Preoperative immunonutrition in patients undergoing liver resection:A prospective randomized trial

BACKGROUND Preoperative supplementation with immunonutrients, including arginine and n-3 fatty acids, has been shown in a number of systematic reviews to reduce infectious complications in patients who have undergone gastrointestinal surgery. Limited information, however, is available on the benefits of nutritional supplementation enriched with arginine and n-3 fatty acids in patients undergoing liver resection.AIM To evaluate the effects of preoperative nutritional supplementation enriched with arginine and n-3 fatty acids on inflammatory and immunologic markers and clinical outcome in patients undergoing liver resection.METHODS Thirty-four patients undergoing liver resection were randomized to either five days of preoperative Impact? [1020 kcal/d, immunonutrition(IMN) group], or standard care [no supplementation, standard care(STD) group]. Nutritional status was measured at study entry by subjective global assessment(SGA).Functional assessments(grip strength, fatigue and performance status) were carried out at study entry, on the day prior to surgery, and on postoperative day(POD) 7 and 30. Inflammatory and immune markers were measured at study entry, on the day prior to surgery, and POD 1, 3, 5, 7, 10 and 30. Postoperative complications were recorded prospectively until POD30.RESULTS A total of 32 patients(17 IMN and 15 STD) were analysed. All except four patients were SGA class A. The plasma ratio of(eicosapentaenoic acid plus docosahexaenoic acid) to arachidonic acid was higher in IMN patients on the day prior to surgery and POD 1, 3, 5 and 7(P < 0.05). Plasma interleukin(IL)-6 concentrations were elevated in the IMN group(P = 0.017 for POD7). No treatment effect was detected for functional measures, immune response(white cell count and total lymphocytes) or markers of inflammation(C-reactive protein,tumour necrosis factor-α, IL-8, IL-10). There were 10 patients with infectious complications in the IMN group and 4 in the STD group(P = 0.087). Median hospital stay was 9(range 4–49) d in the IMN group and 8(3-34) d in the STD group(P = 0.476).CONCLUSION In well-nourished patients undergoing elective liver resection, this study failed to show any benefit of preoperative immunonutrition.

Ethnographic Decision Tree Modeling of the Decision Criteria and Decision Patterns for Adult Married Women with Unexpected Pregnancies

Introduction: As far as adult and married women were concerned, when they occurred to “unplanned pregnancy”, they felt so surprised and concussive all the time. Besides, the unplanned pregnancy also affects the other members in the family system. Therefore, when married women have to face the choice: “birth” or “abortion”, they’ll consider lots of thoughts and different decision criteria and decision pattern under various influences on physician, mind, mental and society. The purpose of this study was to investigate the criteria considered and the decision patterns involved when adult married women decide whether to terminate or continue an unplanned pregnancy. Methods: The study uses the method—“Ethnographic Decision Tree Modeling” [1] to build model of the decision criteria and decision patterns involved when adult married women make a decision about their unplanned pregnancy. There are three process in the research method: “Pilot Study”—interview two groups, every group distinct 4 married adult women with unplanned pregnancies, which decide whether to terminate or continue an unplanned pregnancy, what is the items of decision characters affect to the choice: “birth” or “abortion”. “Building of the Model”, displays the importance in proper order of those items and build the modeling with these two groups of women. “Testing of the Model”: investigate the criteria considered and the decision patterns involved when adult married women decide whether to terminate or continue an unplanned pregnancy. The study interviewed 34 married adult women with 43 unplanned pregnancies totally. Results: The result of the study finds out 12 items of decision characters, including planning to get pregnant or not, stability of feelings for married partner, the points of view on life, was affected by mother, mother-in-law, an husband’s emphasis on male, the meanings of children, the financial burden, the plan an assignment of career and time, the past pregnant experiences, the status of raising children, the health of parents and fetus, the effect of living environment, and social and cultural vision. Besides, there are four decision patterns of married adult women with unplanned pregnancy are “receiving abortion positively”;“giving birth as long as getting pregnancy naturally”;“ the minds are hesitative and changeable”, and “being forced by important others.” Conclusion: By setting the decision model tree, we found several decision criteria and patterns, and possible modes actions to be taken, could offer to see the adult married women’s decision-making and struggles in mind about unplanned pregnancy.

