[Effects of early enteral nutrition in the treatment of patients with severe burns].

Objective: To investigate the effects of early enteral nutrition (EEN) in the treatment of patients with severe burns. Methods: Medical records of 52 patients with severe burns hospitalized in the three affiliations of authors from August to September in 2014 were retrospectively analyzed and divided into EEN group (n=28) and non-early enteral nutrition (NEEN) group (n=24) according to the initiation time of enteral nutrition. On the basis of routine treatment, enteral nutrition was given to patients in group EEN within post injury day (POD) 3, while enteral nutrition was given to patients in group NEEN after POD 3. The following items were compared between patients of the two groups, such as the ratio of enteral nutrition intake to total energy intake, the ratio of parenteral nutrition intake to total energy intake, the ratio of total energy intake to energy target on POD 1, 2, 3, 4, 5, 6, 7, 14, 21, and 28, the levels of prealbumin, serum creatinine, blood urea nitrogen, total bilirubin, direct bilirubin, and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score on POD 1, 3, 7, 14, and 28, the first operation time, the number of operations, and the frequencies of abdominal distension, diarrhea, vomiting, aspiration, catheter blockage, and low blood sugar within POD 28. Data were processed with χ(2)test, ttest, Wilcoxon rank sum test, and Bonferroni correction. Results: (1) The ratio of parenteral nutrition intake to total energy intake of patients in group EEN on POD 1 was obviously lower than that in group NEEN (Z=2.078, P<0.05). The ratio of enteral nutrition intake to total energy intake and the ratio of total energy intake to energy target of patients in group EEN on POD 2 and 3 were obviously higher than those in group NEEN (Z=5.766, 6.404, t=4.907, 6.378, P<0.01). The ratio of total energy intake to energy target of patients in group EEN was obviously lower than that in group NEEN on POD 4, 5, 6, and 7 (t=4.635, 2.547, 3.751, 5.373, P<0.05 or P<0.01). On POD 2, 4, 5, 14, 21, and 28, the ratio of enteral nutrition intake to total energy intake of patients in group EEN was obviously higher than the ratio of parenteral nutrition intake to total energy intake within the same group (Z=5.326, 2.046, 2.129, 4.118, 3.174, 3.963, P<0.05 or P<0.01). In group NEEN, the ratio of enteral nutrition to total energy intake of patients on POD 1, 2, and 3 was obviously lower than the ratio of parenteral nutrition intake to total energy intake within the same group (Z=2.591, 2.591, 3.293, P<0.05 or P<0.01), while the ratio of enteral nutrition to total energy intake of patients on POD 14, 21, 28 was obviously higher than the ratio of parenteral nutrition intake to total energy intake within the same group (Z=2.529, 3.173, 3.133, P<0.05 or P<0.01). (2) The prealbumin levels of patients in the two groups were close on POD 1, 3, 7, and 14 (t=1.983, 0.093, 0.832, 1.475, P>0.05). On POD 28, the prealbumin level of patients in group EEN was obviously higher than that in group NEEN (t=3.163, P<0.05). The levels of serum creatinine, blood urea nitrogen, total bilirubin, and direct bilirubin of patients in the two groups at all time points post injury were close (Z=1.340, 0.547, 0.245, 0.387, 0.009, 1.170, 0.340, 1.491, 0.274, 1.953, 0.527, 0.789, 0.474, 1.156, 0.482, 0.268, 0.190, 0.116, 1.194, 0.431, P>0.05). (3) The APACHE Ⅱ scores of patients in group EEN were (22.5±3.1) and (15.6±3.8) points respectively on POD 1 and 3, which were close to (23.6±3.0) and (17.6±4.2) points of patients in group NEEN (t=1.352, 1.733, P>0.05). The APACHE Ⅱ scores of patients in group EEN on POD 7, 14, and 28 were (13.6±3.6), (13.8±4.1), and (15.5±4.1) points, respectively, which were obviously lower than (18.5±3.9), (19.5±4.2) and (20.8±3.8) points of patients in group NEEN (t=4.677, 4.843, 4.792, P<0.05). (4) Within POD 28, the time of the first operation, the number of operations, and the frequencies of abdominal distension, diarrhea, vomiting, aspiration, catheter blockage and hypoglycemia were similar between patients of the two groups (t=0.684, 0.782, Z=0.161, 1.751, 0.525, 0.764, 0.190, 0.199, P>0.05). Conclusions: EEN in the treatment of patients with severe burns potentially increases the energy intake at early stage and improves APACHE Ⅱ score and prealbumin level on POD 28, without increasing frequencies of adverse reactions.

Polymorphisms of CASR gene increase the risk of primary hyperparathyroidism.

