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2021 Vol. 8, No. 5
Published: 2021-11-26
 
455 Research progress on correlation between frailty and malnutrition and clinical outcome in elderly surgical patients
Liu Chengyu, Zhu Mingwei
Frailty is a clinically more common geriatric syndrome characterized by decreased physiological capacity of multiple organ systems, thus increasing sensitivity to stressful events, with a high prevalence in geriatric surgical patients. Genetic factors, demographic and sociological factors, poor lifestyle, malnutrition, sarcopenia, anxiety, and depression are all risk factors for frailty, and the occurrence of frailty syndrome is the result of the interaction of multiple factors, including aging⁃related changes, genes and environment, and chronic diseases. Frailty is closely related to malnutrition, both of which share many pathophysiological pathways, including loss of body tissue and chronic inflammation, and both screening assessment tools also have overlapping indicators, such as weight loss and impaired physical function. Frailty is associated with adverse clinical outcomes, which can lead to disability and reduced function in elderly surgical patients, increased risk of death and postoperative complications, prolonged length of hospital stays, increased hospital costs, increased need for long⁃term care and poor quality of life. The effective intervention means for elderly surgical frail patients are exercise intervention and nutritional support. Exercise intervention should be progressive and personalized, with resistance exercise as the core, supplemented by aerobic exercise, balance and flexibility training. If more than 60% of the recommended energy and protein goals for elderly surgical patients cannot be met through diet alone, oral nutritional supplementation is preferred to improve malnutrition status.
2021 Vol. 8 (5): 455-458 [Abstract] ( 280 ) HTML PDF (869 KB)  ( 416 )
459 Advances of the anti‑tumor research of metformin
Liu Xiangliang, Ji Wei, Li Wei
Metformin is a classic hypoglycemic drug. It reduces fasting and postprandial hyperglycemia in diabetic patients by reducing liver glucose synthesis and intestinal glucose absorption. It is mainly aimed at obese patients with type 2 diabetes. Recent studies have shown that metformin can also inhibit the proliferation, migration，invasion of tumor cells and inhibit tumor angiogenesis.Meanwhile it also can induce apoptosis and induce cell differentiation. Metformin affects the signal transduction pathway and energy metabolism of tumor cells and immune cells through adenosine monophosphate protein kinase (AMPK)⁃dependent which is divided into direct and indirect ways and non⁃AMPK⁃dependent mechanisms, participates in improving the tumor immune microenvironment of hypoxia and immunosuppression, improves metabolism and immune function by regulating intestinal flora, and exerts an anti⁃tumor effect and then achieve the purpose of treating tumors.There have been many clinical trials, which have adopted different treatment measures in combination with metformin, and have achieved certain results. This article reviews the effects of metformin on tumor cells, tumor microenvironment, intestinal flora and the related clinical trials of metformin against tumor.
2021 Vol. 8 (5): 459-467 [Abstract] ( 375 ) HTML PDF (1086 KB)  ( 474 )
468 Perioperative managements and construction of risk assessment system based on the preoperative risk factors
1YuDingye,2YuZhen,1CaiWei
Complications can occur after any abdominal surgery. Complications include incision infection, pneumonia, urinary tract infection, enteroplegia and so on, which may increase the length of hospital stay and mortality. How to prevent surgical complications has become a difficult problem for surgeons. Through a large number of literature studies and the research results of our team, we integrated and classified the risk factors that may affect the prognosis of patients preoperatively, and then screened out the independent risk factors which correlated with postoperative complications, postoperative fatigue syndrome postoperative ileus and so on, including sarcopenia, visceral fat area/total abdominal muscle area, old age, anemia, hypoproteinemia, NRS 2002 score≥3, ASA grade≥3, gastrectomy, open surgery, duration of operation≥4 hours, TNM stage≥ stage Ⅲ and postoperative opioids use≥0.3 mg/kg. From the multi⁃dimensional integration of medical treatment, nursing, anesthesia, and education, we concluded that the five major factors such as sarcopenia diagnosis, nutritional risk, anesthesia, past medical history and surgery are the key points to prevent postoperative complications, and constructed a multi⁃dimensional model diagram of the postoperative complication prevention system in order to take effective preventive measures earlier and provide a basis for clinical prediction of the risk of surgical complications, which is significantly important for avoiding postoperative complications.
