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2023 Vol. 10, No. 6
Published: 2023-12-09
 
700 Election and evaluation of nutritional tool for elderly patients of digestive surgery during perioperative period
Zhou Jianping,Dong Ming
The morbidity of the elders with chronic diseases increased obviously. Tumor - related deaths have compromised to 28. 6% of all - cause deaths for elder population. Patients over 65 years old have occupied a ratio about 25% - 33% of all the hospitalized patients in department of surgery. Meanwhile surgery-related complications mortality re-admission rate and commercial burden all increased significantly. For this reason choosing adequate tools aiming at the aged patients for the nutritional screening and evaluation before operation and predicting surgery - related risks and outcomes will contribute crucially to reduce the morbidity of post-operative complications and mortality while enhance prehabilitation efficiently further save medical resources and improve the efficiency of society. This article introduced the circumstance of graying society in China and the evaluations of nutrition tools which aim at elderly patients in Department of Digestive Surgery for prediction perioperative risks and outcomes. Several single -centered researches have implicated that geriatric nutritional risk index GNRI played a positive role in predicting the perioperative risks and outcomes of elderly patients with colorectal cancer or hepatic cell carcinoma. To be specific GNRI may actually be beneficial to evaluate pre - operatively nutritional status and predict the risks of severely surgery - related complications overall survival and recurrence-free or progression - free survival. Five meta - analyses studies searched at present elucidated a common conclusion in consistent with the single-centered researches mentioned above. However the four articles all emphasized that the original researches included in analysis were mostly retrospective designed which means limited sample sizes and high heterogeneity in integrated data. Therefore it still needs efforts of our fellows in surgery to conduct multi-centered prospective well-designed clinical study to evaluate GNRI tools objectively.
2023 Vol. 10 (6): 700-704 [Abstract] ( 146 ) HTML PDF (902 KB)  ( 216 )
705 Strategy of perioperative nutrition therapy for pancreatic cancer
Zheng Xin, Sun Bei
Patients with pancreatic cancer are susceptible to perioperative malnutrition. Preoperative malnutrition factors include pancreatic insufficiency and tumor-induced metabolic changes postoperative stress and inflammation increase the risk of short-term nutritional deterioration and perioperative malnutrition is an independent risk factor for overall poor prognosis so it is necessary to carry out a comprehensive nutritional management. Nutritional screening is routinely performed after admission and quantitative nutritional screening tools can be used to determine the nutritional risk. Further nutritional assessment is required for patients with higher nutritional risk. Enhanced recovery after surgery suggests that nutritional therapy should be performed for patients who have lost more than 15% of their body weight or have a body mass index of less than 18. 5 kg / m 2 before surgery and nutritional therapy should be based on the principle of stepwise escalation. The preoperative nutritional status will affect the timing of surgery. A single indicator cannot completely describe the nutritional status of postoperative patients and it is recommended to use multiple methods to dynamically monitor the nutritional status and analyze it comprehensively. Postoperative nutritional therapy should be individualized in accordance with the patient 's condition and nutritional status and a reasonable choice of nutritional support pathway can avoid additional pain and economic burden for patients. Early oral feeding is considered to be safe and effective but artificial nutrition should be initiated in time for patients with poor oral tolerance. Enteral nutrition has advantages such as maintaining intestinal function but total parenteral nutrition is of great value in the treatment of severe intestinal fistula delayed gastric emptying and other complications.
2023 Vol. 10 (6): 705-710 [Abstract] ( 107 ) HTML PDF (926 KB)  ( 126 )
711 Advances in nutritional therapy for complicated intra-abdominal infection
1Meng Meng,2Guan Guoxin,2Luo Fuwen
Complicated intra-abdominal infection cIAI as a common infectious disease in surgery is characterized by difficult treatment complex and variable condition high prevalence and high mortality rate often combined with gastrointestinal dysfunction reduced intestinal mucosal barrier function intestinal flora imbalance and loss of nutrients which seriously affects the patient 's prognosis. In recent years with the continuous development of diagnosis and treatment technology the survival rate of patients has been improved but there are still more complications and long hospitalization time. In this context nutritional therapy has become an important means of supplementing drug therapy and surgical intervention. As clinical nutrition continues to advance nutritional therapy strategies are being developed and optimized and clinicians are gradually taking the concept of nutritional therapy deeper and deeper into their hearts. Early nutritional support has been shown to improve patients ' nutritional status enhance immunity promote postoperative recovery and reduce complications and mortality. Individualized nutritional protocols are nutritional treatment plans based on patients' individual differences including their conditions nutritional status and tolerance which can more effectively improve patients' nutritional status and therapeutic effects. Overall nutritional support has an important role in the treatment of cIAI but there are still some controversies and challenges such as accurately assessing the nutritional needs of patients choosing the most suitable nutritional therapy and preventing complications of nutritional therapy. In the future with the advancement of research technology and the accumulation of clinical experience the application of nutritional therapy in complex abdominal infections will hopefully make more progress.
