1.Plumbagin ameliorates pulmonary fibrosis by modulating TGF-β1/Smad2 and Nrf2/NOX4 pathways
Hui LI ; Hengzhao HU ; Tingting YU ; Huixian HU ; Jiale WANG ; Jing WU ; Wei HAO
Chinese Journal of Clinical Pharmacology and Therapeutics 2025;30(1):61-69
AIM:To investigate the protective ef-fect of plumbagin(PL)against pulmonary fibrosis(PF)and its possible mechanisms.METHODS:Sixty male C57BL/6 mice were randomly divided into control,bleomycin group(BLM),low dose PL group(1 mg/kg)and high dose PL group(2 mg/kg).The mice PF model was replicated using intratracheal injection of BLM(3 mg/kg),and then PL(1 or 2 mg/kg)was injected intraperitoneally for 3 weeks and the animals were executed.HE and Masson staining were used to observe morphological changes in lung tissue and collagen deposition.The activities or levels of superoxide dismutase(SOD),glutathione(GSH),malondialdehyde(MDA)and hy-droxyproline(HYP)were measured in mouse lung tissue;ELISA for interleukin-6(IL-6)in mouse lung tissue.Immunohistochemical detection of nuclear factor-related factor 2(Nrf2)and reduced nicotin-amide adenine dinucleotide phosphate oxidase 4(NOX4)positive cell expression in mouse lung tis-sue.The expression levels of α-smooth muscle ac-tin(α-SMA),collagen Ⅰ(Col Ⅰ),collagen Ⅲ(Col Ⅲ),IL-6,transforming growth factor-β1(TGF-β1),p-Smad2,Nrf2 and NOX4 were detected by Western blotting.RESULTS:Compared with the BLM group,PL treatment attenuated lung parenchymal and in-terstitial injury and extracellular matrix deposition in mice,reduced HYP content(P<0.01,P<0.05),de-creased protein expression of α-SMA,collagen Ⅰand Ⅲ(P<0.01,P<0.05),diminished IL-6 secretion(P<0.01);improved the body's antioxidant capacity(increased SOD and GSH activity and decreased MDA content,P<0.01,P<0.05),significantly down-regulated TGF-β1,p-Smad2 and NOX4-positive cells and protein expression(P<0.01,P<0.05)and up-regulated Nrf2-positive cells and protein expression(P<0.01,P<0.05).CONCLUSION:PL may slow down the PF process by modulating the TGF-β1/Smad2 and Nrf2/NOX4 pathways to attenuate inflammato-ry responses and collagen deposition and improve the body's antioxidant capacity.
2.Identification of shared key genes and pathways in osteoarthritis and sarcopenia patients based on bioinformatics analysis.
Yuyan SUN ; Ziyu LUO ; Huixian LING ; Sha WU ; Hongwei SHEN ; Yuanyuan FU ; Thainamanh NGO ; Wen WANG ; Ying KONG
Journal of Central South University(Medical Sciences) 2025;50(3):430-446
OBJECTIVES:
Osteoarthritis (OA) and sarcopenia are significant health concerns in the elderly, substantially impacting their daily activities and quality of life. However, the relationship between them remains poorly understood. This study aims to uncover common biomarkers and pathways associated with both OA and sarcopenia.
METHODS:
Gene expression profiles related to OA and sarcopenia were retrieved from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) between disease and control groups were identified using R software. Common DEGs were extracted via Venn diagram analysis. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted to identify biological processes and pathways associated with shared DEGs. Protein-protein interaction (PPI) networks were constructed, and candidate hub genes were ranked using the maximal clique centrality (MCC) algorithm. Further validation of hub gene expression was performed using 2 independent datasets. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of key genes for OA and sarcopenia. Mouse models of OA and sarcopenia were established. Hematoxylin-eosin and Safranin O/Fast Green staining were used to validate the OA model. The sarcopenia model was validated via rotarod testing and quadriceps muscle mass measurement. Real-time reverse transcription PCR (real-time RT-PCR) was employed to assess the mRNA expression levels of candidate key genes in both models. Gene set enrichment analysis (GSEA) was conducted to identify pathways associated with the selected shared key genes in both diseases.
