OBJECTIVETo conduct a systematic review of the safety and efficacy of enhanced recovery after surgery(ERAS) program in perioperative management of pancreaticoduodenectomy.

METHODSA computerized search was performed in databases including PubMed, Embase, Medline, Web of Science, Cochrane Library, CNKI, Wanfang and VIP for randomized controlled trials (RCTs) or clinical controlled trials (CCTs) describing an ERAS program in patients undergoing pancreaticoduodenectomy published between January 1966 and May 2014. After assessment of methodological quality and data extraction, meta-analysis was performed using RevMan 5.2.0 software.

RESULTSSix RCTs and 8 CCTs including 2565 patients were selected for this study, including the study group(n=1366) and the control group (n=1199). Compared with the control group, the study group had a shorter length of hospital stay(WMD=-3.67, 95% CI:-5.66--1.68, P<0.05), lower postoperative complication rate(OR=0.73, 95% CI:0.56-0.95, P<0.05) and lower mortality(OR=0.63, 95% CI:0.44-0.91, P<0.05). However, no significant differences existed in mortality, readmission rate and re-operation rate between the two groups.

CONCLUSIONSEnhanced recovery after surgery programme in perioperative management of pancreaticoduodenectomy is safe and effective. But due to the medium quality of the literature. This still need more rigorously designed RCTs to prove the safety and efficiency of ERAS programme for the patients undergoing pancreaticoduodenectomy.

Humans ; Length of Stay ; Pancreaticoduodenectomy ; Postoperative Complications

OBJECTIVETo study characteristics of energy metabolism in the skeletal muscle of rats with postoperative fatigue syndrome (POFS) and the interventional effect of ginsenoside Rb1.

METHODWe chose resection of 70% of the "middle" small intestine as the rat model for POFS. Ninety-six adult male SPF SD rats were randomly divided into the control group, the model group, and the ginsenoside Rb1-treated group by body weight. And then, each group was further randomly divided into four subgroups, according to different postoperative investigated time points, such as postoperative day 1, postoperative day 3, postoperative day 7 and postoperative day 10. So the animals were divided into twelve subgroups (n = 8 in each subgroup). Rats of the control group and the model group were injected intraperitoneally with saline at the dose of 10 mL x kg(-1) one hour before the operation and once a day during the postoperative days. Rats of the ginsenoside Rb1-treated group were administered 10 mg x kg(-1) ginsenoside Rb1 by the same method. The skeletal muscles were sampled on postoperative day 1, 3, 7 and 10. The contents of ATP, ADP, AMP in skeletal muscles were determined by HPLC, and the activities of Na(+)-K(+)-ATPase and Ca(2+)-ATPase were investigated by colorimetry.

RESULTCompared with the control group, the content of ATP in skeletal muscle of rats of the model group decreased significantly on postoperative day 3 (P < 0.05), while the content of ADP significantly increased on postoperative day 7 and 10 (P < 0.05). The activity of Na(+)-K(+)-AT-Pase decreased on postoperative day 3 and 7 (P < 0.05), and the activity of Ca(2+)-ATPase decreased on postoperative day 7. After supplement of ginsenoside Rb1, on the investigated time points, all the negative changes of the indicators discovered above were significantly adjusted (P < 0.05) in rats of the ginsenoside Rb1-treated group, while no significant differences were investigated.

CONCLUSIONDuring a certain period of postoperative time, the activity of energy metabolism is depressed in the skeletal muscle of rats with POFS, but it can be improved by supplement of ginsenoside Rb1.

Animals ; Calcium-Transporting ATPases ; physiology ; Energy Metabolism ; drug effects ; Fatigue ; drug therapy ; metabolism ; Ginsenosides ; pharmacology ; therapeutic use ; Male ; Muscle, Skeletal ; metabolism ; Postoperative Complications ; drug therapy ; metabolism ; Rats ; Rats, Sprague-Dawley ; Sodium-Potassium-Exchanging ATPase ; physiology ; Syndrome

Postoperative ileus (POI), one of the most common postoperative complications, impacts digestive function through neural reflex and intestine inflammation, and severely influences the therapeutic effect as well as the long-term outcome of the patients. As a major component of comprehensive peri-operative therapies, nutrition support treatment provides necessary daily energy and nutrient support for the patients, effectively prevents POI and promotes digestive motility. Therefore, the authors further elaborate on nutrition support treatment for postoperative ileus based on the latest research worldwide.

