维持性血液透析患者营养状况及营养不良的影响因素分析

目的:探讨维持性血液透析(MHD)患者营养状况以及营养不良的影响因素,为临床工作提供指导。方法:选择2010年-2014年在我院进行MHD治疗的120例患者作为研究对象,采用改良定量主观整体评估表(MQSGA)并结合相关生化指标测定等手段综合评估透析患者营养状况,分析MHD患者发生营养不良的危险因素。结果:MQSGA评估显示,营养正常组50例(41.67%),轻中度营养不良组61例(50.83%),重度营养不良组9例(7.50%)。不同营养状况组患者间Alb、PA、Cr比较差异有统计学意义(P0.05)。Logistic回归模型显示,Kt/V1.20、年龄≥60岁、透析龄≥3年及hs-CRP≥3 mg/L是MHD患者发生营养不良的危险因素。结论:MHD患者中发生营养不良的比例较大,Kt/V1.20、年龄≥60岁、透析龄≥3年及hs-CRP≥3 mg/L是其危险因素,可作为评价生营养不良的可靠指标。     

黄葵胶囊联合组合型人工肾对糖尿病肾病维持性血液透析患者炎性因子、氧化应激及生活质量的影响

摘要 目的：探讨黄葵胶囊联合组合型人工肾对糖尿病肾病维持性血液透析患者炎性因子、氧化应激及生活质量的影响。方法：选取2018年10月~2019年9月我院收治的120例终末期糖尿病肾病维持性血液透析患者,将其按照随机数字表法分为观察组和对照组,各60例。两组患者均给予基础治疗,对照组采取组合型人工肾治疗。观察组在对照组基础上给予黄葵胶囊治疗。比较两组治疗3个月后的肾功能指标、炎性因子水平、氧化应激指标水平及生活质量,并统计不良反应发生情况。结果：治疗3个月后,两组血清尿素氮(BUN)、血清肌酐(Scr)、白蛋白排泄率(UAER)、超敏-C反应蛋白(hs-CRP)、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、晚期氧化蛋白产物（AOPP）、丙二醛（MDA）水平低于治疗前,且观察组低于对照组（P＜0.05）。两组过氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-PX）水平及SF-36各维度评分均高于治疗前,且观察组高于对照组（P＜0.05）。两组不良反应发生率比较无明显差异（P＞0.05）。结论：黄葵胶囊联合组合型人工肾治疗终末期糖尿病肾病可有效减轻患者氧化应激及炎症反应,改善患者肾功能及生活质量,安全性高,具有较好的临床应用价值。     

Effect of dexmedetomidine-induced anesthesia on the postoperative cognitive function of elder patients after laparoscopic ovarian cystectomy

ObjectiveTo investigate the effect of dexmedetomidine at maintenance dose on the postoperative function of elder patients after general anesthesia for laparoscopic ovarian cystectomy.MethodsWe enrolled a total of 96 elder patients who were admitted to this hospital for laparoscopic ovarian cystectomy under general anesthesia between March 2015 and March 2017, and divided them into two groups, Group A (n = 48) and B (n = 48). Patients in both groups received the same methods for anesthesia induction and maintenance drugs. At the beginning of operation, patients in Group A received the intravenous injection of dexmedetomidine (0.8 μg/kg) followed by maintenance dose [0.5 μg/(kg h)] to the end of operation, while those in Group B underwent intravenous injection of 0.9% normal saline at the same rate, during which blood pressure, heart rate, oxyhemoglobin saturation and dosage of anesthetics at T1 (5 min after being delivered into the operation room), T2 (immediately after anesthesia induction), T3 (immediately after intubation), T4 (immediately after operation), T5 (immediately after end of operation) and T6 (immediately after extubation). Then, the levels of NSE, IL-6, CRP and HMGB1 were compared between two groups at 24 h before the operation, at the end, 24 h, 3 d and 7 d after operation. Besides, we also compared the postoperative cognitive functions and incidence of adverse reactions at 1 d before, 1, 2, 3 and 7 d after operation through MOCA scales.ResultsAt T3, T4 and T6, comparisons of the average arterial pressure and heart rate showed that the differences between the two groups had statistical significance (p < .05). At the end of operation, and at 24 h, 3 d and 7 d after operation, we found that the levels of IL-6 and CRP in patients of two groups were all significantly elevated when compared with those before operation; at the end of operation and at 24 h and 3 d after operation, the levels of IL-6 and CRP in the Group B were higher than those in the Group A, and the differences had statistical significance (p < .05). At the end of operation and at 24 h and 3 d after operation, the levels of NSE and HMGB1 in two group were higher than those before operation, and a more significant elevation was identified in Group B with statistically significant differences (p < .05); at 7 d after operation, a decreasing trend was found in the level of HMGB1, which, however, remained higher than the preoperative level, and the level in Group B was still higher than that in Group A with statistically significant differences (p < .05). At 2 d after operation, we found that the scores of MOCA in the Group B were remarkably decreased in comparison with the scores in Group A with a statistically significant difference (p < .05). Moreover, the incidence rate of postoperative cognitive dysfunction (POCD) in the Group A was significantly lower than that in the Group B, and the difference had statistical significance (p < .05).ConclusionDexmedetomidine can ameliorate the postoperative cognitive functions of elder patients who received the laparoscopic ovarian cystectomy under general anesthesia, and effectively decrease the incidence rate of POCD without any obvious or severe adverse reaction. Thus, it can serve as a kind of adjuvant drug for general anesthesia in clinical practice.     