2021 Vol. 8 (5): 468-474 [Abstract] ( 244 ) HTML PDF (1012 KB)  ( 557 )
475 Strategies of parenteral nutrition in critically ill patients after abdominal surgery
1ChangZhigang,1YanXiaoyu,2ZhuMingwei
With the development of clinical and basic research, as well as practical experience of nutrition therapy, enteral nutrition occupies the dominant route of therapy after abdominal surgery compared with parenteral nutrition. Currently, parenteral nutrition is often used supplementarily for patients with insufficient enteral feeding, or totally for whom unable to carry out enteral nutrition. Cautions should be paid according to the indications and contraindications of parenteral nutrition, avoiding the misuse of parenteral nutrition. A considerable percent of postoperative patients who need parenteral nutrition have complex complications with prolonged courses of disease, thus often need intensive care treatment. Nutrition therapy including energy and protein needs should be individualized based on the pathophysiological and metabolic characteristics of critically ill patients. Timing of adding supplemental parenteral nutrition should be based on patient′s nutrition risk, early supplemental parenteral nutrition is indicated to those with high nutrition risk. Glutamine can be added to parenteral nutrition, while attention should also be paid to the choice of lipids. New lipids including structured lipids, omega⁃3 fatty acids, and lipid emulsion formulas of soybean oil, medium⁃chain triglycerides, olive oil, and fish oil (SMOF) might be beneficial to surgical critically ill patients. This article reviews the indications, targets of energy and proteins, time to initiation and formula of parenteral nutrition for critically ill patients after abdominal surgery, as well as the related progress and concepts in recent years, with the aim to provide new information for clinical practice.
2021 Vol. 8 (5): 475-480 [Abstract] ( 288 ) HTML PDF (1149 KB)  ( 374 )
481 Research progress on the relationship between adipocytes and tumor metastasis
1, 2Fang Yan，1WangShuyi，1XiongBin
Obesity is one of the major chronic diseases threatening people′s health, which is mainly caused by the expansion of adipose tissue. In the human body, adipose tissue is a dynamic endocrine organ responsible for energy homeostasis. Obesity is associated with metabolic disorders, altered steroid secretion, chronic subclinical inflammation, and an increased risk of many cancers. Tumor cells are closely related to adipocytes in microenvironment, on the one hand, adipocyte⁃derived cytokines, such as IL⁃6, CCL2, TNF-α, leptin and adiponectin, can promote tumor invasion and metastasis through activation of different signaling pathways. Free fatty acids and lipid droplets derived from adipocytes can be transferred to tumor cells through FABP4, CD36 and other transporters, which can increase the rate of tumor β oxidation, produce a lot of ATP, and promote the division and proliferation of tumor cells. On the other hand, adipocytes can induce metabolic reprogramming of Treg cells, CD8+ cytotoxic T cells and macrophages, promote the proliferation of Treg cells and M2⁃type macrophages, inhibit the tumor⁃killing activity of CD8+ cytotoxic T cells, and lead to tumor immune escape. The reprogramming of neutrophils disrupts the adhesion of vascular endothelial cells and leads to increased vascular wall permeability, which is conducive to the passage of tumor cells through the vascular wall and metastasis to distant places. This review mainly explores the relationship between adipocytes and tumor metastasis, aiming to provide new targets for tumor therapy.
2021 Vol. 8 (5): 481-486 [Abstract] ( 375 ) HTML PDF (1175 KB)  ( 494 )
487 Expert consensus on improving the compliance to oral nutritional supplements in clinical practice
1WuBeiwen，2YeXianghong，3LiSuyun，4ShaoXiaoping，5TangXiaoli，6ChenYongyi，7QinLiyuan，8QiQian，9CaoWeixin
Oral nutritional supplements is the preferred nutritional therapy for patients with malnutrition or nutritional risk without enteral nutrition contraindications. Patient compliance is the key factor affecting the implementation of oral nutritional supplements. Improving compliance to oral nutritional supplements is of great significance to achieve the goal of nutritional treatment and promote the nutritional status of patients. But due to various factors derived from patients, medical institutions, supplements, and other aspects, patients′ compliance to oral nutritional supplements is poor. The clinical practice of using oral nutritional supplements should be further standardized from the following aspects：① the best team building for nutrition therapy;② patient evaluation before oral nutritional supplements therapy; ③ health education for patients with oral nutritional supplements; ④ prevention and management of intolerance to oral nutrition supplements; ⑤ management of symptoms or diseases that affect nutrient intake; ⑥ improvement of patients′ acceptance of supplements; ⑦ follow⁃up and monitoring of patients, to improve patient′s compliance to oral nutritional supplements.
