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.

Evaluation of the Efficacy of Alanyl-Glutamine for Nutritional Support in Septicemia

Objective:To evaluate the therapeutic efficacy of alanyl-glutamine(Ala-Gln)in the nutritional support of sepsis.Methods:120 cases of sepsis patients admitted to the hospital in the past three years were selected and grouped by randomization method,Group A was treated with Ala-Gln,and Group B was treated with conventional nutritional support therapy,and the therapeutic effects were compared.Results:Before treatment,there was no difference in nutritional indexes,immune function indexes,and inflammatory factors between the two groups(P>0.05).After treatment,the nutritional indexes of Group A were higher than those of Group B,the immune function indexes were higher than those of Group B,and the inflammatory factors were lower than those of Group B(P<0.05).Except for mortality,the regression of group A was better than that of group B(P<0.05).Conclusion:Ala-Gln can improve the nutritional indexes of septicemia patients during the treatment period,enhance their immune function,reduce the inflammatory response of the body,and promote the regression of the disease.

Analysis of the Application Effect of Tracheal Stent Placement in the Nutritional Support Treatment of Tracheoesophageal Fistula

Objective:To evaluate and analyze the application effect of tracheal stent placement in nutritional support therapy for tracheoesophageal fistula.Methods:Clinical data of 32 patients who underwent nutritional support therapy for tracheoesophageal fistula in our hospital from September 2021 to September 2022 were collected,and all patients underwent tracheal silicone stenting,comparing dyspnea classification and Karnofsky score before and after stenting,and conducting post-treatment follow-up.Results:In 32 patients with tracheoesophageal fistula,dyspnea grading improved from grades III and IV to grades 0 to II.Before treatment,10 patients(31.06%)were in grade IV,17 patients(53.12%)were in grade III,and five patients(15.62)were in grade II;after treatment,13 patients(40.63%)were in grade I,12 patients(37.50%)were in grade I,and seven patients(21.87%)were in grade 0(P<0.05);Karnofsky score(37.52±4.86 before treatment)improved significantly to 71.39±8.24 one week after treatment(P<0.05).Nine patients with tracheoesophageal fistula were placed with silicone Y14-10-10 stent,11 with silicone 18-14-14 stent,three with silicone Y15-12-12,and seven with silicone stent 16-13-13.Conclusion:Silicone tracheobronchial stent placement for the treatment of tracheoesophageal fistula is technically feasible,simple,and safe,with reliable near-term efficacy,and is worthy of popularization and application.

Exploring choices of early nutritional support for patients with sepsis based on changes in intestinal microecology

BACKGROUND Sepsis exacerbates intestinal microecological disorders leading to poor prognosis.Proper modalities of nutritional support can improve nutrition,immunity,and intestinal microecology.AIM To identify the optimal modality of early nutritional support for patients with sepsis from the perspective of intestinal microecology.METHODS Thirty patients with sepsis admitted to the intensive care unit of the General Hospital of Ningxia Medical University,China,between 2019 and 2021 with indications for nutritional support,were randomly assigned to one of three different modalities of nutritional support for a total of 5 d:Total enteral nutrition(TEN group),total parenteral nutrition(TPN group),and supplemental parenteral nutrition(SPN group).Blood and stool specimens were collected before and after nutritional support,and changes in gut microbiota,short-chain fatty acids(SCFAs),and immune and nutritional indicators were detected and compared among the three groups.RESULTS In comparison with before nutritional support,the three groups after nutritional support presented:(1)Differences in the gut bacteria(Enterococcus increased in the TEN group,Campylobacter decreased in the TPN group,and Dialister decreased in the SPN group;all P<0.05);(2)different trends in SCFAs(the TEN group showed improvement except for Caproic acid,the TPN group showed improvement only for acetic and propionic acid,and the SPN group showed a decreasing trend);(3)significant improvement of the nutritional and immunological indicators in the TEN and SPN groups,while only immunoglobulin G improved in the TPN group(all P<0.05);and(4)a significant correlation was found between the gut bacteria,SCFAs,and nutritional and immunological indicators(all P<0.05).CONCLUSION TEN is recommended as the preferred mode of early nutritional support in sepsis based on clinical nutritional and immunological indicators,as well as changes in intestinal microecology.