2023 Vol. 10 (6): 711-716 [Abstract] ( 132 ) HTML PDF (1322 KB)  ( 175 )
717 Interpretation of Guideline for clinical application of parenteral and enteral nutrition in adults patients in China 2023 edition
Zhang Li,Wang Xinying
The incidence of malnutrition in hospitalized patients is high and proper nutritional treatment can improve the nutritional status of patients reduce stress damage reduce the incidence of complications and mortality and thus accelerate the recovery of patients. As an indispensable and important part of the course of disease treatment clinical nutrition has been paid more and more attention. Establishing a standardized clinical nutrition diagnosis and treatment path to improve patients' nutritional status and clinical outcomes is the key problem in the medical field. In April 2023 Guideline for clinical application of parenteral and enteral nutrition in adults patients in China 2023 edition was officially published. Based on published clinical nutrition guidelines and the latest clinical evidence at home and abroad the guidelines propose 60 recommendations from 37 specific issues such as nutrition screening and assessment enteral nutrition and parenteral nutrition clinical practice. It comprehensively summarizes the clinical diagnosis and treatment principles which also provides more comprehensive nutritional treatment program guidance. This article will interpret some key contents of the guideline to provide a clinical reference for the standardized nutritional diagnosis treatment and management of patients.
2023 Vol. 10 (6): 717-722 [Abstract] ( 250 ) HTML PDF (923 KB)  ( 431 )
723 Research progress of artificial intelligence-based imaging evaluation in tumor-associated sarcopenia
Song He, Zhou Jianping
Sarcopenia is a syndrome of progressive loss of skeletal muscle mass and strength resulting in physical disability reduced quality of life and death. Sarcopenia is common in the elderly and patients with cancer. Tumor combined with sarcopenia often occurs in the solid tumors such as gastrointestinal cancers head and neck cancers breast cancers and lung cancers. Due to frequent morbidity tumor combined with sarcopenia is highly correlated with adverse reaction of radiation therapy and chemotherapy and also with perioperative complications and diagnosis. Diagnostic methods for sarcopenia can be divided into non - imaging and imaging tests. At present studies on imaging evaluation and diagnosis of tumor - associated sarcopenia have been carried out extensively. Traditional diagnostic methods are cumbersome time-consuming and laborious. With the development of computer science in recent years the method of artificial intelligence driven by massive data computing power and algorithms can quickly and accurately accomplish imaging evaluation. This article reviews the specific imaging methods for the assessment of tumor-associated sarcopenia the advantages and disadvantages of AI - assisted assessment methods and the results of meta - studies. The aim is to clarify the important clinical value and application prospect of artificial intelligence method in evaluating tumor-associated sarcopenia provide a basis for further large-scale clinical studies and increase clinicians' attention to AI-related evaluation.
2023 Vol. 10 (6): 723-728 [Abstract] ( 159 ) HTML PDF (1880 KB)  ( 197 )
729 Chinese expert consensus on the treatment of malignant bowel obstruction (2023)
China Anti-cancer Association
Malignant bowel obstruction is a common end-stage event in advanced cancer patients and 20% of tumors eventually develop into malignant bowel obstruction. However malignant bowel obstruction patients have poor prognosis and lack of effective treatment. The diagnosis and treatment path treatment strategy surgical indications and contraindications and the benefit of surgical treatments are all topics that need to be explored. The Chinese Anti -Cancer Association organized many experts with rich clinical experience in the field of diagnosis and treatment of malignant bowel obstruction to discuss the definition epidemiology pathophysiology treatment principles and methods and efficacy evaluation of malignant bowel obstruction redefined the definition of malignant bowel obstruction and summarized the pathophysiological mechanism of the occurrence and development of malignant bowel obstruction. The treatment strategy of "multi-disciplinary consultation hierarchical diagnosis and treatment integrated treatment and precise intensification" for malignant bowel obstruction were proposed and the indications contraindications surgical methods and evaluation methods and indicators of the surgical effect of malignant bowel obstruction were defined and the effects of surgical treatment and drug therapy for malignant bowel obstruction were evaluated. The Chinese expert consensus on the treatment of malignant bowel obstruction 2023 will certain significance for improving the standard treatment level of malignant bowel obstruction.
