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Impact of postoperative omega-3 fatty acid-supplemented parenteral nutrition on clinical outcomes and immunomodulations in colorectal cancer patients

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World Journal of Gastroenterology 2008年第15期14卷 2434-2439页

作者： Bin Liang, Shan Wang, Ying-Jiang Ye, Xiao-Dong Yang, You-Li Wang, Jun Qu, Qi-Wei Xie, Mu-Jun Yin, Division of Surgical Oncology and Division of Gastroenterological Surgery, Peking University People’s Hospital, Beijing 100044, China Author contributions: Liang B and Wang S contributed equally to this work Liang B and Wang S designed the research Liang B, Ye YJ, Yang XD, Wang YL, Qu J, Xie QW, Yin MJ performed the research and collected the data Wang S and Ye YJ supervised the research Liang B and Ye YJ analyzed the data Liang B wrote the paper and revised the manuscript. Division of Surgical Oncology Peking University People's Hospital Beijing 100044 China.

AIM: To investigate the effect of omega-3 fatty acid parenteral supplementation postoperatively on clinical outcomes and immunomodulation in colorectal cancer patients. METHODS: Forty-two patients undergoing radical colorectal cancer resection with an indication for total parenteral nutrition postoperatively were enrolled in this prospective, double-blind, randomized, controlled study. Patients received total parenteral nutrition supplemented with either soybean oil (LCT; Intralipid, Fresenius-Kabi, SO group, n = 21) or a combination of omega-3 fish oil and soybean oil (LCT:fish oil = 5:1, fish oil; Omegaven, Fresenius-Kabi, FO group, n = 21), up to a total of 1.2 g lipid/kg per day for 7 d postoperatively. A same volume calorie and nitrogen was administrated. Routine blood test, biochemistry, systemic levels of IL-6 and TNF-α, percentage of CD3+, CD4+, and CD8+ lymphocytes were evaluated preoperatively and on postoperative d 1 and 8. Patient outcome was evaluated considering mortality during the hospital stay, length of postoperative hospital stay, and occurrence of infectious complications. RESULTS: Both lipid regimens were well tolerated. No differences between the two groups were noticed in demographics, baseline blood test, biochemistry, serum levels of IL-6 and TNF-α, percentage of CD4+, CD8+ lymphocytes, and ratios of CD4+/CD8+. Compared with those on postoperative d 1, serum IL-6 levels onpostoperative d 8 were significantly depressed in the FO group than in the reference group (-44.43 ± 30.53 vs -8.39 ± 69.08, P = 0.039). Simultaneously, the ratios of CD4+/CD8+ were significantly increased in the FO group (0.92 ± 0.62 vs 0.25 ± 1.22, P = 0.035). In addition, depression of serum TNF-α levels (-0.82 ± 2.71 vs 0.27 ± 1.67, P = 0.125) and elevation of CD3+ and CD4+ lymphocyte percentage (12.85 ± 11.61 vs 3.84 ± 19.62, P = 0.081, 17.80 ± 10.86 vs 9.66 ± 17.55, P = 0.084, respectively) were higher in the FO group than in the reference group. Patients in the FO

关键词： Colorectal cancer parenteral nutrition Omega-3 fatty acids Immunomodulation Abdominalsurgery

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Ursodeoxycholic acid prevention on cholestasis associated with total parenteral nutrition in preterm infants:a randomized trial

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World Journal of Pediatrics 2022年第2期18卷 100-108页

作者： Si-Ying Liu Li-Wen Chang Jing Wang Min Xie Lei-Lei Chen Wei Liu Department of Pediatrics Tongji HospitalTongji Medical CollegeHuazhong University of Science and Technology1095 Jiefang AvenueWuhan 430030HubeiChina

