Soluble epoxide hydrolase: Gene structure,expression and deletion

Mammalian soluble epoxide hydrolase (sEH) converts epoxides to their corresponding diols through the addition of a water molecule. sEH readily hydrolyzes lipid signaling molecules, including the epoxyeicosatrienoic acids (EETs), epoxidized lipids produced from arachidonic acid by the action of cytochrome p450s. Through its metabolism of the EETs and other lipid mediators, sEH contributes to the regulation of vascular tone, nociception, angiogenesis and the inflammatory response. Because of its central physiological role in disease states such as cardiac hypertrophy, diabetes, hypertension, and pain sEH is being investigated as a therapeutic target. This review begins with a brief introduction to sEH protein structure and function. sEH evolution and gene structure are then discussed before human small nucleotide polymorphisms and mammalian gene expression are described in the context of several disease models. The review ends with an overview of studies that have employed the sEH knockout mouse model.     

营养风险筛查及肠内营养支持对老年患者营养状况和感染性并发症的影响

目的：观察营养支持治疗在老年住院患者整体治疗中的重要性。方法：采用营养风险筛查方法NRS2002,对2009年7月-2012年3月在我院内科干部病房住院的老年患者进行营养风险筛查,选取NRS2002评分〉13分的有营养风险患者62例,随机分为2组,应用肠内营养持支持组和普通饮食对照组,各31例。分析营养支持治疗对患者实验室营养指标：包括血清白蛋白（ALB）、前白蛋白（PA）、总胆固醇（TC）、血红蛋白（Hb）水平影响及感染性并发症：包括肺部感染、尿路感染、褥疮发生率的影响变化。结果：入院14d后,营养支持组各营养指标均显著高于对照组值,差异有统计学意义（P〈0．05）;营养支持组肺部感染、褥疮、尿路感染的发生率均显著低于对照组（P〈0．05）。结论：肠内营养可以使有营养风险的老年住院患者的营养状况得到改善,同时减轻显著降低其肺部感染、褥疮、尿路感染并发症的发生率,改善老年患者的生活质量。     

Family Presence During Resuscitation: Attitudes of Yale-New Haven Hospital Staff

Introduction: A novel paradigm of patient- and family-centered care has been promoted and adopted by many parties in the United States. This new attitude emphasizes the role of the family in the care of the patient. One topic that should be affected by the new paradigm is family presence during resuscitation, which continues to be a highly debatable topic with no widespread implementation. The objective of this study was to assess the attitudes of Yale Emergency Department (ED) health care personnel toward Family Presence during Resuscitation (FPDR).Materials and Methods: In 2012, we surveyed 100 health care professionals in the Yale-New Haven Hospital ED, including physicians, nurses, technicians, social workers, and chaplains. One researcher analyzed the qualitative data, and both researchers reviewed the results to increase internal validity.Results: Seventy-seven percent of staff members favored allowing the option of FPDR. Seventy-six percent of staff members believed that family members would want to be present during their loved one’s resuscitation.Conclusion: Given scientific evidence to support FPDR and the staff’s wide acceptance of it, we recommend drafting and implementing a protocol for allowing FPDR. The protocol should be individualized to the Yale-New Haven Hospital ED setting.     

肠内营养对长期禁食危重症患者炎性因子和免疫功能的影响

目的:探讨肠内营养对长期禁食危重症患者炎性因子和免疫功能的影响。方法:选取我院收治的已禁食14天以上的危重病人56例,分别于实施肠内营养前,实施肠内营养后第1,3,7天检测患者外周血中的内毒素、肿瘤坏死因子-α、C反应蛋白、白细胞、白细胞介素及T淋巴细胞亚群和抗组织相容性抗原-DR水平,分析肠内营养实施前后指标。结果:实施肠内营养第1,3天内毒素、肿瘤坏死因子-α、C反应蛋白、白细胞、白细胞介素-1及白细胞介素-6水平高于实施前,差异均有统计学意义(P0.05);实施肠内营养第7天CD4、CD4/CD8水平高于实施前,差异有统计学意义(P0.05);内毒素、肿瘤坏死因子-α、白细胞、C反应蛋白、白细胞介素-1、白细胞介素-6、白细胞介素-4、白细胞介素-10、CD3、抗组织相容性抗原-DR差异无统计学意义(P0.05)。结论:危重病人在长期禁食后恢复肠内营养后初期全身炎症反应明显,随着实施过程逐步减轻,并可增强患者免疫功能。     

Relationship between weight of rescuer and quality of chest compression during cardiopulmonary resuscitation

Background

According to the guidelines for cardiopulmonary resuscitation (CPR), the rotation time for chest compression should be about 2 min. The quality of chest compressions is related to the physical fitness of the rescuer, but this was not considered when determining rotation time. The present study aimed to clarify associations between body weight and the quality of chest compression and physical fatigue during CPR performed by 18 registered nurses (10 male and 8 female) assigned to light and heavy groups according to the average weight for each sex in Japan.

