Investigation of the material basis of Xiexin Tang to alleviate type 2 diabetes mellitus based on spectrum-effect analysis by UPLC-Q-TOF/MS.

Xiexin Tang (XXT) is a classic prescription for treating diabetes in clinical practices for thousands of years in China, which has been also proved by a large number of modern pharmacological studies. However, due to its complex composition, the bioactive ingredients of XXT is still unclear. In present researches, spectrum-effect relationship analysis is widely used to explore the material basis of traditional medical herbs, so this method was adopted in this study. Firstly, the extract of XXT was separated and enriched into 5 fractions by macroporous adsorption resin. Then, UPLC-Q-TOF/MS method was used for qualitative identification of components in each eluting part, and efficacy of each fraction was assessed by the T2DM rat model. Based on grey relational analysis and pearson bivariate correlation analysis, it was found that the components such as berberine, gallic acid, catechin, epicatechin, acteoside, berberastine and 1-O-galloyl-ß-D-glucose might be the main effective basis of XXT to improve T2DM.

The antioxidant activities of flavonoids in Jerusalem artichoke (Helianthus tuberosus L.) leaves and their quantitative analysis.

The main targets of this work were to evaluate the antioxidative properties of flavonoids in Jerusalem artichoke (Helianthus tuberosus L.) leaves and quantitatively determine their contents. 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2-azino-bis (3-ethylbenzothiazoline)-6-sulphonic acid (ABTS) and hydroxyl free radicals scavenging assays were performed to determine their antioxidative capacities. The validated ultra high-performance liquid chromatography-quadrupole-time-of-flight/mass spectrometry (UHPLC-Q-TOF/MS) method was subsequently applied to the quality evaluation of eleven batches of Jerusalem artichoke leaves grown in different habitats at different harvesting time. Results indicated that two flavonoids isolated from Jerusalem artichoke leaves showed stronger antioxidant effects than the positive control, butylated hydroxytoluene (BHT). And the total contents of the two flavonoids in the Jerusalem artichoke leaves of flowering stage from Dalian, Liaoning Province, China, were the highest, their contents varied significantly depending on region and harvesting time. This study indicated that the leaves of Jerusalem artichoke possessed excellent antioxidant properties, highlighting their candidacy as natural antioxidants, which could be utilized therapeutically to protect the body from diseases caused by oxidative stress.

Epimedium flavonoids protect neurons and synapses in the brain via activating NRG1/ErbB4 and BDNF/Fyn signaling pathways in a chronic cerebral hypoperfusion rat model.

Cerebral hypoperfusion is a common feature of cerebral small vascular disease (CSVD), which has been considered as one of the causes of cognitive decline in recent years. Epimedium flavonoids (EF) are the main ingredients extracted from Epimedium. The purpose of this study was to investigate the effects of EF on cognitive impairment, and the underlying mechanisms in rats with permanent occlusion of the bilateral common carotid artery (2VO). EF (50, 100, and 200 mg/kg) was intragastrically administered for 12 weeks starting 2 weeks after 2VO surgery. The results showed that EF treatment improved learning and memory impairment in 2VO rats evaluated by novel object recognition and Y-maze tests. NeuN immunohistochemical staining indicated that EF alleviated neuronal loss in the hippocampus and cerebral cortex of 2VO rats. MAP-2 immunofluorescence staining and western blotting showed that EF protected neuronal dendrites and increased the expression of cytoskeleton proteins MAP-2 and NF200 in the hippocampus of 2VO rats. Moreover, EF protected the synapse ultrastructure detected by transmission electron microscopy, and increased the expression of synaptic plasticity-related proteins, including synaptophysin, synaptotagmin-I, synapsin I, PSD-95, p-NMDA2B, and p-CaMKII-α in the hippocampus of 2VO rats. In addition, EF increased the expression of neuregulin-1 (NRG-1), p-ErbB4, brain-derived neurotrophic factor (BDNF), p-Fyn, PI3K, p-Akt, and p-CREB in the hippocampus of 2VO rats. These results suggest that EF may protect neurons and synapses by activating the NRG1/ErbB4, BDNF/Fyn, and P13 K/Akt/CREB pathways in the hippocampus and cerebral cortex, thus improving cognitive impairment induced by chronic cerebral hypoperfusion. EF may be a potential candidate drug for chronic cerebral hypoperfusion and CSVD therapy.

