To study the effects of arginine supplementation in total parenteral nutrition (TPN) on lymphocytic immune function in postoperative patients with gastric cancer. Thirty six patients with gastric cancer receiving TPN were eligible for entry into randomized and prospective clinical trial of the study. T cell subsets, NK cell activity, plasma IL-2 content and peripheral blood CD25 were measured in before and after parenteral nutrition of the patients. Results: usual TPN could not improve lymphocytic immunosuppression of postoperative patients with gastric cancer. The patients receiving arginine supplementation in TPN might enhance lymphocytic immune function by increasing CD4 level, IL-2 production and NK cell activity, but there was no significant effect of arginine on CD25 expression. Conclusion: there are some effects of supplement with arginine on releasing of the cellular immunosuppression and restoring of lymphocytic immune function.
Forty critical patients with respiratory failure in the intensive care unit were randomly divided into two groups,Group A with administration of parenteral nutritino(PN) and Group B,no parenteral nutrition given.Blood gas analysis and respiratory monitoring showed that the respiratory rate,pH、PaO2、PaCO2 and HCO3- had no marked difference between the two groups.But in Group A there was a slight decrease of Pao2/FiO2 and a marked increase of A-aDO2 and the pulmonary shunt.This study indicates that the content of fat emulsion and hydrocarbon in PN may be the main factor that affects the respiratory function.
ObjectiveTo explore the value of geriatric nutritional risk index (GNRI) and sarcopenia on predicting postoperative complications in elderly patients with gastric cancer. MethodsAccording to the inclusion and exclusion criteria, the elderly (aged ≥60 years) patients with gastric cancer underwent radical gastrectomy in the Department of Gastrointestinal Surgery of Xuzhou Central Hospital from January 1, 2017 to December 31, 2021 were retrospectively gathered. The occurrence of postoperative complications (grade 2 or beyond by the Clavien-Dindo classification) was analyzed. The risk factors affecting postoperative complications were analyzed by univariate and multivariate logistic regression analyses to construct the prediction model, then was visualized by drawing a nomogram. The differentiation of the nomogram between the patients with postoperative complications and without postoperative complications was evaluated by the receiver operating characteristic (ROC) curve. The accuracy of the nomogram was evaluated by the calibration curve. Further, the clinical net benefit rate was analyzed by the decision curve analysis (DCA) to evaluate the clinical practicability. ResultsA total of 236 patients were gathered, 97 (41.1%) of whom had postoperative complications during hospitalization. The results of multivariate logistic regression analysis showed that the age, gender, GNRI, sarcopenia, surgical mode, and American Society of Aneshesiologists classification were the factors influencing the postoperative complications (P<0.05). The differentiation of nomogram based on the influencing factors was well, the area under the ROC curve was 0.732. The calibration curve showed that the model prediction curve was close to the ideal curve. The clinical net benefit rate by the DCA was higher when the probability of postoperative complications was 0.18 to 0.72. ConclusionsThe efficiency of nomogram based on GNRI and sarcopenia is well for predicting the occurrence of postoperative complications in elderly patients with gastric cancer. However, the nomogram needs to be further validated by prospective studies and external data.
ObjectiveTo compare the impact of early enteral nutrition (EN) and parenteral nutrition (PN) on the postoperative efficacy of esophageal cancer through meta-analysis of relevant randomized controlled trial (RCT).MethodsPubMed, Medline, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to April 2018 to identify potential RCT which assessed clinical efficacy between EN and PN for postoperative patients with esophageal cancer. According to the inclusion and exclusion criteria, two researchers independently screened and evaluated literature. Meta-analysis was performed by RevMan 5.3 software.ResultsA total of 30 RCT studies were selected, including 3 969 patients. Meta-analysis results showed that: there was a significant difference between EN and PN in postoperative anastomotic fistulas (I2=0%, OR=0.67, 95%CI 0.45-0.99, P=0.04), postoperative pulmonary infections (I2=0%, OR=0.42, 95%CI 0.32-0.55, P<0.000 1), postoperative albumin levels (I2=38%, MD=0.78, 95%CI 0.51-1.06, P<0.000 01),time of first anal exhaust after operation (I2=0%, MD=–23.16, 95%CI –25.16-21.16, P<0.000 01) and postoperative incision infection (I2=0%, RR=0.36, 95%CI 0.21-0.64, P=0.000 5).ConclusionCompared with PN, early EN can significantly reduce the incidence of major postoperative complications and shorten the time of first anal exhaust after surgery. In addition, EN is superior to PN in improving nutritional status, increasing weight and reducing costs and side effects.