Methods

Five-minute chest compressions were then performed on a manikin that was placed on the floor. Measurement parameters were compression depth, heart rate, oxygen uptake, integrated electromyography signals, and rating of perceived exertion. Compression depth was evaluated according to the ratio (%) of adequate compressions (at least 5 cm deep).

Results

The ratio of adequate compressions decreased significantly over time in the light group. Values for heart rate, oxygen uptake, muscle activity defined as integrated electromyography signals, and rating of perceived exertion were significantly higher for the light group than for the heavy group.

Conclusion

Chest compression caused increased fatigue among the light group, which consequently resulted in a gradual fall in the quality of chest compression. These results suggested that individuals with a lower body weight should rotate at 1-min intervals to maintain high quality CPR and thus improve the survival rates and neurological outcomes of victims of cardiac arrest.     

双歧杆菌四联活菌片联合肠内营养对慢性阻塞性肺疾病合并呼吸衰竭患者的临床疗效

目的探讨双歧杆菌四联活菌片联合肠内营养对慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者的临床疗效,为后续研究提供参考。方法选取2016年5月至2019年3月我院收治的92例COPD合并呼吸衰竭患者为研究对象,依照随机数字表法将其分为对照组和观察组,每组46例。所有患者均在常规对症治疗的基础上给予肠内营养支持治疗,对照组患者同时给予双歧杆菌活菌胶囊治疗,观察组患者给予双歧杆菌四联活菌片进行治疗。治疗7 d后评价患者治疗效果、营养指标水平、肠道菌群分布及免疫功能。结果营养干预前,两组患者各项指标之间差异均无统计学意义(均P0.05)。营养干预后,观察组患者呼吸困难评分(1.58±0.22)低于对照组(1.72±0.25),而体质量、血清白蛋白、前白蛋白、总淋巴细胞计数以及肠道双歧杆菌和嗜酸乳杆菌数量均显著高于对照组(均P0.05)。在营养干预过程中两组患者均未监测到与本研究药物明确相关的严重不良反应。结论对COPD合并呼吸衰竭患者在肠内营养的基础上应用四联活菌进行营养干预,不仅能够显著改善患者的呼吸症状、营养状况和免疫功能,而且能够提高肠道益生菌数量,患者无明显不良反应发生,值得临床推广应用。     

益生菌联合肠内营养对比单用肠内营养在改善胃癌手术患者预后效果的Meta分析

目的对益生菌联合肠内营养对比单用肠内营养在改善胃癌手术患者预后效果进行Meta分析,以得出综合评价结论。方法利用PubMed、Cochrane、Embase、CNKI、维普和万方数据库进行文献检索,搜集有关益生菌联合肠内营养对比单用肠内营养改善胃癌手术患者预后效果的随机对照试验,由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,应用RevMan 5.3分析软件进行Meta分析。结果最终纳入8个临床随机对照试验,共552例患者。Meta分析显示,与仅用肠内营养相比,益生菌联合肠内营养能更有效地降低胃癌患者术后血清内毒素水平[MD=-15.94,95%CI(-27.40,-4.49),P=0.006]、血清TNF-α水平[MD=-9.25,95%CI(-14.51,-3.99),P0.001]、术后腹泻发生率[OR=0.41,95%CI(0.20,0.83),P=0.010];缩短术后住院天数[MD=-1.62,95%CI(-2.78,-0.46),P=0.006];提高淋巴细胞[MD=0.24,95%CI(0.07,0.42),P=0.007],粪便双歧杆菌[MD=1.94,95%CI(0.71,3.17),P=0.002]和乳杆菌[MD=2.21,95%CI(0.69,3.74),P=0.004]计数水平。益生菌还有增加胃癌患者术后血清IgG[MD=2.37,95%CI(-0.32,5.06),P=0.080]和IgM[MD=0.73,95%CI(-0.35,1.82),P=0.190]水平的趋势,但差异无统计学意义。结论当前证据表明,益生菌联合肠内营养治疗胃癌术后临床疗效确切,远优于仅用肠内营养,可以增强胃癌患者术后的机体免疫力、降低感染和腹泻的发生率、减轻全身炎性反应、维持肠道微生态的平衡,促进患者康复。受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证。     

