Sarcopenia is one of the most common complications of end-stage liver disease (ESLD) and is an independent risk factor for mortality in ESLD patients. Increasing evidence has indicated that nutritional intervention plays an important role in improving the prognosis of ESLD complicated with sarcopenia. Timely identification and early treatment of sarcopenia in ESLD are indispensable for improving patient outcome and quality of life. Accumulating in-depth researches on the pathogenesis and metabolic characteristics of sarcopenia in ESLD patients have provided increasing evidence for the nutritional treatment of sarcopenia in ESLD. Here we reviewed and summarized the research progress regarding the early identification, nutritional risk screening, assessment, and intervention of sarcopenia in ESLD.

Objective:To explore the effects of self-made Huoxue Xiaozhong Xunxi Decoction combined with functional exercise on postoperative swelling of affected limbs, bone metabolism and recovery of knee function in patients with traumatic fracture of tibial plateau (FTP).Methods:Randomized controlled trial. totally 80 patients after FTP surgery in the Qidong Hospital of Traditional Chinese Medicine were enrolled and divided into two groups by random number table method from January 2018 to January 2022, with 40 cases in each group. After surgery, control group was treated with functional exercise, while observation group was additionally treated with self-made Huoxue Xiaozhong Xunxi Decoction. All were treated continuously for 8 weeks. The perioperative indexes (operation time, incision length, intraoperative blood loss, postoperative drainage volume, leaving bed time) in the two groups were recorded. The postoperative swelling and pain of affected limbs were observed, and detumescence time, pain relief time, fracture healing time and complete weight-bearing time were recorded. The knee function was evaluated by Hospital for Special Surgery (HSS). The level of serum bone morphogenetic protein-2 (BMP-2) was detected by ELISA, and total n-terminal propeptide of typeⅠprecollagen (t-PINP) and β-crossLaps (β-CTX) were detected by full-automatic immunoluminescence analyzer. The occurrence of postoperative complications in the two groups was recorded.Results:There was no significant difference in operation time, incision length, intraoperative blood loss, postoperative drainage volume or leaving bed time between the two groups ( P>0.05). The total effective rate of the observation group was 97.5% (39/40), while the control group was 80.0% (32/40), with statistical significance ( χ2=6.14, P=0.013). The detumescence time, pain relief time, fracture healing time and complete weight-bearing time were earlier in the observation group than control group ( P<0.01). After 10 d of treatment, VAS score and swelling degree in observation group were lower than those in the control group ( t=7.05, 3.81, P<0.01). After 8 weeks of treatment, levels of serum BMP-2 [(625.16±67.43) μg/L vs. (542.35±53.27) μg/L, t=6.10], t-PINP [(54.16±7.29) μg/L vs. (50.34±6.12) μg/L, t=2.54] and β-CTX [(1.26±0.38) μg/L vs. (1.04±0.23) μg/L, t=3.13] in observation group were higher than those in the control group ( P<0.05). During treatment, the incidence of complications in the observation group was 2.5% (1/40) and the control group was 7.5% (3/40), without statistical significance ( χ2=1.05, P=0.305). Conclusion:Self-made Huoxue Xiaozhong Xunxi Decoction combined with functional exercise is beneficial to improve pain and swelling of affected limbs and bone metabolism, and promote the recovery of knee function in patients after FTP surgery.