Effect of preoperative immunonutrition and other nutrition models on cellular immune parameters

AIM:To evaluate the effects of preoperative immunonutrition and other nutrition models on the cellular immunity parameters of patients with gastrointestinal tumors before surgical intervention.In addition,effects on postoperative complications were examined. METHODS:Patients with gastrointestinal tumors were randomized into 3 groups.The immunonutrition group received a combination of arginine,fatty acids and nucleotides.The second and third group received normal nutrition and standard enteral nutrition,respectively.Nutrition protocols were administered for 7 d prior to the operation.Nutritional parameters,in particular prealbumin levels and lymphocyte subpopulations(CD4+,CD8+,CD16+/56+,and CD69 cells)were evaluated before and after the nutrition protocols.Groups were compared in terms of postoperative complications and duration of hospital stay. RESULTS:Of the 42 patients who completed thestudy,16 received immunonutrition,13 received normal nutrition and 13 received standard enteral nutrition. prealbumin values were low in every group,but this parameter was improved after the nutritional protocol only in the immunonutrition group(13.64±8.83 vs 15.98±8.66,P=0.037).Groups were similar in terms of CD4+,CD16+/56,and CD69+prior to the nutritional protocol;whereas CD8+was higher in the standard nutrition group compared to the immunonutrition group.After nutritional protocols,none of the groups had an increase in their lymphocyte subpopulations.Also,groups did not differ in terms of postoperative complications and postoperative durations of hospital stay. CONCLUSION:Preoperative immunonutrition provided a significant increase in prealbumin levels,while it did not significantly alter T lymphocyte subpopulation counts,the rate of postoperative complications and the duration of hospital stay.

Diagnostic value of plasminogen activity level in acute mesenteric ischemia

AIM: To investigate the changes in plasminogen activity level during mesenteric ischemia. METHODS: We performed laparotomy in 90 female Wistar-Albino rats (average weight 230 g). In sham groups (SL) (GroupsⅠand Ⅱ) the superior mesenteric artery (SMA) and vein (SMV) were explored, but not tied. In SMA groups (Groups Ⅲ and Ⅳ) the SMA was ligated, and in SMV groups (Groups Ⅴ and Ⅵ) the SMV was ligated. On re-laparatomy 2 mL of blood was drawn at 1 h in groupsⅠ, Ⅲ and Ⅴ, and at 3 h in groups Ⅱ, Ⅳ and Ⅵ. Plasminogen levels were assessed and comparisons were made between groups and within each group. RESULTS: The mean plasminogen activity in the SL group was significantly higher than SMA (25.1 ± 10.8 vs 11.8 ± 4.6, P < 0.001) or SMV (25.1 ± 10.8 vs 13.7 ± 4.4, P < 0.001) groups both at 1 h and at 3 h (29.8 ± 8.9 vs 15.1 ± 5.7, P < 0.0001; 29.8 ± 8.9 vs 14.2 ± 2.9, P < 0.0001). There were no significant differences between the values of SMA and SMV groups at 1 h (P = 0.28) and at 3 h (P = 0.71). In each group, plasminogen activity levels did not change significantly between the two measurements performed at 1 h and 3 h. CONCLUSION: We conclude that blood plasminogen activities decrease during early phases of both arterial and venous mesenteric ischemia which may be a useful marker for early diagnosis.

Does N ratio affect survival in D1 and D2 lymph node dissection for gastric cancer?

AIM:To identify whether there could have been changes in survival if lymph node ratio (N ratio) had been used.METHODS:We assessed 334 gastric adenocarcinoma cases retrospectively between 2001 and 2009.Two hundred and sixteen patients out of 334 were included in the study.Patients were grouped according to disection1 (D1) or dissection 2 (D2) dissection.We compared the estimated survival and actual survival determined by Pathologic nodes (pN) class and N ratio,and SPSS 15.0 software was used for statistical analysis.RESULTS:Ninety-six (44.4%) patients underwent D1 dissection and 120 (55.6%) had D2 dissection.When groups were evaluated,23 (24.0%) patients in D1 and 21 (17.5%) in D2 had stage migration (P=0.001).When both D1 and D2 groups were evaluated for number of pathological lymph nodes,despite the fact that there was no difference in N ratio between D1 and D2 groups,a statistically significant difference was found between them with regard to pN1 and pN2 groups (P=0.047,P=0.044 respectively).In D1,pN0 had the longest survival while pN3 had the shortest.In D2,pN0 had the longest survival whereas pN3 had the shortest survival.CONCLUSION:N ratio is an accurate staging system for defining prognosis and treatment plan,thus decreasing methodological errors in gastric cancer staging.