RESULTS:
A total of 89 common DEGs were identified in the gene expression profiles of OA and sarcopenia, including 76 upregulated and 13 downregulated genes. These 89 DEGs were significantly enriched in protein digestion and absorption, the PI3K-Akt signaling pathway, and extracellular matrix-receptor interaction. PPI network analysis and MCC algorithm analysis of the 89 common DEGs identified the top 17 candidate hub genes. Based on the differential expression analysis of these 17 candidate hub genes in the validation datasets, AEBP1 and COL8A2 were ultimately selected as the common key genes for both diseases, both of which showed a significant upregulation trend in the disease groups (all P<0.05). The value of area under the curve (AUC) for AEBP1 and COL8A2 in the OA and sarcopenia datasets were all greater than 0.7, indicating that both genes have potential value in predicting OA and sarcopenia. Real-time RT-PCR results showed that the mRNA expression levels of AEBP1 and COL8A2 were significantly upregulated in the disease groups (all P<0.05), consistent with the results observed in the bioinformatics analysis. GSEA revealed that AEBP1 and COL8A2 were closely related to extracellular matrix-receptor interaction, ribosome, and oxidative phosphorylation in OA and sarcopenia.
CONCLUSIONS
AEBP1 and COL8A2 have the potential to serve as common biomarkers for OA and sarcopenia. The extracellular matrix-receptor interaction pathway may represent a potential target for the prevention and treatment of both OA and sarcopenia.
Sarcopenia/genetics*
;
Osteoarthritis/genetics*
;
Computational Biology/methods*
;
Humans
;
Protein Interaction Maps/genetics*
;
Animals
;
Mice
;
Gene Expression Profiling
;
Gene Ontology
;
Transcriptome
;
Male
;
Signal Transduction/genetics*
;
Gene Regulatory Networks
3.Mechanism by which mechanical stimulation regulates chondrocyte apoptosis and matrix metabolism via primary cilia to delay osteoarthritis progression.
Huixian LING ; Sha WU ; Ziyu LUO ; Yuyan SUN ; Hongwei SHEN ; Haiqi ZHOU ; Yuanyuan FU ; Wen WANG ; Thai Namanh NGO ; Ying KONG
Journal of Central South University(Medical Sciences) 2025;50(5):864-875
OBJECTIVES:
Osteoarthritis (OA) is one of the most common chronic degenerative diseases, with chondrocyte apoptosis and extracellular matrix (ECM) degradation as the major pathological changes. The mechanical stimulation can attenuate chondrocyte apoptosis and promote ECM synthesis, but the underlying molecular mechanisms remain unclear. This study aims to investigate the role of primary cilia (PC) in mediating the effects of mechanical stimulation on OA progression.
METHODS:
In vivo, conditional knockout mice lacking intraflagellar transport 88 (IFT88flox/flox IFT88 knockout; i.e., primary cilia-deficient mice) were generated, with wild-type mice as controls. OA models were established via anterior cruciate ligament transection combined with destabilization of the medial meniscus, followed by treadmill exercise intervention. OA progression was evaluated by hematoxylin-eosin staining, safranin O-fast green staining, and immunohistochemistry; apoptosis was assessed by TUNEL staining; and limb function by rotarod testing. In vitro, primary articular chondrocytes were isolated from mice and transfected with lentiviral vectors to suppress IFT88 expression, thereby constructing a primary cilia-deficient cell model. Interleukin-1β (IL-1β) was used to induce an inflammatory environment, while cyclic tensile strain (CTS) was applied via a cell stretcher to mimic mechanical loading on chondrocytes. Immunofluorescence and Western blotting were used to detect the protein expression levels of type II collagen α1 chain (COL2A1), primary cilia, IFT88, and caspase-12; reverse transcription polymerase chain reaction was performed to assess COL2A1 mRNA levels; and flow cytometry was used to evaluate apoptosis.
RESULTS:
In vivo, treadmill exercise significantly reduced Osteoarthritis Research Society International (OARSI) scores and apoptotic cell rates, and improved balance ability in wild-type OA mice, whereas IFT88-deficient OA mice showed no significant improvement. In vitro, CTS inhibited IL-1β-induced ECM degradation and apoptosis in primary chondrocytes; however, this protective effect was abolished in cells with suppressed primary cilia expression.
CONCLUSIONS
Mechanical stimulation delays OA progression by mediating signal transduction through primary cilia, thereby inhibiting cartilage degeneration and chondrocyte apoptosis.