Multidisciplinary diagnosis and treatment nutritional support intervention for gastrointestinal tumor radiotherapy:Impact on nutrition and quality of life

BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem.This study aims to provide a scientific basis for improving clinical treatment effects,quality of life,and prognosis of patients with gastrointestinal tumors.AIM To explore the clinical effect of the multidisciplinary diagnosis and treatment(MDT)nutrition intervention model on patients with gastrointestinal tumors.METHODS This was a case control study which included patients with gastrointestinal tumors who received radiotherapy at the Department of Oncology between January 2021 and January 2023.Using a random number table,120 patients were randomly divided into MDT and control groups with 60 patients in each group.To analyze the effect of MDT on the nutritional status and quality of life of the patients,the nutritional status and quality of life scores of the patients were measured before and after the treatment.RESULTS Albumin(ALB),transferrin(TRF),hemoglobin(Hb),and total protein(TP)levels significantly decreased after the treatment.The control group had significantly lower ALB,TRF,Hb,and TP levels than the MDT group,and the differences in these levels between the two groups were statistically significant(P<0.05).After the treatment,the MDT group had significantly more wellnourished patients than the control group(P<0.05).The quality of life total score,somatic functioning,role functioning,and emotional functioning were higher in the MDT group than in the control group.By contrast,pain,fatigue,nausea,and vomiting scores were lower in the MDT group than in the control group(P<0.05).CONCLUSION MDT nutritional intervention model effectively improves the nutritional status and quality of life of the patients.The study provides a rigorous theoretical basis for improving the prognosis of cancer patients.In the future,we intend to provide additional treatment methods for improving the quality of life of patients with cancer.

Nutritional status efficacy of early nutritional support in gastrointestinal care: A systematic review and meta-analysis

BACKGROUND Gastrointestinal surgery is a complicated process used to treat many gastrointestinal diseases,and it is associated with a large trauma:Most patients often have different degrees of malnutrition and immune dysfunction before surgery and are prone to various infectious complications during postoperative recovery,thus affecting the efficacy of surgical treatment.Therefore,early postoperative nutritional support can provide essential nutritional supply,restore the intestinal barrier and reduce complication occurrence.However,different studies have shown different conclusions.AIM To assess whether early postoperative nutritional support can improve the nutritional status of patients based on literature search and meta-analysis.METHODS Articles comparing the effect of early nutritional support and delayed nutritional support were retrieved from PubMed,EMBASE,Springer Link,Ovid,China National Knowledge Infrastructure,China Biology Medicine databases.Notably,only randomized controlled trial articles were retrieved from the databases(from establishment date to October 2022).The risk of bias of the included articles was determined using Cochrane Risk of Bias V2.0.The outcome indicators,such as albumin,prealbumin,and total protein,after statistical intervention were combined.RESULTS Fourteen literatures with 2145 adult patients undergoing gastrointestinal surgery(1138 patients(53.1%)receiving early postoperative nutritional support and 1007 patients(46.9%)receiving traditional nutritional support or delayed nutritional support)were included in this study.Seven of the 14 studies assessed early enteral nutrition while the other seven studies assessed early oral feeding.Furthermore,six literatures had"some risk of bias,"and eight literatures had"low risk".The overall quality of the included studies was good.Meta-analysis showed that patients receiving early nutritional support had slightly higher serum albumin levels,than patients receiving delayed nutritional support[MD(mean difference)=3.51,95%CI:-0.05 to 7.07,Z=1.93,P=0.05].Also,patients receiving early nutritional support had shorter hospital stay(MD=-2.29,95%CI:-2.89 to-1.69),Z=-7.46,P<0.0001)shorter first defecation time(MD=-1.00,95%CI:-1.37 to-0.64),Z=-5.42,P<0.0001),and fewer complications(Odd ratio=0.61,95%CI:0.50 to 0.76,Z=-4.52,P<0.0001)than patients receiving delayed nutritional support.CONCLUSION Early enteral nutritional support can slightly shorten the defecation time and overall hospital stay,reduce complication incidence,and accelerate the rehabilitation process of patients undergoing gastrointestinal surgery.