2021 Vol. 8 (5): 487-494 [Abstract] ( 508 ) HTML PDF (987 KB)  ( 699 )
495 Chinese expert consensus on the safety of parenteral nutrition
Chinese Society of Nutritional Oncology, Chinese Society for Parenteral and Enteral Nutrition
Parenteral nutrition (PN) serves as an important therapeutic modality in all clinical departments, which can improve the nutritional intake and nutritional status of patients, and improve the clinical outcome of patients. PN is one of the most risky forms of medication. That is used for a variety of indications, has diverse prescription components and infusion approaches. There are many differences between doctors of different specialties in the grasp of indications, prescription components, infusion route selection and other aspects, which may lead to safety PN problems, even to death. To improve the safety of parenteral nutrition for Chinese clinicians and maximize the clinical benefits of parenteral nutrition. Chinese Society of Nutritional Oncology, Chinese Society of Parenteral and Enteral Nutrition organized experts to formulate this consensus. This consensus according to Chinese nutrition diagnosis and treatment status, published evidence, combined with clinical, pharmaceutical, nutrition, nursing and other fields of expertise. These consensus recommendations are based on practices and Oxford Center for Evidence⁃based Medicine (OCEBM) grading standards that are generally accepted to minimize errors with PN therapy, categorized in the areas of PN prescribing, compounding, infusion route selection, and complications administration.
2021 Vol. 8 (5): 495-502 [Abstract] ( 735 ) HTML PDF (874 KB)  ( 1496 )
503 Expert opinion on nutritional treatment for patients with prostate cancer
Chinese Society of Nutritional Oncology，Chinese Society for Parenteral and Enteral Nutrition
The incidence of prostate cancer has increased rapidly in recent years. In the world, the incidence of prostate cancer ranks second among all malignant tumors in men. With the aging of the population and the change of diet, the incidence of prostate cancer in China has increased rapidly in recent years. Patients with prostate cancer can generally be ingested by mouth during treatment, so there are few reports on nutritional treatment of patients with prostate cancer. However, patients with prostate cancer will have a variety of related adverse reactions in the course of long⁃term treatment, which need to be improved through dietary nutrition regulation. Therefore, it is necessary to screen and evaluate the nutritional risk of prostate cancer patients at different stages of treatment, and select the patients with nutritional risk and malnutrition for reasonable and targeted nutritional treatment. Dietary nutrition therapy for prostate cancer：① high fat intake is positively correlated with the risk of prostate cancer; ② a vegan diet helps to reduce the risk of prostate cancer；③ maintaining a healthy weight and regular physical exercise may contribute to the prevention and treatment of prostate cancer；④ the increase of high⁃fat milk intake may increase tumor⁃specific mortality in patients with prostate cancer；⑤ it is controversial whether vitamins and minerals play a role in the prevention and treatment of prostate cancer; ⑥ increasing foods rich in lycopene and tea polyphenols is beneficial to reduce the risk of prostate cancer; ⑦ diet and nutritional therapy can help to reduce the degree of CRF in patients with surviving tumors.
2021 Vol. 8 (5): 503-507 [Abstract] ( 399 ) HTML PDF (830 KB)  ( 612 )
508 Prognostic value of preoperative controlling nutritional status score in patients undergoing colorectal cancer surgery
1HuBin,2WuEncun,1YanZhengyuan
Objective To analyze the application value of preoperative controlling nutritional status (CONUT) score for evaluating the follow⁃up prognosis in colorectal cancer (CRC) patients after radical resection. Methods A total of 186 patients with CRC diagnosis in Lishui Hospital from February 2014 to February 2016 were retrospectively summarized. According to the preoperative CONUT score, they were divided into high⁃CONUT group (≥ 3) and low⁃CONUT group (≤ 2). Kaplan⁃Meier curve was used to compare the 5⁃year overall survival rate (OS). Univariate and multivariate Cox regression were used to analyze the risk factors of OS. Results 186 patients were divided into high⁃CONUT group (n=101) and low⁃CONUT group (n=85). In high⁃CONUT group, the age was older, body mass index (BMI) was less, prognostic nutritional index (PNI) was lower, neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were higher, TNM stage, tumor diameter and serum carcinoembryonic antigen (CEA) level were higher, too(P<0.05). The OS of high⁃CONUT group was lower than that of low⁃CONUT group, and the same to the patients in different TNM stages (P<0.05). Regression analysis showed that age ≥ 60 years, BMI<18.5 kg/m2, TNM stage ( Ⅱ b ~ Ⅲ) and CONUT score ≥ 3 were independent risk factors to OS (P<0.05). Conclusion Higher preoperative CONUT score may indicate the risk of poor prognosis in patients with CRC after radical resection. CONUT score can provide important reference for clinicians to formulate appropriate nutritional intervention plan.
