Male and female rats with severe protein restriction present delayed wound healing

C-reactive protein to albumin ratio predict responses to programmed cell death-1 inhibitors in hepatocellular carcinoma patients

BACKGROUND

Over the years, programmed cell death-1 (PD-1) inhibitors have been routinely used for hepatocellular carcinoma (HCC) treatment and yielded improved survival outcomes. Nonetheless, significant heterogeneity surrounds the outcomes of most studies. Therefore, it is critical to search for biomarkers that predict the efficacy of PD-1 inhibitors in patients with HCC.

AIM

To investigate the role of the C-reactive protein to albumin ratio (CAR) in evaluating the efficacy of PD-1 inhibitors for HCC.

METHODS

The clinical data of 160 patients with HCC treated with PD-1 inhibitors from January 2018 to November 2022 at the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed.

RESULTS

The optimal cut-off value for CAR based on progression-free survival (PFS) was determined to be 1.20 using x-tile software. Cox proportional risk model was used to determine the factors affecting prognosis. Eastern Cooperative Oncology Group performance status [hazard ratio (HR) = 1.754, 95% confidence interval (95%CI) = 1.045-2.944, P = 0.033], CAR (HR = 2.118, 95%CI = 1.057-4.243, P = 0.034) and tumor number (HR = 2.932, 95%CI = 1.246-6.897, P = 0.014) were independent prognostic factors for overall survival. CAR (HR = 2.730, 95%CI = 1.502-4.961, P = 0.001), tumor number (HR = 1.584, 95%CI = 1.003-2.500, P = 0.048) and neutrophil to lymphocyte ratio (HR = 1.120, 95%CI = 1.022-1.228, P = 0.015) were independent prognostic factors for PFS. Two nomograms were constructed based on independent prognostic factors. The C-index index and calibration plots confirmed that the nomogram is a reliable risk prediction tool. The ROC curve and decision curve analysis confirmed that the nomogram has a good predictive effect as well as a net clinical benefit.

CONCLUSION

Overall, we reveal that the CAR is a potential predictor of short- and long-term prognosis in patients with HCC treated with PD-1 inhibitors. If further verified, CAR-based nomogram may increase the number of markers that predict individualized prognosis.

Predictive factors associated with anastomotic leakage after resection of rectal cancer: a multicenter study with the Hiroshima Surgical study group of Clinical Oncology

PURPOSE

Several factors have been reported as risk factors for anastomotic leakage after resection of rectal cancer. This study aimed to evaluate the risk factors for anastomotic leakage, including nutritional and immunological indices, following rectal cancer resection.

METHODS

This study used a multicenter database of 803 patients from the Hiroshima Surgical study group of Clinical Oncology who underwent rectal resection with stapled anastomosis for rectal cancer between October 2016 and April 2020.

RESULTS

In total, 64 patients (8.0%) developed postoperative anastomotic leakage. Five factors were significantly associated with the development of anastomotic leakage after rectal cancer resection with stapled anastomosis: male sex, diabetes mellitus, C-reactive protein/albumin ratio ≥ 0.07, prognostic nutritional index < 40, and low anastomosis under peritoneal reflection. The incidence of anastomotic leakage was correlated with the number of risk factors. The novel predictive formula based on odds ratios in the multivariate analysis was useful for identifying patients at high risk for anastomotic leakage. Diverting ileostomy reduced the ratio of anastomotic leakage ≥ grade III after rectal cancer resection.

CONCLUSIONS

Male sex, diabetes mellitus, C-reactive protein/albumin ratio ≥ 0.07, prognostic nutritional index < 40, and low anastomosis under peritoneal reflection are possible risk factors for developing anastomotic leakage after rectal cancer resection with the stapled anastomosis. Patients at high risk of anastomotic leakage should be assessed for the potential benefits of diverting stoma.