Examining the impact of early enteral nutritional support on postoperative recovery in patients undergoing surgical treatment for gastrointestinal neoplasms

BACKGROUND Patients with gastrointestinal tumors often suffer from poor nutritional status during treatment.Surgery is the main treatment for these patients,but the long postoperative recovery period is often accompanied by digestive and absorption dysfunction,leading to further deterioration of the nutritional status.Early enteral nutrition support is hypothesized to be helpful in improving this situation,but the exact effects have yet to be studied in depth.AIM To observe the effect of early enteral nutritional support on postoperative recovery in patients with surgically treated gastrointestinal tract tumors,with the expectation that by improving the nutritional status of patients,the recovery process would be accelerated and the incidence of complications would be reduced,thus improving the quality of life.METHODS A retrospective analysis of 121 patients with gastrointestinal tract tumors treated in our hospital from January 2020 to January 2023 was performed.Fifty-three of these patients received complete parenteral nutrition support as the control group for this study.The other 68 patients received early enteral nutritional support as the observation group of this study.The clinical indicators comparing the two groups included time to fever,time to recovery of postoperative bowel function,time to postoperative exhaustion,and length of hospital stay.The changes in immune function and nutritional indexes in the two groups were compared.Furthermore,we utilized the SF-36 scale to compare the changes in the quality of life between the two groups of patients.Finally,the occurrence of postoperative complications between the two patient groups was also compared.RESULTS The postoperative fever time,postoperative bowel function recovery time,postoperative exhaustion time,and hospitalization time were all higher in the control group than in the observation group(P<0.05).The levels of CD3+,CD4+,immunoglobulin(Ig)A,IgM,and IgG in the observation group were significantly higher than those in the control group at 1 d and 7 d postoperatively,while CD8+was lower than in the control group(P<0.05).Total protein,albumin,prealbumin,and transferrin levels were significantly higher in the observation group than in the control group at 7 d postoperatively(P<0.05).The SF-36 scores of patients in the observation group were significantly higher than those in the control group(P<0.0001).The overall incidence of adverse reactions after the intervention was significantly lower in the control group than in the observation group(P=0.021).CONCLUSION We found that patients with gastrointestinal tumors are nutritionally vulnerable,and early enteral nutrition support programs can improve the nutritional status of patients and speed up postoperative recovery.This program can not only improve the immune function of the patient and protect the intestinal function,but it can also help to improve the quality of life of the patient.However,this program will increase the incidence of complications in patients.Caution should be taken when adopting early enteral nutrition support measures for patients with gastric cancer.The patient's condition and physical condition should be comprehensively evaluated and closely monitored to prevent possible complications.

Altered Nutrition State in the Severe Multiple Trauma Patients Undergoing Adjuvant Recombinant Human Growth Hormone Nutritional Support Therapy

