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Lee B.-J.,The Intensive Care Unit | Lin J.-S.,Chung Shan Medical University | Lin Y.-C.,Chung Shan Medical University | Lin P.-T.,Chung Shan Medical University
Nutrition | Year: 2015

Objective: Inflammation mediators have been recognized as risk factors for the pathogenesis of coronary artery disease (CAD). The purpose of this study was to investigate the effect of l-carnitine supplementation (LC, 1000 mg/d) on inflammation markers in patients with CAD. Methods: We enrolled 47 patients with CAD in the study. The patients with CAD were identified by cardiac catheterization as having <50% stenosis of one major coronary artery. The patients were randomly assigned to the placebo (n = 24) and LC (n = 23) groups and the intervention was administered for 12 wk. The levels of LC, antioxidant status (malondialdehyde and antioxidant enzymes activities), and inflammation markers (C-reactive protein [CRP], interleukin [IL]-6, and tumor necrosis factor [TNF]-α) were measured. Results: Thirty-nine participants completed the study (19 placebo; 20 LC). After LC supplementation, the levels of inflammation markers were significantly reduced compared with the baseline (CRP, P < 0.01; IL-6, P = 0.03; TNF-α, P = 0.07) and those in the placebo group (CRP, P < 0.05; IL-6, P= 0.04; TNF-α, P = 0.03). The levels of inflammation markers were significantly negatively correlated with the levels of LC and antioxidant enzymes activities (P < 0.05). Conclusions: We suggest that LC supplementation, due to its antioxidant effects, may have potential utility to reduce inflammation in CAD. © 2015 Elsevier Inc. Source


Hou C.-T.,Changhua Christian Hospital | Wu Y.-H.,Changhua Christian Hospital | Huang P.-N.,St. Martin de Porres Hospital | Cheng C.-H.,The Intensive Care Unit | Huang Y.-C.,Chung Shan Medical University
Clinical Nutrition | Year: 2011

Background & aims: Stress, inflammation, and clinical conditions may increase the utilization and metabolic turnover of vitamin B-6 and lower the body pool of vitamin B-6. There is the possibility that hyperglycemia in critically ill patients might be at least partially due to compromised vitamin B-6 status. The purpose of this study was to compare blood glucose responses between critically ill surgical patients with adequate and deficient vitamin B-6 status. Methods: The study was designed as a cross-sectional observational study. Thirty-four patients in the surgical intensive care unit (SICU) were enrolled. The severity of illness (APACHE II score), the length of ventilation dependency, and the lengths of SICU and hospital stay were recorded. The levels of serum hemoglobin, hematocrit, albumin, prealbumin, C-reactive protein, glucose, insulin, glycated hemoglobin, C-peptide and creatinine were determined. Vitamin B-6 intake was recorded for 7 days. Vitamin B-6 status was assessed by direct measures [plasma and erythrocyte pyridoxal 5′-phosphate (PLP), pyridoxal (PL) and 4-pyridoxic acid (4-PA), and urinary 4-PA] and indirect measures [erythrocyte alanine and aspartate aminotransaminase activity coefficient]. Results: Fourteen patients were classified into the deficient vitamin B-6 group (plasma PLP < 20 nmol/L), while there were 20 patients in the adequate vitamin B-6 group. The mean serum glucose concentration of both groups indicated patients was in the hyperglycemic state (serum glucose > 126 mg/dL). However, mean serum glucose concentration significantly decreased by day 7 in the adequate vitamin B-6 group, whereas patients still remained in the hyperglycemic state (serum glucose > 126 mg/dL) in the deficient vitamin B-6 group. There were significantly correlations of relatively higher plasma PLP at admission (day 1) with the reduction of blood glucose concentration (r s = 0.72, p = 0.029) on day 7 in the deficient vitamin B-6 group. However, erythrocyte PLP concentration was positively associated with blood glucose level (r s = 0.88, p = 0.002) at admission in the deficient vitamin B-6 group after adjusting for age, gender, APACHE II score, diabetic history and insulin therapy. Conclusions: Surgically ill patients with adequate plasma PLP concentration at admission showed improved blood glucose response at day 7. Higher plasma PLP at admission was a major contributing factor in the reduction of glucose concentration in critically ill surgical patients with deficient vitamin B-6 status. © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. Source


Lee B.-J.,Chung Shan Medical University | Lee B.-J.,The Intensive Care Unit | Yen C.-H.,Chung Shan Medical University | Hsu H.-C.,Chung Shan Medical University | And 3 more authors.
Nutrition Research | Year: 2012