C-Reactive Protein/Albumin Ratio on the First Day after Surgery Predicts Short-Term Complications of Gastrectomy for Gastric Cancer

Postoperative complications of gastrectomy for gastric cancer affect the efficacy of surgery. It is of clinical significance to identify high-risk patients with postoperative complications as early as possible. A total of 206 patients who underwent gastrectomy were enrolled in this study. Univariate and multivariate analyses were used to determine the risk factors for postoperative complications. The cutoff value and diagnostic accuracy of the C-reactive protein/albumin ratio were calculated by receiver operating characteristic curves. A total of 64 (31.1%) patients developed postoperative complications. Multivariate analysis confirmed that the C-reactive protein/albumin ratio on the first day after operation was an independent risk factor for postoperative complications (OR = 2.538, 95%CI: 1.346-4.785, P = 0.004). The cutoff value of the C-reactive protein/albumin ratio on the first day after operation was 2.105 calculated by receiver operating characteristic curves. Patients with a C-reactive protein/albumin ratio greater than 2.105 had a higher incidence of postoperative complications (43.2% vs 22.0%, P = 0.001) and longer postoperative hospital stay (15.3 ± 1.2 vs 13.0 ± 0.5, P = 0.042) than patients with less than 2.105. Patients with C-reactive protein/albumin ratio greater than 2.105 on the first day after operation are more likely to have postoperative complications.

Evaluating the beneficial effects of dietary restrictions: A framework for precision nutrigeroscience

Dietary restriction (DR) has long been viewed as the most robust nongenetic means to extend lifespan and healthspan. Many aging-associated mechanisms are nutrient responsive, but despite the ubiquitous functions of these pathways, the benefits of DR often vary among individuals and even among tissues within an individual, challenging the aging research field. Furthermore, it is often assumed that lifespan interventions like DR will also extend healthspan, which is thus often ignored in aging studies. In this review, we provide an overview of DR as an intervention and discuss the mechanisms by which it affects lifespan and various healthspan measures. We also review studies that demonstrate exceptions to the standing paradigm of DR being beneficial, thus raising new questions that future studies must address. We detail critical factors for the proposed field of precision nutrigeroscience, which would utilize individualized treatments and predict outcomes using biomarkers based on genotype, sex, tissue, and age.

The Role of Reduced Methionine in Mediating the Metabolic Responses to Protein Restriction Using Different Sources of Protein

Dietary protein restriction and dietary methionine restriction (MR) produce a comparable series of behavioral, physiological, biochemical, and transcriptional responses. Both dietary regimens produce a similar reduction in intake of sulfur amino acids (e.g., methionine and cystine), and both diets increase expression and release of hepatic FGF21. Given that FGF21 is an essential mediator of the metabolic phenotype produced by both diets, an important unresolved question is whether dietary protein restriction represents de facto methionine restriction. Using diets formulated from either casein or soy protein with matched reductions in sulfur amino acids, we compared the ability of the respective diets to recapitulate the metabolic phenotype produced by methionine restriction using elemental diets. Although the soy-based control diets supported faster growth compared to casein-based control diets, casein-based protein restriction and soy-based protein restriction produced comparable reductions in body weight and fat deposition, and similar increases in energy intake, energy expenditure, and water intake. In addition, the prototypical effects of dietary MR on hepatic and adipose tissue target genes were similarly regulated by casein- and soy-based protein restriction. The present findings support the feasibility of using restricted intake of diets from various protein sources to produce therapeutically effective implementation of dietary methionine restriction.

Supplementation of egg white peptides on attenuating skin mechanical damage symptoms: a promising way to accelerate wound healing process

Recent studies have indicated that active peptides can induce an improvement in wound repair. Herein, we evaluated egg white peptides (EWPs) as a nutritional supplement to improve mechanical skin damage in BALB/c mice. Two symmetrical circular full-thickness wounds were created with 5 mm biopsy punches in the skin of the mouse dorsal region, and EWPs (200, and 400 mg kg^-1) were administrated by gavage for 14 days. We analyzed the EWPs for their in vivo and in vitro antioxidant capability, toxicity, and microscopy of skin wounds, and there was no cytotoxicity or in vivo toxicity. During the period of wound healing, EWPs could promote healthy cell migration, increase serum superoxide dismutase and catalase activities and accelerate the wound healing process in a time- and dose-dependent manner, whereas the levels of malondialdehyde and reactive oxygen species showed the opposite trend. After administration with 400 mg kg^-1 EWPs for 10 days, the wound had almost healed. Meanwhile, EWPs significantly enhanced serum amino acids, particularly enhancing the content of Arg, Glu, Pro, Met, and Lys, which could provide sufficient nutrition in the wound healing process. The present study demonstrates that EWPs possess a positive potential to accelerate the wound healing process of mechanical skin damage at the cellular and animal level.