Background Preterm infants with long-term parenteral nutrition(PN)therapy are at risk for cholestasis associated with total parenteral nutrition(PNAC).This study examined the safety and efficacy of ursodeoxycholic acid(UDCA)in preventing PNAC in preterm *** research aimed to investigate the prophylactic effect of preventive oral UDCA on PNAC in preterm *** We compared oral administration of UDCA prophylaxis with no prophylaxis in a randomized,open-label,proof-of-concept trial in preterm neonates with PN *** low-birth-weight preterm infants(<1800 g)who were registered to the neonatal intensive care unit(NICU)within 24 hours after birth were *** main endpoint was the weekly values of direct bilirubin(DB)of neonates during the NICU *** Eventually,a total of 102 preterm neonates from January 2021 to July 2021 were enrolled in this prospective study(42 in the UDCA group and 60 in the control group).Notably,the peak serum level of DB[13.0(12-16)vs.15.2(12.5-19.6)μmol/L,P<0.05]was significantly lower in the UDCA group than that in the control group without *** peak serum level of total bilirubin(101.1±34 vs.116.5±28.7μmol/L,P<0.05)was also significantly lower in the UDCA group than in the control ***,the proportion of patients who suffered from neonatal cholestasis(0.0%vs.11.7%,P<0.05)in the UDCA group was significantly *** UDCA prophylaxis is beneficial in preventing PNAC in NICU infants receiving prolonged PN.

关键词： Cholestasis parenteral nutrition Preterm infant Ursodeoxycholic acid

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Role of perioperative parenteral nutrition in severely malnourished patients with Crohn's disease

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World Journal of Gastroenterology 2005年第36期11卷 5732-5734页

作者： Guo-Xiang Yao Xiu-Rong Wang Zhu-Ming Jiang Si-Yuang Zhang An-Ping Ni Department of Surgery Peking Union Medical College HospitalCAMS and PUMC Beijing 100730 China Department of Surgery Tongji Hospital TongjiMedical College Huazhong University of Science and TechnologyWuhan 430030 Hubei Province China

AIM： To evaluate the effect of perioperative parenteral nutrition on serum immunoglobulin, weight change, and post-operative outcome in severely malnourished patients with Crohn＇s disease. METHODS： Thirty-two severely malnourished patients with Crohn＇s disease who had undergone surgery in our hospital were reviewed. Sixteen patients who received perioperative parenteral nutrition were enrolled in the study group, and the other 16 patients who did not receive parenteral nutrition were enrolled in the control group. Serum immunoglobulin, body mass index （BMI）, liver function, weight change, and postoperative complications were evaluated. RESULTS： Serum IgM levels elevated 1 wk before surgery in both groups, and decreased to normal value （from 139±41 to 105±29 mg/dL, P = 0.04） 4 wk after operation in the study group, while no significant changes was noted in the control group （from 133±16 to 129±13 mg/dL, P = 0.34）. There were no significant changes in concentrations of IgG and IgA. The BMI of the study group increased from 13.9±0.6 to 15.3±0.7 kg/m^2 （P = 0.02） with no significant change in the control group （14.1±0.7 and 14.5±0.5, respectively, P = 0.81）. The percentage of resuming work was higher in the study group than in the control group. CONCLUSION： Perioperative parenteral nutrition possibly ameliorates the humoral immunity, reverses malnutrition, and facilitates rehabilitation. 2005 The WJG Press and Elsevier Inc. All rights reserved

关键词： parenteral nutrition Malnourished patients Crohn's disease

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Glutamine dipeptide for parenteral nutrition in abdominal surgery:A meta-analysis of randomized controlled trials

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World Journal of Gastroenterology 2006年第46期12卷 7537-7541页

作者： Ya-Min Zheng Fei Li Ming-Ming Zhang Xiao-Ting Wu Department of General Surgery XuanwuHospital Capital Medical University Beijing 100053 China Department of GeneralSurgery Huaxi Hospital Chengdu 610041 Sichuan ProvinceChina