In order to observe the nutrition state in the severe multiple trauma patients undergoing adjuvant recombinant human growth hormone (rhGH) nutritional support therapy, 45 patients with severe multiple traumas (ISS>25) were randomly divided into 3 groups. All the 3 groups had been supplied with nitrogen and caloricity according to the need of patients for 16 days. The rhGH therapy started 48 h after surgery and lasted for 14 days in two rhGH-treated groups in which rhGH was 0.2 and 0.4 U/(kg·d) respectively, and the resting group served as control one. The levels of nitrogen balance, prealbumin and safety variables (blood sugar, Na+, TT3 and TT4) were observed and com- pared among the three groups. The levels of nitrogen balance on the postoperative day (POD) 3 and 5 in the rhGH-treated groups were -1.28±3.19, 5.45±2.00 and -0.18±2.55, 6.11±1.60, respectively, which were significantly higher than those in the control group (-5.17±1.68 and -1.08±3.31, P<0.01). The values of prealbumin on the POD 3 and 5 in the rhGH-treated groups were 180.19±27.15, 194.44±50.82 and 194.94±29.65, 194.11±16.17, respectively, which were significantly higher than those in the control group (117.42±19.10 and 135.63±28.31, P<0.01). There was no sig- nificant difference between the rhGH 0.2 U/(kg·d) group and rhGH 0.4 U/(kg·d) group in both of the levels of nitrogen balance and prealbumin. It is concluded that the nutritional support therapy with adjuvant rhGH which starts 48 h after surgery improves the nutrition state of the patients with severe multiple trauma. It is safe for severe multiple trauma patients who accept rhGH at the dose of 0.2 and 0.4 U/(kg·d).

Nutritional Support Treatment for Severe Chronic Hepatitis and Posthepatitic Cirrhosis

The therapeutic effectiveness of nutritional support in the treatment of severe chronic hepatitis and posthepatitic cirrhosis was evaluated. 143 patients with severe chronic hepatitis and 83 with posthepatitic cirrhosis were evaluated with SGA for assessing the nutritional status before the treatment. Patients with severe chronic hepatitis were divided into three groups： group A subject to enteral nutrition （EN） and parenteral nutrition （PN）, group B subject to comprehensive treatment （CT） ＋PN; group C subject to CT＋EN. The patients with posthepatitic cirrhosis were divided in- to two groups： group D receiving CT and group E receiving CT＋ PN ＋ EN. The function of liver and kidney and nutritional status were monitored to assess the therapy in 6 weeks. The results showed before treatment, over 90% patients had moderate to severe malnutrition. After nutritional support, the liver function （ALT, T-bil） and nutritional status （TP, TC） in group A was improved significantly as compared with that in groups B and C （P〈0.05）. Compared with group D, the values of TP and Alb were increased significantly in group E （P〈0. 05）, but the levels of ALT, AST and T-bil had no obvious change. It was suggested that most patients with severe chronic hepatitis or posthepatitic cirrhosis had malnutrition to varying degrees. The nutritional support treatment could obviously improve the nutritional status of these patients, and was helpful to ameliorate the liver function of the patients with severe chronic hepatitis. Among the methods of nutritional support treatment, PN combined with EN had the best effectiveness.

Relationship between Nutritional Support and Tuberculosis Treatment Outcomes in West Bengal, India

Introduction: Poverty and poor nutrition are associated with the risk of developing tuberculosis (TB). Socioeconomic factors may interfere with anti-tuberculosis treatment compliance and its outcome. We examined whether providing nutritional support (monthly supply of rice and lentil beans) to TB patients who live below the poverty line was associated with TB treatment outcome. Methods: This was a retrospective cohort study of sputum smear-positive pulmonary TB patients living below the poverty line (income of <$1.25 per day) registered for anti-tuberculosis treatment in two rural districts of West Bengal, India during 2012 to 2013. We compared treatment outcomes among patients who received nutritional support with those who did not. A log-binomial regression model was used to assess the relation between nutritional support and unsuccessful treatment outcome (loss-to-follow-up, treatment failure and death). Results: Of 173 TB patients provided nutritional support, 15 (9%) had unsuccessful treatment outcomes, while 84 (21%) of the 400 not provided nutrition support had unsuccessful treatment outcomes (p < 0.001). After adjusting for age, sex and previous treatment, those who received nutritional support had a 50% reduced risk of unsuccessful treatment outcome than those who did not receive nutritional support (Relative Risk: 0.51;95% Confidence Intervals: 0.30 - 0.86). Conclusion: Under programmatic conditions, monthly rations of rice and lentils were associated with lower risk of unsuccessful treatment outcome among impoverished TB patients. Given the relatively small financial commitment needed per patient ($10 per patient per month), the national TB programme should consider scaling up nutritional support among TB patients living below the poverty line.