Early Postoperative Hypoalbuminaemia as a Risk Factor for Postoperative Pneumonia Following Hip Fracture Surgery

Purpose

Postoperative pneumonia is a common and devastating complication of hip fracture surgery in older individuals. This study aimed to determine the relationship between early postoperative hypoalbuminaemia and pneumonia after hip fracture surgery.

Patients and Methods

In this retrospective cohort study conducted at one centre, we reviewed the medical records of 1155 consecutive patients (>60 years) who underwent hip fracture surgery. Multivariate logistic regression analysis was performed to identify the independent risk factors for postoperative pneumonia. After determining the cut-off value for postoperative serum albumin, the patients were divided into two groups according to the minimum serum albumin level recorded during the first two postoperative days: group A included patients with a minimum serum album level less than 3.0 g/dL and group B included patients with a minimum serum album level of at least 3.0 g/dL. The prevalence of postoperative pneumonia was analysed using inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) analyses.

Results

The incidence of postoperative pneumonia following hip fracture surgery was 5.1% (n=59). Age, cardiovascular disease, and early postoperative hypoalbuminaemia during the first two postoperative days were independent risk factors for postoperative pneumonia. Early postoperative hypoalbuminaemia was associated with postoperative pneumonia development in the PSM and IPTW analyses (P = 0.016 and <0.001, respectively).

Conclusion

This study demonstrated that early postoperative hypoalbuminaemia is an independent risk factor for the development of postoperative pneumonia in patients undergoing hip fracture surgery.

Perioperative improvement in serum albumin level in patients with left ventricular assist device

BACKGROUND

The negative impact of baseline hypoalbuminemia on clinical outcome following left ventricular assist device (LVAD) implantation is well known. However, the implications of perioperative change in serum albumin levels on post-LVAD outcomes remain uninvestigated.

METHODS

Among consecutive patients with baseline serum albumin <3.5 g/dl who received durable LVAD implantation between April 2014 and August 2017 and were followed for 1 year, the impact of perioperative change in serum albumin level from baseline to 3 months post-LVAD on the incidence of adverse events was investigated.

RESULTS

Sixty-eight patients (median 60 years and 69% male) were included. Serum albumin change was an independent predictor of the occurrence of adverse events with an adjusted hazard ratio of 0.32 (95% confidence interval, 0.13-0.78) and a cutoff change of 0.7 g/dl. Those with albumin increase >0.7 g/dl had higher 1-year freedom from adverse events (45% vs. 14%, p = .008), dominantly due to lower incidence of death or sepsis compared with those without (p < .05 for both).

CONCLUSION

Among those with baseline hypoalbuminemia, a considerable perioperative increase in serum albumin levels following LVAD implantation was associated with lower mortality and morbidity. The implication of aggressive nutrition intervention on LVAD patients is the next concern.

Preoperative Protein or Methionine Restriction Preserves Wound Healing and Reduces Hyperglycemia

BACKGROUND

Dietary restriction (DR), defined as reduced nutrient intake without malnutrition, is associated with longevity extension, improved glucose metabolism, and increased stress resistance, but also poor wound healing. Short-term preoperative DR followed by a return to normal feeding after surgery results in improved surgical outcomes in preclinical models. However, the effect of preoperative DR on wound healing and perioperative glucose homeostasis is currently unknown. Here, we tested the effects of two different preoperative DR regimens-protein restriction (PR) and methionine restriction (MR)-on wound healing and perioperative glucose homeostasis using an established murine model of wound healing in both nondiabetic and diabetic mice.

MATERIALS AND METHODS

Surgical outcomes were tested using the McFarlane flap in nondiabetic and streptozotocin-induced diabetic mice. Short-term dietary preconditioning included 1 wk of PR or MR diet (1-2 wk) versus an isocaloric complete diet before surgery; all mice were returned to a complete diet postoperatively. Outcome measures of flap wound recovery included skin viability and laser Doppler imaging of flap perfusion and assessment of CD45+ cell infiltration. Glucose homeostasis was assessed by glucose tolerance testing and by perioperative glucose levels in the diabetic cohort.

RESULTS

No significant differences were observed in percentage of viable skin, perfusion, or immune cell infiltration at 7-10 d after surgery in PR or MR mice compared with controls in healthy or diabetic mice. Preoperative glucose tolerance and postoperative glucose levels were however significantly improved by both PR and MR in diabetic mice.