2021 Vol. 8 (5): 508-513 [Abstract] ( 332 ) HTML PDF (960 KB)  ( 312 )
514 Clinical study on the effect of enteral nutrition on nutritional status of patients with rectal cancer undergoing concurrent chemoradiotherapy
Qing Xiaoyan，Zhu Li，Liu Dingyi，Yuan Daozu
Objective To investigate the effects of enteral nutrition on weight, nutritional status, adverse reactions, anxiety, sleep quality and doctor⁃patient satisfaction in patients with rectal cancer undergoing concurrent chemoradiotherapy. Methods Patients with rectal cancer receiving chemoradiotherapy were randomly divided into study group (chemoradiotherapy combined with enteral nutrition group) and control group (chemoradiotherapy group). Secondary study endpoints included comparison of adverse reactions and treatment completion rates, comparison of patients′ anxiety level, sleep quality, and doctor⁃patient relationship satisfaction, using 2 and t tests. Results From March 2019 to March 2020, 42 patients were included from Chengdu Seventh People′s Hospital in the study group and the control group.The weight loss of the study group was significantly lower than that of the control group(P<0.05). The decrease of hemoglobin, lymphocyte count, serum albumin and serum prealbumin in the study group was lower than that in the control group (P<0.05).The incidence of ≥Ⅲ° bone marrow suppression and anxiety in the study group were significantly lower than those in the control group, and the quality of sleep and satisfaction of doctor⁃patient relationship in the study group were significantly higher than those in the control group (P<0.05).There was no significant difference in the incidence of ≥Ⅱ° radioactive proctitis (P>0.05). Conclusion Enteral nutrition can help maintain the weight of patients with rectal cancer after concurrent chemorradiotherapy and chemotherapy, improve the nutritional status, reduce the incidence of bone marrow suppression, improve patients′ sleep quality and doctor⁃patient relationship satisfaction, and reduce patients′ anxiety, which is worthy of clinical promotion.
2021 Vol. 8 (5): 514-518 [Abstract] ( 263 ) HTML PDF (828 KB)  ( 356 )
519 The nutritional immune and inflammation related parameters for non‑small cell lung cancer patients
Wang Xiaolan, Han Wei, Wang Ying
Objective To evaluate the prognostic value of three nutritional⁃immune and inflammation⁃related parameters, including prognostic nutritional index (PNI), Glasgow prognostic score (GPS) and controlling nutritional status (CONUT), for non⁃small cell lung cancer (NSCLC) patients. Methods A total of 186 NSCLC patients who were treated with curative resection in our hospital from September 2014 to May 2018 were included in this study. All patients were divided into study groups based on different nutritional⁃and immune⁃related parameters. The prognostic value of PNI, GPS and CONUT for NSCLC patients was determined by Kaplan⁃Meier survival curve and receiver operation characteristics (ROC) curve, respectively. Moreover, the Cox multivariate regression analysis was used to identify the independent prognostic factors for NSCLC patients. Results All NSCLC patients were divided into two groups based on the CONUT score, and the results showed that the overall survival (OS) of patients with CONUT≥2 was significantly shorter than that of patients with CONUT 0~1. The 3⁃year OS of two study groups was 70.6% and 94.0%, respectively (χ²=29.249, P<0.001), with a significantly statistical difference. Similarly, patients were divided into PNI>45.0 and PNI≤ 45.0 group based on the cut⁃off value of PNI. The results indicated that low PNI was significantly correlated to the poor OS of NSCLC patients (3⁃year OS: 66.5% vs 92.6%，χ²=28.686, P<0.001). Additionally, Kaplan⁃Meier curves showed that the 3⁃year OS of GPS 2 and GPS 0-1 group was 61.7% and 90.7%, respectively. There was a significantly statistical difference between the two groups (χ²=18.499, P<0.001). ROC curve showed that the area under curve (AUC) of CONUT, PNI and GPS was 0.753 (95%CI=0.659~0.846), 0.734 (95%CI=0.629~ 0.839) and 0.669 (95%CI=0.552~0.786), respectively. The results of multivariate Cox analysis demonstrated that CONUT (HR=4.068 and 95%CI=1.310~12.631, P=0.015), PNI (HR=4.043 and 95%CI=1.585~10.307, P=0.003) and TNM stage (HR=2.428, 95%CI=1.153~ 5.111, P=0.020) were independently risk factors to the prognosis of NSCLC patients. Conclusion Both PNI and CONUT were independent prognostic factors for NSCLC patients, and they could be used as simple and useful parameter for prognostic prediction of NSCLC patients.