2023 Vol. 10 (6): 729-736 [Abstract] ( 608 ) HTML PDF (8494 KB)  ( 413 )
737 Expert consensus on tumor-associated diarrhea
Chinese Society of Nutritional Oncology, Chinese Society for Parenteral and Enteral Nutrition
Cancer patients with diarrhea seriously affect their quality of life and treatment effect and even life - threatening. Diarrhea can be caused by tumor itself but also by various treatments such as radiotherapy and chemotherapy targeted drugs immunotherapy intestinal infection drugs tumor surgery enteral nutrition and other factors. The clinical manifestations of tumor-associated diarrhea are mainly divided into the following three types gastrointestinal symptoms systemic intoxication symptoms and water electrolyte and acid-base balance disorders. Classifying these symptoms as " uncomplicated" or " complex" can help to determine the appropriate treatments. For patients with uncomplicated tumor - associated diarrhea of grade 1 or 2 and no other complications conservative treatments such as health education oral rehydration and antidiarrheal therapy is preferred. Complex tumor-associated diarrhea including grade 1 or 2 diarrhea with risk factors such as moderate to severe cramping ≥ grade 2 nausea and vomiting fever sepsis gastrointestinal bleeding etc. grade 3 or 4 diarrhea requires hospitalization and further evaluation of the condition and close monitoring of vital signs and can be actively treated with maintenance basic glucose and electrolyte infusion. A multidisciplinary team including gastroenterologists should conduct the assessment.
2023 Vol. 10 (6): 737-741 [Abstract] ( 536 ) HTML PDF (862 KB)  ( 491 )
742 Study on correlation between bioelectrical impedance phase angle and nutritional status in elderly patients with hypertension
Yi Haiwei, Yu Yunlan, Song Qingxiang
Objective To study the relationship between bioelectrical impedance phase Angle PA and nutritional status in elderly patients with hypertension and to explore the feasibility of assessing the nutritional status of patients. Method A total of 415 elderly hypertensive patients admitted to the First People′s Hospital of Lianyungang from January to December 2021 were enrolled. General data collection nutritional risk screening nutritional assessment anthropometry body composition analysis and blood biochemical examination were performed. Using a case-control study the patients were divided into normal PA group and low PA group according to phase angle. The relationship between PA and nutrition related indexes were analyzed. Result The nutritional risk and proportion of malnutrition in low PA group were higher than those in normal PA group P< 0. 05 . Body weight body mass index upper arm circumference waist circumference hip circumference diastolic blood pressure grip strength walking speed skeletal muscle mass percentage of body fat appendicular skeletal muscle mass ASM appendicular skeletal muscle mass index ASMI hemoglobin albumin total cholesterol triglyceride and low density lipoprotein cholesterol in low PA group were all lower than those in normal PA group P<0. 05 . Correlation analysis showed that PA was negatively correlated with body fat percentage r = -0. 321 P<0. 05 and positively correlated with body weight r = 0. 231 body mass index r = 0. 132 upper arm circumference r = 0. 381 hip circumference r = 0. 135 grip strength r = 0. 274 walking speed r = 0. 192 skeletal muscle mass r = 0. 499 ASM r = 0. 464 ASMI r = 0. 562 hemoglobin r = 0. 316 albumin r = 0. 163 and triglyceride r = 0. 105 P< 0. 05 . Low PA was significantly associated with nutritional risk and degree of malnutrition P < 0. 05 . Conclusion Phase angle is an effective index of nutritional status in elderly hypertensive patients and has potential clinical application value in nutritional screening and evaluation of elderly hypertension patients.