CONCLUSIONS

Short-term dietary preconditioning with PR or MR did not impair wound healing in nondiabetic or diabetic mice. However, both regimens reduced preoperative hyperglycemia in diabetic mice. Thus, brief preoperative dietary manipulations stand as strategies to potentially improve perioperative hyperglycemia with no deleterious effects on wound healing in mice.

Impact of Childhood Malnutrition on Host Defense and Infection

The global impact of childhood malnutrition is staggering. The synergism between malnutrition and infection contributes substantially to childhood morbidity and mortality. Anthropometric indicators of malnutrition are associated with the increased risk and severity of infections caused by many pathogens, including viruses, bacteria, protozoa, and helminths. Since childhood malnutrition commonly involves the inadequate intake of protein and calories, with superimposed micronutrient deficiencies, the causal factors involved in impaired host defense are usually not defined. This review focuses on literature related to impaired host defense and the risk of infection in primary childhood malnutrition. Particular attention is given to longitudinal and prospective cohort human studies and studies of experimental animal models that address causal, mechanistic relationships between malnutrition and host defense. Protein and micronutrient deficiencies impact the hematopoietic and lymphoid organs and compromise both innate and adaptive immune functions. Malnutrition-related changes in intestinal microbiota contribute to growth faltering and dysregulated inflammation and immune function. Although substantial progress has been made in understanding the malnutrition-infection synergism, critical gaps in our understanding remain. We highlight the need for mechanistic studies that can lead to targeted interventions to improve host defense and reduce the morbidity and mortality of infectious diseases in this vulnerable population.

Calorie restriction in rodents: Caveats to consider

The calorie restriction paradigm has provided one of the most widely used and most useful tools for investigating mechanisms of aging and longevity. By far, rodent models have been employed most often in these endeavors. Over decades of investigation, claims have been made that the paradigm produces the most robust demonstration that aging is malleable. In the current review of the rodent literature, we present arguments that question the robustness of the paradigm to increase lifespan and healthspan. Specifically, there are several questions to consider as follows: (1) At what age does CR no longer produce benefits? (2) Does CR attenuate cognitive decline? (3) Are there negative effects of CR, including effects on bone health, wound healing, and response to infection? (4) How important is schedule of feeding? (5) How long does CR need to be imposed to be effective? (6) How do genotype and gender influence CR? (7) What role does dietary composition play? Consideration of these questions produce many caveats that should guide future investigations to move the field forward.

Postoperative decrease of serum albumin predicts short-term complications in patients undergoing gastric cancer resection

AIM

To find an accurate and simple predictor for postoperative short-term complications after gastrectomy.

METHODS

Two hundred and twenty-three patients undergoing gastric cancer resection between October 1, 2015 and September 30, 2016 were enrolled in this study. Univariate and multivariate analyses were used to identify risk factors for complications after gastrectomy. The cutoff values and diagnostic accuracy were examined by receiver operating characteristic curves.

RESULTS

Sixty-two (27.8%) patients had short-term complications after gastric cancer resection. The postoperative decrease in serum albumin (∆ALB) was an independent risk factor for complications (OR = 17.957, 95%CI: 6.073-53.095, P < 0.001). The cutoff value was 14.0% and the area under the curve was higher than that of C-reactive protein on postoperative day 3 (area under the curve: 0.806 vs 0.709). Patients with ∆ALB ≥ 14.0% were more likely to have short-term complications after gastrectomy (46.7% vs 5.0%, P < 0.001), prolonged hospital stay (17.2 ± 10.8 d vs 14.1 ± 4.2 d, P = 0.007) and higher comprehensive complication index (P < 0.001) than those with ∆ALB < 14.0%.

CONCLUSION

Postoperative ∆ALB with a cutoff of 14.0% can be used to recognize patients who have high risk of short-term complications following gastric cancer resection.

Early Postoperative Decrease of Serum Albumin Predicts Surgical Outcome in Patients Undergoing Colorectal Resection

BACKGROUND

A simple and accurate predictor of postoperative complications is needed for early and safe discharge after surgery. A decrease in serum albumin is commonly observed early after surgery, even in patients with normal preoperative levels. However, whether it predicts patient postoperative outcome is unknown.

