Objective To investigate the role of rehabilitation therapy both on nutritional status and intestinal adaptation of patients with short bowel syndrome (SBS). Methods The literatures about rehabilitation therapy for SBS were reviewed. Results Intestinal rehabilitation refers to the process of restoring enteral autonomy, in order to get rid of parenteral nutrition, usually by means of dietary, medical, and surgical treatment. Recent researches showed that medication and the use of specific nutrients and growth factors could stimulate intestinal absorption and might be useful in the medical management of SBS. Conclusion Intestinal rehabilitation is of benefit in the treatment of SBS and would play a greater role in the future.
Objective To investigate the nutritional status of hospitalized patients with chronic kidney disease (CKD), analyze the influencing factors, and construct a predictive model to provide a localized theoretical basis and more convenient risk prediction indicators and models for clinical nutrition support and intervention treatment of CKD patients in China. Methods Convenience sampling was used to select hospitalized CKD patients from Department of Nephrology, West China Hospital, Sichuan University, from January to October 2019. General information questionnaires, the Nutritional Risk Screening 2002 scale, and the Huaxi Emotional-distress Index questionnaire were used for data collection. Single factor analyses and multiple logistic regression analysis were conducted to explore the risk factors for malnutrition in CKD hospitalized patients. A predictive model was established and evaluated using receiver operating characteristic (ROC) curve analysis and bootstrap resampling. Results A total of 1059 valid copies of questionnaires were collected out of 1118 distributed. Among the 1059 CKD hospitalized patients, 207 cases (19.5%) were identified as having nutritional risk. The multiple logistic regression analysis showed that CKD stage [odds ratio (OR)=1.874, 95% confidence interval (CI) (1.631, 2.152), P<0.001], age [OR=1.015, 95%CI (1.003, 1.028), P=0.018], and the Huaxi Emotional-distress Index [OR=1.024, 95%CI (1.002, 1.048), P=0.033] were independent risk factors for malnutrition in CKD hospitalized patients, while serum albumin [OR=0.880, 95%CI (0.854, 0.907), P<0.001] was an independent protective factor. The evaluation of the multiple logistic regression analysis predictive model showed a concordance index of 0.977, standard deviation of 0.021, and P<0.05. The area under the ROC curve was 0.977. Conclusions The prevalence of malnutrition is relatively high among CKD hospitalized patients. CKD stage, age, psychological status, and serum albumin are influencing factors for malnutrition in CKD hospitalized patients. The multiple logistic regression model based on the above indicators demonstrates good predictive performance and is expected to provide assistance for early nutritional intervention to improve the clinical outcomes and quality of life for CKD patients with malnutrition in China.
ObjectiveTo systematically review the efficacy of enteral nutrition combined with parenteral nutrition (EN+PN) and enteral nutrition alone (EN) in gastric cancer patients undergoing gastrectomy. MethodsPubMed, EMbase, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) of EN+PN and EN in gastric cancer patients undergoing gastrectomy from inception to September 25th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 23 RCTs were included. The results of meta-analysis showed that compared to EN group, EN+PN group had a shorter hospital stay (MD=?1.75, 95%CI ?2.45 to ?1.05, P<0.000 1) and a lower risk of postoperative complications (RR=0.55, 95%CI 0.46 to 0.66, P<0.000 1). However, there was no statistical difference in the first exhaust time between the two groups. ConclusionThe current evidence shows that EN+PN may contribute to reducing the incidence of postoperative complications and shortening the length of hospital stay in gastric cancer patients. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
Objective To investigate the impact of nutritional risk on unplanned readmissions in elderly patients with chronic obstructive pulmonary disease (COPD), to provide evidence for clinical nutrition support intervention. Methods Elderly patients with COPD meeting the inclusive criteria and admitted between June 2014 and May 2015 were recruited and investigated with nutritional risk screening 2002 (NRS 2002) and unplanned readmission scale. Meanwhile, the patients’ body height and body weight were measured for calculating body mass index (BMI). Results The average score of nutritional risk screening of the elderly COPD patients was 4.65±1.33. There were 456 (40.07%) patients who had no nutritional risk and 682 (59.93%) patients who had nutritional risk. There were 47 (4.13%) patients with unplanned readmissions within 15 days, 155 (13.62%) patients within 30 days, 265 (23.28%) patients within 60 days, 336 (29.53%) patients within 180 days, and 705 (61.95%) patients within one year. The patients with nutritional risk had significantly higher possibilities of unplanned readmissions within 60 days, 180 days and one year than the patients with no nutritional risk (all P<0.05). The nutritional risk, age and severity of disease influenced unplanned readmissions of the elderly patients with COPD (all P<0.05). Conclusions There is a close correlation between nutritional risk and unplanned readmissions in elderly patients with COPD. Doctors and nurses should take some measures to reduce the nutritional risk so as to decrease the unplanned readmissions to some degree.