AIM: To assess the clinical and economical validity of glutamine dipeptide supplemented to parenteral nutrition (PN) in patients undergoing abdominal surgery. METHODS: A meta-analysis of all the relevant randomized controlled trials (RCTs) was performed. The trials compared the standard PN and PN supplemented with glutamine dipeptide in abdominal surgery. RCTs were identified from the following electronic databases: the Cochrane Library, MEDLINE, EMBASE and ISI web of knowledge (SCI). The search was undertaken in April 2006. Literature references were checked by computer or hand at the same time. Clinical trials were extracted and evaluated by two reviewers independently. Statistical analysis was performed by RevMan4.2 software from Cochrane Collaboration. A P value of < 0.05 was considered statistically significant. RESULTS: Nine RCTs involving 373 patients were included. The combined results showed that glutamine dipeptide has a positive effect in improving postoperative cumulative nitrogen balance (weighted mean difference (WMD = 8.35, 95% CI [2.98, 13.71], P = 0.002), decreasing postoperative infectious morbidity (OR = 0.24, 95% CI [0.06, 0.93], P = 0.04), shortening the length of hospital stay (WMD= -3.55, 95% CI [-5.26, -1.84], P < 0.00001). No serious adverse effects were found. CONCLUSION: Postoperative PN supplemented with glutamine dipeptide is effective and safe to decrease the infectious rate, reduce the length of hospital stay and improve nitrogen balance in patients undergoing abdominal surgery. Further high quality trials in children and severe patients are required, and mortality and hospital cost should be considered in future RCTs with sufficient size and rigorous design.

关键词： Glutamine dipeptide parenteral nutrition Abdominal surgery Meta-analysis

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Effects of glutamine-containing total parenteral nutrition on phagocytic activity and anabolic hormone response in rats undergoing gastrectomy

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World Journal of Gastroenterology 2005年第6期11卷 817-822页

作者： Chen-Hsien Lee Wan-Chun Chiu Soul-Chin Chen Chih-Hsiung Wu Sung-Ling Yeh Institute of nutrition and Health Sciences Department of Surgery

AIM: To investigate the effect of glutamine (Gln)-containing parenteral nutrition on phagocytic activity and to elucidate the possible roles of Gln in the secretion of anabolic hormones and nitrogen balance in rats undergoing a gastrectomy. METHODS: Rats with an internal jugular catheter were divided into 2 experimental groups and received total parenteral nutrition (TPN). The TPN solutions were isonitrogenous and identical in nutrient compositions except for differences in amino acid content. One group received conventional TPN (control), and in the other group, 25% of the total amino acid nitrogen was replaced with Gin. After receiving TPN for 3 d, one-third of the rats in each experimental group were sacrificed as the baseline group. The remaining rats underwent a partial gastrectomy and were killed 1 and 3 d, respectively, after surgery. Plasma, peritoneal lavage fluid (PLF), and urine samples were collected for further analysis. RESULTS: The Gln group had fewer nitrogen losses 1 and 2 d after surgery (d1, 16.6±242.5 vs-233.4±205.9 mg/d, d2, 31.8±238.8 vs-253.4±184.6 mg/d, P<0.05). There were no differences in plasma growth hormone (GH) and insulin-like growth factor-1 levels between the 2 groups before or after surgery. The phagocytic activity of peritoneal macrophages was higher in the Gln group than in the control group 1 d after surgery (A 1185±931 vs323±201, P<0.05). There were no differences in the phagocytic activities of blood polymorphonuclear neutrophils between the 2 groups at the baseline or on the postoperative days. No significant differences in interleukin-1β or interleukin-6 concentrations in PLF were observed between the 2 groups. However, tumor necrosis factor-α level in PLF was significantly lower in the Gln group than in the control group on postoperative d 3. CONCLUSION: TPN supplemented with Gln can improve the nitrogen balance, and enhance macrophage phagocytic activity at the site of injury. However, Gin supplementation has no effect on p