2021 Vol. 8 (5): 519-524 [Abstract] ( 299 ) HTML PDF (1006 KB)  ( 304 )
525 Effect of nutritional risk screening before assessment on GLIM cretiria malnutrition diagnosis
Lian Yuying, Zhao Yin
Objective According to global leadership initiative on malnutrition (GLIM) diagnostic criteria, two procedures of direct diagnosis and nutritional risk screening before diagnosis were used to diagnose malnutrition in hospitalized patients with malignant tumors, and to discuss the consistency of the two procedures. Methods From January to December 2020, 385 patients with malignant tumors were randomly selected from the first people′s Hospital of Yibin. The incidence of malnutrition was assessed by direct GLIM criteria diagnosis (one⁃step) and nutritional risk screening and then diagnosis (two⁃step), finally the consistency of the two procedures in diagnosing malnutrition was compared. Results ① The incidence of nutritional risk in patients with malignant tumors was 51.4% (198/385), and there were significant differences in the incidence of nutritional risk among different age groups, tumor types and tumor stages (P<0.05). ② Among the five phenotypes of GLIM criteria, the incidence of weight loss, low body mass index (BMI), muscle loss, eating loss or digestive dysfunction and the burden of disease or inflammation was 44.4% (171/385), 17.9% (69/385), 42.3% (163/385), 76.1% (293/385), and 38.7% (149/385) respectively. ③ According to the GLIM criteria, the positive rate of malnutrition diagnosed by“one−step”and "two⁃step" was 51.4% (198/385) and 42.6% (164/385) respectively. No matter "one⁃step" or "two⁃step", the positive rate of malnutrition had significant differences in age, tumor type and tumor stage. The older the age, the higher the incidence of malnutrition, digestive system tumor was higher than other tumors, and the higher the tumor stage, the higher the incidence was(P<0.05). ④ 127 cases of malnutrition were diagnosed by the two procedures. There was a good consistency between "one⁃step" and "two⁃step" in the diagnosis of malnutrition with kappa value 0.44. Conclusion The incidence of malnutrition and nutritional risk in patients with malignant tumors is high. The "two⁃step" method recommended by GLIM is more suitable for nutritional diagnosis and treatment.
2021 Vol. 8 (5): 525-529 [Abstract] ( 196 ) HTML PDF (903 KB)  ( 331 )
530 Study on the correlation between nutritional status, pain degree and quality of life in tumor patients
1HuangYingchun,2LiMingjie,3LiHuiyu,1YeXianghong,1ZhangLi,1WangXinying
Objective To explore the relationship between nutritional status, pain degree and life quality of tumor patients. Methods A total of 50 cancer patients in General Hospital of Eastern Theater Command were investigated by demographic information questionnaire, numerical rating scale (NRS)、patient generated subjective global assessment（PG⁃SGA）and EORTC QLQ⁃C30. Results The incidence of pain in cancer patients was 60% and the incidence of severe malnutrition was 46%. Comparison of the number of pain cases with different nutritional status was statistically significant (P<0.01). Somatic function, emotional function, overall health status were negatively correlated with pain (P<0.05) while constipation and shortness of breath were positively correlated with pain (P<0.05). Nutritional status scores were negatively correlated with somatic function, role function, emotional function, overall health status in the quality of life score (P<0.05), and positively correlated with fatigue, pain, loss of appetite (P<0.01). Conclusion The incidence of pain and malnutrition in cancer patients is high and affects each other, so it is worth further exploring its correlation.