Epimedium flavonoids improve cognitive impairment and white matter lesions induced by chronic cerebral hypoperfusion through inhibiting the Lingo-1/Fyn/ROCK pathway and activating the BDNF/NRG1/PI3K pathway in rats.

Chronic cerebral hypoperfusion is a common cause of cerebral small vascular disease (CSVD). White matter (WM) lesions are the typical pathological manifestation of CSVD and contribute to cognitive decline. Epimedium flavonoids (EF) are the main component in Epimedium brevicornu Maxim., which is commonly used in traditional Chinese medicine. The purpose of this study was to investigate the effects of EF on cognitive impairment and the underlying mechanisms in a CSVD rat model induced with chronic cerebral hypoperfusion. The model was established by permanent bilateral common carotid artery occlusion (2VO) in rats. EF (50, 100, and 200 mg/kg) was intragastrically administered once a day for 12 weeks starting 2 weeks after 2VO surgery. The learning and memory capacity of the rats were measured using the Morris water maze and step-through tests. WM lesions were observed by MRI-diffusion tensor imaging, transmission electron microscopy, and LFB staining. Oligodendrocytes were detected by immunohistochemistry. Western blotting assay was used to determine the level of protein expression. The results showed that EF significantly improved learning and memory impairment, alleviated WM nerve fiber injuries and demyelination, and increased the number of mature oligodendrocytes in the corpus callosum, subcortical WM, and periventricular WM in 2VO rats. Mechanistically, EF reduced the expression of Lingo-1 and ROCK2 and increased the levels of phosphorylated (p-) Fyn, brain-derived neurotrophic factor (BDNF), TrkB, neuregulin-1 (NRG-1), p-ErbB4, PI3K p85 and p110α, p-Akt, and p-CREB in the corpus callosum of 2VO rats. These results suggest that EF may improve cognitive impairment and WM lesions induced by chronic cerebral hypoperfusion through inhibiting the Lingo-1/Fyn/ROCK pathway and activating the BDNF/TrkB, NRG-1/ErbB4, and the downstream PI3K/Akt/CREB pathways in WM. Thus, EF can be used as a potential neuroprotective agent in CSVD therapy.

Identification of novel CDK2 inhibitors by a multistage virtual screening method based on SVM, pharmacophore and docking model.

Cyclin-dependent kinase 2 (CDK2) is the family of Ser/Thr protein kinases that has emerged as a highly selective with low toxic cancer therapy target. A multistage virtual screening method combined by SVM, protein-ligand interaction fingerprints (PLIF) pharmacophore and docking was utilised for screening the CDK2 inhibitors. The evaluation of the validation set indicated that this method can be used to screen large chemical databases because it has a high hit-rate and enrichment factor (80.1% and 332.83 respectively). Six compounds were screened out from NCI, Enamine and Pubchem database. After molecular dynamics and binding free energy calculation, two compounds had great potential as novel CDK2 inhibitors and they also showed selective inhibition against CDK2 in the kinase activity assay.

Network pharmacology-based identifcation of potential targets of the flower of Trollius chinensis Bunge acting on anti-inflammatory effectss.

The flower of Trollius chinensis Bunge was widely used for the treatment of inflammation-related diseases in traditional Chinese medicine (TCM). In order to clarify the anti-inflammatory mechanism of this Chinese herbs, a comprehensive network pharmacology strategy that consists of three sequential modules (pharmacophore matching, enrichment analysis and molecular docking.) was carried out. As a result, Apoptosis signal-regulating kinase 1 (ASK1), Janus kinase 1 (JAK1), c-Jun N-terminal kinases (JNKs), transforming protein p21 (HRas) and mitogen-activated protein kinase 14 (p38α) that related to the anti-inflammatory effect were filtered out. In further molecular dynamics (MD) simulation, the conformation of CID21578038 and CID20055288 were found stable in the protein ASK1 and JNKs respectively. The current investigation revealed that two effective compounds in the flower of Trollius chinensis Bunge played a crucial role in the process of inflammation by targeting ASK1 and JNKs, the comprehensive strategy can serve as a universal method to guide in illuminating the mechanism of the prescription of traditional Chinese medicine by identifying the pathways or targets.

Randomized controlled clinical trial assessing the effects of oral nutritional supplements in postoperative gastric cancer patients.