关键词： parenteral nutrition Glutamine Phagocytosis Gastrectomy

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Influence of L-methionine-deprived total parenteral nutrition with 5-fluorouracil on gastric cancer and host metabolism

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World Journal of Gastroenterology 2001年第5期7卷 698-701页

作者： Hong-Bing Xiao~1 Wei-Xin Cao~2 Hao-Ran Yin~2 Yan-Zhen Lin~2 Shi-Hui Ye~1 1 Department of Surgery,Affiliated Railway Hospital,Tongji University,Shanghai 200072,China2 Department of Surgery,Affiliated Ruijin Hospital,Shanghai Second Medical University,Shanghai 200025,China Department of Surgery Affiliated Railway Hospital Tongji University Shanghai 200072 China. xhawbin@***

AIM: To investigate the influence of L-methionine-deprived total parenteral nutrition with 5-FU on gastric cancer and host metabolism. METHODS: N-methyl-N'-nitro-nitrosoguanidine (MNNG) induced gastric cancer rats were randomly divided into four groups: Met-containing TPN group (n=11), Met-deprived TPN group (n =12), Met-containing TPN+5-FU group (n=11) and Met-deprived TPN+5-FU group (n=12). Five rats in each group were sacrificed after 7 days of treatment and the samples were taken for examination. The remaining rats in each group were then fed separately with normal diet after the treatment until death, the life span was noted. RESULTS: The tumors were enlarged in Met-containing group and shrank in Met-deprived group markedly after the treatment. The DNA index (DI) of tumor cells and the body weight (BW) of rats had no significant change in the two groups, however, the ratio of tumor cells'S phase was increased. The ratio of G2M phase went up in Met-containing group, but down in Met-deprived group. In the other two groups that 5-FU was added, the BW of rats, and the diameter of tumors, the DI of tumor cells, the S and G2M phase ratio of tumor cells were all decreased, particularly in Met-deprived plus 5-FU group. Pathological examination revealed that the necrotic foci of the tumor tissue increased after Met-deprived TPN treatment, and the nucleoli of tumor cells enlarged. In MetTPN+5-FU group, severe nuclear damage was also found by karyopyknosis and karyorrhexis, meanwhile there was slight degeneration in some liver and kidney cells. The serum free Met and Cysteine decreased markedly (P<0.001), while other amino acids, such as serum free serine and glutamine increased significantly (P<0.005). All the rats died of multiple organ failure caused by cancer metastasis. The average survival time was 18.6 days in Met-containing TPN group, 31 days in Met-deprived TPN group, 27.5 days in Met-containing TPN+5-FU group, and 43 days in Met-deprived TPN+5-FU group (P&

关键词： parenteral nutrition Animals Antimetabolites, Antineoplastic Body Weight DNA, Neoplasm Fluorouracil Male Methionine Rats Rats, Wistar Research Support, Non-U.S. Gov't S Phase Stomach Neoplasms

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The association between weight stability and parenteral nutrition characteristics and survival in patients with colorectal cancer

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Gastroenterology Report 2019年第6期7卷 419-425,I0002页

作者： Wenli Liu Aiham Qdaisat Eric Lee Jason Yeung Khanh Vu Jun-Zhong Lin Todd Canada Shouhao Zhou Lorenzo Cohen Eduardo Bruera Sai-Ching J.Yeung Department of Palliative Rehabilitation and Integrative MedicineThe University of Texas MD Anderson Cancer CenterHoustonTXUSA Department of Emergency Medicine The University of Texas MD Anderson Cancer CenterHoustonTXUSA McGovern Medical School HoustonTXUSA Biomedical Science Texas A&M UniversityCollege StationTXUSA Department of General Internal Medicine The University of Texas MD Anderson Cancer CenterHoustonTXUSA Department of Colorectal Surgery Sun Yat-sen University Cancer CenterGuangzhouGuangdongP.R.China Division of Pharmacy The University of Texas MD Anderson Cancer CenterHoustonTXUSA Department of Public Health Sciences Pennsylvania State University School of MedicineHersheyPAUSA Department of Endocrine Neoplasia and Hormonal Disorders The University of Texas MD Anderson Cancer CenterHoustonTXUSA

