Objective:To investigate the relationship between nutritional status and cognitive function in patients with Alzheimer's disease (AD),and to provide rationale for clinicians in nutrition intervention of AD patients.Methods:Sixty cases of elderly AD patients and 50 cases with normal elderly control were enrolled from the neurological department.Nutritional status and cognitive function were assessed using the laboratory parameters,mini nutritional assessment method (short-form Mini-Nutritional fine assessment,MNA-SF) and MMSE (Mini-Mental State,Examination,MMSE) survey.Results:Compared with control group,the AD group had significantly different laboratory index and MNA-SF score (P ＜ 0.05).MNA-SF scores were positively correlated with MMSE scores in patients with AD (r =0.59,P ＜ 0.05).Conclusion:The incidence of malnutrition in AD patients is high,and it is related to their cognitive function.The nutritional knowledge should be strengthened among doctors and nurses treating patients with AD.

Objective:To investigate the effect of early enteral nutrition on ventilator-associated pneumonia in patients with Guillain Barre syndrome.Methods:This study was a prospective study.The study subjects were 36 patients diagnosed with Guillain Barre syndrome in the neuro-intensive care unit of our hospital from May 2011 to May 2017.Among them,18 patients received enteral nutrition support treatment within 24 hours after mechanical ventilation (early group),and 18 patients received enteral nutrition support treatment more than 24 hours after mechanical ventilation (control group).The two groups were compared with nutritional indicators,complications of enteral nutrition,ventilatorassociated pneumonia incidence,mechanical ventilation time,NICU residence time,APACHE Ⅱ score and mortality after treatment.Results:In the early group,the incidence of ventilator-associated pneumonia,mechanical ventilation time,NICU residence time and APACHE Ⅱ score after treatment were lower than the control group and the nutritional status index were better than the control group.Meanwhile,the incidence of complications of enteral nutrition such as diarrhea,gastrointestinal bleeding and stress hyperglycemia was relatively low.Moreover,the fatality rate was lower than the control group,but there was no statistical significance.Conclusions:Early application of enteral nutrition support therapy can improve the nutritional status of patients,reduce the incidence of ventilator-associated pneumonia,shorten the time of mechanical ventilation,reduce mortality and improve the prognosis of patients.

Objective:To validate the revised BMI-MNA-SF and CC-MNA-SF with regard to association and agreement with the full MNA(R),considered as gold standard,in geriatric internal medicine patients.Methods:105 cases of hospitalized elderly patients in internal medicine were recruited for the study.The nutritional status correlation and coherence were evaluated with the revised BMI-MNA-SF、CC-MNA-SF and the full MNA(R),respectively.Results:The BMI-MNA-SF and CC-MNA-SF all correlated strongly with the full MNA(R) (Pearson's correlation coefficient r=0.9080,0.8381 respectively;P ＜ 0.001).High values of sensitivity,specificity and predictive values were observed for the BMI-MNA-SF and CC-MNA-SF against the full MNA(R) as the dichotomized categorizations "malnourished-at risk of malnutrition" vs "well nourished" and "malnourished" vs "at risk of malnutrition-well nourished" were considered.Most of values of those for CC-MNA-SF are lower slightly than BMI-MNA-SF.Areas under the ROC curves also reached high values (BMI-MNA-SF:0.951 and CC-MNA-SF:0.938 for the first categorization;BMI-MNA-SF:1.000 and CC-MNA-SF:0.985 for the second one) showing both tests excellent accuracy with the full-MNA.The agreement between the MNA-SFs and the ful1-MNA was quantified as the percentage of correct classifications.The BMI-MNA-SF classified 83.81％,correctly and the CC-MNA-SF classified 68.57％ correctly.Malnutrition proportions of subjects were not underestimated by both MNA-SFs.Conclusion:The revised BMI-MNA-SF and CC-MNA-SF are rapid、easy and reliable tools are capable to identify malnourished individuals in internal medicine and those who are at risk of malnutrition.Due to the special characteristics of elderly patients,the CC-MNA-SF is a good option to replace the BMI-MNA-SF when BMI is not available.

Objective:To explore the effect of early drinking and eating for gastric cancer patients with multimode health propaganda and education during postoperative Enhanced Recovery After Surgery (ERAS).Methods:Sixty patients who would received radical operation of gastric cancer were randomly divided into two groups:observation group (30 cases) and control group (30 cases).Patients in the observation group were employed the multi-mode health propaganda and education which were guided more detailed and quantitative regimens for early drinking and eating.Patients in the control group were carried out with routine methods.The compliance of postoperative drinking and eating,the rate of complications and patients satisfaction were compared between the two groups.Results:The compliance of postoperative drinking and eating of the observation group was significantly higher than that of the control group.Hospital patient satisfaction in health-education projects (19.50 ± 0.50) of the observation group was significantly higher than that (16.12 ± 3.21) of the control group (P ＜ 0.05).The rate of gastrointestinal complications in the observation patients was significantly lower,compared with that in the control patients (P ＜ 0.05).Conclusion:During the postoperative ERAS for gastric cancer patients,early drinking and eating guided by multi-mode health propaganda and education is safe and effective,for which could increase the postoperative compliance,decrease the rate of complication.It is worth promoting early quantitative drinking and eating after operation.