2021 Vol. 8 (5): 530-533 [Abstract] ( 246 ) HTML PDF (815 KB)  ( 335 )
534 A clinical study on prognosis of lung cancer patients by prognostic nutritional index and NRS 2002 scores
1ChengLan,1XuQingzhen,1LiCongling，2LiLi,1XieMingran,3LiYi
Object To evaluate the preoperative nutritional status of patients with lung cancer surgery by PNI and NRS 2002, and to compare their effects on prognosis. Methods A total of 172 patients with lung cancer diagnosed from January 2017 to October 2017 in the Department of Thoracic Surgery, Anhui Provincial Hospital, the First Affiliated Hospital of China University of Science and Technology were enrolled. The prognostic nutrition index (PNI) and nutritional risk screening 2002 (NRS 2002) were used to evaluation the preoperative nutritional status of lung cancer patients.The patients were divided into high PNI group and low PNI group with a cutoff point of 48. Nutritional risk screening was performed at admission. Patients with a NRS 2002 total score of ≥3 had a nutritional risk, and those with a score of <3 had no nutritional risk. Results The number of lymph node metastasis,late TNM stage and postoperative complication rates in the low PNI group were higher than in the high PNI group,and the postoperative hospital stay and chest lead time were longer than those in the high PNI group(P<0.05). The incidence of nutritional risk was 16.86%. The late TNM stage,postoperative adjuvant treatment and postoperative complication rates in the nutrition risk group were higher than in the no nutrition risk group,and chest lead time was longer than that in the no nutrition risk group(P<0.05). In terms of specificity of the two nutritional assessment methods in predicting postoperative complications of lung cancer, PNI was higher than NRS 2002 score（85.5% vs 67.5%，P>0.05）. Conclusion The preoperative nutritional status can affect the prognosis of lung cancer patients to some extent. There was no significant difference in predicting the postoperative complications of lung cancer patients, the specificity of PNI was higher than that of NRS 2002. In view of the simplicity and convenience of the two evaluation methods, it has certain clinical application value.
2021 Vol. 8 (5): 534-538 [Abstract] ( 332 ) HTML PDF (867 KB)  ( 340 )
539 Clinical study on malnutrition and the level of inflammatory indicators in peripheral blood of patients with digestive tract cancer
Pan Li, Wei Haobin, Liu Weiwei, He Yongjing, Wang Yu, Li Suyi
Objective To investigate the nutritional status of patients with common digestive tract cancer and analyze the correlation between nutritional status and tumor characteristic factors and blood inflammatory indicators.Methods Clinical data of 298 patients with esophageal cancer, gastric cancer and colorectal cancer in our hospital from January 2019 to December 2020 were collected.According to the PG⁃SGA score, the patients were divided into three groups: no or mild malnutrition, moderate malnutrition and severe malnutrition, and the differences in related clinical characteristics, blood and inflammatory indicators among the three groups were compared. Results Among the 298 patients, no or mild malnutrition accounted for 34.2%, moderate malnutrition accounted for 26.5% and severe malnutrition accounted for 39.3%.There were no significant differences in age, gender, degree of tumor differentiation and blood lipid levels among the three groups (P>0.05).Patients in stage Ⅲ-Ⅳ were more likely to suffer from moderate or severe malnutrition than those in stage Ⅰ-Ⅱ.In the severe malnutrition group, the proportions of esophageal cancer, gastric cancer and colorectal cancer were 41.0% vs 36.8% vs 22.2%, respectively, P<0.05.Patients with severe malnutrition had lower levels of BMI, HB, LY, TP, and PAB.And they were more likely to have hypoproteinemia, high platelet count, and elevated D⁃dimer levels.The results also showed that the proportion of WBC, CRP, IL⁃6 and NLR in peripheral blood increased with the increase of malnutrition degree, which were 1.9% vs 7.6% vs 14.5%, 29.4% vs 51.9% vs 61.5%, 15.7% vs 27.8% vs 53.0% and 35.3% vs 38.0% vs 70.9%, respectively, with significant differences (P<0.05).The proportion of PLR increased in severe malnutrition group was more than 50% (P<0.05).The optimum cut⁃offs of IL⁃6, NLR and PLR were 4.75, 2.47 and 150.5 for moderate or severe malnutrition.Conclusion Patients with digestive tract cancer are prone to moderate or severe malnutrition. The clinical stages and inflammatory indicators are correlated with nutritional status to a certain extent, and have suggestive value in clinical application to guide early intervention.