Objective:Knowledge about the impact of metabolic disturbances and parenteral nutrition(PN)characteristics on the survival of cancer patients receiving PN is *** aimed to assess the association between clinical and PN characteristics and survival in colorectal-cancer patients receiving PN ***:Our study included 572 consecutive colorectal-cancer patients who had received PN support between 2008 and *** characteristics,body mass index,weight,medical/surgical history,indication for PN,PN data and survival were *** between clinical and PN characteristics and survival were analysed with important confounding ***:The final cohort included 437 evaluable patients,with a mean age of 57 ***-one percent of the study population had advanced stage of colorectal *** weight(weight change≥2.5%)prior to PN initiation[hazard ratio(HR)=1.41,P=0.023]was adversely associated with survival after adjusting for multiple factors including cancer *** obstruction(HR=1.75,P=0.017)as a PN indication was associated with worse survival when compared with without bowel *** PN amino acid by ideal body weight(g•kg^(-1))(HR=0.59,P=0.029)was associated with longer survival,whereas a higher percentage of non-PN intravenous calories(HR=1.04,P=0.011)was associated with shorter survival independently of confounding ***:Body mass index and weight stability can be useful nutritional indices for survival prediction in cancer patients receiving *** planning should take into account of non-PN calories to achieve optimal energy support and *** research is needed to define optimal PN amino-acid requirement and energy balance.

关键词： BMI weight loss non-parenteral calorie energy balance parenteral nutrition

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Early enteral nutrition vs parenteral nutrition following pancreaticoduodenectomy: Experience from a single center

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World Journal of Gastroenterology 2016年第14期22卷 3821-3828页

作者： Jian-Wen Lu Chang Liu Zhao-Qing Du Xue-Min Liu Yi Lv Xu-Feng Zhang Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering the First Affiliated Hospital of Xi'an Jiaotong University Xi'an 710061 Shaanxi Province China Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center Xi'an 710061 Shaanxi Province China Department of Health Statistics the First Affiliated Hospital of Xi'an Jiaotong University Xi'an 710061 Shaanxi Province China

AIM: To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition (TPN) and early enteral nutrition supplemented with parenteral nutrition (EEN + PN).METHODS: Three hundred and forty patients receiving pancreaticoduodenectomy (PD) from 2009 to 2013 at our center were enrolled retrospectively. Patients were divided into two groups depending on postoperative nutrition support scheme: an EEN + PN group (n = 87) and a TPN group (n = 253). Demographic characteristics, comorbidities, preoperative biochemical parameters, pathological diagnosis, intraoperative information, and postoperative complications of the two groups were ***: The two groups did not differ in demographic characteristics, preoperative comorbidities, preoperative biochemical parameters or pathological findings (P > 0.05 for all). However, patients with EEN + PN following PD had a higher incidence of delayed gastric emptying (16.1% vs 6.7%, P = 0.016), pulmonary infection (10.3% vs 3.6%, P = 0.024), and probably intraperitoneal infection (18.4% vs 10.3%, P = 0.059), which might account for their longer nasogastric tube retention time (9 d vs 5 d, P = 0.006), postoperative hospital stay (25 d vs 20 d, P = 0.055) and higher hospitalization expenses (USD10397 vs USD8663.9, P = 0.008), compared to those with ***: Our study suggests that TPN might be safe and sufficient for patient recovery after PD. Postoperative EEN should only be performed scrupulously and selectively.