OBJECTIVE

The purpose of this study was to evaluate whether the reduction in serum albumin within 2 postoperative days compared with the preoperative level could serve as an independent predictor of postoperative complications after colorectal surgery.

DESIGN

This was a retrospective study from a single institution.

SETTINGS

The study was conducted in a tertiary referral hospital.

PATIENTS

A total of 626 patients undergoing major colorectal surgery between December 2012 and January 2016 were eligible for this study.

MAIN OUTCOME MEASURES

Univariate and multivariate analyses were performed to identify risk factors for postoperative complications and to identify the factors associated with Δalbumin. Receiver operating characteristic curves were developed to examine the cutoff value of the change in albumin in predicting postoperative complications.

RESULTS

Among all of the patients, the median Δalbumin after surgery was 15%. ΔAlbumin was an independent risk factor for overall complications (p < 0.01). The cutoff value was 15%, and an increased area under the curve compared with C-reactive protein occurred on postoperative day 3 or 4. Patients with a Δalbumin ≥15% experienced more postoperative major complications, a higher comprehensive complication index, a longer postoperative stay, and increased surgical site infections (p < 0.05) than those <15%. ΔAlbumin correlated with sex, type of surgery, stoma creation, C-reactive protein on postoperative day 3 or 4, and intraoperative blood transfusion. Postoperative C-reactive protein remained independently associated with Δalbumin (p < 0.01).

LIMITATIONS

The study was limited by its retrospective nature.

CONCLUSIONS

A cutoff value of a 15% reduction in serum albumin within 2 postoperative days could help to identify patients with a high probability of postoperative complications and permit safe and early discharge after colorectal surgery.

Diagnostic accuracy of the postoperative ratio of C-reactive protein to albumin for complications after colorectal surgery

Background

The ratio of C-reactive protein to albumin, as a novel inflammation-based prognostic score, is associated with outcomes in cancer and septic patients. The diagnostic accuracy of the CRP/albumin ratio has not been assessed in colorectal surgery for postoperative complications.

Methods

A total of 359 patients undergoing major colorectal surgery between 2012 and 2015 were eligible for this study. Uni- and multivariate analyses were performed to identify risk factors for postoperative complications. Receiver operating characteristic curves were developed to examine the cutoff values and diagnostic accuracy of the CRP/albumin ratio and postoperative CRP levels.

Results

Among all the patients, 139 (38.7%) were reported to have postoperative complications. The CRP/albumin ratio was an independent risk factor for complications (OR 4.413; 95% CI 2.463–7.906; P < 0.001), and the cutoff value was 2.2, which had a higher area under the curve compared to CRP on postoperative day 3 (AUC 0.779 vs 0.756). The CRP/albumin ratio also had a higher positive predictive value than CRP levels on postoperative day 3. Patients with CRP/albumin ≥2.2 suffered more postoperative complications (60.8% vs 18.6%, P < 0.001), longer postoperative stays (10 (4–71) vs 7 (3–78) days, P < 0.001), and increased surgical site infections (SSIs) (21.1% vs 4.8%, P < 0.001) than those with CRP/albumin <2.2.

Conclusions

The ratio of C-reactive protein to albumin could help to identify patients who have a high probability of postoperative complications, and the ratio has higher diagnostic accuracy than C-reactive protein alone for postoperative complications in colorectal surgery.

Hypoalbuminemia Within Two Postoperative Days Is an Independent Risk Factor for Acute Kidney Injury Following Living Donor Liver Transplantation: A Propensity Score Analysis of 998 Consecutive Patients

OBJECTIVE

Acute kidney injury is a known major complication of liver transplantation. Previous reports have shown that hypoalbuminemia is associated with an increased risk of acute kidney injury. However, little is known about the relationship between the early postoperative albumin level and acute kidney injury after living donor liver transplantation. The aim of this study was to identify the influence of the postoperative albumin level on acute kidney injury prevalence after living donor liver transplantation.

DESIGN

A retrospective analysis.

SETTING

A tertiary care university hospital.