Effect of Nutritional Support on Treatment of Multi-Drug Resistant Tuberculosis in Rajshahi Division, Bangladesh

Introduction: Multi-drug resistant tuberculosis (MDR-TB) is a public health crisis throughout the world including Bangladesh particularly due to its complexities in diagnosis, longer treatment regimen, and adverse drug reaction. Nutritional supplementation has significant impact on patient’s weigh gain and optimum weight gain is a biomarker of treatment response. The objective of this study was to measure body mass index (BMI) progress among MDR-TB patients in different phases of treatment. Methodology: A prospective observational study was conducted from March 2010 to July 2015 in Chest Disease Hospital (CDH), Rajshahi and different communities of Rajshahi Division, Bangladesh. A total of 233 confirmed MDR-TB patients were selected from CDH who received treatment and nutritional support from ongoing national TB control program (NTP). They received free diagnosis, follow up tests, treatment and nutritional support as regular diet as well as cash amount Bangladeshi taka (BDT.) 1000 per month in CDH. Along with treatment, they also received only cash amount BDT. 1500 per month as nutritional support at community level. Weight measurement was taken at regular interval from enrollment to completion of treatment. Chi-square, paired t-test and linear regression analysis were used in this study. Results: The baseline prevalence of undernourished (BMI < 18.5 kg/m2) was 82.4%. After two months of treatment, 14.5% underweight patients gained weight and reverted to normal BMI. Regression analysis showed the decreasing tendency of BMI progress with increasing age which was significant among male patients (p < 0.05). We observed reversely that patients gained more BMI in intensive phase than continuation phase of treatment. The cohort results demonstrated that the treatment success rate was lower (<83%) among initially underweight patients than their counterparts (>92%). Conclusion: Nutritional support has synergistic effect on treatment response. Adequate nutritional support with proper treatment would help to get better outcomes particularly at community level. Gender issue should also be addressed at household level.

A Cross-Sectional Study on Appetite, Nutritional Status and Nutritional Support of Hospitalized Patients

Objective: To understand the appetite and nutritional status of hospitalized patients in a tertiary A general hospital in Guangzhou, Guangdong Province. Methods: A cross-sectional survey of appetite and nutritional status assessment on inpatients in 44 wards of the hospital was conducted. Taking all “conscious patients hospitalized for more than 48 hours” in the hospital on November 25, 2020 as the survey subjects, the patients’ appetite, dietary intake, nutrition and nutritional support in the past week were investigated. Results: A total of 890 cases were investigated, among which 25 cases (2.81%) with missing data were excluded, and thus 865 investigated cases were considered effective. The incidence of nutritional risk was 28.67%, malnutrition 13.29%, external tube feeding nutrition 3.24%, parenteral nutrition 7.05%, and oral nutritional supplement 10.40%. The average score of appetite assessment was (6.99 ± 2.43) points. Among them, cases with appetite assessment scores < 5 points accounted for 15.84%, and 52 patient cases utilized appetite-improving drugs. Among the 137 patients with appetite scores < 5, only 7 patients utilized appetite-improving drugs. The patients’ dietary self-evaluation scores were averagely (4.08 ± 1.16) points, and the daily intake compliance rate of patients was 85.78%. Appetite assessment score was correlated with dietary intake score (r = 0.548) and daily intake compliance rate (r = 0.263) (p < 0.01). The differences in body weight, BMI, grip strength, albumin, and hemoglobin concentration of patients with different appetite states were statistically different (p < 0.01). Appetite was an influencing factor of weight change (β = −0.079, p = 0.023). The difference between the appetite assessment scores and the daily intake compliance rates of patients with different nutritional support methods was statistically significant (p < 0.05);the individualized diet group had the highest appetite assessment score (8.57 ± 1.70), while the parenteral nutrition group had the lowest appetite assessment score (4.90 ± 2.99);the individualized diet group had the highest daily intake rate of 100%, followed by the parenteral nutrition group with 96.72%, and the regular diet group had the lowest rate of 84.02%. Conclusion: The appetite of hospitalized patients is closely related to nutritional status, and therefore, attention should be paid to the appetite status and nutritional status of hospitalized patients. Inpatients with different nutritional support methods should be given individualized appetite and nutritional interventions.