OBJECTIVE: To evaluate correlations between polymorphisms of calcium-sensing receptor (CASR) gene [A986S (rs1081725), R990G (rs1042636) and Q1011E (rs1801726)] and the risk of primary hyperparathyroidism (PHPT) among human population. METHODS: Relevant studies were retrieved from online databases using computer-based search strategies, which were then supplemented by manual search strategies. Case-control studies related to our topic were identified based on strict inclusion and exclusion criteria. Statistical analyses were conducted using the Comprehensive Meta-analysis 2.0 (Biostat Inc., Englewood, NJ, USA). RESULTS: We retrieved 202 studies from online databases and other sources initially and eventually enrolled six studies into our meta-analysis. These six studies contained a sum of 693 PHPT patients and 1252 healthy controls. Our meta-analysis results showed that single nucleotide polymorphisms (SNPs) of CASR gene A986S (rs1081725) and R990G (rs1042636), but not Q1011E (rs1801726), may increase the risk of PHPT [A986S (rs1081725): allele model: P = 0.013; dominant model: P = 0.044; R990G (rs1042636): allele model: P = 0.023; dominant model: P = 0.026)]. Subgroup analyses based on ethnicity showed that among Asians, A986S (rs1081725) increased the PHPT risk (P = 0.04) under the allele model, but not under the dominant model. Among Caucasians, there was no association between gene frequencies and PHPT under both the allele and dominant model. In Asians, no significant association was observed between R990G (rs1042636) and PHPT risk, but in Caucasians, R990G (rs1042636) significantly increased the incidence of PHPT [R990G (rs1042636): allele model: P = 0.015; dominant model: P = 0.009)]. CONCLUSION: Our results indicate that SNPs of CASR gene A986S (rs1081725) and R990G (rs1042636) may increase the risk of PHPT, and the polymorphisms can potentially be used as important biological markers for early diagnosis of PHPT.

Aqueous extract of Anoectochilus formosanus attenuate hepatic fibrosis induced by carbon tetrachloride in rats.

The aim of this study was to investigate the effects of aqueous extract of Anoectochilus formosanus (AFE) on liver fibrogenesis in carbon tetrachloride (CCl4)-induced cirrhosis. Fibrosis was induced in rats by oral administration of CCl4 (20%, 0.5 ml/rat, p.o.) twice a week for 8 weeks. AFE (0.5 and 2.0 g/kg, p.o., daily for 8 weeks) was administered to rats simultaneously. AFE showed reducing actions on the elevated levels of GOT and GPT caused by CCl4. Liver fibrosis in rats induced by CCl4 led to the drop of serum albumin concentration; the AFE increased the albumin concentration. The CCl4-induced liver fibrosis markedly caused liver atrophy and splenomegalia, while AFE increased the liver weight, and decreased the spleen weight. The CCl4-induced liver fibrosis decreased the protein content, and increased collagen contents in rat's liver. AFE significantly increased the contents of protein and reduced the amount of collagen in the liver. In CCl4-treated rats, glutathione concentrations of liver were not affected. AFE significantly increased liver glutathione concentrations. All these results clearly demonstrate that AFE can reduce the liver fibrogensis in rats induced by CCl4.

Ameliorative effects of Anoectochilus formosanus extract on osteopenia in ovariectomized rats.

The purpose of this study was to determine ameliorative effects of crude aqueous extract of Anoectochilus formosanus (AFE) on osteopenia in ovariectomized (OVX) rats. First, all of the rats were divided into sham and OVX groups. The OVX rats were allowed to lose bone for 6 weeks. At 6 weeks post-OVX, the OVX rats were divided into four groups treated with water, 17beta-estradiol (30 microg/kg, daily s.c. injection) or AFE (0.5, 2 g/kg, daily, orally) for 12 weeks. In OVX rats, the increases of body weight and serum total cholesterol were significantly decreased by AFE or 17beta-estradiol treatment. In OVX rats, atrophy of uterus and vagina was preserved by treatment with 17beta-estradiol, but not by AFE. The decreased weight of pituitary was increased by treatment with both 17beta-estradiol and AFE. There were decreases in bone density and calcium content including the right femur and the fourth lumbar vertebra, when compared with the sham control rats. Treatment with either 17beta-estradiol or AFE ameliorated these changes induced by OVX. In addition, ovariectomy increased serum alkaline phosphatase levels. The increases were suppressed by the treatment with 17beta-estradiol and AFE. Our results demonstrated that AEF could ameliorate ovariectomy-induced osteopenia.

Effect of CDA-II, urinary preparation, on lipofuscin, lipid peroxidation and antioxidant systems in young and middle-aged rat brain.

The levels of lipofuscin and lipid peroxidation reflect the degree of free radical-induced oxidative damage in the brain. We examined the effects of CDA-II, a preparation of human urine, on lipofuscin and lipid peroxidation in the brain of young (3.5 months) and middle-aged rats (17 months). The rats were given CDA-II orally at dosages of 0.3 or 1.0 g/kg daily for 8 weeks. CDA-II significantly suppressed the contents of lipofuscin and lipid peroxidation in both young and middle-aged rats. CDA-II also elevated the activity of superoxide dismutase, and the amounts of glutathione and ascorbic acid in the middle-aged rats, but not in the young ones. Our results suggest that the protection against oxidative damage by CDA-II in the young rat brain may be due to its scavenging activity against free radicals. In the middle-aged rats, in addition to the scavenging activity, the levels of endogenous antioxidants were also enhanced by the CDA-II treatment.