Coronary artery disease (CAD) is the leading cause of death worldwide. The purpose of this study was to investigate the relationship between plasma levels of coenzyme Q10 and vitamin B-6 and the risk of CAD. Patients with at least 50% stenosis of one major coronary artery identified by cardiac catheterization were assigned to the case group (n = 45). The control group (n = 89) comprised healthy individuals with normal blood biochemistry. The plasma concentrations of coenzyme Q10 and vitamin B-6 (pyridoxal 5'-phosphate) and the lipid profiles of the participants were measured. Subjects with CAD had significantly lower plasma levels of coenzyme Q10 and vitamin B-6 compared to the control group. The plasma coenzyme Q10 concentration (β = 1.06, P = .02) and the ratio of coenzyme Q10 to total cholesterol (β = .28, P = .01) were positively correlated with vitamin B-6 status. Subjects with higher coenzyme Q10 concentration (≥516.0 nmol/L) had a significantly lower risk of CAD, even after adjusting for the risk factors for CAD. Subjects with higher pyridoxal 5'-phosphate concentration (≥59.7 nmol/L) also had a significantly lower risk of CAD, but the relationship lost its statistical significance after adjusting for the risk factors of CAD. There was a significant correlation between the plasma levels of coenzyme Q10 and vitamin B-6 and a reduced risk of CAD. Further study is needed to examine the benefits of administering coenzyme Q10 in combination with vitamin B-6 to CAD patients, especially those with low coenzyme Q10 level. © 2012 Elsevier Inc. Source


Chen S.-J.,Chung Chou University of Science and Technology | Yen C.-H.,Chung Shan Medical University | Huang Y.-C.,Chung Shan Medical University | Lee B.-J.,Chung Shan Medical University | And 3 more authors.
PLoS ONE | Year: 2012

Metabolic syndrome (MS) represents a cluster of physiological and anthropometric abnormalities. The purpose of this study was to investigate the relationships between the levels of inflammation, adiponectin, and oxidative stress in subjects with MS. The inclusion criteria for MS, according to the Taiwan Bureau of Health Promotion, Department of Health, were applied to the case group (n = 72). The control group (n = 105) comprised healthy individuals with normal blood biochemical values. The levels of inflammatory markers [high sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6), adiponectin, an oxidative stress marker (malondialdehyde), and antioxidant enzymes activities [catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx)] were measured. Subjects with MS had significantly higher concentrations of inflammatory markers and lower adiponectin level, and lower antioxidant enzymes activities than the control subjects. The levels of inflammatory markers and adiponectin were significantly correlated with the components of MS. The level of hs-CRP was significantly correlated with the oxidative stress marker. The IL-6 level was significantly correlated with the SOD and GPx activities, and the adiponectin level was significantly correlated with the GPx activity. A higher level of hs-CRP (≥1.00 mg/L), or IL-6 (≥1.50 pg/mL) or a lower level of adiponectin (<7.90 μg/mL) were associated with a significantly greater risk of MS. In conclusion, subjects suffering from MS may have a higher inflammation status and a higher level of oxidative stress. A higher inflammation status was significantly correlated with decreases in the levels of antioxidant enzymes and adiponectin and an increase in the risk of MS. © 2012 Chen et al. Source


Iwashyna T.J.,Monash University | Iwashyna T.J.,University of Michigan | Iwashyna T.J.,Center for Clinical Management Research | Hodgson C.L.,Monash University | And 5 more authors.
Critical Care and Resuscitation | Year: 2015

Objective: To identify the characteristics of patients with “persistent critical illness” (PerCI), as perceived by Australian and New Zealand intensive care unit clinicians. Patients with PerCI were defined as those whose reason for being in the ICU was now more related to their ongoing critical illness than their original reason for admission to the ICU. Design and participants: Using a web-based survey, we recruited clinicians affiliated with the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group (CTG) who cared for adults. Clinicians included doctors, nurses, physiotherapists, dietitians, research managers and others. We used the ANZICS-CTG mailing list to email a single request for anonymous participation. Results: A total of 101 eligible clinicians responded to our survey. PerCI was believed to develop after a median of 10 days (IQR, 7–14 days), and to be somewhat uncommon (occurring in 10% of all ICU patients [IQR, 5%–15%], and in 50% of all patients with a prolonged ICU length of stay [IQR, 20%–60%]). Ninety per cent of respondents thought that patients with PerCI required ongoing invasive mechanical ventilation, and the most common problems were thought to be respiratory insufficiency (68%), delirium (59%) and acquired neuromuscular disease (54%). Ten per cent of patients with PerCI were expected to be alive and well and at home 6 months after ICU discharge, with another 15% alive and at home but requiring significant help. The remainder were expected to die within 6 months or to need institutional care. Conclusion: Patients with PerCI appear to be an identifiable group of ICU patients, with definable characteristics, substantial stress associated with their care, and poor perceived long-term outcomes. © 2015, Critical Care and Resuscitation. All rights reserved. Source

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