2023 Vol. 10 (6): 742-748 [Abstract] ( 105 ) HTML PDF (918 KB)  ( 104 )
749 Prognostic value of peripheral blood inflammatory-nutritional parameter nomogram model in epithelial ovarian cancer
1Yuan Li,2Xiao Huajing
Objective To investigate the prognostic value of six inflammation and nutrition-related parameters in peripheral blood for ovarian cancer patients and develop a nomogram model based on these parameters and clinicopathological features and test its clinical value for prognostic assessment. Method A total of 206 ovarian cancer patients who underwent surgical treatment in Nanjing Lishui People's Hospital n = 56 and the Second Affiliated Hospital of Nanjing Medical University n = 150 between June 2017 and June 2020 were included in this retrospective study and their clinical data and peripheral blood parameters were collected. The predictive values of the neutrophil - to - lymphocyte ratio NLR platelet - to - lymphocyte ratio PLR lymph - to - monocyte ratio LMR prognostic nutritional index PNI total cholesterol-to-lymphocyte ratio TCLR and C-reactive protein-to-albumin ratio CAR for overall survival OS of ovarian cancer patients were compared using the receiver operation characteristics ROC curve. The univariate and multivariate Cox regression analysis was conducted to select independent prognostic factors for ovarian cancer patients and a nomogram model was developed based on these factors. The predictive performance of the model was evaluated by the Harrell's consistency index C-index and calibration curves. Result The best cutoff values of PNI and CAR were 47. 8 and 0. 08 with the AUC values of 0. 803 95%CI = 0. 736-0. 870 and 0. 749 95% CI = 0. 673-0. 824 respectively. The predictive values of PNI and CAR were superior to other parameters. In the univariate analysis a total of 8 variables may affect the OS of ovarian cancer patients they are age P= 0. 011 serum CA125 P= 0. 001 postoperative residual focus P<0. 001 FIGO stage P = 0. 001 LMR P<0. 001 PNI P<0. 001 CAR P<0. 001 and TCLR P = 0. 037 . The multivariate Cox regression analysis showed that serum CA125 level HR= 2. 814 95%CI = 1. 469-5. 394 P = 0. 002 residual disease HR = 3. 324 95%CI = 1. 736-6. 361 P< 0. 001 FIGO stage HR= 4. 454 95%CI = 1. 360-14. 583 P = 0. 014 PNI HR = 3. 615 95%CI = 1. 852-7. 057 P<0. 001 and CAR HR = 3. 330 95%CI = 1. 684-6. 584 P = 0. 001 were independent prognostic factors for ovarian cancer patients. A prognostic model was constructed according to the above five variables with a C-index of 0. 821 95%CI = 0. 756-0. 886 . The calibration curves shows a good consistency between the predicted 1-year 3-year as well as 5-year survival probabilities and the actual observations. Conclusion PNI and CAR were independent prognostic parameters for ovarian cancer patients. The prognostic model integrated with these parameters and clinicopathological features showed an excellent and stable predictive performance and it might be used as an effective tool of risk stratification and personalized treatment decision-making.
2023 Vol. 10 (6): 749-756 [Abstract] ( 76 ) HTML PDF (2479 KB)  ( 71 )
757 Application of body composition analysis in head and neck tumors patients through the peri-radiation period
1Li Yan,1Zhong Renming,2Shi Lei,2Li Xuemei,2Hu Wen
Objective Using biological impedance analysis to monitor the body composition through the peri - radiation period. Exploring the relationship between the changes in body composition and its relationship with myelosuppression. Method A total of 60 patients with head and neck tumors in our hospital were selected from September 2022 to March 2023. The patients were collected biochemical indicators and body composition before radiotherapy 2 weeks of radiotherapy 4 weeks of radiotherapy. According to myelosuppression occurs we compared the difference in body composition of the two groups with the radiotherapy time. Computing the risk ratio of PA phase angle with myelosuppression. Comparing patients' white blood cells neutral granulocytes platelets and hemoglobin changes in low PA group and normal PA group with radiotherapy time. Result All patients' body composition have significantly decreased during radiotherapy P<0. 05 . For the myelosuppression group the contents of fat mass and visceral fat area were higher than the normal group P<0. 05 and other related indicators were lower P<0. 05 . Compared with normal PA group hemoglobin and white blood cells were lower than the normal PA group P<0. 05 and the risk of myelosuppression in low PA group is higher OR= 3. 75 95%CI = 1. 27-9. 83 . Conclusion With the progress of radiotherapy the body composition of each human will be attenuated. However the body composition measurement data of patients with myelosuppression were worse. PA of patients with head and neck tumors are closely related to myelosuppression and low PA patients are more likely to cause myelosuppression. Monitoring PA can detect the potential risk of myelosuppression which helps to conduct nutritional intervention in time and improve prognosis.