Effect of a urinary preparation on liver injury by short-term carbon tetrachloride treatment in rats.

The hepatoprotective effect of a preparation of human urine (PHU) was assessed against short-term carbon tetrachloride (CCl4) treatment in rats. Significant prevention of liver injury by PHU was found after CCl4 treatment, judging by the changes of serum biochemical parameters, and hepatic protein and triglyceride contents. The increased liver lipid peroxidation, and decreased liver vitamin C concentrations observed after CCl4 treatment were significantly prevented by PHU administration. The increase in liver glutathione (GSH) contents observed after CCl4 treatment was further increased by PHU treatment. Liver catalase activity decreased after CCl4 treatment, while liver superoxide dismutase and GSH-peroxidase activities did not change. PHU administration further inhibited the decrease in liver catalase activity after CCl4 treatment. These results indicate that PHU administration can prevent liver injury induced by CCl4 in rats by inhibiting enhanced lipid peroxidation and by improving disrupted active oxygen metabolism in the injured liver.

Ameliorative effect of an urinary preparation on acetaminophen and D-galactosamine induced hepatotoxicity in rats.

The effect of oral administration of a preparation of human urine (PHU) on acute liver injury was examined in rats intoxicated with acetaminophen and D-galactosamine. The results indicated that PHU protected the liver from acetaminophen and D-galactosamine-induced injury as judged by morphological and biochemical observation. An increase in lipid peroxide concentrations and decrease in protein concentrations occurred in the liver by D-galactosamine injection, PHU administration significantly prevented these changes.

Effect of pretreatment of rats with an urinary preparation on liver injuries induced by carbon tetrachloride and alpha-naphthylisothiocyanate.

The effect of oral administration of a preparation of human urine (PHU) on the progression of acute liver injury was examined in rats intoxicated with carbon tetrachloride (CCl4) and alpha-naphthylisothiocyanate (ANIT) PHU protected the liver from CCl4-induced injury as judged by morphological and biochemical observations. In contrast, PHU aggravated ANIT-induced injury as judged also by morphological and biochemical observation. PHU prevented the increase in hepatic glutathione (GSH) and lipid peroxidation induced by CCl4. But PHU enhanced the increase in hepatic GSH caused by ANIT. These results indicate that the effect of PHU on hepatic GSH concentrations is through an indirect pathway. Clinical application of PHU on hepatitis should be explored further.

Effects of Cimicifugae rhizoma on serum calcium and phosphate levels in low calcium dietary rats and on bone mineral density in ovariectomized rats.

We studied the effects of ethyl acetate-(EtOAc) soluble fractions from methanol (MeOH) extracts of Cimicifugae rhizoma derived from two species - Cimicifuga heracleifolia Komarov and C. foetida L. - and four triterpenoids (1-4) isolated from them on the serum calcium (Ca) and phosphate (P) levels in low - Ca dietary rats. The EtOAc-soluble fraction from C. heracleifolia Komarov (HE) significantly drecreased Ca levels when administered. Similarly, the EtOAc-soluble fraction from C. foetida L. (FE) significantly lowered serum Ca levels at doses of 100 and 200 mg/kg/day, while the four triterpenoids (1-4) did the same at a dose of 25mg/kg/day. Interestingly only 7,8-didehydro-24-0-acetylhydroshengmanol-3-0-ß-xyloside (4) showed a significant influence on serum P levels. The effects of HE and FE on the bone mineral density (BMD) of the lumbar spine (L 2-4) in ovariectomized rats were measured by dual energy X-ray absorptiometry (DXA). Rats treated with HE and FE showed a significant increase in BMD compared to untreated ovariectomized rats. BMD was lower in the latter than in sham-operated rats.

Histological study on crude drugs pai-wei, pai-chein and indigenous species of Cynanchum in Taiwan.

The botanical origins of Cynanchum species (Cynanchum spp.) on the Taiwan market have been established by histological studies in the present paper. The results showed that the Chinese crude drug Pai-wei on the Taiwan market was derived from the dried roots of Cynanchum atratum Bunge; that of Pai-chein was derived from the dried roots of C. stauntonii (Decne.) Hand.-Mazz; and the Wanling-shu used locally in Taiwan was derived from the dried roots of C. taiwanianum Yamazaki.

[P6 acupoint injection reduced postoperative nausea and vomiting].

Despite improvements in anesthetic techniques postoperative vomiting still remains a problem, particularly in ambulant outpatients, and when an opioid is given before or during anesthesia. Anti-emetic are of limited value and often cause drowsiness or other side effects. We report a study in which a simple acupuncture procedure was used in patients undergoing fraction D & C under standard intravenous anesthesia. Sixty-four patients were included and allocated randomly into one of the two groups: control group receiving standard fentanyl-valium-thiopentone anesthesia alone, and the other group receiving injection of 3 mL normal saline into the P6 acupuncture point after the anesthesia. Ten out of the 32 control patients experienced nausea or vomiting compared with only 2 out of 32 patients receiving acupoint injection. The reduction in nausea was significant. These findings cannot be well explained, but it is recommended that the use of acupuncture as an anti-emetic should be explored further.