Animals
;
Chondrocytes/cytology*
;
Apoptosis/physiology*
;
Mice
;
Cilia/metabolism*
;
Osteoarthritis/pathology*
;
Extracellular Matrix/metabolism*
;
Mice, Knockout
;
Disease Progression
;
Interleukin-1beta
;
Male
;
Cells, Cultured
4.Plumbagin ameliorates pulmonary fibrosis by modulating TGF-β1/Smad2 and Nrf2/NOX4 pathways
Hui LI ; Hengzhao HU ; Tingting YU ; Huixian HU ; Jiale WANG ; Jing WU ; Wei HAO
Chinese Journal of Clinical Pharmacology and Therapeutics 2025;30(1):61-69
AIM:To investigate the protective ef-fect of plumbagin(PL)against pulmonary fibrosis(PF)and its possible mechanisms.METHODS:Sixty male C57BL/6 mice were randomly divided into control,bleomycin group(BLM),low dose PL group(1 mg/kg)and high dose PL group(2 mg/kg).The mice PF model was replicated using intratracheal injection of BLM(3 mg/kg),and then PL(1 or 2 mg/kg)was injected intraperitoneally for 3 weeks and the animals were executed.HE and Masson staining were used to observe morphological changes in lung tissue and collagen deposition.The activities or levels of superoxide dismutase(SOD),glutathione(GSH),malondialdehyde(MDA)and hy-droxyproline(HYP)were measured in mouse lung tissue;ELISA for interleukin-6(IL-6)in mouse lung tissue.Immunohistochemical detection of nuclear factor-related factor 2(Nrf2)and reduced nicotin-amide adenine dinucleotide phosphate oxidase 4(NOX4)positive cell expression in mouse lung tis-sue.The expression levels of α-smooth muscle ac-tin(α-SMA),collagen Ⅰ(Col Ⅰ),collagen Ⅲ(Col Ⅲ),IL-6,transforming growth factor-β1(TGF-β1),p-Smad2,Nrf2 and NOX4 were detected by Western blotting.RESULTS:Compared with the BLM group,PL treatment attenuated lung parenchymal and in-terstitial injury and extracellular matrix deposition in mice,reduced HYP content(P<0.01,P<0.05),de-creased protein expression of α-SMA,collagen Ⅰand Ⅲ(P<0.01,P<0.05),diminished IL-6 secretion(P<0.01);improved the body's antioxidant capacity(increased SOD and GSH activity and decreased MDA content,P<0.01,P<0.05),significantly down-regulated TGF-β1,p-Smad2 and NOX4-positive cells and protein expression(P<0.01,P<0.05)and up-regulated Nrf2-positive cells and protein expression(P<0.01,P<0.05).CONCLUSION:PL may slow down the PF process by modulating the TGF-β1/Smad2 and Nrf2/NOX4 pathways to attenuate inflammato-ry responses and collagen deposition and improve the body's antioxidant capacity.
5.Compound Yuye Decoction protects diabetic rats against cardiomyopathy by inhibiting myocardial apoptosis and inflammation via regulating the PI3K/Akt signaling pathway
Wenxiang ZHANG ; Huixian GU ; Pengde CHEN ; Siyu WU ; Hongyan MA ; Lan YAO
Journal of Southern Medical University 2024;44(7):1306-1314
Objective To explore the therapeutic mechanism of compound Yuye Decoction against diabetic cardiomyopathy(DCM).Methods Drugbank,Gene Cards,OMIM and PharmGKb databases were used to obtain DCM-related targets,and the core targets were identified and functionally annotated by protein-protein interaction network analysis followed by GO and KEGG enrichment analysis.The"Traditional Chinese Medicine-Key Component-Key Target-Key Pathway"network was constructed using Cytoscape 3.9.1,and molecular docking was carried out for the key components and the core targets.In the animal experiment,Wistar rat models of DCM were treated with normal saline or Yuye Decoction by gavage at low(0.29 g/kg)and high(1.15 g/kg)doses for 8 weeks,and the changes in cardiac electrophysiology and histopathology were evaluated.The changes in serum levels of LDH,CK,and CK-MB were examined,and myocardial expressions of PI3K,P-PI3K,Akt,P-AKT,BAX,IL-6,and TNF-α were detected using Western blotting.Results We identified 61 active compounds in Yuye Decoction with 1057 targets,3682 DCM-related disease targets,and 551 common targets between them.Enrichment of the core targets suggested that apoptosis,inflammation and the PI3K/Akt pathways were the key signaling pathways for DCM treatment.Molecular docking studies showed that the active components in Yuye Decoction including gold amidohydroxyethyl ester and kaempferol had strong binding activities with AKT1 and PIK3R1.In DCM rat models,treatment with Yuye Decoction significantly alleviated myocardial pathologies,reduced serum levels of LDH,CK and CK-MB,lowered myocardial expressions of BAX,IL-6 and TNF-α,and increased the expressions of P-PI3K and P-AKT.Conclusion The therapeutic effect of compound Yuye Decoction against DCM is mediated by its multiple active components that act on multiple targets and pathways to inhibit cardiomyocyte apoptosis and inflammatory response by regulating the PI3K/Akt signaling pathway.