2023 Vol. 10 (6): 757-763 [Abstract] ( 83 ) HTML PDF (904 KB)  ( 112 )
764 Establishment and validation of the nomogram model for critical weight loss in patients with nasopharyngeal carcinoma after chemoradiotherapy
Ding Xiaoxia, Shen Haihua
2023 Vol. 10 (6): 764-770 [Abstract] ( 75 ) HTML PDF (3684 KB)  ( 52 )
771 Relevance and clinical value between Geriatric nutritional risk index and long - term prognostic survival time in elderly patients with hepatocellular carcinoma undergoing transcatheter chemoembolization
Lyu Li, Wang Peiyue, An Ran
Objective The relevance and clinical value between Geriatric nutritional risk index GNRI and long-term prognosis of patients with hepatocellular carcinoma after Transarterial chemoembolization TACE were analyzed. Method A total of 120 patients with hepatocellular carcinoma who received TACE at the First Medical Center of the Chinese People's Liberation Army General Hospital from June 2016 to May 2019 were selected and divided into a survival group 34 cases and a death group 86 cases according to their 3-year survival. The clinical data of the two groups were compared and the influence of clinical data on the long-term prognosis of hepatocellular carcinoma TACE patients was analyzed by Cox regression with survival function and the correlation between GNRI and the long-term prognosis survival time of hepatocellular carcinoma TACE patients was analyzed by Spearman. Result The age of the death group 74. 29±2. 3 was significantly higher than the survival group 71. 40±3. 29 P<0. 05 . The GNRI in the death group 88. 36±3. 69 was significantly lower than that in the survival group 92. 42±3. 54 P<0. 05 . The maximum diameter of tumor cirrhosis distant metastasis and thrombal of vascular tumor in the death group were statistically significant compared with those in the control group P<0. 05 . Death group sex hepatitis B virus surface antigen HBsAg hepatitis C virus HCV TNM stage tumor site liver function Child Pugh grade tumor number AFP ascites invasion of liver capsule coronary heart disease hypertension dilated cardiomyopathy diabetes atrial fibrillation previous stroke hyperlipidemia smoking history drinking history TACE treatment times were not statistically significant compared with survival group P>0. 05 . Cox regression analysis of survival function showed that old age and cirrhosis were risk factors for death in patients with hepatocellular carcinoma treated with TACE P<0. 05 and high GNRI were protective factors for death in patients treated with TACE treated with hepatocellular carcinoma P < 0. 05 . According to Spearman analysis GNRI was positively correlated with survival time of hepatocellular carcinoma patients undergoing TACE P<0. 05 . Conclusion Age cirrhosis and low GNRI are risk factors for death in TACE patients. GNRI may be correlated with the survival time of TACE patients. Early assessment of GNRI can provide a scientific basis for effectively predicting the prognosis of patients.
2023 Vol. 10 (6): 771-777 [Abstract] ( 91 ) HTML PDF (1299 KB)  ( 52 )
778 Prognostic value of GLIM ESPEN 2015 and PG-SGA in postoperative complications of esophageal cancer
Wang Yan, Liu Zhen, Gao Yaqi, Jia Ke
Objective To explore the predictive value of the global leadership initiative on malnutrition GLIM the European Society for Parenteral Enteral Nutrition Expert Consensus on Malnutrition 2015 ESPEN 2015 and patient-generated subjective global assessment PG- SGA in analyzing postoperative complications of esophageal cancer. Method The clinical data of 128 cases of oesophageal cancer patients admitted to Wuhan Central Hospital from January 2019 to March 2023 were selected and the patients were divided into the complication group 49 cases and the no-complication group 79 cases according to the occurrence of postoperative complications. GLIM ESPEN 2015 and PG- SGA were compared to assess the preoperative nutritional status of 128 patients to analyze the factors affecting postoperative complications and ROC analysis was used to obtain the efficacy of GLIM ESPEN 2015 PG-SGA with the combined data to predict the occurrence of postoperative complications. Result There were 33 cases of malnutrition in GLIM- assessed patients 18 cases of malnutrition in ESPEN 2015 - assessed patients and 19 cases of malnutrition in PG - SGA-assessed patients and the incidence of malnutrition was higher in the GLIM-assessed patients than in the ESPEN 2015-assessed patients and the PG-SGA-assessed patients P<0. 05 . Binary logistic regression analysis showed that TNM staging stage Ⅲ-Ⅳ GLIM malnutrition ESPEN 2015 malnutrition and PG-SGA malnutrition were all risk factors for postoperative complications in patients with esophageal cancer P < 0. 05 . The proportion of patients with malnutrition assessed by GLIM ESPEN 2015 and PG-SGA in TNM stage Ⅲ - Ⅳ was higher than that in TNM stage Ⅰ- Ⅱ. The presence of TNM staging and malnutrition assessed by GLIM ESPEN 2015 and PG-SGA was correlation P<0. 05 . ROC analysis was used to obtain the AUC of GLIM ESPEN 2015 PG- SGA and combined data to predict the occurrence of postoperative complications were 0. 645 0. 568 0. 578 and 0. 716 respectively P<0. 05 . Conclusion Patients with esophageal cancer are mostly at risk of malnutrition before surgery and malnutrition is closely related to the clinical characteristics of esophageal cancer patients which is an independent risk factor for the occurrence of postoperative complications. GLIM ESPEN 2015 and PG - SGA can be used to assess the status of preoperative malnutrition in esophageal cancer and the combination of the three predicts the occurrence of postoperative complications in esophageal cancer with a good efficacy.