关键词： Pancreaticoduodenectomy Postoperative complications Enteral nutrition parenteral nutrition Delayed gastric emptying

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Fish oil-based lipid emulsion:current updates on a promising novel therapy for the management of parenteral nutrition-associated liver disease

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Gastroenterology Report 2015年第2期3卷 110-114页

作者： Shishira Bharadwaj Tushar Gohel Omer J.Deen Robert DeChicco Abdullah Shatnawei Center for Human nutrition Department of Gastroenterology/HepatologyThe Cleveland Clinic FoundationClevelandOHUSA

Intestinal failure is characterized by loss of enteral function to absorb necessary nutrients and water to sustain *** nutrition(PN)is a lifesaving therapeutic modality for patients with intestinal *** PN is also needed for patients who have short bowel syndrome due to extensive resection or a dysmotility disorder with ***,prolonged PN is associated with short-term and long-term *** nutrition-associated liver disease(PNALD)is one of the long-termcomplications associated with the use of an intravenous lipid emulsion to prevent essential fatty acid deficiency in these *** affects 30–60%of the adult population on long-term ***,PNALD is one of the indications for isolated liver or combined liver and intestinal *** is no consensus on how to manage PNALD,but fish oil-based lipid emulsion(FOBLE)has been suggested to play an important role both in its prevention and *** is significant improvement in liver function in those who received FOBLE as lipid supplement compared with those who received soy-based lipid *** have also demonstrated that FOBLE reverses hepatic steatosis and reduces markers of inflammation in patients on long-term *** prospective studies with larger sample sizes are needed to further strengthen the positive role of FOBLE in PNALD.

关键词： intestinal failure parenteral nutrition parenteral nutrition-associated liver disease fish oil-based lipid emulsion

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Effects of parenteral nutrition with and without GH on the GH/IGF-1 axis after hepatectomy in hepatocellular carcinoma with liver cirrhosis

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Frontiers of Medicine 2007年第3期1卷 287-293页

作者： CAO Jie LUO Shimin LIANG Lijian LAI Jiaming CHEN Shanming Department of General Surgery Affiliated Guangzhou First Municipal People’s HospitalGuangzhou Medical CollegeGuangzhou 510180China Department of Hepatobiliary Surgery The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510180China Department of Scientific Research and Education Affiliated Guangzhou First Municipal People’s HospitalGuangzhou Medical CollegeGuangzhou 510180China

Postoperative hepatic insulin-like growth factor-1(IGF-1)production may be severely disturbed in patients with liver *** alterations in the GH/IGF-1 axis are thought to play an important role in the protein catabolism that complicates major surgical *** aim of this study was to explore the effects of parenteral nutrition(PN)with and without growth hormone(GH)on the GH/IGF-1 axis after hepatectomy for hepatocellular carcinoma(HCC)with cirrhosis and evaluate the potential roles of recombinant human GH(rhGH)***-four patients with HCC with cirrhosis who underwent hepatectomy were randomly divided into two groups:a PN group(n=12)and an rhGH+PN group(n=12).Liver function,serum GH,IGF-1 and IGFBP-3 were measured before the operation and at postoperative days(POD)1 and ***-like growth factor-1 and IGFBP-3 mRNA in the liver tissue was detected by *** liver Ki67 immunohistochemistry staining was *** the same time,12 patients with cholelithiasis or liver hemangioma who underwent operation served as normal control *** POD 6,serum prealbumin,GH,IGF-1,IGFBP-3,hepatic IGF-1 mRNA,IGFBP-3 mRNA and liver Ki67 LI were higher in the rhGH+PN group than in the PN *** was no significant difference in the 6-and 12-month tumor-free survival rate and the median tumor-free survival time between the PN group and the rhGH+PN group(P>0.05).These data indicate that rhGH+PN could ameliorate the changes in the GH/IGF-1 axis after hepatectomy for HCC in the setting of cirrhosis.

关键词： carcinoma,hepatocellular parenteral nutrition growth hormone insulin-like growth factor I insulin-like growth factor binding protein 3

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