6.Compound Yuye Decoction protects diabetic rats against cardiomyopathy by inhibiting myocardial apoptosis and inflammation via regulating the PI3K/Akt signaling pathway
Wenxiang ZHANG ; Huixian GU ; Pengde CHEN ; Siyu WU ; Hongyan MA ; Lan YAO
Journal of Southern Medical University 2024;44(7):1306-1314
Objective To explore the therapeutic mechanism of compound Yuye Decoction against diabetic cardiomyopathy(DCM).Methods Drugbank,Gene Cards,OMIM and PharmGKb databases were used to obtain DCM-related targets,and the core targets were identified and functionally annotated by protein-protein interaction network analysis followed by GO and KEGG enrichment analysis.The"Traditional Chinese Medicine-Key Component-Key Target-Key Pathway"network was constructed using Cytoscape 3.9.1,and molecular docking was carried out for the key components and the core targets.In the animal experiment,Wistar rat models of DCM were treated with normal saline or Yuye Decoction by gavage at low(0.29 g/kg)and high(1.15 g/kg)doses for 8 weeks,and the changes in cardiac electrophysiology and histopathology were evaluated.The changes in serum levels of LDH,CK,and CK-MB were examined,and myocardial expressions of PI3K,P-PI3K,Akt,P-AKT,BAX,IL-6,and TNF-α were detected using Western blotting.Results We identified 61 active compounds in Yuye Decoction with 1057 targets,3682 DCM-related disease targets,and 551 common targets between them.Enrichment of the core targets suggested that apoptosis,inflammation and the PI3K/Akt pathways were the key signaling pathways for DCM treatment.Molecular docking studies showed that the active components in Yuye Decoction including gold amidohydroxyethyl ester and kaempferol had strong binding activities with AKT1 and PIK3R1.In DCM rat models,treatment with Yuye Decoction significantly alleviated myocardial pathologies,reduced serum levels of LDH,CK and CK-MB,lowered myocardial expressions of BAX,IL-6 and TNF-α,and increased the expressions of P-PI3K and P-AKT.Conclusion The therapeutic effect of compound Yuye Decoction against DCM is mediated by its multiple active components that act on multiple targets and pathways to inhibit cardiomyocyte apoptosis and inflammatory response by regulating the PI3K/Akt signaling pathway.