2023 Vol. 10 (6): 778-784 [Abstract] ( 75 ) HTML PDF (1361 KB)  ( 73 )
785 Prognostic value of nutritional index body mass index and N stage before chemoradiotherapy in prognostic prediction of nasopharyngeal carcinoma patients
1Luo Beibei,2He Dan,3Jiang Xue,1Li Zilin,1He Linjing,2Wu Xiaolin
Objective To discuss the application value of prognostic nutritional index PNI body mass index and N stage before radiotherapy in predicting the clinical outcome of nasopharyngeal carcinoma NPC patients undergoing radiochemotherapy. Method From January 2010 to December 2015 128 NPC patients undergoing radiochemotherapy in No. 416 Hospital of the nuclear industry were selected and retrospectively analyzed their general information treatment plan laboratory examination pathology and imaging data. The clinical outcomes were followed up until December 20 2021. Kaplan-Meier method was used to draw the survival curve. Log rank χ2 Test and Cox regression analysis was used to explore the prognositic factors of nasopharyngeal carcinoma patients. Result The mortality was 21. 88% during the median at 69. 5 months follow- up. The 3 - year and 5 - year survival rates of 128 patients were 94. 53% and 80. 47% respectively. Receiver operating characteristic ROC curve showed that albumin ALB lymphocyte LYM PNI white blood cell WBC and body mass index BMI were statistically significant in predicting the survival rate of patients P< 0. 05 with cut-off values at 37. 5 g / L 1. 75 × 10 9 / L 45. 0 4. 55 × 10 9 / L and 21. 85 kg / m 2 respectively. Univariate analysis showed that PNI ALB LYM and WBC were all risk factors for prognosis while tumor stage T stage N stage and BMI were all protective factors for prognosis. Multivariate Cox regression showed that PNI ≥ 45. 0 and BMI ≥ 21. 85 kg / m 2 were protective factors while N stage 2 to 3 was a risk factor for the prognosis of nasopharyngeal carcinoma patients with HR 95%CI 0. 784 0. 725-0. 847 、 0. 824 0. 700-0. 970 and 4. 289 1. 737 - 10. 589 respectively P < 0. 05 . Conclusion The nutritional status of nasopharyngeal carcinoma patients before radiochemotherapy is related to the clinical prognosis. PNI BMI and N stage can be used as independent prognostic factors of nasopharyngeal carcinoma patients.
2023 Vol. 10 (6): 785-791 [Abstract] ( 85 ) HTML PDF (2114 KB)  ( 95 )
792 Construction of sensitive quality index system for nutritional management of elderly malignant lymphoma
Xu Yang, Xing Shuangshuang, Pu Yiqin
Objective To construct a sensitive quality index system for nutrition management of elderly malignant lymphoma and provide an objective and reliable basis for evaluating the quality of clinical nutrition management. Methods The " structure - process- result " quality assessment model was used as the basis of system construction supplemented by American Hopkins evidence-based theory through literature search Delphi method and analytic hierarchy process were used to determine the sensitive quality indexes and weights of nutritional management of elderly malignant lymphoma. Results After 2 rounds of expert letter inquiries round 1 n = 28 round 2 n = 26 the effective questionnaire recovery rates were 92. 9% and 96. 2% respectively the expert authority coefficients were 0. 852 and 0. 865 and the Kendall coordination coefficients of expert opinions were 0387 and 0. 418 respectively. The difference was statistically significant P< 0. 05 . Finally a sensitive quality index system for elderly malignant lymphoma nutrition management was constructed including 3 first-level indicators 8 second-level indicators and 20 third-level indicators. Conclusion The sensitive quality index system of nutrition management for elderly malignant lymphoma is scientific reliable and practical which provides a basis for improving the quality of clinical nutrition management.
