INTRODUCTION: There is a lack of guidelines or formal systematic synthesis of evidence for nutrition therapy in older critically ill patients. This study is a scoping review to explore the state of evidence in this population. METHOD: MEDLINE and Embase were searched from inception until 9 February 2022 for studies that enrolled critically ill patients aged ≥60 years and investigated any area of nutrition therapy. No language or study design restrictions were applied. RESULTS: Thirty-two studies (5 randomised controlled trials) with 6 topics were identified: (1) nutrition screening and assessments, (2) muscle mass assessment, (3) route or timing of nutrition therapy, (4) determination of energy and protein requirements, (5) energy and protein intake, and (6) pharmaconutrition. Topics (1), (3) and (6) had similar findings among general adult intensive care unit (ICU) patients. Skeletal muscle mass at ICU admission was significantly lower in older versus young patients. Among older ICU patients, low muscularity at ICU admission increased the risk of adverse outcomes. Predicted energy requirements using weight-based equations significantly deviated from indirect calorimetry measurements in older vs younger patients. Older ICU patients required higher protein intake (>1.5g/kg/day) than younger patients to achieve nitrogen balance. However, at similar protein intake, older patients had a higher risk of azotaemia. CONCLUSION Based on limited evidence, assessment of muscle mass, indirect calorimetry and careful monitoring of urea level may be important to guide nutrition therapy in older ICU patients. Other nutrition recommendations for general ICU patients may be used for older patients with sound clinical discretion.
Adult ; Humans ; Aged ; Critical Illness/therapy* ; Enteral Nutrition ; Nutritional Support ; Nutritional Requirements ; Intensive Care Units ; Energy Intake

Tumor invasion and metastasis are regarded as main reasons for the failure of therpy and the reason of patients death.The mechnism of tumor metastasis is still uncertain.The pre-metastatic niche hypothesis provides us with new ideas to discover the mechnism.Numerous materials are involved in the formation of the pre-metastatic niche according to this hypothesis,including bone marrow-derived cells,microvesicles,exosomes,CD44,and so on.A further research on this hypothesis helps to deeply understand the nature of metastasis and leads clinical doctors to explore novel targets for clinical diagnoses and therapies.

OBJECTIVETo explore the clinicopathologic features of CD30-positive sinusoidal large B-cell lymphoma (CD30 + SLBCL) and its relative correlation with Epstein-Barr virus (EBV).

METHODSTwo cases of CD30 + SLBCL, a 65-year-old men and a 85-year-old women were morphologically and immunophenotypically analyzed. EBV status was also evaluated through not only the polymerase chain reaction (PCR) amplification to the EBV Bam HIW DNA sequence, but also an immunohistochemical detection of the latent membrane protein 1 (LMP1).

RESULTSThe patients presented with similarly superficial lymphadenopathy. One of them died of the tumor within 10 months. Microscopically, both of the neoplasms were characterized by a cohesive sinus growth pattern and the monomorphic cytology of the tumor cells. Immunohistochemically, They were both positive for CD45, CD30, and CD20 or CD79alpha, whereas neither expressed EMA, ALK1, nor any histiocytic/T-lineage markers. No evidence of EBV-infection could be found either.

CONCLUSIONSCD30 + SLBCL is a morphologically and immunophenotypically distinctive variant of diffuse large B-cell lymphoma, which should be distinguished from T/null cell type anaplastic large cell lymphoma and some other nodal lesions with a predominantly sinusoidal infiltrative pattern. CD30 + SLBCL may not be correlation with EBV.

Aged ; Aged, 80 and over ; Diagnosis, Differential ; Female ; Humans ; Immunohistochemistry ; Ki-1 Antigen ; analysis ; Lymphoma, B-Cell ; diagnosis ; pathology ; Lymphoma, Large-Cell, Anaplastic ; diagnosis ; pathology ; Male ; Middle Aged

Tissue was obtained from 14 aborted human fetuses, ranging from 13-32 weeks of gestation (wg). The crown-rump length (CR) ranged from 8.3-33 cm. Frontal sections of the specimens were prosessed for SEM and observation were focused on the areas adjacent to the middle part of the calcarine fissure.At 13 wg (CR 8.3 cm), the visual cortex (area 17) was composed of five zones: viz., the ventricular zone, the subventricular zone, the intermediate zone, the cortical plate and the marginal zone. These five zones showed a series of transformations with increasing age. 1) The ventricular zone became progressively thinner, mitotic activity of the ventrieular cells decreased progressively and finally the ventricular ceils differentiated into a single layer of ependymal cells. 2) The subventricular zone and the inter mediated zone were replaced by fiber bundles of white matter. 3) The cortical plate increased in width, exhibited the greatest growth rate, and became differentiated. At 21 wg (CR 20cm), the lower part of the cortical plate first gave rise to laminae VI and V. At 23 wg (CR 22cm), lamina Ⅳ was established in the middle part of cortical plate. At 26 wg (CR 25cm), laminae Ⅲ and Ⅱ could be identified in the upper part of cortical plate. 4) The marginal zone transformed into lamina Ⅰ at its original site.