The problems of nutritional support for head and neck malignant tumor patients undergoing radiotherapy

Nutritional support is a vital approach to improve symptoms of head andneck cancer, which are caused by radiotherapy. Although nutritional supporthas rapid progress, it could appear a variety of problems in nutritionaltreatment for head and neck cancer patients during radiotherapy. It is introducedthat how to implement nutritional support for head and neck cancerpatients during radiotherapy. It is more important to analyze the problemsin nutrition assessment and nutrition support and intervention. It could bedesigned more convenient nutrition assessment system and try to find outmore sufficient and effective nutrition markers. It also needs to enhancethe nutrition education for patients and their family. In addition to, it couldbe more work to do in oral, nasal feeding and gastrostomy nutrition supplementationand parenteral nutrition support and intervention. Thus, it isa long way to make nutritional support be better in head and neck cancerpatients during radiotherapy.

Application of Nutritional Support in the Comprehensive Treatment of Gastric Cancer: A Case Report

Objective To relieve long-term malnutrition caused by a malignant tumor affecting the pylorus and to prolong the patient survival.Methods A patient presented with complete pyloric obstruction due to pyloric tumors,and achieved good therapeutic effects through nutritional support and effective chemotherapy.Results After about 40 days of treatment,all physiological indicators were improving.After chemotherapy,the pyloric tumor shrank and the complete obstruction was relieved.The patient was able to eat and drink normally.Conclusion Nutritional support,combined with chemotherapy,may effectively treat complete pyloric obstruction caused by advanced tumors.

Gut,metabolism and nutritional Support for COVID-19:Experiences from China

There is little research that focuses on the relationship between the gut,metabolism,nutritional support and COVID-19.As a group of Chinese physicians,nutritionists and scientists working on the frontline treating COVID-19 patients,we aim to integrate our experiences and the current clinical evidence to address this pressing issue in this article.Based on our clinical observations and available evidence,we recommend the following practice.Firstly,the Nutritional Risk Screening 2002 tool should be used routinely and periodically;for patients with a score≥3,oral nutritional supplements should be given immediately.Secondly,for patients receiving the antiviral agents lopinavir/ritonavir,gastrointestinal side effects should be monitored for and timely intervention provided.Thirdly,for feeding,the enteral route should be the first choice.In patients undergoing mechanical ventilation,establishing a jejunal route as early as possible can guarantee the feeding target being achieved if gastric dilatation occurs.Fourthly,we suggest a permissive underfeeding strategy for severe/critical patients admitted to the intensive care unit during the first week of admission,with the energy target no more than 20 kcal/kg/day(for those on mechanical ventilation,this target may be lowered to 10–15 kcal/kg/day)and the protein target around 1.0–1.2 g/kg/day.If the inflammatory condition is significantly alleviated,the energy target may be gradually increased to 25–30 kcal/kg/day and the protein target to 1.2–1.5 g/kg/day.Fifthly,supplemental parenteral nutrition should be used with caution.Lastly,omega-3 fatty acids may be used as immunoregulators,intravenous administration of omega-3 fatty emulsion(10 g/day)at an early stage may help to reduce the inflammatory reaction.