Objective:To explore the effect of nutritional intervention on nutritional status and acute radiation oral mucositis in patients with head and neck cancer.Methods:Sixty-eight patients with head and neck cancer received radiotherapy were randomly divided into two groups.There were thirty-three patients in nutritional intervention group(NI),the rest for the control group.The nutritional status score (PG-SGA),mean weight,body mass index (BMI)and acute radiation oral mucositis score in the two groups were before radiotherapy,at the end of radiotherapy,one month after radiotherapy were analyzed and compared.There was no significant difference in PG-SGA scores between the two groups before radiotherapy.The PG-SGA scores in NI remained stable,no difference at between each time point.At the end of radiotherapy and 1 month after radiotherapy,the PG-SGA scores in NI were significantly lower than those in CG (P ＜ 0.001,P ＜ 0.05 respectively),while the nutritional status deteriorated in CG and the scores at the end of radiotherapy and one month after radiotherapy were significantly higher than those before radiotherapy(P ＜ 0.001,P ＜ 0.05 respectively).The mean weight in NI remained stable during radiotherapy.At the end of radiotherapy,the mean weight in NI were significantly higher than those in CG (P ＜ 0.001).While the mean weight in CG were in the declining tendency,and at the end of radiotherapy they were significantly lower than those before radiotherapy P ＜ 0.001).The trend of BMI is the same as that of mean weight.There was no significant difference between the two groups in the incidence of severe acute radioactive oral mucosal reaction (1Ⅲ + Ⅳ grade) (P ＞ 0.05).At one month after radiotherapy,the incidence of total acute radiation mucositis (Ⅰ + Ⅱ + Ⅲ + Ⅳ) and severe acute radiation mucositis (Ⅲ + Ⅳ grade)in NI were significantly lower than those in CG(x2=4.556,P ＜ 0.053,P ＜ 0.05;x 2=4.712,P ＜ 0.05,P ＜ 0.05 respectively).Nutritional intervention can effectively maintain the nutritional status of patients received radiotherapy of head and neck cancer,and promote the recovery of acute radiation oral mucositis.

Objective:Based on the evaluation of the disease associated nutrition knowledge,diet attitude and practice (KAP) in patients with liver failure this study aimed to identify factors that correlated with KAP level,and to provide evidence for the disease specific nutritional education programs.Methods:In this study,178 patients with liver failure were randomized selected from a tertiary hospital between October 2015 and February 2017.Liver failure disease associated nutrition knowledge,diet attitude and practice were assessed through questionnaire.Results:The average score of disease nutrition KAP items in patients with liver failure wes (1.56 ± 0.44) points,with the highest average score of diet attitude was (1.80 ± 0.50) and the lowest average score of nutrition knowledge was (1.39 ± 0.60) points.There was a significant negative correlation between the KAP scores and the PG-SGA classification (P ＜ 0.01).Education level,family income,disease status are risk factor of disease nutrition KAP in patients with liver failure.Conclusion:Patients with liver failure are characterized by limited nutritional knowledge,active diet attitude,and moderate diet behavior.The improvement of nutrition knowledge,dietary attitude and behavior level in patients with liver failure is important.Those with lower level of education,lower income and shorter duration of disease should be given more attention.

Objective:NRS 2002 nutritoanl risk assessment and PG-SGA scale were used to evaluate the effect of different nutritional treatments on fibula myocutaneous flap reconstruction of mandibular defect postoperative patients,and to find the appropriate timing and method of nutritional support for this kind of patients.Methods:50 cases of fibula myocutaneous flap reconstruction of mandibular defect postoperative patients were divided into two groups according to the nutritional risk assessment and the opinions of the research team including the mixed nutrition support treatment group (SPNS + EN) and the conventional nutrition support treatment group (TEN).The indexes of the patients on the day before surgery and 1,7,13 postoperative days were monitored,including lymphocyte count (LYM),serum albumin (ALB),hemoglobin (HB),potassium (K),sodium (NA),chloride (CL) and nutritional risk screening score (NRS) and other indicators to evaluate therapeutic effect of two groups.Results:The indicators showed no significant differences in the two groups before operation.For K and Na,the levels of the SPN + EN group was higher than that of the TEN group.Hemoglobin (HB) and NRS score on the 13rd day after surgery were statistically different between the two groups (P ＜ 0.05).Besides,Lymphocyte count (LYM) and chloride (CL) on the 1st and 7th after operation showed significant different,too(P ＜ 0.05).Conclusion:By nutritional risk assessment in patients with NRS 2002 before operation,PG-SGA after operation,we corrected the electrolyte and acid-base imbalance,improved stress state of postoperative patients with adjustment of nutritional therapy and intervention to timely and effectively provide plenty of energy and protein.