Sarcopenia is a syndrome associated with reduced strength, mass and function of skeletal muscles. Aging of gastric cancer patients, lack of nutritional intake, and pathological mechanisms of gastric cancer increase the likelihood of sarcopenia. Sarcopenia is associated with the development of gastric cancer and may be a risk factor for the formation of gastric cancer. Sarcopenia is closely related to the prognosis and treatment of gastric cancer. At present, the treatment of sarcopenia is still in the exploratory stage, and more research is needed to obtain better treatment plans and improve the quality of life of patients. This article reviews the research status of sarcopenia and gastric cancer in order to provide evidence for clinical research.
ObjectiveTo investige the effects of multidisciplinary perioperative nutrition management on nutrition and postoperative complications of patients with esophageal cancer.MethodsA total of 239 patients with esophageal cancer who received elective surgical treatment were included in the study. They were divided into a trial group (120 patients) and a control group (119 patients) according to the random number table method. There were 97 males and 23 females in the trial group with an average age of 63.78±9.13 years, and 94 males and 25 females in the control group with an average age of 64.12±7.91 years. The control group received routine diet management, and the trial group received multidisciplinary perioperative nutrition management. The differences of nutrition and postoperative complications between the two groups were compared.ResultsThe total protein and albumin levels on postoperative days 3 and 7 in the trial group were higher than those in the control group (P<0.05), patients' postoperative anal exhaust time was shorter than that in the control group (P<0.05), the incidence of postoperative gastrointestinal adverse reactions, lung infection, postoperative anastomotic fistula, hypoproteinemia on postoperative days 3 and 7 was lower than that in the control group (P<0.05), and hospitalization cost was lower than that in the control group (P<0.05).ConclusionMultidisciplinary nutrition management can effectively improve the nutrition of patients, promote the rapid recovery of postoperative gastrointestinal function, reduce postoperative complications, and reduce hospitalization costs. It has high clinical reference and promotion value.
Objective To evaluate the effectiveness of enteral immunonutrition for patients with acute pancreatitis. Methods The randomized controlled trials (RCTs) about enteral immunonutrition for patients with acute pancreatitis were searched in following databases: PubMed (1966 to August 2012), MEDLINE (Ovid, 1946 to August 2012), CENTRAL (Issue 3, 2012), CBM (1978 to August 2012), CNKI (1979 August 2012), VIP (1989 to August 2012), and WanFang Data (1977 to August 2012). The relevant materials and each reference of literature were also searched manually. Two reviewers independently screened the literature according to the predefined inclusion and exclusion criteria, extracted the data and assessed the quality, and then the meta-analysis was conducted by using RevMan 5.0 software. Results A total of 6 RCTs involving 197 patients were included. The results of meta-analysis showed that there were no significant differences between the enteral immunonutrition group and the routine enteral nutrition group in following aspects: infectious complications and mortality rate, length of stay, level of C-reactive protein and numeration of leucocyte after treatment, and APACHE II score. Conclusion At present, no evidence shows enteral immunutrition is superior to routine enteral nutrition in acute pancreatitis. For the quantity and quality limitation of the included studies, more high-quality and large-sample RCTs are required to investigate the proper ingredients and dosage of enteral immunonutrition suitable for patients with acute pancreatitis.
