paralysis of lower digestive tract in TPF-T group were significantly lower than those in TP group [gastric retention: 14.29% (8/56) vs. 32.14% (18/56), diarrhea: 12.50% (7/56) vs. 35.71% (20/56), paralysis of lower digestive tract: 7.14% (4/56) vs. 23.21% (13/56)], the length of hospital stay was significantly shorter in the TPF-T group than that in the TP group (days: 18.77±5.08 vs. 21.71±6.67, P < 0.05); however, there was no significant difference in mortality between the two groups [14.29% (8/56) vs. 21.43% (12/56), P > 0.05]. Conclusion TPF-T could more effectively maintain nutritional status, reduce inflammatory reaction, improve immunity, protect intestinal mucosal barrier function, and has fewer adverse reactions, which was helpful to improve the prognosis of septic shock patients.
ABSTRACT
Objective To investigate the effects of high energy enteral nutrition (EN) on nutritional status and immune function in patients with heart failure caused by pulmonary cardiac disease. Methods Eighty-six patients with heart failure caused by pulmonary heart disease were continuously collected from March 2017 to March 2018 in the Department of Critical Care Medicine of Taizhou First People's Hospital, and they were divided into a high-energy EN group and a standard EN group according to the different use of EN preparations, each group with 43 cases. The high-energy EN group were treated with high energy EN solution TPF-T (Ruineng), and the standard EN group were treated with standard EN solution TP (Ruisu); the initial EN infusion velocity in all the patients was 25 mL/h, the calorific calorie would reach the target to 104.6-125.5 kJ·kg-1·d-1, and the protein would target to 1.5-2 g·kg-1·d-1 within 3 days;the blood glucose was controlled within the scope of 7.8-11.1 mmol/L. The differences in rates of calorie and protein goal targeting situations, nutritional status, inflammatory response and immune function were compared between the two groups. Results From the 3rd day to 7th day after EN application, the rates of calorie and protein goal targeted in the high-energy EN group were significantly higher than those in the standard EN group [calorie targeted rate: 69.77% (30/43) vs. 41.86% (18/43), protein targeted rate: 25.58% (11/43) vs. 11.63% (5/43), all P < 0.05]. With the extension of EN application, nutritional indexes such as albumin (Alb), prealbumin (PA), transferrin (TRF), etc. and the immune indexes such as human leucocyte antigen (HLA)-DR positive rate, immunoglobulins (IgA, IgG), etc. were persistently increased in both groups, reaching the peak values on the 7th day, and the indexes in high-energy EN group were significantly higher than those in the standard EN group [Alb (g/L): 36.43±5.81 vs. 33.79±5.34, PA (mg/L): 278.83±47.56 vs. 251.67±41.92, TRF (mg/L): 3.58±0.64 vs. 3.26±0.81, HLA-RD positive rate: (53.22±6.11)% vs. (50.21±5.69)%, IgA(mg/L): 165.34±40.13 vs. 141.54±38.76, IgG (mg/L): 4 990.68±881.66 vs. 4 211.75±861.54, all P < 0.05]. However, the levels of inflammatory factors such as C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) in both groups were gradually decreased, reaching the valley values on the 7th day, and the indexes in high-energy EN group were significantly lower than those in the standard EN group [TNF-α(ng/L): 14.43±8.69 vs. 20.59±9.45, CRP (mg/L): 21.33±6.35 vs. 27.36±7.83, all P < 0.05]. Conclusion High energy EN not only can improve the nutritional status in patients with pulmonary heart failure, but also can reduce patients’ inflammation response and elevate their immune function.
ABSTRACT
The excessive enrichment of trace elements, such as Pb and Cd, from food may contribute to the decline of migratory red-crowned cranes (Grus japonensis) in China. To test this prediction, we determined the concentrations of Pb and Cd, as well as further macro and trace elements (Ca, Mg, Cu, Zn) in the target species and their prey (sediment, reed root, mollusk, arthropods, and common fish species) in both the wintering (Yancheng wetland) and breeding sites (Zhalong wetland) of cranes in China. The maximum concentrations of Pb (130 mg kg-1 dry weight (dw)) and Cd (10.60 mg kg-1 dw) in the sediments of breeding site and the maximum concentration of Cd (4.50 mg kg-1 dw) in the sediments of wintering site exceeded the probable effect level values (91.30 mg kg-1 for Pb and 3.53 mg kg-1for Cd), suggesting the potential exposure risk of the examined species. Indeed, Pb and Cd contents of essential foods, i.e., aquatic animals, sampled in two sites were above the limit of allowable concentration recommended by the Joint Food and Agriculture Organization of the United Nations/World Health Organization food standards program. Approximately 80, 31.4, and 60.3 mg kg-1 dw of Pb were detected in the eggshells, liver, and kidney, respectively, of the target species, and the values are above the levels of concern (1.7 mg kg-1 for eggshell and 30 mg kg-1 for liver and kidney) in common birds. Nevertheless, the increased Pb and Cd levels in the prey and bodies of the red-crowned cranes did not induce the levels of Ca and Mg depletion. Average contents of the macronutrients, Ca (1.38 g kg-1 dw) and Mg (1.32 g kg-1 dw), in the liver of the examined species exceeded the background concentrations (0.2-0.4 g kg-1 for Ca and 0.4-0.8 g kg-1 for Mg) in the liver of birds. Consumption of Ca-rich foods, e.g., grits and exoskeleton species, may aid in compensating the possible loss caused by the increased Pb and Cd concentrations in the bodies of the cranes.
