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Transjugular intrahepatic portosystemic shunt-placement increases arginine/asymmetric dimethylarginine ratio in cirrhotic patients

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World Journal of Gastroenterology 2008年第47期14卷 7214-7219页

作者： Michiel PC Siroen Reiner Wiest Milan C Richir tom teerlink Jan A Rauwerda Friedrich T Drescher Niels Zorger Paul AM van Leeuwen Department of Surgery VU University Medical CenterAmsterdam 1007 MBThe Netherlands Department of Internal Medicine University HospitalRegensburg D-93042Germany Department of Clinical Chemistry VU University Medical CenterAmsterdam 1007 MBThe Netherlands Department of Radiology University HospitalRegensburg D-93042Germany

AIM:To analyze the change of dimethylarginine plasma levels in cirrhotic patients receiving transjugular intrahepatic portosystemic shunt(TIPS).METHODS:To determine arginine,asymmetric dimethylarginine(ADMA),symmetric dimethylarginine(SDMA),and nitric oxide(NO) plasma levels,blood samples were collected from the superior cava,hepatic,and portal vein just before,directly after,and 3 mo after ***:A significant increase in the arginine/ADMA ratio after TIPS placement was ***,TIPS placement enhanced renal function and thereby decreased systemic SDMA *** patients with renal dysfunction before TIPS placement,both the arginine/ADMA ratio and creatinine clearance rate increased significantly,while this was not the case in patients with normal renal function before TIPS *** function did not change significantly after TIPS placement and no significant decline in ADMA plasma levels was ***:The increase of the arginine/ADMA ratio after TIPS placement suggests an increase in intracellular NO *** addition,this study suggests that TIPS placement does not alter dimethylarginine dimethylaminohydrolase(DDAH) activity and confirms the major role of the liver as an ADMA clearing organ.

关键词： Asymmetric dimethylarginine Symmetricdimethylarginine Arginine Liver cirrhosis Transjugularintrahepatic portosystemic shunt

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Antioxidant enriched enteral nutrition and oxidative stress after major gastrointestinal tract surgery

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World Journal of Gastroenterology 2008年第45期14卷 6960-6969页

作者： Mireille FM van Stijn Gerdien C Ligthart-Melis Petra G Boelens Peter G Scheffer tom teerlink Jos WR Twisk Alexander PJ Houdijk Paul AM van Leeuwen Department of Surgery VU University Medical Center Amsterdam Amsterdam and Medical Center Alkmaar Department of Surgery VU University Medical Center Amsterdam Department of Surgery Catharina Hospital Department of Clinical Chemistry VU University Medical Center Amsterdam Department of Epidemiology and Biostatistics VU University Medical Center Amsterdam Department of Surgery Medical Center Alkmaar

AIM: To investigate the effects of an enteral supple-ment containing antioxidants on circulating levels of antioxidants and indicators of oxidative stress after major gastrointestinal ***: Twenty-one patients undergoing major upper gastrointestinal tract surgery were randomised in a single centre, open label study on the effect of postoperative enteral nutrition supplementedwith antioxidants. The effect on circulating levels of antioxidants and indicators of oxidative stress, such as F2-isoprostane, was studied. RESULTS: The antioxidant enteral supplement showed no adverse effects and was well tolerated. After surgery a decrease in the circulating levels of antioxidant parameters was observed. Only selenium and glutamine levels were restored to pre-operative values one week after surgery. F2-isoprostane increased in the first three postoperative days only in the antioxidant supplemented group. Lipopolysaccharide binding protein (LBP) levels decreased faster in the antioxidant group after ***: Despite lower antioxidant levels there was no increase in the circulating markers of oxidative stress on the first day after major abdominal surgery. The rise in F2-isoprostane in patients receiving the antioxidant supplement may be related to the conversion of antioxidants to oxidants which raises questions on antioxidant supplementation. Module AOX restored the postoperative decrease in selenium levels. The rapid decrease in LBP levels in the antioxidant group suggests a possible protective effect on gut wall integrity. Further studies are needed on the role of oxidative stress on outcome and the use of antioxidants in patients undergoing major abdominal surgery.

关键词： Antioxidants Critical illness Enteral nutrition Oxidative stress Surgery Upper gastrointestinal tract

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