BACKGROUND: Postoperative weight loss and malnutrition are major issues in gastric cancer patients. The concept of oral nutritional supplements (ONS) is gaining widespread acceptance. We investigated the effects of ONS administration on postoperative body weight loss in patients with gastric cancer who had undergone total gastrectomy or distal gastrectomy. METHODS: Patients were randomized to either the treatment or the control group. In both groups, standard surgery for gastric cancer was performed. In the treatment group, intervention with ONS was performed until 12 weeks after discharge. In the control group, patients were fed the usual postoperative diet. Weight, body composition, quality of life, hematological parameters, and blood chemistry were evaluated. RESULTS: We analyzed 113 cases (73 distal gastrectomy, 40 total gastrectomy). Weight loss in the ONS group after total gastrectomy was significantly less than that in the control group. Weight loss and skeletal muscle mass loss after distal gastrectomy did not differ significantly between the ONS and control groups. CONCLUSION: This study showed ONS after total gastrectomy to significantly diminish postoperative weight loss.

Prospective double-blind randomized study on the efficacy and safety of an n-3 fatty acid enriched intravenous fat emulsion in postsurgical gastric and colorectal cancer patients.

BACKGROUND: A lipid emulsion composed of soybean oil (long-chain triglycerides, LCT), medium-chain triglycerides (MCT) and n-3 poly-unsaturated fatty acids (PUFAs) was evaluated for immune-modulation efficacy, safety, and tolerance in patients undergoing major surgery for gastric and colorectal cancer. METHODS: In a prospective, randomized, double-blind study, 99 patients with gastric and colorectal cancer receiving elective surgery were recruited and randomly assigned to either the study group, receiving the n-3 PUFAs enriched intravenous fat emulsion (IVFE), or the control group, receiving a lipid emulsion comprised of soybean oil and MCTs (0.8 - 1.5 g · kg-1 · day-1) as part of total parenteral nutrition (TPN) regimen from surgery (day -1) up to post-operative day 7. Safety and efficacy parameters were assessed on day -1 and post-operative visits on day 1, 3, and 7. Adverse events were documented daily and compared between the groups. RESULTS: Pro-inflammatory markers, laboratory parameters, and adverse events did not differ prominently between the 2 groups, with the exception of net changes (day 7 minus day -1) of free fatty acids (FFAs), triglyceride, and high-density lipoprotein (HDL). Net decrease of FFAs was remarkably higher in the study group, while the net increase of triglyceride and decrease of HDL was significantly lower. CONCLUSIONS: The n-3 PUFA-enriched IVFE showed improvements in lipid metabolism. In respect of efficacy, safety and tolerance both IVFE were comparable. In patients with severe stress, there is an inflammation-attenuating effect of n-3 PUFAs. Further, adequately powered clinical trials will be necessary to address this question in postsurgical GI cancer patients. TRIAL REGISTRATION: US ClinicalTrials.gov NCT00798447.

Glutamine supplementation attenuates expressions of adhesion molecules and chemokine receptors on T cells in a murine model of acute colitis.

BACKGROUND: Migration of T cells into the colon plays a major role in the pathogenesis in inflammatory bowel disease. This study investigated the effects of glutamine (Gln) supplementation on chemokine receptors and adhesion molecules expressed by T cells in mice with dextran sulfate sodium- (DSS-) induced colitis. METHODS: C57BL/6 mice were fed either a standard diet or a Gln diet replacing 25% of the total nitrogen. After being fed the diets for 5 days, half of the mice from both groups were given 1.5% DSS in drinking water to induce colitis. Mice were killed after 5 days of DSS exposure. RESULTS: DSS colitis resulted in higher expression levels of P-selectin glycoprotein ligand- (PSGL-) 1, leukocyte function-associated antigen- (LFA-) 1, and C-C chemokine receptor type 9 (CCR9) by T helper (Th) and cytotoxic T (Tc) cells, and mRNA levels of endothelial adhesion molecules in colons were upregulated. Gln supplementation decreased expressions of PSGL-1, LFA-1, and CCR9 by Th cells. Colonic gene expressions of endothelial adhesion molecules were also lower in Gln-colitis mice. Histological finding showed that colon infiltrating Th cells were less in the DSS group with Gln administration. CONCLUSIONS: Gln supplementation may ameliorate the inflammation of colitis possibly via suppression of T cell migration.

Randomized clinical trial of new intravenous lipid (SMOFlipid 20%) versus medium-chain triglycerides/long-chain triglycerides in adult patients undergoing gastrointestinal surgery.