A Controlled Study on the Effect of Preoperative Nutritional Assessment and Intervention on the Clinical Efficacy of Patients with Esophageal Cancer

The purpose of this study was to analyze the effect of preoperative nutritional assessment and intervention on the clinical efficacy of patients with esophageal cancer.First,110 patients with esophageal cancer admitted to our hospital from December 2014 to December 2016 were selected,including 78 males and 27 female were randomly selected as the observation group and control group.In the observation group,26 cases received nutritional support,22 cases did not receive nutritional support,15 cases in the control group,47 cases did not receive nutritional support.The non-protein calories were no less than 41.8kj•kg-1•d-1.Albumin(PAB),transferrin(TRF)and albumin(ALB)were tested before,1 and 5 days after surgery.IgA,IgG and IgM were detected by immunosuspension analyzer.Flow cytometry was used to detect CD3 and CD4.The incidence of postoperative complications(incision infection,pulmonary infection,anastomotic fistula,chylothorax,bleeding,esophagotracheal fistula,cardiovascular complications,and digestive tract diseases)was observed.The results showed that 48 patients(43.64%)in the observation group had nutritional risk(≥3 points),while 62 patients(56.36%)in the control group had no nutritional risk(<3 points).There were statistically significant differences between the observation group and the control group in gender,degree of differentiation,etc.(P<0.05),but no significant differences in age,complications,tumor size,metastasis,lymph node metastasis,etc.(P>0.05)postoperative indicators showed that all indicators continued to decline.The level of immune factors in the nutrition support group was higher than 1 day before surgery and close to the preoperative level.This indicated that effective preoperative nutritional support for esophageal cancer patients with nutritional risk can inhibit the decomposition of immunoglobulin,which is conducive to the recovery of postoperative immune function and improve the tolerance of the body to comprehensive tumor treatment.At the same time,the incidence of postoperative complications in the nutritional support group was significantly lower than that in the non-nutritional support group,indicating that active preoperative nutritional support intervention can reduce the occurrence of postoperative complications and improve the prognosis of patients.

Concurrent chemoradiotherapy combined with enteral nutrition support:a radical treatment strategy for esophageal squamous cell carcinoma patients with malignant istulae

Background: Concurrent chemoradiotherapy(CCRT) significantly increases the survival rate of esophageal squa?mous cell carcinoma(ESCC) patients with malignant fistulae. Recent clinical evidence has shown the benefits of enteral nutrition for malnourished cancer patients. In this study, we aimed to validate that, with the support of enteral nutrition, ESCC patients who develop malignant fistulae might be able to complete CCRT and achieve long?term survival.Methods: We reviewed the medical records of 652 patients with ESCC who received definitive CCRT at Sun Yat?sen University Cancer Center between January 2010 and December 2012. Treatment outcome and toxicity were ret?rospectively evaluated in 40 ESCC patients with malignant fistulae. All the 40 patients were treated with CCRT and evaluated by clinical nutritionists using nutrition risk screening(NRS) before, during, and after treatment. Twenty?two patients received a nasogastric tube, and 18 underwent percutaneous endoscopic gastrostomy feeding. The median energy intake was 2166 kcal/day. Treatment response was evaluated at 3 months after the completion of CCRT.Results: With a median follow?up of 18 months(range, 3–39 months), patients' 1?year overall survival(OS) rate was 62.5%, and the estimated OS time was 25.5 months. Univariate analysis showed that the NRS score(P n NRS score(P se to treatment(P < 0.001) were sig= 0.003), increase i= 0.024), fistula closure(P = 0.011), and responnifi?cantly associated with OS. Multivariate analysis showed that tumor response(P = 0.044) and increase in NRS score(P = 0.044) were independent predictors of OS. Grade 3 vomiting was observed in 8 patients(20.0%), grade 3 neutro?penia was observed in 11 patients(27.5%), and grade 3 cough was observed in 13 patients(32.5%); 2 patients(5.0%) died of massive bleeding during treatment.Conclusions: CCRT combined with enteral nutrition support is effective for ESCC patients with malignant fistulae. Patients have an increased potential to be cured, especially those who experience complete response and have an increase in NRS score. Careful observation and nutrition support are required for patients with advanced T?category ESCC who undergo CCRT.