Modeling a version of the good-genes hypothesis: female choice of locally adapted males

In addition to other potential causes, immigration into locally adapted populations has been suggested to maintain the genetic variance in fitness that is necessary for the good-genes hypothesis. Using population-genetic simulations, the present contribution shows that co-occurring local adaptation and migration can maintain genetic variance in fitness. In combination with an effect of local adaptation on condition and condition-dependent sexual signaling, such a scenario therefore enables the evolution and maintenance of female choice for locally adapted males. The simulations show that this mechanism can also work when choice is costly, and that the potential benefit is similar to that in other good-genes mechanisms. As a consequence of female choice in favor of locally adapted males, differentiation between populations can be expected to increase due to the decreased effective gene flow between populations. Based on such effects, choice of locally adapted males has the potential to play an important role in speciation and adaptive radiation.     

Maintenance nitrogen requirement of an obligate nectarivore, the honey possum, Tarsipes rostratus

A nitrogen balance feeding trial was carried out with the marsupial honey possum, Tarsipes rostratus, using four pollen-honey diets varying in nitrogen content from 9.4 mg · g⁻¹ to 2.3 mg · g⁻¹ dry matter. The dietary maintenance nitrogen requirement (MNR) was determined by regression analysis as 89 ± 21 mg N · kg^−0.75 · day⁻¹ and the truly digestible MNR was 79 mg N · kg^−0.75 · day^−1.. Regressing nitrogen balance on daily nitrogen intake separately for ten males and seven females revealed that the slopes of the fitted lines did not vary significantly, but the difference in the intercepts approached significance. This suggests that the MNR for females may be lower than that of males. The nitrogen digestibility of the diet was 76% and the biological value (BV) was 58%. A comparison of the MNR of the honey possum with that of other marsupials shows that it is indeed much lower than that of herbivorous macropodid marsupials and is close to that of the sap- and gum-feeding sugar glider, Petarurus breviceps. The endogenous urinary nitrogen excretion (EUN) of the honey possum was 42 mg N · kg^−0.75 · day⁻¹ and a regression analysis with other published data showed that the EUN per unit basal heat production is significantly lower than that of eutherian mammals. Measurements of the actual feeding rates of animals in the field, taken together with the low MNR, do not lend support to the hypothesis that the honey possum exhibits a reduced rate of reproduction due to a deficiency in dietary nitrogen. It is possible that the quality of nitrogen provided by pollen, as reflected in its composition of essential amino acids, may be a limiting factor. Accepted: 15 September 2000     

Anterior neural plate regionalization in cripto null mutant mouse embryos in the absence of node and primitive streak