Objective:To investigate the effect of bedside ultrasound in measuring the gastric residual volume in postoperative patients with rheumatic heart disease complicated with cachexia with enteral nutrition support.Method:From June 2015 to May 2017,60 patients with rheumatic heart disease complicated with cachexia who admitted in ICU were randomly divided into two groups,group A (routine enteral nutrition plan plus ultrasound monitoring GRV)and group B (routine enteral nutrition plan plus withdraw every 4h to monitor the GRV),to guide the implementation of enteral nutrition.Results:There was significant difference in Hb,TP and ALB levels between the two groups (P ＜0.05).The nutritional status of group A was better than that of group B.The incidence of gastric retention and pulmonary infection in group A was significant lower than group B (P ＜0.05).The length of target feeding time and ICU stay had a statistically difference in group A and group B [(3.02 ± 0.78) d vs (4.89 ± 0.69) d,t=2.278,P=0.019] and [(10.41 ± 1.98) d vs (11.39 ± 1.75) d,t=2.384,P=0.015].Conclusion:The application of bedside ultrasound to monitor the gastric residual volume can be an accurate method to guide enteral nutrition in postoperative patients with rheumatic heart disease complicated with cachexia,which can improve the nutrition status,shorten the length of target feeding time and ICU stay and reduce enteral nutrition-related complications.

Objective:This study aims to characterize the bacterial profile presenting in peripheral blood of severe acute pancreatitis (SAP) patients and investigate the potential role of circulating microorganisms in the development of systemic infection.Methods:A total of 30 patients with SAP were recruited in this study and divided into three groups:infected,sepsis and Septic shock (n =10 for each group).The peripheral blood was collected sterilely for extraction of DNA,which was subsequently amplified using the universe primers targeted the V6-V8 region of 16S ribosomal RNA genes.The amplicons were separated by denaturing gradient gel electrophoresis (DGGE),and then the gels were stained and photographed.The bands were cut out and sequenced to determine the closest bacterial relatives.Results:As shown in DGGE profile,multiple DNA bands (3 to 8 bands) were detected in peripheral blood from all (100％) of SAP patients complicated with septic shock.The microorganisms most frequently presenting in the blood of these cases included Escherichia coli,Bacillus coagulans,Pseudomonas putida,Pseudomonas aeruginosa,and Klebsiella pneumonia,with an incidence of 40 ％ or higher.In patients with sepsis,bacterial DNA consisting of 2 to 4 bands was observed in 90％ of the blood samples.The most common bacterial species was Pseudomonas putida (60％),followed by Shigella flexneri (40％),Staphylococcus aureus (30％) and Enterococcusfaecium (20％).By contrast,the positive rate of blood bacterial DNA was relatively lower in infected patients (70 ％).Of them,single bacterial species was commonly found in the blood samples.Conclusions:Our data showed that the bacterial profiles presenting in peripheral blood are distinct among SAP patients with different manifestations.Polymicrobial translocation could contribute to the development of systemic infection,offering novel insights into the pathogenesis of sepsis in SAE The findings are helpful for the prevention and treatment for bacterial infection and complications of SAP.

Objective:To measure the kinetic parameters of murine plasma albumin synthesis by deuterated water (2H2O).Methods:Twenty SD rats received 2H2O-labelled intraperitoneal injection and drinking.At the end of the 1st,3rd,5th,6th,10th week,every 4 rats was respectively sacrificed by cardiac puncture for blood collection.Plasma albumin was purified by trichloroacetic acid and ethanol,identified by SDS-PAGE and hydrolyzed by hydrochloric acid.The alanine in albumin and plasma was separated,purified and derived.The deuterium enrichments of alanyl unit in albumin and alanine in plasma were determined by GC-MS.The fractional synthesis rate of albumin and synthetic dynamic equation were calculated.Results:The fractional synthesis rate of plasma albumin was 15.3％/w,and synthetic dynamic equation was ft =1.256 × (1-e-0.153t).Conclusion:The kinetic parameters of plasma albumin synthesis can be measured by 2H2O labeling method,which can be applied in the study of physiological and pathological metabolic mechanism.