7.Personalized glycemic management for patients with diabetic ketoacidosis based on machine learning
Ruirui WANG ; Lijuan WU ; Huixian LI ; Xin LI
Chinese Critical Care Medicine 2024;36(6):635-642
Objective:To explore the optimal blood glucose-lowering strategies for patients with diabetic ketoacidosis (DKA) to enhance personalized treatment effects using machine learning techniques based on the United States Critical Care Medical Information Mart for Intensive Care-Ⅳ(MIMIC-Ⅳ).Methods:Utilizing the MIMIC-Ⅳ database, the case data of 2 096 patients with DKA admitted to the intensive care unit (ICU) at Beth Israel Deaconess Medical Center from 2008 to 2019 were analyzed. Machine learning models were developed, and receiver operator characteristic curve (ROC curve) and precision-recall curve (PR curve) were plotted to evaluate the model's effectiveness in predicting four common adverse outcomes: hypoglycemia, hypokalemia, reductions in Glasgow coma scale (GCS), and extended hospital stays. The risk of adverse outcomes was analyzed in relation to the rate of blood glucose decrease. Univariate and multivariate Logistic regression analyses were conducted to examine the relationship between relevant factors and the risk of hypokalemia. Personalized risk interpretation methods and predictive technologies were applied to individualize the analysis of optimal glucose control ranges for patients.Results:The machine learning models demonstrated excellent performance in predicting adverse outcomes in patients with DKA, with areas under the ROC curve (AUROC) and 95% confidence interval (95% CI) for predicting hypoglycemia, hypokalemia, GCS score reduction, and extended hospital stays being 0.826 (0.803-0.849), 0.850 (0.828-0.870), 0.925 (0.903-0.946), and 0.901 (0.883-0.920), respectively. Analysis of the relationship between the rate of blood glucose reduction and the risk of four adverse outcomes showed that a maximum glucose reduction rate > 6.26 mmol·L -1·h -1 significantly increased the risk of hypoglycemia ( P < 0.001); a rate > 2.72 mmol·L -1·h -1 significantly elevated the risk of hypokalemia ( P < 0.001); a rate > 5.53 mmol·L -1·h -1 significantly reduced the risk of GCS score reduction ( P < 0.001); and a rate > 8.03 mmol·L -1·h -1 significantly shortened the length of hospital stay ( P < 0.001). Multivariate Logistic regression analysis indicated significant correlations between maximum bicarbonate levels, blood urea nitrogen levels, and total insulin doses with the risk of hypokalemia (all P < 0.01). In terms of establishing personalized optimal treatment thresholds, assuming optimal glucose reduction thresholds for hypoglycemia, hypokalemia, GCS score reduction, and extended hospital stay were x1, x2, x3, x4, respectively, the recommended glucose reduction rates to minimize the risks of hypokalemia and hypoglycemia should be ≤min{ x1, x2}, while those to reduce GCS score decline and extended hospital stay should be ≥ max{ x3, x4}. When these ranges overlap, i.e., max{ x3, x4} ≤ min{ x1, x2}, this interval was the recommended optimal glucose reduction range. If there was no overlap between these ranges, i.e., max{ x3, x4} > min{ x1, x2}, the treatment strategy should be dynamically adjusted considering individual differences in the risk of various adverse outcomes. Conclusion:The machine learning models shows good performance in predicting adverse outcomes in patients with DKA, assisting in personalized blood glucose management and holding important clinical application prospects.
8.Prokaryotic expression and purification of the transcription factor TaNAC14 in wheat (Triticum aestivum).
Zhijun CHEN ; Lijian ZHANG ; Qing CHI ; Baowei WU ; Lanjiya AO ; Huixian ZHAO
Chinese Journal of Biotechnology 2024;40(11):4171-4182
The transcription factors (TFs) in the NAC family are involved in regulating multiple biological processes, playing an important role in plant growth, development, and stress adaptation. Our previous studies have demonstrated that TaNAC14, a member of the NAC family in wheat (Triticum aestivum L.), positively regulates root growth and development and enhances the drought tolerance of wheat seedlings. In this study, we analyzed the physicochemical properties and structure and verified the subcellular localization and transcriptional activation activity of TaNAC14. The prokaryotic expression vector pET21a-HMT-TaNAC14 was constructed and transformed into Escherichia coli BL21 CodonPlus (DE3)-RIPL. The conditions for inducing the expression of the recombinant protein HMT-TaNAC14 were optimized. The solubility of the recombinant protein was analyzed, and the protein was purified by affinity chromatography on a Ni-nitrilotriacetic acid column. The results indicated that TaNAC14 had a conserved domain of the NAM family. It was located in the nucleus and had transcriptional activation activity. The optimal conditions for expression of the recombinant protein in E. coli were induction with 0.2mmol/L IPTG for 4 h. The recombinant protein mainly existed in the soluble form, and the target protein was obtained after purification. This study lays a foundation for the identification of target genes regulated by TaNAC14.