BACKGROUND: SMOFlipid 20% is intravenous lipid emulsion (ILE) containing long-chain triglycerides (LCT), medium-chain triglycerides (MCT), olive oil, and fish oil as a mixed emulsion containing α-tocopherol. The aim was to assess the efficacy of this new ILE in gastrointestinal surgery compared with MCT/LCT. METHODS: In this prospective study, 40 patients were randomized to SMOFlipid 20% or MCT/LCT (Lipovenoes 20%) group. Clinical and biochemistry data were collected. Inflammatory markers (CRP, IL-6, IL-10, TNF-α, TGF-ß1) and oxidative stress (ROS and superoxide) were measured. RESULTS: Thirty-five patients (17 males and 18 females) with a mean age of 57 years completed the study. The patients' demographic characteristics (age, gender, height, body weight, and BMI) were similar without significant differences between groups. The increment of triglyceride on day 6 from baseline was significantly lower in SMOFlipid group than in Lipovenoes MCT/LCT group. Inflammatory markers, as well as superoxide radical and total oxygen radical were not different between groups. CONCLUSIONS: Despite the comparable effect on inflammatory response, because of its well-balanced fatty acid pattern, relatively low n-6:n-3 ratio, and high vitamin E content, SMOFlipid had a better triglyceride-lowering effect as compared with MCT/LCT in adult patients undergoing gastrointestinal surgery.

[Transpupillary thermotherapy for circumscribed choroidal hemangiomas].

OBJECTIVE: To study the effects of transpupillary thermotherapy (TTT) on circumscribed choroidal hemangiomas (CCH). METHODS: It was a retrospective cases series study. One hundred and fourteen cases (114 eyes) in out-patient department were enrolled in the study with 80 male cases and 34 female cases. The age ranged from 16 to 71 yrs with an average at 44 years. Single eye was affected in all cases. Indirect ophthalmoscope, fundus fluorescein angiography (FFA), ultrasound (B) were used for the examination. Treatment was delivered via slit lamp by using an 810 nm diode laser (Irises) with spots or composed spots (larger tumor) covering the whole tumor. If the tumor was located or partly located in the fovea, laser spot should be avoided in the fovea and papillo-macular bundle. The laser power should be lesser (light gray color) in parafovea area. Routine laser spot (gray-white color) was used in perifovea area. A width of 200 µm out of disk border should not be placed by laser spot in paradisk tumor cases. RESULTS: The visual acuity (VA) ≥ 0.5 of pre-and post-treatment was 17 eyes (14.9%) and 27 eyes (23.7%), respectively. Pre-treatment, the retinal detachment extended in the inferior part in 27 cases (23.7%) except on the tumor surface. The tumor was located at macular area in 67 cases (58.8%), around the disc in 35 cases (30.7%), at the temporal arcuate in 12 cases (10.5%). In our cases, VA maintenance with fluid absorption was noted in 76 cases (66.7%) after the treatment. VA improvement with fluid absorption in 28 case (24.6%). Both VA maintenance and improvement (rate of efficiency) with fluid absorption were 91.2%. Fluid non-absorption or VA decline was regarded as unsuccessful in 10 cases (8.8%). The average thickness of 32 cases tumor pre- and post-treatment was (3.90 ± 1.15) mm and (2.41 ± 1.30) mm. Twenty seven cases were followed up for ≥ 1 year (mean 22.8 months) with rate of efficiency at 81.5%. The complications (9 eyes, 7.9%) contained minor macular hemorrhage in 2 eyes, macular pucker in 3 eyes, macular edema and cystoid macular edema in 2 eyes, retinal branch occlusion in 1 eye, and arcuate scotoma in 1 eye. CONCLUSIONS: The treatment of TTT on CCH, whether the tumor located around-disc or in foveal area with exudative fluid could get successful in the majority of cases. TTT is one of the treatments worth doing owing to fewer complications, less expenses and easy-doing with definite and persistent effect.

Parenteral glutamine supplement has synergic effects in minimally invasive surgery of subtotal gastrectomy patients.