【摘要】 目的 觀察慢性心力衰竭營養支持治療的療效。 方法 將2007年1月〖CD3/5〗2009年10月期間收治的56例慢性心力衰竭住院患者隨機分為常規治療組及強化營養支持治療組,每組28例患者。其中,強化治療組是在常規治療的基礎上,給與強化營養支持治療。比較兩組治療前后6 min步行距離、NYHA心功能評級及射血分數。 結果 治療后,患者6 min步行距離、心功能評級強化營養治療組優于常規治療組。左心室射血分數兩組無差異。 結論 對慢性心力衰竭患者,營養支持治療是重要的治療手段。【Abstract】 Objective To study the efficacy of nutritional support treatment for chronic heart failure. Methods 56 patients with chronic heart failure hospitalized patients were randomly divided into conventional therapy group and enhanced nutritional support therapy group, 28 patients in each group. Where enhenced therapy group is on the basis of conventional therapy to give extra enhanced intensive nutrition support treatment. Before and after treatment were compared sixminutes walking distance, NYHA cardiac function class, ejection fraction, mortality. Results After treatment, patients with sixminutes walking distance, cardiac function class,enhanced nutritional support therapy group is better than conventional treatment group. Left ventricular ejection fraction was no difference. Conclusion Patients with chronic heart failure, nutritional support treatment is an important treatment.
【Abstract】 Objective To detect the expression of Bcl-2/adenovirus E1B 19-kDa-interacting protein 3 (BNIP3)in cell death induced by nutrition deprivation in nucleus pulposus cells so as to further understand the mechanism of deathin nucleus pulposus cells. Methods Two adult Sprague Dawley rats, male or female, weighing 150-200 g, were involvedin this experiment. The cells isolated from rat caudal disc were cultured under the condition of L-DMEM culture media,10%FBS, and 21%O2 (control group) and under the condition of DMEM-free glucose culture media, no serum, and 1% O2(experimental group). The expressions of BNIP3 gene and protein were detected by real-time fluorescent quantitative PCR,immunofluorescence staining, and Western blot. The cell apoptosis rate and mitochondrial membrane potential were measuredby flow cytometry at 24, 48, and 72 hours after culture. Results The expression of BNIP3 decreased in the control group;the expressions of BNIP3 showed an increasing tendency with time in the experimental group, and BNIP3 combined withmitochondria. Significant differences were observed in the expressions of BNIP3 gene and protein between 2 groups at the othertime (P lt; 0.05) except that no significant difference was observed in the expression of BNIP3 gene at 24 hours (P gt; 0.05). Thecell apoptosis rate and mitochondrial membrane potential were significantly lower in the experimental group than those in thecontrol group (P lt; 0.05). Conclusion Upregulation of BNIP3 and translocation to mitochondria may be involved in nucleuspulposus cell death in nutrition deprivation.
ObjectiveTo observe the effects of levocarnitine by intravenous injection on nutritional and microinflammatory state in maintenance hemodialysis patients. MethodsBetween October 2010 and October 2011, 62 maintenance hemodialysis (>6 months) patients in our dialysis center were enrolled in this study, and were randomly divided into treatment group (n=32) and control group (n=30). Patients in the treatment group were injected with levocarnitine (1.0 g once) after every dialysis for 3 months, while patients in the control group only accepted routine hemodialysis therapy. Blood biochemical indicators, serum high sensitive C-reactive protein (hs-CRP) were measured and compared at the experiment onset and 3 months later. ResultsAfter treatment with levocarnitine for three months, the average serum levels of albumin (Alb), hemoglobin (Hb), triacylglycerol (TG), high density lipoprotein cholesterol (HDL-C) and hs-CRP, and the conditions of dialysis hypotension, muscular spasm, lacking in strength, and anorexia were significantly different between the two groups (P<0.05). But there was no significant difference in total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) between the two groups (P>0.05). For the control group, after treatment, Alb, Hb and condition of anorexia changed significantly (P<0.05), while TC, TG, LDL-C, HDL-C, hs-CRP, conditions of dialysis hypotension, muscular spasm and lacking of strength did not change (P>0.05); for the treatment group, after treatment, all Alb, Hb, TG, HDL-C, hs-CRP, conditions of dialysis hypotension, muscular spasm, lacking of strength and anorexia changed significantly (P<0.05), while TC and LDL-C did not change obviously (P>0.05). ConclusionLevocarnitine can significantly improve the nutritional and microinflammatory state and better the quality of life in maintenance hemodialysis patients.