CaMKII versus DAPK1 Binding to GluN2B in Ischemic Neuronal Cell Death after Resuscitation from Cardiac Arrest

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肠内营养对活动期溃疡性结肠炎伴营养不良患者营养状况、肠黏膜屏障功能和肠道菌群的影响

摘要 目的：观察肠内营养对活动期溃疡性结肠炎（UC）伴营养不良患者营养状况、肠黏膜屏障功能和肠道菌群的影响。方法：选取2019年8月~2021年9月期间上海长征医院收治的120例活动期UC伴营养不良患者,根据随机数字表法分为对照组（60例,接受全肠外营养治疗）和研究组（60例,接受肠内营养治疗）。观察两组治疗3周后的临床总有效率,对比两组治疗前、治疗3周后的营养状况、肠黏膜屏障功能指标和肠道菌群数量,记录两组治疗期间不良反应发生率。结果：研究组（90.00%）临床总有效率高于对照组（68.33%）（P<0.05）。研究组治疗3周后D-乳酸（D-LA）、二胺氧化酶（DAO）、内毒素（ET）水平低于对照组同期（P<0.05）。研究组治疗3周后血清白蛋白、血红蛋白水平高于对照组同期（P<0.05）。研究组治疗3周后乳酸杆菌、双歧杆菌数量高于对照组同期,大肠杆菌数量则低于对照组同期（P<0.05）。两组不良反应发生率对比无差异（P>0.05）。结论：活动期UC伴营养不良患者选用肠内营养进行治疗,可促进营养状况和肠黏膜屏障功能改善,调节肠道菌群结构,安全有效。     

两种肠内营养方案对重症急性胰腺炎患者 肠道菌群及预后的影响

目的探讨肠内免疫微生态营养和免疫增强型肠内营养方案对重症急性胰腺炎患者肠道菌群及远期预后的影响。方法选择2014年1月至2017年6月在我院就诊的重症急性胰腺炎患者156例。按照随机数字表法将患者分为A组(肠内免疫微生态营养方案组)、B组(免疫增强型肠内营养方案组)和对照组(常规肠内营养方案组),各52例。检测患者治疗前后T淋巴细胞及其亚群NK细胞、B淋巴细胞,血清免疫球蛋白及ALB、TF、PA等营养指标。同时检测患者肠道菌群,判定3组患者肠道菌失调症发生率。治疗后对患者随访6个月,记录并发症及不良预后。结果治疗后A组和B组患者患者CD+4细胞、CD+8细胞、CD+4/CD+8、NK细胞、B淋巴细胞水平显著高于治疗前,对照组患者除CD+8细胞和NK细胞外,其余各细胞水平亦显著高于治疗前(P0.05),且A组和B组患者治疗后各细胞水平高于对照组(P0.05)。治疗后A组和B组患者IgA、IgG、IgM水平显著升高,且A组和B组高于对照组(P0.05),同时3组患者治疗后ALB水平显著高于治疗前,且A、B组高于对照组,但A组和B组治疗后ALB水平比较差异无统计学意义(P0.05)。发病7～10d后,A组患者菌群失调发生率为5.77%,低于B组(19.23%)和对照组(36.54%),两两比较差异均有统计学意义(P0.05)。治疗6个月后,A组患者出现1例胰腺及胰周感染,1例MODS,0例病死;B组出现1例胰腺及胰周感染,2例MODS,3例菌血症,1例腹腔感染,2例病死;对照组出现6例胰周胰腺感染,7例MODS,5例菌血症,3例腹腔感染,3例病死。A组和B组预后显著优于对照组,且A组预后优于B组(P0.05)。结论肠内免疫微生态营养与免疫增强型肠内营养均能显著提高重症急性胰腺炎患者营养状况,提高免疫水平,且肠内免疫微生态营养在改善肠道菌群及预后方面具有更好的效果,值得临床推广。