BACKGROUND/AIMS: Exogenous glutamine supplement is known to improve morbidity and mortality of critically-ill patients. This study was conducted to elucidate the role of glutamine in minimally invasive surgery. METHODOLOGY: We retrospectively reviewed subtotal gastrectomy patients in National Taiwan University Hospital from Dec 2005 to Dec 2008. The patients were divided into three groups. Group 1 underwent subtotal gastrectomy by laparotomy without glutamine supplement, group 2 underwent subtotal gastrectomy by laparotomy with glutamine supplement and group 3 underwent gasless laparoscopy-assisted subtotal gastrectomy with parenteral glutamine supplement. RESULTS: There were 155 patients in total; 85 patients in group 1, 17 in group 2 and 53 in group 3. The mean flatus days after operation are 3.6, 3.1 and 2.8 for groups 1, 2 and 3, respectively (p=0.001). Oral intake after operation was commenced after 6.7, 5.0 and 4.7 days (p=0.006). The body temperature had borderline differences between groups 3 and 1. There were significant differences in postoperative systemic responses including heart rates (p<0.001) and tenderness (p=0.011) 5 days after operation for group 3 vs. group 1. Minimally invasive surgery was a negative factor for postoperative body temperature change. Glutamine was a significant factor for postoperative heart rate change and reduction of tenderness. CONCLUSIONS: Glutamine supplement may have synergic effects of rapid recovery in minimal invasive surgery for subtotal gastrectomy patients by minimizing the postoperative systemic response and accelerating recovery.

[Clinical features and treatment of choroidal metastasis].

OBJECTIVE: To assess the clinical features and management of choroidal metastasis. METHODS: Fundus examination was performed in 49 patients (66 eyes) with choroidal metastasis. Fundus fluorescein angiography (FFA) was performed in 44 cases, combined with indocyanine green angiography (ICGA) examination in 12 cases. B-scan ultrasound examination was performed in 8 cases. Transpupillary thermotherapy (TTT) was performed in 24 eyes, combined with photo-dynamic therapy in one eye. Plaque radio-therapy was used in one eye. The parameters of treatment for TTT were 1.2 - 3 mm spot size, 450 - 1000 mV, 60 s; 2 sessions of TTT in 2 eyes and 3 sessions in 3 eyes. RESULTS: Fourteen cases were male and 35 cases were female. Both eyes were affected in 17 cases (34.7%). Age ranged from 23 - 74 years old with an average of 47 years. The visual acuity was 0.05 or less in 13 eyes; 0.06 - 0.2 in 22 eyes and 0.3 or more in 31 eyes. Primary tumours were found in 40 cases (81.6%) (surgical excision in 25 cases), consisting of breast carcinoma in 16 cases (32.7%), lung carcinoma in 14 cases (28.6%), hepatoma and cholangiocarcinoma in 3 cases, colon and stomach carcinomas in 3 cases, gynecologic appendix carcinoma (including 1 case of ovarian mucous cyst adenocarcinoma) in 2 cases, nasopharyngeal adenocarcinoma in 1 case, vertebra tumor in 1 case, undetected in 5 cases (10.2%) and under detection in 4 cases (8.2%). The fundus had 1 lesion in 58 eyes (58/66 = 87.8%), 2 lesions in 4 eyes (4/66 = 6.0%), 3 or more lesions in 2 eyes (including 7 lesions in 1 eye). According to the location and development status of the lesions, they could be divided into solitary type, 39 eyes (39/66 = 59.1%); diffuse type, 19 eyes (19/66 = 28.8%); and early type, 8 eyes (8/66 = 12.1%). FFA examination: early stage lesions showed hypofluorescence and later stage lesions showed moderate to strong hyperfluorescence. In 8 cases of solitary lesions, the size of the lesion measured by B-scan averaged 11.5 mm x 10.5 mm x 3.6 mm with the maximal height at 4.9 mm. The tumor became flattened and vision remained stable at 3 months after plaque radiotherapy in 1 case. Three cases were followed-up for 2, 3, and 4 months after TTT treatment. The lesions remained stable with vision unchanged or slightly decreased. CONCLUSIONS: The choroidal metastasis has specific clinical features. The classification of metastatic lesions into solitary, diffuse and early types is helpful for the evaluation of the disease process. The primary tumor can be found in 80% of cases. The most common primary cancer is breast carcinoma, followed by lung carcinoma. These two cancers account for 75% of primary tumors. In solitary type and early type lesions, TTT combines with systemic treatment could result in regression of lesions, saving of vision and improvement of the life quality.

Effects of parenteral glutamine supplementation on modulating the immune response in rats undergoing a total gastrectomy.