Perioperative nutrition support in hepatobiliary and pancreatic surgery

Early in 1936,Stduley found that there was a E close relationship between nutritional status and postoperative outcome in surgical patients.In modern surgery combined with use of prophylactic antibiotics,better anesthesia,improved suture materials and optimal physiotherapy,the rate of postoperative complications in malnourished patients has significantly decreased.But recent studies [1,2]

Nutrition Support Practices of Hematopoietic Stem Cell Transplantation Centers in China's Mainland

Summary:It has been identified that malnutrition can influence the immune system and time of engraftment,and it's also associated with increased incidence of complications,prolonged length of hospital stays,and transplant mortality and morbidity in patients undergoing hematopoietic stem cell transplantation(HSCT),so dynamic nutrition care is highly important.The aim of this study was to better understand the differences between clinical nutrition practices and international recommendations as well as possible barriers to the use of nutrition support in HSCT patients.An evidence-based nutrition support pathway was constructed through a systematic literature review to identify evidence and recommendations relating to the relevant issues.Then,a questionnaire consisting of 28 questions that focused on the 4 topics,namely,assessment and screening for malnutrition,nutrition support interventions,nutrition support in gastrointestinal graft-ver5U5・host disease(GVHD)and neutropenic diet was developed by the study authors and used for data collection.Responses of 18 HSCT centers from 17 provinces were received.General assessment for malnutrition was performed at 72%(13/18)centers.Parenteral nutrition(PN)was given as the first option to HSCT patients in the majority of centers,despite the fact that current guidelines recommend enteral nutrition(EN)over PN.As many as 72%(13/18)of the centers considered a neutropenic diet in the management of HSCT patients,but only one center had a formal neutropenic diet protocol in place for transplant recipients.Criteria for initiating nutrition support in patients with gastrointestinal GVHD were heterogeneous among the centers,and PN was the most widely used technique.The survey results revealed significant heterogeneity with regard to nutrition support practices among the centers,as well as between the practices and the guidelines.Standard nutrition support guidelines or protocols for nutrition support practices were absent in most of the centers.

Effects of enteral nutrition intervention on immune and nutritional indexes of patients with gastric malignant cancer during postoperative chemotherapy

Objective The aim of this study was to investigate changes in nutritional status and related indexes in patients with Nutritional Risk Score(NRS)≥3 gastric cancer after nutritional support treatment.Methods A total of 50 patients with gastric cancer were divided into two groups according to the different nutritional support treatment they received during postoperative chemotherapy:immune-enhanced enteral nutrition group(n=25)and conventional enteral nutrition group(n=25).Changes in patient’body mass index(BMI),hemoglobin(HB),serum total protein(TP),serum albumin(ALB),and immune indexes(CD3+,CD4+/CD8+,CD3+/CD8+)were monitored before and after chemotherapy.At the same time,the incidence and classification of gastrointestinal adverse reactions after chemotherapy were assessed.Results Compared with the conventional enteral nutrition group,the nutritional and immune indexes in the immune-enhanced enteral nutrition group were significantly improved.After chemotherapy,the incidence of adverse reactions in the digestive tract was relatively lower and the grade was reduced.Conclusion Immune-enhanced enteral nutrition support can significantly improve the nutritional status of patients,improve immune function,increase the susceptibility of cancer patients to chemotherapy,reduce toxicity and adverse effects,and improve the quality of life of tumor patients compared with conventional enteral nutrition support.