2021 Vol. 8 (5): 539-544 [Abstract] ( 238 ) HTML PDF (995 KB)  ( 253 )
545 Relationship of non‑alcoholic fatty liver disease and the risk of ischemic stroke: a meta‑analysis
1,2YaoZhicui,1LiXiaoling,1RenPeng,1WangWentao,1LiZengning
Objectives Several studies have emerged indicating that ischemic stroke is associated with nonalcoholic fatty liver disease (NAFLD), and we aimed to systematically review and quantify the association between ischemic stroke and NAFLD. Methods PubMed, the Web of Science, China Academic Journals Full-text Database, Wanfang Data, the Cochrane Library, Chinese biomedical literature and Embase were searched (until January 2020) for studies examining the relationship of NAFLD and ischemic stroke. The odds ratio (OR) value and 95% confidence interval (CI) of the included studies were pooled. At the same time, the subgroup analysis was conducted according to region, diagnostic method and serum transaminase level. Results Nine articles met inclusion criteria, with a total of 4, 206 individuals. A significant association was found between NAFLD and ischemic stroke in eight studies (OR = 2.53, 95%CI=1.83-3.49). No significant heterogeneity was detected among studies in all comparisons. These results remained essentially unchanged after excluding any of the studies in the sensitivity analysis. Subgroup analysis by continent showed that, in Europe and America, the combined risk of NAFLD patients occurred ischemic stroke was 2.17 (95%CI=1.03-4.58); in Asia, the risk was 3.23 (95%CI=1.83-5.7); in Africa, the risk was 2.28 (95%CI=1.44-3.61). Subgroup analysis by different methods of diagnosing fatty liver showed that diagnostic methods may be a confounding factor affecting the relationship between NAFLD and ischemic stroke risk (abdominal ultrasound diagnosis, OR=2.60, 95%CI=1.87-3.61; liver biopsy diagnosis, OR=1.08, 95%CI=0.18-6.52). Subgroup analysis by serum transaminase levels showed that the levels of ALT were significantly associated with an increased risk of ischemic stroke in NAFLD patients (the mean difference of ALT was 1.14 U/L, 95%CI=0.68-1.61). The levels of AST were significantly associated with an increased risk of ischemic stroke in NAFLD patients (the mean difference of AST was 0.57 U/L, 95%CI=0.25-0.80). The level of GGT was significantly associated with an increased risk of ischemic stroke in NAFLD patients (the mean difference of GGT was 1.08 U/L, 95%CI=0.38-1.78). Conclusions This meta⁃analysis indicated that nonalcoholic fatty liver disease can increase the risk incident of ischemic stroke.
2021 Vol. 8 (5): 545-551 [Abstract] ( 135 ) HTML PDF (1605 KB)  ( 390 )
552 Research progress of enteral nutrition‑related diarrhea in critically ill patients
1HuAiping，2XiangMingfang，2ZhangXuan，1YangShuang
If there are no special abnormalities in the digestive system of critically ill patients, it is recommended to start enteral nutrition from 24 to 48 hours after admission to the ICU, but the incidence of diarrhea in critically ill patients during enteral nutrition is rather high, which caused loss of nutrients, disturbance of water⁃electrolyte acid⁃base balance, and even forced interruption of enteral nutrition.It often leads to adverse clinical outcomes, increasing the length of hospital stay and mortality.The pain and economic burden it brings to patients cannot be ignored.Currently, most of the epidemiological studies on diarrhea in critically ill patients come from abroad, which cannot fully reflect the actual situation in China; there is still lack of unified diagnostic and evaluation standards;EN diarrhea is a comprehensive result of many factors, the condition of critically ill patients is complex, and we are still facing great challenges in its prevention and treatment.To ensure the safety of enteral nutrition treatment, the medical staff must have the awareness of risk assessment, monitor the risk factors and assess gastrointestinal function dynamically, then formulate personalized and reasonable nutrition programs to minimize the incidence of EN diarrhea.Therefor, the article summarized the definition、assessment tools、risk factors、nursing and treatment strategies of enteral nutrition⁃related diarrhea in critically patients in recent years.Aiming to provide reference for medical staff to scientifically implement enteral nutrition，reduce the incidence of enteral nutrition⁃related diarrhea in critically ill patients, and improve the effect of feeding.