居住于美国26个州的妇女妊娠前和妊娠期的家庭暴力:与母亲及新生儿健康的关系

Objective: To conduct a population-based assessment of associations of intimate partner violence in the year prior to and during pregnancy with maternal and neonatal morbidity. Study design: Data from women giving birth in 26 U.S. states and participating in the 2000 to 2003 Pregnancy Risk Assessment Monitoring System(n=118,579) were analyzed. Results: Women reporting intimate partner violence in the year prior to pregnancy were at increased risk for high blood pressure or edema(adjusted odds ratio 1.37-1.40), vaginal bleeding(adjusted odds ratio 1.54-1.66), severe nausea, vomiting or dehydration(adjusted odds ratio 1.48-1.63), kidney infection or urinary tract infection(adjusted odds ratio 1.43-1.55), hospital visits related to such morbidity(adjusted odds ratio 1.45-1.48), and delivery preterm(adjusted odds ratio 1.37), of a low-birthweight infant(adjusted odds ratio 1.17), and an infant requiring intensive care unit care(adjusted odds ratio 1.31-1.33) compared with those not reporting intimate partner violence. Women reporting intimate partner violence during but not prior to pregnancy experienced higher rates of a subset of these concerns. Conclusion: Women experiencing intimate partner violence both prior to and during pregnancy are at risk for multiple poor maternal and infant health outcomes, suggesting prenatal risks to children from mothers’abusive partners.

Fatty liver disease and risk of all cause and cause-specific mortality outcomes in the older population

Accumulating evidence in recent years has reinforced the notion that non-alcoholic fatty liver disease/metabolic dysfunction-associated fatty liver disease/metabolic dysfunction steatotic liver disease(NAFLD/MAFLD/MASLD)is a multisystem disease that increases the risk of all-cause and disease-specific mortality(1,2).

Diabetes is associated with increased risk of hepatocellular carcinoma in non-alcoholic steatohepatitis with cirrhosis-implications for surveillance and future pharmacotherapy

Hepatocellular carcinoma(HCC)is the most common liver-related complication seen in patients with non-alcoholic fatty liver disease(NAFLD)and non-alcoholic steatohepatitis(NASH)(1).NASH is strongly associated with type 2 diabetes mellitus(T2DM)but it has also been apparent for a number of years that T2DM is associated with an increased risk of HCC independent of the presence of NASH(2).A 2006 meta-analysis of retrospective cohort studies and case-control studies demonstrated an association between T2DM and an increased risk of HCC(3).International guidelines advocate surveillance for HCC in patients with NASH who have progressed to cirrhosis(4).An important clinical question is whether T2DM confers an increased risk of HCC once patients with NASH have progressed to cirrhosis.In a recent study by Yang and colleagues(5),the authors reported strong evidence that T2DM is an independent risk factor for HCC in patients with NASH-related cirrhosis.Yang and colleagues performed a retrospective analysis of a prospectively registered research dataset of patients with NASH-related cirrhosis.

Screening for early-onset neonatal sepsis on the Kaiser Permanente sepsis risk calculator could reduce neonatal antibiotic usage by two-thirds

Importance:Effective screening strategies for early-onset neonatal sepsis(EONS)have the potential to reduce high volume parenteral antibiotics(PAb)usage in neonates.Objective:To compare management decisions for EONS,between CG149 National Institute for Health and Care Excellence(NICE)guidelines and those projected through the virtual application of the Kaiser Permanente sepsis risk calculator(SRC)in a level 2 neonatal unit at a district general hospital(DGH).Methods:Hospital records were reviewed for maternal and neonatal risk factors for EONS,neonatal clinical examination findings,and microbial culture results for all neonates born at≥34 weeks’gestation between February and July 2019,who were(1)managed according to CG149-NICE guidelines or(2)received PAb within 72 h following birth at a DGH in Winchester,UK.SRC projections were obtained using its virtual risk estimator.Results:Sixty infants received PAb within the first 72 h of birth during the study period.Of these,19(31.7%)met SRC criteria for antibiotics;20(33.3%)met the criteria for enhanced observations and none had culture-proven sepsis.Based on SRC projections,neonates with’’≥1 NICE clinical indicator and≥1 risk factor’were most likely to have a sepsis risk score(SRS)>3.Birth below 37 weeks’gestation(risk ratio[RR]=2.31,95%confidence interval[CI]:1.02–5.22)and prolonged rupture of membranes(RR=3.14,95%CI:1.16–8.48)increased the risk of an SRS>3.Interpretation:Screening for EONS on the SRC could potentially reduce PAb usage by 68%in term and near-term neonates in level 2 neonatal units.

Utility of liver resection for breast cancer liver metastases,time for action

Breast cancer is the most common cancer in women with approximately 25-40%of these cases eventually develop metastases;the majority of which will be multi-site and include the liver(BCLM)exclusively in approximately 5%of patients with metastatic disease(1).The management and treatment of BCLM requires a multi-disciplinary approach with the current standard approach“with or without extrahepatic disease”being systemic chemotherapy and/or hormonal therapy,depending on tumour hormone receptor status(2).This is associated with a median survival time of 14.3 months(95%CI:13.5-15.5 months)(3).Loco-regional treatment to BCLM has not been accepted as treatment strategy despite encouraging results from multiple case series.