2023 Vol. 10 (6): 792-798 [Abstract] ( 73 ) HTML PDF (933 KB)  ( 98 )
799 Correlation between intestinal flora characteristics and diarrhea risk in patients with gastric cancer during chemotherapy
Yang Jingjing,Zhou Tingting,Zhao Haixia
Objective To explore the correlation between intestinal flora characteristics and diarrhea risk in patients with gastric cancer during chemotherapy. Method 120 patients with gastric cancer who underwent radical gastrectomy from August 2018 to February 2022 in the Department of Oncology of the First People's Hospital of Huai'an were selected as the research object. All patients received chemotherapy after operation and were divided into two groups according to whether diarrhea occurred during chemotherapy or not. The intestinal flora was determined by 16S rDNA gene sequencing and the characteristics composition and differences of intestinal flora were compared between the two groups. The related factors affecting diarrhea were analyzed by multivariate Logistic regression. Draw receiver operating characteristic curve ROC and analyze the characteristics of intestinal flora through the area under the curve AUC to guide the chemotherapy diarrhea. Result 16S rDNA gene sequencing was used to analyze 120 fecal flora samples Shannon's index 2. 92 ± 0. 43 Simpson 's index 1. 71 ± 0. 63 Chao1 's index 781. 26 ± 124. 26 and Ace index 7635. 26±225. 74 in the occurrence group and those in the non-occurrence group 2. 38±0. 61 、 1. 95±0. 72 、 715. 26±147. 25 、 7706. 68±2534. 68 . There was no significant difference P>0. 05 . The Beta diversity in the occurrence group 0. 31±0. 10 was lower than that in the non-occurrence group 0. 46±0. 13 P < 0. 05 . The sequence of patients' fecal flora mainly belongs to four phyla including Proteobacteria Firmicutes Bacteroidetes and Proteobacteria. In the occurrence group Actinomycetes 5. 56±1. 05 Firmicutes 69. 64±2. 06 Bacteroides 16. 75±2. 19 Proteobacteria 18. 26±2. 74 and non-occurrence groups 4. 42±0. 74 72. 65±1. 55 . Multivariate Logistic regression results showed that Beta diversity OR= 1. 320 95%CI = 1. 110-1. 570 was the risk factors for diarrhea Bacteroides OR = 0. 761 95%CI = 0. 629-0. 921 and Actinomycetes OR= 0. 255 95%CI = 0. 120-0. 521 were a protective factor in the occurrence of diarrhea. Conclusion For patients with gastric cancer receiving chemotherapy the change and composition of intestinal flora are the related factors of diarrhea during chemotherapy so we can give targeted medication guidance through the change of intestinal flora.
2023 Vol. 10 (6): 799-805 [Abstract] ( 98 ) HTML PDF (3661 KB)  ( 80 )
806 The predictive value of serum serum creatinine / cystatin C ratio for sarcopenia in advanced non-small cell lung cancer
Shen Lili Cai Jinhong Bao Yahong Li Qianqian Liu Jianhui
Objective This study aimed to explore the clinical value of serum creatinine Cr / cystatin C CysC ratio as a predictor of sarcopenia for patients with advanced non-small cell lung cancer NSCLC . Method This study included 134 advanced NSCLC patients who were initially diagnosed and treated with chemotherapy in our hospital from January 2019 to January 2022. The skeletal muscle index SMI at the third lumbar level measured by computed tomography CT and handgrip strength were used to diagnose sarcopenia. The linear relationships between serum Cr/ CysC ratio and various nutritional parameters were determined by the Pearson's correlation coefficient and the receiver operating characteristics ROC curve was used to evaluate its predictive value for sarcopenia. Result 46 34. 3% of 134 advanced NSCLC patients were diagnosed with sarcopenia which was found in 35 males 33. 0% and 11 females 39. 3% . Serum Cr/ CysC ratio was positively correlated with with serum albumin value r = 0. 186 P = 0. 032 SMI r = 0. 288 P = 0. 020 and handgrip strength r = 0. 362 P < 0. 001 . The ROC curve showed that the best threshold of serum Cr/ CysC ratio was 0. 872 and its AUC value was 0. 744 95%CI = 0. 660-0. 829 with a sensitivity of 84. 8% and specificity of 61. 4% respectively. The serum Cr/ CysC ratio OR= 0. 005 95%CI = 0. 001-0. 061 P<0. 001 was identified as a protect risk factor of sarcopenia for advanced NSCLC patients. Conclusion The serum Cr/ CysC ratio was significantly correlated with skeletal muscle mass and muscle strength and it could be a simple and effective tool of sarcopenia screening for advanced NSCLC patients.