2021 Vol. 8 (5): 552-557 [Abstract] ( 274 ) HTML PDF (842 KB)  ( 514 )
558 Research progress of albumin‑bilirubin grade in evaluating efficacy and prognosis of patients with hepatocellular carcinoma
Li Xi, Shang Xiao, Ma Xiaohui, Wang Nanya
Hepatocellular carcinoma (HCC) is one of the most common malignancy tumors and and the incidence and mortality of liver cancer in our country both rank first in the world. At present, the treatment methods for HCC are diverse, including surgical treatment (hepatectomy, liver transplantation), local ablation therapy, interventional therapy, radiation therapy, immunotherapy, targeted therapy, and chemotherapy.But these treatments both have requirements for the liver function of patients, because these treatments may cause damage to the liver function of patients with liver cancer more or less, and some patients with liver cancer are already at an advanced stage when they are discovered, and they already have liver damage. Therefore, it is very necessary to establish a simple and effective model that can evaluate the liver function of patients with liver cancer to guide its clinical efficacy and prognosis. Child⁃Pugh score is the most commonly used clinical method to evaluate liver function currently, and it has been already included in the BCLC staging system to guide the clinical treatment and prognosis of patients with liver cancer. However, it contains five indicators, albumin, total bilirubin, hepatic encephalopathy, ascites, and prothrombin time, they are not weighted, and ascites and hepatic encephalopathy are highly subjective. In addition, Albumin and ascites are also factors that affect each other, thereby reducing the objectivity and accuracy of the score. Albumin⁃bilirubin（ALBI）grade is a new method proposed in recent years to assess liver function. It only contains two objective indicators of albumin and bilirubin, which is simpler and more objective than Child⁃Pugh score. The specific calculation formula is ALBI=(log10 bilirubin×0.66)+(albumin×⁃0.085). According to the score, the patients with liver cancer are divided into three grades, ALBI grade 1: ALBI≤⁃2.60, ALBI grade 2: ⁃2.60⁃1.39, the higher the grade, the worse the liver function. In recent years, the role of ALBI grade in evaluating the efficacy and prognosis of patients with liver cancer has been universally verified. This review summarizes the research progress of ALBI grade in evaluating efficacy and prognosis of patients with liver cancer through liver transplantation, liver resection, liver radiofrequency ablation, hepatic artery chemoembolization and targeted therapy, and immunotherapy, as well as the combination of ALBI grade and other staging systems to assess the prognosis of patients with liver cancer
2021 Vol. 8 (5): 558-563 [Abstract] ( 1197 ) HTML PDF (870 KB)  ( 594 )
564 Implementation and research progress of ERAS in colorectal cancer
Chen Wenhao, Yu Zhen
Colorectal cancer is one of the most common causes of cancer deaths worldwide. And nowadays surgery is still the preferred treatment for it. Colorectal surgery is usually classed as grade Ⅲ or Ⅳ surgery according to the surgical classification. It often requires general anesthesia, and the scope of operation is larger and the duration of operation is longer, which has a great impact on the trauma of patients, leading to slow postoperative recovery and prolonged hospital stay. In recent years, people′s awareness of medical safety is constantly enhanced, and the requirements for the treatment effect of clinical diseases are also increasingly high, prompting medical institutions to constantly improve the level of medical treatment, so as to improve the adverse outcome of disease treatment. Enhanced recovery after surgery (ERAS) protocols integrate a series of optimized perioperative management measures, aiming at alleviating various perioperative stress responses, improving organ dysfunction and speeding up postoperative recovery of patients. Benefits of ERAS implementation in colorectal surgery include reduced length of stay and decreased complications without an increase in readmissions. In recent years, the concept of ERAS has been rapidly developed and applied at home and abroad. Intervention measures based on the concept of ERAS can achieve satisfactory application effects. However, ERAS requires multidisciplinary collaboration and the active participation of patients and their families, and its introduction in China has been slow. However, the rapid development of colorectal surgery technology and the reform of medical payment system provide more favorable support for the further promotion and application of ERAS concept in the field of colorectal.
2021 Vol. 8 (5): 564-567 [Abstract] ( 384 ) HTML PDF (917 KB)  ( 452 )
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