ObjectiveTo systematically review the predictors of enteral nutrition feeding intolerance in critically ill patients. MethodsThe PubMed, Web of Science, Cochrane Library, Embase, CNKI, WanFang Data, VIP and CBM databases were searched to collect relevant observational studies from the inception to 6 August, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. ResultsA total of 18 studies were included, including 28 847 patients. The results of the meta-analysis showed that gender, age, severity of illness, hypo-albuminemia, length of stay, postpyloric feeding, mechanical ventilation and mechanical ventilation time, use of prokinetics, use of sedation drugs, use of vasoactive drugs and use of antibiotics were predictors of enteral nutrition feeding intolerance in critically ill patients, among which postpyloric feeding (OR=0.46, 95%CI 0.29 to 0.71, P<0.01) was a protective factor. ConclusionAccording to the influencing factors, the medical staff can formulate a targeted enteral nutrition program at the time of admission to the ICU to reduce the occurrence of feeding intolerance. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To investigate the correlation between nutrition related blood biochemical indexes levels and Patient-Generated Subjective Global Assessment (PG-SGA) in preoperative nutritional assessment of patients with gastric cancer. Methods One hundred and seventeen gastric cancer patients who underwent surgery were enrolled in this study by the Department of Gastrointestinal Surgery of West China Hospital. Nutritional status of each patient was evaluated by PG-SGA, in the meantime, nutrition related blood biochemical indexes levels such as transferrin (TRF), prealbumin (PA), albumin (Alb), and hemoglobin (HGB) were measured by analysis of fasting venous blood, then take correlation analysis on the result. Results Eighty cases (68.4%) were in malnutrition (PG-SGA score≥4). The TRF, PA, Alb, and HGB in malnutrition patients were lower than those in non-malnutrition patients (PG-SGA score<4, n=37, P<0.05). The TRF, PA, Alb, and HGB levels of gastric cancer patients had significant negtive correlation with PG-SGA score, the correlation coefficients was –0.629, –0.545, –0.418, and –0.235, respectively (P<0.05). When the PG-SGA score was greater than or equal to 4 points, the optimum cutoff value for TRF, PA, Alb, and HGB was 2.31 g/L, 190.50 mg/L, 38.65 g/L, and 100.50 g/L, respectively (P<0.05). Conclusions The incidence of malnutrition is high in gastric cancer patients preoperatively. The TRF, PA, Alb, and HGB are significantly decreased in the patients with malnutrition, and these indicators has significant negtive correlation with PG-SGA score. The current study indicated that a gastric cancer patient might be in malnutrition when the biochemical levels are less than or equal to TRF 2.31 g/L, PA 190.50 mg/L, Alb 38.65 g/L, HGB 100.50 g/L, and sufficient attention should be paid when any of these occasions appear clinically. The combination of PG-SGA score and nutrition related blood biochemical indexes levels could provide a more accurate assessment of preoperative nutritional status, and the evidence of nutritional intervention for patients with gastric cancer.
Objective To study the manageable methods, effect of early use of enteral nutrition after operations on esophageal cancer patients. Methods By different way of nutritional support after operation, 209 cases of esophageal cancer were divided into two groups in which enteral nutrition（EN） group,146 cases, were managed with early use of nutritional support through intestine and parenteral nutrition（PN） group, 63 cases, were given nutrition by way of veins. Complications, general recovery and blood biochemical criteria after operation between those two groups were compared. Results No cases of anastomotic fistula occurred in the two groups. The incidence of complications in EN group was significantly lower than that in PN group（P〈0.01）, and the occurrence of diarrhea was higher in EN group （P=0. 000）. The time needed for recovery of bowel sounds, anal exsufflation, defecation and hospital stay was shorter and hospital fee lower in EN group than those in PN group（P=0. 000）. The total amount of gastrointestinal and closed thoracic drainages decreased more significantly in EN group （P= 0. 000） and the value of albumin, globulin and total protein was significantly higher also in EN group （P = 0. 000）. But the amount of BUN, creatinine and neutrophil was significantly lower in EN group （P = 0. 000）. Conclusion Early use of enteral nutrition after operation on esophageal cancer is safe, effective and practical, with more significant advantages than those of parenteral nutrition.