2023 Vol. 10 (6): 806-811 [Abstract] ( 75 ) HTML PDF (1343 KB)  ( 44 )
812 Value of controlling nutritional status score and related indicators in predicting the prognosis of osteosarcoma patients
1He Haiyan,1Liu Youping,1Zhang Rui,2Li Juan,1Peng Guolin
Objective To discuss the value of controlling nutritional status score CONUT and related indicators in predicting the prognosis of osteosarcoma patients. Method From 2000 to 2018 medical records of 92 patients with osteosarcoma were collected from the First Peoples' Hospital of Yibin and the Second Hospital of Yibin and followed up the clinical outcomes of patients until Dec. 30 2022. ROC curve analysis was used to calculate the cut-off values of SII and CONUT for prognosis prediction Kaplan-Meier method Log-rank test and Cox regression analysis was used to draw survival curves and analyze the influencing factors of prognosis among osteosarcoma patients. Result The medium follow-up time of 92 patients was 58 37 66 months with an medium survival time of 50 23 61 months. The 5-year survival rate was 51. 09% 95%CI = 40. 31%-61. 87% . The area under the ROC curves AUC of SII and CONUT were 0. 726 and 0. 951 respectively with the optimal cut-off values of 671. 66×10 9 / L and 1. 5 points P<0. 01 . Cox regression showed that whether metastasis when diagnosis T stage 3 to 4 and Enneking stage Ⅲ are risk factors of prognosis for patients with HR 95% CI of 2. 751 1. 166 - 6. 491 2. 230 1. 033 - 4. 815 and 4. 889 1. 094 - 21. 854 respectively. CONUT≥2 points are protective factors of prognosis with HR 95%CI of 0. 065 0. 023-0. 184 P<0. 05 . Conclusion CONUT score T stage whether metastasis when diagnosis and Enneking stage are related to the prognosis of osteosarcoma patients while SII is not related to the clinical outcomes of patients with osteosarcoma.
2023 Vol. 10 (6): 812-818 [Abstract] ( 70 ) HTML PDF (2542 KB)  ( 71 )
819 Research progress in diagnosis and nutritional treatment of postoperative chylothorax in lung cancer
1Zhao Yuetong,2Liu Qinghao,1Dou Pan
Chylothorax is a common complication after radical surgery for lung cancer. Chylothorax after lung cancer surgery can lead to a large loss of serum albumin immunoglobulin fat soluble vitamins minerals immune cells and immune factors resulting in protein energy malnutrition fatsoluble vitamin deficiency electrolyte disorder severe infection and other complications. The mortality rate is high and timely and correct intervention is needed. The diagnosis of chylothorax still lacks a unified standard and there are various treatment methods for chylothorax. In recent years the view that the first line treatment for chylothorax is nutritional therapy has become increasingly recognized. However there are various ways and means of nutritional therapy including special natural diet oral nutrition supplementation enteral nutrition supplementary parenteral nutrition and total parenteral nutrition. This article reviews the diagnostic criteria localization diagnostic methods and various treatment methods for postoperative chylothorax in lung cancer with a focus on the latest research progress and methods of nutritional therapy. It also elaborates on the advantages and problems of different nutritional therapy methods and provides multiple implementation methods for different nutritional regimens providing reference for further standardized treatment in clinical practice improving patient nutritional status and accelerating the recovery of chylothorax.
2023 Vol. 10 (6): 819-824 [Abstract] ( 163 ) HTML PDF (1324 KB)  ( 162 )
825 Research progress on related factors of pathogenesis for cancer anorexia
1Wei Xinxin,2Qi Shujing,3Zhang Yong,3Qi Ruixia
Cancer anorexia can appear throughout the disease of cancer patients and is often ignored. The disease is common in advanced cancer patients with an incidence of up to 80%. Cancer anorexia is related to the chronic disease or anti-cancer treatment of cancer patients with characters of loss of appetite with or without weight loss negatively affects quality of life and even cancer anorexia-cachexia syndrome which directly affects the survival outcome of patients. Modern medical research believed that cancer anorexia is caused by the failure of normal appetite regulation signal transduction and different from malnutrition or hunger it is caused by metabolic abnormalities. However the current research on the pathogenesis of cancer anorexia has not been completely clear. Most studies believed that pro-inflammatory cytokines such as interleukin-1 tumor necrosis factor-α and interleukin-6 and peripheral hormones such as ghrelin leptin and cholecystokinin central neuropeptide can alter normal regulation signals that govern appetite in different ways and then lead to cancer anorexia. Herein we aimed to review the recent related factors of pathogenesis progress for cancer anorexia and can provide references for further research on evaluation of cancer anorexia and new therapeutic targets.
2023 Vol. 10 (6): 825-829 [Abstract] ( 80 ) HTML PDF (891 KB)  ( 146 )
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