PATIENTS

Nine hundred and ninety-eighty patients underwent living donor liver transplantation.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We divided the enrolled patients into two groups: group 1 included patients whose postoperative albumin level was less than 3.0 g/dL (n = 522), and group 2 included patients with an albumin level greater than or equal to 3.0 g/dL (n = 476). The prevalence of acute kidney injury, major adverse cardiac events, hospital stay, ICU stay, 30-day mortality, and overall mortality was analyzed using inverse probability of treatment weighting and propensity-score matching (n = 249 pairs) analysis. The prevalence of acute kidney injury was higher in group 1 defined by both Acute Kidney Injury Network (after adjusting for inverse probability of treatment weighting [n = 364; 69.7%] and propensity-score matching [n = 152; 61.0%]) and Risk, Injury, Failure, Loss, and End-stage kidney disease criteria (after adjusting for inverse probability of treatment weighting [n = 419; 80.3%] and propensity-score matching [n = 190; 76.3%]). The overall mortality was higher in group 1 after adjusting for inverse probability of treatment weighting (n = 61; 11.7%) and propensity-score matching (n = 23; 9.2%). The hospital (p < 0.001) and ICU (p = 0.006) stays were significantly prolonged in group 1. Acute kidney injury was associated with ICU stay by the Acute Kidney Injury Network criteria (p = 0.034), and overall mortality was correlated with acute kidney injury by the Risk, Injury, Failure, Loss, and End-stage kidney disease criteria (p = 0.014).

CONCLUSIONS

Early postoperative hypoalbuminemia is an independent risk factor for acute kidney injury, and postoperative acute kidney injury is related to postoperative ICU stay and overall mortality after living donor liver transplantation.

Selenium added unripe carica papaya pulp extracts enhance wound repair through TGF-β1 and VEGF-a signalling pathway

BACKGROUND

Increased wound healing efficiency by Se(2+) added Carica papaya L. (Caricaceae) fruit extract was linked to increased antioxidant and anti-inflammatory responses during healing. We investigated the impact of Se(2+) or Zn(2+) added papaya water (WE) and phosphate-buffered saline (PE) extracts on cells recruitment and bio-molecular alterations on days 4 and 10 post wounding in an in vivo excision wound.

METHODS

Excision wounds were created on the dorsum of Sprague Dawley rats and treated topically twice/day with 20 μL of PE and WE (5 mg extract/mL), 0.5 μgSe(2+) added PE and WE (PES and WES), or 100 μMZn(2+) added PE and WE (PEZ and WEZ). Deionised water (negative) and Solcoseryl (positive) were applied on the control groups. Histochemical and biochemical assays were used to evaluate cellular and bio-molecular changes in the wound.

RESULTS

PES (PE + 0.5 μg Se(2+)) only increased significantly (p < 0.05) wound total protein content (95.14 ± 1.15 mg/g tissue vs positive control; 80.42 ± 0.86 mg/g tissue) on day 10 post wounding. PES increased significantly (p < 0.05) the number of fibroblasts/high power field (HPF) (75.60 ± 9.66) but decreased significantly (p < 0.05) the number of polymorphonuclear leukocytes/HPF (59.20 ± 12.64) in the wound compared to positive control (50.60 ± 12.58 fibroblasts/HPF, 101.00 ± 27.99 polymorphonuclear leukocytes/HPF) on day 4. Similar results were recorded for WES. PES demonstrated increased neovascularization, TGF-β1 and VEGFA expressions at day 4 and increased collagen at day 10.

CONCLUSION

Papaya extract improved wound repair by increasing fibroblasts recruitment and reducing polymorphonuclear leukocytes infiltration through early transient expressions of TGF-β1 and VEGFA at the wound area. The processes were amplified with Se(2+) addition.

The effect of 17β-estradiol on cutaneous wound healing in protein-malnourished ovariectomized female mouse model

Cutaneous wound healing is delayed by protein malnutrition (PM). On the other hand, estrogen promotes cutaneous wound healing by its anti-inflammatory and cell proliferation effects. Therefore, we hypothesized that estrogen administration in protein-malnourished ovariectomized (OVX) female mice might improve the inflammatory response and promote cutaneous wound healing as well as normal nutrition. To test this hypothesis, we used full-thickness excisional wounds in Control SHAM, PM SHAM, PM OVX and PM OVX+17β-estradiol mice. The Control diet included 200 g/kg protein and the PM diet included 30 g/kg protein. The ratio of wound area in the Control SHAM group was significantly smaller than those in the three PM groups. In addition, microscopic findings also showed that the ratio of collagen fibers, the ratio of myofibroblasts and the number of new blood vessels in the Control SHAM group were significantly greater than those in the three PM groups. However, the number of Ym1-positive cells as an anti-inflammatory M2-like macrophage marker in the PM OVX+17β-estradiol group was significantly higher than those in the other three groups. These results indicate that the appearance of anti-inflammatory M2-like macrophages was promoted by estrogen administration; however, it could not promote cutaneous wound healing upon a low-protein diet. Therefore, it may be confirmed that nutrition is more important for promoting cutaneous wound healing than estrogen administration.

