Predictive value of red blood cell distribution width and hematocrit for short-term outcomes and prognosis in colorectal cancer patients undergoing radical surgery

BACKGROUND Previous studies have reported that low hematocrit levels indicate poor survival in patients with ovarian cancer and cervical cancer,the prognostic value of hematocrit for colorectal cancer(CRC)patients has not been determined.The prognostic value of red blood cell distribution width(RDW)for CRC patients was controversial.AIM To investigate the impact of RDW and hematocrit on the short-term outcomes and long-term prognosis of CRC patients who underwent radical surgery.METHODS Patients who were diagnosed with CRC and underwent radical CRC resection between January 2011 and January 2020 at a single clinical center were included.The short-term outcomes,overall survival(OS)and disease-free survival(DFS)were compared among the different groups.Cox analysis was also conducted to identify independent risk factors for OS and DFS.RESULTS There were 4258 CRC patients who underwent radical surgery included in our study.A total of 1573 patients were in the lower RDW group and 2685 patients were in the higher RDW group.There were 2166 and 2092 patients in the higher hematocrit group and lower hematocrit group,respectively.Patients in the higher RDW group had more intraoperative blood loss(P<0.01)and more overall complications(P<0.01)than did those in the lower RDW group.Similarly,patients in the lower hematocrit group had more intraoperative blood loss(P=0.012),longer hospital stay(P=0.016)and overall complications(P<0.01)than did those in the higher hematocrit group.The higher RDW group had a worse OS and DFS than did the lower RDW group for tumor node metastasis(TNM)stage I(OS,P<0.05;DFS,P=0.001)and stage II(OS,P=0.004;DFS,P=0.01)than the lower RDW group;the lower hematocrit group had worse OS and DFS for TNM stage II(OS,P<0.05;DFS,P=0.001)and stage III(OS,P=0.001;DFS,P=0.001)than did the higher hematocrit group.Preoperative hematocrit was an independent risk factor for OS[P=0.017,hazard ratio(HR)=1.256,95%confidence interval(CI):1.041-1.515]and DFS(P=0.035,HR=1.194,95%CI:1.013-1.408).CONCLUSION A higher preoperative RDW and lower hematocrit were associated with more postoperative complications.However,only hematocrit was an independent risk factor for OS and DFS in CRC patients who underwent radical surgery,while RDW was not.

Improvement of the nutritional support management system for patients in intensive care units

BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling.METHODS The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients.RESULTS Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively enhanced.The proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 d.CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.

The influence of increasing temperatures on highland barley yields and on the maximum cultivation altitude on the Tibetan Plateau

Highland barley(Hordeum vulgare Linn.cv.nudum Hook.f.)is the principal cereal crop over the Tibetan Plateau(TP).The response of highland barely to climate change in the past decades,especially in terms of yields still remains uncertain.In this study,its responses to climate change were investigated using daily weather data and agriculture data during 1961–2018.The results showed that the annual mean air temperature over the TP increased at 0.33°C per decade during 1961–2018,and the rate of warming increased with altitude,reaching 0.41°C per decade at altitudes of 4500–4700 m.The growing degree days(GDDs)increased by 9.6%during 2011–2018 compared with the 1960s,whereas low temperature degree days(LDDs)decreased by 40.3%over the same period,indicating that the thermal conditions for highland barley cultivation have improved.A strong relationship was observed between the yield of highland barley and LDDs(−0.76,p<0.001)than GDDs(0.58,p<0.001)in Xizang,where sufficient irrigation water is available from the melting of snow cover or glaciers.In Sichuan,with abundant precipitation,significant correlations were noticed between county-level barley yield and GDDs and LDDs(0.60,p<0.001;−0.65,p<0.001).In Qinghai,the dry regions,county-level yields were influenced significantly by temperature and precipitation.These results indicated that climate warming was beneficial to highland barley yield in most region of the TP,mainly due to decreased LDDs.The potential altitude at which highland barley cultivation is feasible increased by approximately 280–484 m during 2016–2018,compared with 1981–1983.In Xizang,highland barley could be cultivated up to an altitude of 4507 m a.s.l.between 2016 and 2018,and it increased to 4179 m a.s.l.in Qinghai.These results could help local government to take actions to adapt to global warming and improve food security.