The relation between the role of the organizer at the gastrula stage and the activity of earlier signals in the specification, maintenance, and regionalization of the developing brain anlage is still controversial. Mouse embryos homozygous for null mutation in the cripto gene die at about 9.0 days postcoitum (d.p.c.) and fail to gastrulate and to form the node (the primary organizer). Here, we study the presence and the distribution of anterior neural plate molecular domains in cripto null mutants. We demonstrate that, in cripto(-/-) embryos, the main prosencephalic and mesencephalic regions are present and that they assume the correct topological organization. The identity of the anterior neural domains is maintained in mutant embryos at 8.5 d.p.c., as well as in mutant explants dissected at 8.5 d.p.c. and cultured in vitro for 24 h. Our data imply the existence of a stable neural regionalization of anterior character inside the cripto(-/-) embryos, despite the failure in both the gastrulation process and node formation. These results suggest that, in mouse embryos, the specification of the anterior neural identities can be maintained without an absolute requirement for the embryonic mesoderm and the node.     

Modelling nitrogen-corrected apparent metabolisable energy requirement for egg production of 3 BW types of Yellow Broiler breeder hens during the egg-laying period

Accurate prediction of energy requirement is important in formulating diets, but an energy model for Yellow Broiler breeder hens is publicly unavailable. The objective of this study was to establish energy prediction models for the nitrogen-corrected apparent metabolisable energy (AMEn) requirement of different categories of Yellow Broiler breeder hens during the egg-laying period. Data for modelling were collected from research papers, public databases and production data from companies. Breeder hens were generally categorised into three BW types: heavy, medium and light (HBWT, MBWT and LBWT). Published articles were cited for providing coefficients of AMEn maintenance requirement (AMEnm, 101 kcal/kg BW^0.75, 423 KJ/kg BW^0.75) and growth requirement (AMEng, 5.33 kcal/g, 22.3 KJ/g), respectively. Models of AMEn for egg production (AMEnp) were established from the known daily intake of AMEn (AMEni) and those of maintenance and growth by the factorial approach: AMEnp = AMEni ? AMEnm ? AMEng. For the three types of hens, AMEnp HBWT (kcal, KJ) = 2.55 kcal (10.7 KJ) × egg mass (EM, g); AMEnp MBWT (kcal, KJ) = 2.70 kcal (11.3 KJ) × EM (g), and AMEnp LBWT (kcal, KJ) = 2.94 kcal (12.3 KJ) × EM (g) were determined. The total AMEni requirements, depending on Gompertz models, were HBWT: BW (g) = 3 144 × e^{?EXP(?0.162×(week of age (wk)?15.6))}; MBWT: BW (g) = 2 526 × e^{?EXP(?0.333×(wk?19.1))}; LBWT: BW (g) = 1 612 × e^{?EXP(?0.242×(wk?16.5))}. Models of egg production, HBWT: egg production (%) = 124 × e^?0.017×wk/(1 + e^{?0.870×(wk?26.2)}); MBWT: egg production (%) = 144 × e^?0.020×wk/(1 + e^{?0.751×(wk?24.9)}); LBWT: egg production (%) = 163 × e^?0.024×wk/(1 + e^{?0.476×(wk?26.5)})) and egg weight for each wk of the three types of hens during the egg-laying period were all established. These models showed good applicability in simulating and predicting the literature or production data.     

A kinetic inhibition mechanism for maintenance

To fulfil their maintenance costs, most species use mobile pools of metabolites (reserve) in favourable conditions, but can also use less mobile pools (structure) under food-limiting conditions. While some empirical models always pay maintenance costs from structure, the presence of reserve inhibits the use of structure for maintenance purposes. The standard dynamic energy budgets (DEB) model captures this by simply supplementing all costs that could not be paid from reserve with structure. This is less realistic at the biochemical level, and involves a sudden use of structure that can complicate the analysis of the model properties. We here propose a new inhibition formulation for the preferential use of reserve above structure in maintenance that avoids sudden changes in the metabolites use. It is based on the application of the theory for synthesizing units, which can easily become rather complex for demand processes, such as the maintenance. We found, however, a simple explicit expression for the use of reserve and structure for maintenance purposes and compared the numerical behaviour with that of a classical model in oscillating conditions, by using parameters values from a fit of the models to data on yeasts in a batch culture. We conclude that our model can better handle variable environments. This new inhibition formulation has a wide applicability in modelling metabolic processes.