Action of ascorbic acid on the healing of malnourished rats'skin wounds

Objective: To evaluate the action of ascorbic acid on the healing of malnourished rats' cutaneous wounds compared with normal weight rats. Methods: We used 92 adult, male Wistar rats divided into four groups: 24 normal weight rats given only water and chow; 24 normal weight rats given vitamin C by gavage (340 mg/kg 12/12 hours); 22 malnourished rats given only water and chow; and 22 malnourished rats given vitamin C by gavage (340 mg/kg 12/12 hours). Malnutrition was induced by feeding the animals half of their daily energy requirement for 30 days. Two incisions were made, one sutured (healing by primary intention) and one left unsutured (healing by secondary intention). The rats were euthanized on the third, seventh, and fourteenth days of the experiment. Results: The following parameters differed significantly between the groups (p>0.05): granulation of the wound edge in the primary and secondary intention; extent of injuries on day 7 for primary intention and on day 3 for secondary intention; reepithelialization on day 7 for primary intention; fibrin-leukocyte scab on day 14 for primary intention; amount of neovascularization and concentration of macrophages, fibroblasts, and collagen fibers for primary and secondary intention. Conclusion: The use of vitamin C in malnourished and normal weight rats increases fibroblast proliferation and collagen deposition in the tissue, which helps to improve healing both by primary and secondary intention.

Relation of preoperative serum albumin levels to survival in patients undergoing left ventricular assist device implantation

Hypoalbuminemia has been recognized as a prognostic indicator in patients with heart failure. We aimed to investigate the association of hypoalbuminemia with postoperative mortality in patients undergoing left ventricular assist device (LVAD) implantation. We studied 272 consecutive patients undergoing LVAD implantation from 2000 to 2010 at our institution. Preoperative clinical characteristics and laboratory variables associated with mortality were analyzed. Postoperative survival of patients with preoperative hypoalbuminemia (<3.5 g/dl, n = 125) and those with normal albumin concentration (≥3.5 g/dl, n = 147) was compared. Survival after LVAD surgery was better in patients with normal albumin levels compared with those with hypoalbuminemia before surgery (3 and 12 months: 93.2% vs 82.4% and 88.4% vs 75.2%, respectively, p <0.001). Multivariate analysis revealed that preoperative albumin was independently associated with mortality after LVAD implantation (hazard ratio 0.521, 95% confidence interval 0.290 to 0.934; p = 0.029.) Furthermore, the impact of normalization of albumin levels during LVAD support on postoperative survival was analyzed in both groups. Subgroup analysis of patients with preoperative hypoalbuminemia and postoperative normalization of albumin levels (n = 81) showed improved survival compared with those who remained hypoalbuminemia (n = 44) or those who had decreasing albumin levels during LVAD support (n = 40; 3-month survival: 92.6% vs 63.6% and 65.0%; p <0.01). In conclusion, preoperative hypoalbuminemia is associated with poor prognosis after LVAD surgery. Postoperative normalization of albumin level is associated with improved survival. Attention to albumin levels by correcting nutrition, inflammation, and hepatic function could be an effective way to improve prognosis in patients evaluated for LVAD implantation.

Preoperative serum albumin levels predict 1-year postoperative survival of patients undergoing heart transplantation

BACKGROUND

Serum albumin concentration has been recognized as a marker of nutrition, severity of inflammation, and hepatic function in patients with various chronic diseases. The purpose of this study was to investigate the impact of pretransplant serum albumin concentration on post-transplant outcome in heart transplant recipients.