The present study investigated the effect of parenteral glutamine (Gln) supplementation on cellular adhesion molecule expression and release of chemokines responsible for inflammatory cell recruitment in rats undergoing a total gastrectomy. Normal rats with internal jugular catheters were assigned to one control group and two experimental groups and received total parenteral nutrition (TPN). A total gastrectomy was performed in the experimental groups, whereas the control group received a sham operation (Sham). The TPN solutions were isonitrogenous and identical in nutrient composition except that the Sham group and one of the experimental group received conventional (Conv) TPN solution, whereas the other experimental group received 25% of the amino acid nitrogen as Gln. Half of the rats in each group were killed 1 or 3 d after surgery or the Sham to examine their immune response. The results showed that the surgery produced higher polymorphonuclear leucocyte CD11b/CD18 expressions, and Gln supplementation lowered CD11b/CD18 expressions compared with the Conv group post-operatively. The levels of monocyte chemotactic protein-1 and macrophage inflammatory protein-2 in peritoneal lavage fluid were higher in the Gln group than those in the Conv group 1 d post-operatively; these chemotactic proteins had returned to the levels comparable with those in the Sham group on post-operative day 3. These results suggest that Gln supplementation attenuated polymorphonuclear leucocyte integrin expression. In addition, Gln-enriched parenteral nutrition induced an earlier more intensive and rapid immune response to injury than the Conv parenteral nutrition after a total gastrectomy.

Gastrojejunocolic fistula after gastrojejunostomy: a case series.

INTRODUCTION: Gastrojejunocolic (GJC) fistulae represent a significant post-surgical cause of morbidity and mortality. GJC fistulae represent rare post-surgical complications, and most are associated with gastric surgery. In the past, this complication has been under-recognized because a fistula may form years after surgery. CASE PRESENTATION: We describe two cases of gastrojejunocolic fistula in men aged 67 and 60 who both initially presented with watery diarrhea and weight loss. Upper GI studies with small bowel follow-through or barium contrast enema studies allowed a conclusive diagnosis to be made. Both patients underwent one-stage en bloc resection, and their postoperative course was uneventful. CONCLUSION: With surgery, this condition is entirely correctable. Pre-operative nutritional status should be evaluated in patients undergoing corrective surgery, and total parenteral nutrition plays a major role in the provision of bowel rest to allow recovery in malnourished patients.

Glutamine-supplemented total parenteral nutrition attenuates plasma interleukin-6 in surgical patients with lower disease severity.

AIM: Previous reports have shown that decrease in plasma glutamine (Gln) level following major surgery may contribute to the state of immunosuppression. Gln supplementation improves the depletion of body Gln pool, and may have indirect effect on reducing proinflammatory mediator release. This study evaluated whether the effect of Gln dipeptide-enriched total parenteral nutrition (TPN) on postoperative cytokine alteration depended on the disease severity of surgical patients. METHODS: Forty-eight patients with major abdominal surgery were allocated to two groups to receive isonitrogenous (0.228 g nitrogen/kg per d) and isocaloric (30 kcal/kg per d) TPN for 6 d. Control group (Conv) using conventional TPN solution received 1.5 g amino acids/kg per day, whereas the test group received 0.972 g amino acids/kg per day and 0.417 g L-alanyl-L-glutamine (Ala-Gln)/kg per day. Blood samples were collected on d 1 and d 6 postoperatively for plasma interleukin (IL)-2, IL-6, IL-8, and interferon (IFN)-gamma analysis. RESULTS: Plasma IL-2 and IFN-gamma were not detectable. IL-6 concentrations were significantly lower on the 6(th) postoperative day in the Ala-Gln group than those in the Conv group in patients with APACHE II <=6, whereas no difference was noted in patients with APACHE II >6. There was no difference in IL-8 levels between the two groups. No difference in cumulative nitrogen balance was observed on d 2-5 after the operation between the two groups (Ala-Gln -3.2+/-1.6 g vs Conv -6.5+/-2.7 g). A significant inverse correlation was noted between plasma IL-6 levels and cumulative nitrogen balance postoperatively in the Ala-Gln group, whereas no such correlation was observed in the Conv group. CONCLUSION: TPN supplemented with Gln dipeptide had no effect on plasma IL-8 levels after surgery. However, Gln supplementation had a beneficial effect on decreasing systemic IL-6 production after surgery in patients with low admission illness severity, and lower plasma IL-6 may improve nitrogen balance in patients with abdominal surgery when Gln was administered.