Effect of a multidisciplinary nutrition management model in patients with critical illness: A randomized trial.

BACKGROUND: Managing nutrition in critically ill patients involves many medical fields. However, the nutrition management of critically ill patients has not been comprehensive enough to achieve multidisciplinary team cooperation in China and many other countries. Furthermore, there is no standardized management model or process. AIM: To explore the multidisciplinary cooperative nutrition management model for critically ill patients in the ICUs in China, verify its clinical effect and provide a clinical practice reference for the nutrition management of critically ill patients. STUDY DESIGN: A multidisciplinary cooperative nutrition management team, including ICU doctors, ICU nurses, clinical nutritionists, clinical pharmacists and radiologists, was established for critically ill patients. According to a literature review and domestic guidelines, the standardized process of nutritional management for critically ill patients was constructed through the Delphi expert consultation method. One hundred thirty-two patients in the ICU were randomly divided into an experimental group and a control group. A routine nutrition management mode, which was the nutrition management plan mainly formulated by the ICU doctor in charge only and the ICU nurses responsible for the implementation and monitoring of nutrition support, was implemented in the control group. And a multidisciplinary nutrition management mode, which was the nutrition management implemented by the multidisciplinary teams with the standardized nutrition management process for critically ill patients, was adopted in the experimental group. The early nutritional support rate, nutritional indexes (serum albumin, preprotein, haemoglobin and hs-CPR), mechanical ventilation time, ICU hospitalization days and hospitalization expenses of the two groups were compared. RESULTS: The early nutritional support rates of the experimental group and the control group were 89.39% and 69.7%, respectively (χ2 = .002, p = .031). Serum albumin (35.4 vs. 33.1 g/L), preprotein (153.2 vs. 125.9 mg/L) and haemoglobin (97.5 vs. 90.6 g/L) in the experimental group were significantly higher than in the control group (p = .000, .016, .033). The days of hospitalization in the ICU of the experimental group were shorter than in the control group (5.1 vs. 7.1, p = .039). High-sensitivity C-reactive protein, the days of mechanical ventilation and ICU hospitalization expenses of the experimental group were lower than in the control group; however, the difference was not statistically significant (p = .713, .068, .489). CONCLUSIONS: Because of the severity and complexity of patients' diseases, it is necessary to implement multidisciplinary nutrition management for critically ill patients. Research shows that the multidisciplinary nutrition management standardized process for critically ill patients that was constructed in this study can effectively improve nutritional indexes such as serum albumin, preprotein and haemoglobin, shorten the length of stay in the ICU and promote the rehabilitation of patients, and this process be widely used in the clinic. RELEVANCE TO CLINICAL PRACTICE: Structured multidisciplinary nutrition management operational processes can guide clinical practice. They could be widely used in the clinical nutrition management of critically ill patients in critical care units or other departments.

HPLC phenolic profile and induction of apoptosis by Linum usitatissimum extract in LNCaP cells by caspase3 and Bax pathways.

Linum usitatissimum is a candidate as a remedy to treat prostate problems in some folklore medicines. In this study, we have reported the phenolic and flavonoid constituents, antioxidant activity, and potential of the plant extract against prostate cancer cells. The phenolic and flavonoid compound profile of the extract were established using HPLC analysis. While the total phenolic and flavonoid content (TPC and TFC) were analyzed using classic methods. The antioxidant activity of the extract was also evaluated. MTT assay and flow cytometry technique was used to evaluate antiproliferation activity and induction apoptosis of the plant extract on prostate cancer cells of LNCaP. We also evaluated the gene expression of Bax and caspase-3 using the real-time qPCR assay. HPLC result revealed that L. usitatissimum extract (LUE) was rich in phenolic acids such as gallic, ferulic, and vanillic acid with the amount of 3.56, 2.12, 1.24 µg/g extract respectively. 383.4 mg GAE/g and 47.1 mgRuE/g were calculated for total phenolic and flavonoid content. LUE exhibited radical scavenging activity with IC50 = 19.3 ± 1.1 µg/mL. LUE chelated ferrous ions with IC50 = 121.1 ± 1.3 µg/mL. LUE showed anti-proliferative activity on LNCaP cells with the IC50 values of 8.3, 6.3, and 5.4 µg/mL after 24, 48, and 72 h treatment. LUE also increased cell mortality by inducing apoptosis (15.3-29.8%). The real-time qPCR results exhibited an increase in gene expression of Bax and caspase-3. Our in vitro study demonstrates that L. usitatissimum can be considered as an effective agent to inhibit the growth and invasion the human prostate cancer cells.

Prediction of the enantioselectivity of lipases and esterases by molecular docking method with modified force field parameters.

In the work, molecular docking method was applied to extensively predict the enantioselectivity of lipases and esterases. A ligand library consisted of 69 chiral substrates was docked to four lipases and two esterases to set up the prediction model. During the docking process, necessary modification was carried out on van de Waals and hydrogen bond parameters of enzyme/substrate pair so that the ligands were able to adopt productive geometry in the enzymes. The docking results correctly indicated the enantiopreference for 91% (63/69) of docking pairs and the docking energy difference between substrate enantiomers (Delta Delta G(docking)) was significantly (correlation coefficient = 0.72, P < 0.05) correlated with the activation free energy difference (Delta Delta G( not equal)) that was quantitatively correlated with enantioselectivity of the enzymes. The prediction method was further validated by docking with another 12 enzyme/substrate pairs. Moreover, the prediction error was susceptible to the size of groups bonded to substrate's chiral center and expected Delta Delta G( not equal) values but was not related to the substrate type and reaction medium. The possible reasons of observed error were discussed. It is demonstrated that the docking method has great application potential in high performance prediction of enzyme enantioselectivity.