ObjectiveTo explore the diagnostic efficacy of Geriatric Nutritional Risk Index (GNRI) in malnutrition of elderly patients with chronic obstructive pulmonary disease (COPD) in outpatient department. MethodsOne hundred and five elderly outpatients with COPD were enrolled in the study, and their nutritional screening was carried out. The clinical and laboratory parameters of patients in the normal nutrition group (high GNRI group) and malnutrition group (low GNRI group) were compared, and the correlation analysis was conducted. The diagnostic efficacy of GNRI was evaluated based on the malnutrition universal screening tool (MUST). ResultsThe prevalence of malnutrition was high in COPD elderly outpatients. The prevalence of malnutrition in group D was 61.8%. There were significant differences between the two groups in body mass index, serum albumin, FEV1 percentage in the predicted value, 6-minute walk distance, and the number of acute exacerbations in the past year. GNRI was significantly related to the above parameters. The sensitivity, specificity and accuracy of GNRI were 81.8%, 83.6% and 82.9%, using MUST as the standard. ConclusionGNRI can be used for nutritional screening of COPD patients in elderly outpatients, which is simple, convenient and relatively accurate, and can be popularized in other medical institutions.
ObjectiveTo explore the relationship of the level of inflammation and nutritional status with the occurrence and prognosis of refractory diabetic foot.MethodsA total of 70 patients with refractory diabetic foot between August 2015 and August 2017 were randomly selected as the observation group. Another 70 patients with diabetes mellitus (without foot ulcer) who visited the hospital in the same period were set as the control group. The observation group was subgrouped into the non-amputation group and the amputation group according to the follow-up endpoint events, and into the grade Ⅲ, Ⅳ, and Ⅴ groups according to Wagner classification method. The blood levels of inflammatory markers and nutritional markers between groups were compared.ResultsIn the observation group, vascular cell adhesion molecule-1 (VCAM-1), fibroblast growth factor 2 (FGF2), fibrinogen (FIB), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-18, lipoprotein phospholipase A2 (LP-PLA2), C-reactive protein (CRP) levels were significantly higher than those in the control group, and albumin (ALB), prealbumin (PA), and transferrin (TRF) levels were significantly lower than those in the control group, with statistically significant differences (P<0.01). The blood levels of FGF2, FIB, IL-6, IL-18, LP-PLA2, and CRP in the amputation group were significantly higher than those in the non-amputation group, and the levels of TRF, ALB, and PA were significantly lower than those in the non-amputation group (P<0.01). There were statistically significant differences in the levels of FGF2, FIB, IL-6, IL-18, LP-PLA2, CRP, TRF, ALB, and PA in patients with diabetic foot with different Wagner grades (P<0.05). The result of multiple logistic regression analysis showed that IL-6 [odds ratio (OR)=1.487, 95% confidence interval (CI) (1.023, 2.120), P<0.001], IL-18 [OR=1.274, 95%CI (1.052, 1.665), P<0.001], LP-PLA2 [OR=1.478, 95%CI (1.126, 1.789), P<0.001], and CRP [OR=2.085, 95%CI (1.574, 2.782), P<0.001] were independent risk factors for the occurrence of refractory diabetic foot, and TRF [OR=0.645, 95%CI (0.002, 0.898), P<0.001], ALB [OR=0.838, 95%CI (0.429, 0.923), P<0.001], and PA [OR=0.478, 95%CI (0.201, 0.984), P<0.001] were independent protective factors for the occurrence of refractory diabetic foot.ConclusionIn the clinical treatment of diabetic foot, we should pay attention to the monitoring of the level of inflammatory factors and nutritional status, and it is necessary to timely carry out anti-inflammatory treatment and appropriate nutritional support treatment.
Objective To research the effect of ω-3 polyunsaturated fatty acid (PUFA) on inflammatory response and nutritional condition after operation for patients with gastrointestinal malignancies. Methods Forty patients with gastrointestinal malignancies were included in this study from February 1st, 2009 to June 1st, 2009. Forty cases were randomly allocated to experimental group (20 cases) and control group (20 cases). Parenteral nutrition was conducted in continuous 7 days after operation. Comparing with control group, a dose of 10 g of ω-3 PUFA was given to experimental group every day in 7 days after operation in addition. Blood samples were gained before operation, the 2nd and 8th day after operation respectively to measure relative indexes about inflammatory response (WBC, neutrophilic granulocyte and C-reaction protein) and nutrition (total protein, albumin, prealbumin, siderophilin and lymphocyte). Reduction of body mass was also recorded. Results The baseline between experimental group and control group was comparable (Pgt;0.05). The levels of indexes about inflammatory response (WBC, neutrophilic granulocytem and C-reaction protein) and nutrition (total protein, albumin, prealbumin, siderophilin and lymphocyte) between experimental and control group did not reach statistically significant difference in the 2nd day after operation (Pgt;0.05). The levels of neutrophilic granulocyte and C-reaction protein in experimental group were lower than those of control group, and the level of lymphocyte in experimental group was higher than that of control group in the 8th day after operation, and all of them reached statistical significance (Plt;0.05). There was no statistical different in reduction of body mass between experimentalgroupandcontrolgroup.Conclusion ω-3 PUFA can depress the excessively inflammatory reaction and improve the nutritional condition of patients with gastrointestinal malignancies after operation.