METHODS AND RESULTS

Preoperative laboratory variables, including albumin concentration and donor-related information, were obtained from 822 consecutive patients undergoing heart transplant at Columbia University Medical Center between 1999 and 2010. The association between pretransplant albumin concentration and post-transplant 1-year survival was analyzed. Available data from the United Network for Organ Sharing (n=13671) were also analyzed to evaluate the impact of preoperative albumin levels on post-transplant outcome. In our cohort, multivariable analysis revealed that preoperative albumin (mg/dL; hazard ratio, 0.46; P<0.0001) and preoperative total bilirubin (mg/dL; hazard ratio, 1.26; P=0.0002) were associated with post-transplant 1-year mortality. This implied that for every 1 mg/dL increase in albumin concentration, the post-transplant 1-year mortality rate decreased by 54%. The Kaplan-Meier analysis based on our patients cohort and the United Network for Organ Sharing dataset showed lower survival rate at 1-year post-transplant in patients with albumin levels ≤ 3.5 mg/dL compared with those with >3.5 mg/dL (our patients, 91.3 versus 72.4%; P<0.0001; United Network for Organ Sharing, 88.4 versus 84.8%; P<0.0001).

CONCLUSIONS

Pretransplant serum albumin concentration is a strong prognostic marker for post-transplant survival in heart transplant recipients.

TGF-β1 expression in wound healing is acutely affected by experimental malnutrition and early enteral feeding

Malnutrition is associated with the delay or failure of healing. We assessed the effect of experimental malnutrition and early enteral feeding with standard diet or diet supplemented with arginine and antioxidants on the levels of mRNA encoding growth factors in acute, open wound healing. Standardised cutaneous dorsal wounds and gastrostomies for enteral feeding were created in malnourished (M, n = 27) and eutrophic control (E, n = 30) Lewis male adult rats. Both M and E rats received isocaloric and isonitrogenous regimens with oral chow and saline (C), standard (S) or supplemented (A) enteral diets. On post-trauma day 7, mRNA levels of growth factor genes were analysed in wound granulation tissue by reverse transcription polymerase chain reaction (RT-PCR). M(C) rats had significantly lower transforming growth factor β(TGF-β1 ) mRNA levels than E(C) rats (2·58 ± 0·83 versus 3·53 ± 0·57, P < 0·01) and in comparison with M(S) and M(A) rats (4·66 ± 2·49 and 4·61 ± 2·11, respectively; P < 0·05). VEGF and KGF-7 mRNA levels were lower in M(A) rats than in E(A) rats (0·74 ± 0·16 versus 1·25 ± 0·66; and 1·07 ± 0·45 versus 1·79 ± 0·89, respectively; P≤ 0·04), but did not differ from levels in E(C) and M(C) animals. In experimental open acute wound healing, previous malnutrition decreased local mRNA levels of TGF-β1 genes, which was minimised by early enteral feeding with standard or supplemented diets.

Hypoalbuminemia and long-term survival after coronary artery bypass: a propensity score analysis

BACKGROUND

Hypoalbuminemia is associated with increased morbidity in surgical patients. The impact of low albumin level on survival in cardiac surgical patients is unknown. We hypothesized that a low preoperative albumin level negatively affects long-term survival after coronary artery bypass graft (CABG) surgery.

METHODS

We reviewed prospectively gathered data from the records of 1,164 consecutive patients who underwent primary isolated CABG at our institution between 1997 and 2007. Propensity score analysis of 18 preoperative and intraoperative variables balanced potential confounding factors between the two groups of patients, so that the final study cohort consisted of 588 patients: 294 with a preoperative albumin level less than 3.5 g/dL (ie, hypoalbuminemia) and 294 patients with a preoperative albumin level of 3.5 g/dL or greater. We assessed long-term survival by using Kaplan-Meier curves generated by log rank tests.

RESULTS

The two groups of patients were well matched in terms of preoperative and intraoperative covariates. Both groups had similar early outcomes, including 30-day mortality rates (2.0% versus 1.7%; p = 0. 76) and the incidence of major adverse cardiac events (2.7% versus 2.7%; p = 1.0). However, patients with hypoalbuminemia had a significantly worse 8-year survival rate (65% ± 7% versus 86% ± 3%; hazard ratio 2.2; 95% confidence interval: 1.4 to 3.6; p = 0.001) than patients without hypoalbuminemia.

CONCLUSIONS

Although preoperative hypoalbuminemia did not predict increased early postoperative mortality or morbidity in CABG patients, it did independently predict poor long-term survival after CABG. Identifying the mechanism that underlies this relationship is essential in improving overall survival among patients with low serum albumin levels who are undergoing surgical myocardial revascularization.