Triticum/metabolism*
;
Escherichia coli/metabolism*
;
Plant Proteins/metabolism*
;
Transcription Factors/metabolism*
;
Recombinant Proteins/metabolism*
;
Genetic Vectors/genetics*
9.Antitumor effect and mechanism of total alkaloids of Gelsemium elegans and sempervirine in vitro
Huixian CHEN ; Wenyi WANG ; Xinghui TAN ; Gaopan LI ; Xiaoqiong ZHANG ; Desen LI ; Shuisheng WU
China Pharmacy 2023;34(12):1437-1442
OBJECTIVE To explore the antitumor effect and mechanism of total alkaloids of Gelsemium elegans (TA) and sempervirine (SPV) in vitro. METHODS The effects of low, medium and high concentrations of TA (50, 100, 200 μg/mL) and SPV (10, 30, 50 μmol/L) on the morphology of human hepatoma cells (HepG2, Bel-7402), human lung cancer cells (A549) and human colon cancer cells (HCT-8) were observed, and the toxicity of TA and SPV to four tumor cells was monitored. The effects of TA and SPV on the contents of caspase-3 and caspase-9 in the supernatant of HCT-8 cells, the protein expressions of phosphorylated protein kinase B (p-Akt) (Thr308, Ser473), B-cell lymphoma 2 (Bcl-2), Bcl-2-related X protein (Bax), survivin, C/EBP-homologous protein (CHOP), immunoglobulin binding protein (Bip) and microtubule-associated protein 1 light chain 3Ⅱ (LC3Ⅱ) in HCT-8 cells were detected. RESULTS After the intervention of TA and SPV, the volume reduction and nuclear shrinkage were founded in four tumor cells; the cell activity decreased to varying degrees, among which TA and SPV had the best inhibitory effect on HCT-8 cells. After the intervention of TA and SPV, the contents of caspase-3 and caspase-9 in the supernatant of HCT-8 cells, the protein expressions of Bax, CHOP, Bip and LC3Ⅱ all increased to different degrees, while the protein expressions of p-Akt (Thr308, Ser473), Bcl-2 and survivin in HCT-8 cells all decreased to different degrees. CONCLUSIONS TA and SPV have inhibitory effects on the above four tumor cells, and the inhibitory effect on HCT-8 cells is the best. The mechanism of their action on HCT-8 cells may be related to promoting apoptosis, activating endoplasmic reticulum stress and autophagy.
10.Relationship between GNRI and perioperative rehabilitation of elderly patients with gastric cancer
Hanhan Wu ; Jianhua Jiang ; Jing Cheng ; Yunshan Fan ; Lili Hou ; Shixia Guan ; Le Yang ; Shuang Zu ; Huixian Li ; Bao Zhang ; Anla Hu
Acta Universitatis Medicinalis Anhui 2022;57(11):1816-1820
Objective :
To explore the relationship between geriatric nutritional risk index( GNRI) and perioperative nutritional status,postoperative recovery and complications in elderly patients with gastric cancer.
Methods :
In this retrospective study,212 elderly patients ( aged ≥60 years ) with gastric cancer who underwent gastrectomy were recruited.GNRI was used to retrospectively assess the patients' preoperative nutritional status ,and analyze the relationship between GNRI and perioperative nutritional status,postoperative recovery and complications.The ROC curve was applied to explore the value of GNRI in predicting postoperative complications.
Results :
The inci- dence of preoperative nutritional risk in elderly patients undergoing gastric cancer surgery was 45. 07%.Compared with the patients whose GNRI>98 points,the patients whose GNRI≤98 points had different degrees of decrease in serum total protein,albumin,prealbumin,hemoglobin and lymphocyte counts before surgery,day 1 and day 5-8 after surgery (P <0. 05) .The patients whose GNRI <92 points had longer postoperative hospital stay than those with GNRI>98 points (P<0. 05) .With the decrease of GNRI scores,the incidence of complications showed an upward trend(P<0. 001) .The multivariate analysis of the relationship between GNRI and postoperative complica- tions showed that TNM staging of III -IV and GNRI <92 points were independent risk factors for complications. GNRI had a good predictive value for the occurrence of complications (AUC = 0. 639,95% CI : 0. 570-0. 703,P = 0. 001,Cut-off value : 92. 21) .
Conclusion
GNRI can be used for preoperative nutritional assessment for eld- erly gastric cancer patients.Patients with GNRI<92. 21 points should be actively given nutritional therapy to im- prove perioperative nutritional status,speed up postoperative recovery,and reduce the occurrence of complications.


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