The European Society for Clinical Nutrition and Metabolism (ESPEN) online released the latest practical guideline on clinical nutrition in cancer on 15th March, 2021. The new practical guideline is shortened from the ESPEN guideline on nutrition in cancer patients in 2017 for easier use in clinical practice and provides 43 recommendations (without changes compared with the previous guidelines), combined with the diagnosis and treatment flow diagram, on general principles of nutritional therapy for cancer patients and individualized nutritional therapy strategies. Therefore, this new practical guideline is a practical tool for all professionals including physicians, dieticians, nutritionists and nurses in clinical practices.

Malnutrition and dehydration are prevalent in the elderly poplulation, and obesity is also a growing problem, which pose a serious challenge to the nutritional management in geriatrics. In order to better guide clinical practice, the European Society for Clinical Nutrition and Metabolism (ESPEN) published the practical guideline on clinical nutrition and hydration in geria-trics on March 5, 2022. This guideline provides 82 recommendations on clinical nutrition and hydration in geriatrics based on clinical practicability, covering basic problems and general prin-ciples, prevention and treatment of malnutrition/nutri-tional risk, prevention and treatment of specific diseases, as well as prevention and treatment of obesity, along with flow-charts, hoping to be convenient for doctors, nutritionists and nurses to use in clinical practice.

The American Society for Parenteral and Enteral Nutrition (ASPEN) held the annual academic conference online from March 20 to 23,2021. The current hot topics of clinical nutrition were widely discussed on the conference. The authors briefly report and analyze the hot topics of the conference in order to share and exchange with surgical colleagues.

The European Society for Clinical Nutrition and Metabolism held the 43 rd annual academic conference online from September 9 to 14,2021. Based on reports from the con-ference, the authors launched a review on the current hot topics in clinical nutrition.

Cancer cachexia is a complex metabolic syndrome characterized by muscle wasting, fat decomposition, unplanned weight loss, anorexia and immune dysfunction. Cachexia can significantly reduce the efficacy of antitumor therapies and increase treatment-related toxicity on cancer patients. It increases the symptom burden in patients, affects the quality of their life, ultimately shortens patients' survival. Lucubrating the pathogenesis of cachexia is of great significance to provide rationale treatment guidance. Here we reviewed the research progress on pathogenesis of cancer cachexia, including inflammatory response mediated by TNF-α, IL-1, IL-6 and STAT-3 and abnormal nutrition metabolism, as well as mitochondrial dysfunction.

Objective: To investigate the effect of oral nutritional supplements(ONS) on body weight loss and life quality in post-discharge patients with gastric and colorectal cancer. Methods: All the enrolled post-operative gastric or colorectal cancer patients were randomly divided into ONS group and control group. Body weight loss, middle arm circumference, triceps skinfold thickness and right-hand grip strength were measured and the Karnofsky score, ECOG score and QOL score were calculated 3 months after the discharge. Results: The body weight loss of gastric cancer patients was lower in ONS group than in control group since 2 months after discharge.(2 months after discharge: 1.65±2.11vs. 2.70±1.90 kg, t=-2.385 3, P=0.019 3; 3 months after discharge: 1.95±2.75vs. 3.67±2.29 kg, t=-3.134 7, P=0.002 4), There was no difference of body weight loss between two groups in colorectal cancer patients. The middle arm circumference, triceps skinfold thicknessand right-hand grip strength showed no statistic difference between two groups both in gastric and colorectal cancer patients. The Karnofsky score(56.82±13.65%vs. 51.71±9.72%, t=2.014 8, P=0.047 2) and QOL score(41.91±6.92 vs. 38.39±8.77, t=2.059 7, P=0.042 6) were higher in ONS group than in control group in gastric cancer patients. While all 3 types of scores had no difference between two groups in colorectal cancer patients. Conclusion ONS can efficiently reduce the body weight loss and improve the performance status and life qualityin post-discharge gastric cancer patients, but not in colorectal cancer patients.

Malnutrition is closely related to clinical outcomes and accurate evaluation of nutritional status is the cornerstone of nutritional therapy. However, consistent diagnostic criteria for malnutrition have been absent for quite a long period. The Global Leadership Initiative on Malnutrition (GLIM) criteria were introduced in September 2018 and served as a consensus-based evaluation tool. As per GLIM criteria, evaluation of malnutrition should follow a two-step approach with nutritional screening as the first step and then malnutrition diagnosis assessment and severity grading based on etiologic as well as phenotypic metrics. Since debut, GLIM criteria have been applied in different countries, healthcare settings and populations, showing good accuracy and prognostic value for outcomes such as complications and survival. However, most of the studies are retrospective in nature and high-quality prospective studies are needed to better validate GLIM criteria. The way to steer nutritional interventions based on GLIM criteria is also worth future investigation.