Objective:To evaluate the effects of glutamine-enriched parenteral nutrition on short-term postoperative outcomes compared with conventional nutritional support in colorectal cancer patients with enteral nutrition intolerance after surgery.Method:A retrospective cohort study was conducted to collect clinical data from colorectal cancer patients who underwent radical resection at the Department of Gastrointestinal Surgery of Zunyi Medical University Affiliated Hospital from January 2019 to December 2021.The differences in postoperative complication rates,perioperative nutritional indicators,and inflammatory factors between the two groups were analyzed.SPSS 29.0 software was used for statistical analysis.Result:Based on whether glutamine was added to parenteral nutrition,178 patients were divided into a control group(conventional nutritional therapy,n=120)and an observation group(glutamine enhanced nutritional therapy,n=58).The incidence of postoperative complications(Clavien Dindo grade≥III)in the control and observation groups was 14.17%(17/120)and 3.45%(2/58),respectively,with a statistically significant difference(P=0.030).The observation group recovered faster than the control group in terms of time to first expectoration,defecation and intake of liquid diet after surgery,and had a shorter hospital stay after surgery(P<0.05).However,there was no significant difference in the 30-day readmission rate between the two groups(P=0.393).There was no statistically significant difference in the changes in total protein,albumin,pre-albumin,neutrophil/lymphocyte ratio and endogenous creatinine clearance rate between the two groups of patients after surgery(P>0.05).There were also significant differences in the changes in lymphocyte count,white blood cell count,neutrophil percentage,alanine aminotransferase,aspartate aminotransferase,total bilirubin,and urea nitrogen levels between the two groups of patients after surgery(P<0.05).Conclusion:Compared with regular nutritional support,postoperative parenteral glutamine supplementation can reduce the incidence of postoperative complications in colorectal cancer patients,promote recovery of bowel function,shorten postoperative hospital stay,improve patient immune function and reduce inflammatory levels.

Objective:To study the effects of parenteral nutrition containing ω-3 fish oil fat emulsion on the inflammatory status of patients with intestinal fistula at the early stage.Methods:A retrospective analysis was conducted on 28 patients with intestinal fistula who were admitted to the Sixth Department of General Surgery of Anhui Provincial Second People's Hospital from November 2023 to May 2024.The patients were either divided into control group(n=15,parenteral nutrition alone group)or study group(n=13,parenteral nutrition plus ω-3 fish oil fat emulsion)according to whether ω-3 fish oil fat emulsion was added to parenteral nutrition.Both groups of patients received parenteral nutrition support treatment,and the study group was given ω-3 fish oil fat emulsion during treatment.The general information,inflammatory factors in the blood,nutrition,and immune status of two groups of patients were collected and compared.The feces samples on the first and 14th day of admission were collected and analyzed by 16S rRNA high-throughput sequencing of gut microbiota.Results:There was no statistically significant difference in the general information,inflammation,nutrition,immune status,and gut microbiota between the two groups of patients on the first day of admission(P>0.05),indicating comparability between the two groups.After two weeks of parenteral nutrition support,the counts of red blood cells,white blood cells,platelets,lymphocytes,and levels of C-reactive protein,glutamate-pyruvate transaminase,aspartate aminotransferase,total bilirubin,direct bilirubin,total protein,albumin,and creatinine in the research group were similar to those in the control group without statistically significant differences(P>0.05).However,the counts of neutrophils and levels of blood urea nitrogen in the study group were significantly lower than those in the control group(P=0.03 and P=0.01).In addition,the abundance of intestinal flora in the study group was significantly higher than that in the control group(P<0.05).At the genus level,the abundance of Bacteroides_uniformis,Parabacteroides_merdae,Alistipes_finegoldii,Streptococcus_constellatus,Christensenella_minuta were different between the two groups after two weeks of treatment(P<0.05).Conclusion:Parenteral nutrition containing ω-3 fish oil fat emulsion can reduce the counts of neutrophils,which may alleviate inflammatory responses for patients with intestinal fistula at the early stage.

Objective:To investigate the nutritional risk status of children in PICU and analyze its influencing factors.Methods:From July 2021 to February 2023,all children aged 1 to 18 years admitted to PICU of Beijing Children's Hospital were investigated by using the pediatric Yorkhill Malnutrition Scoring tool(PYMS)and the clinical data questionnaire.Results:A total of 492 children in PICU were enrolled.The first nutritional risk screening results showed that there were 32 cases of no/low nutritional risk(6.5%),76 cases of medium risk(15.4%),and 384 cases of high risk(78.1%).The incidence of medium/high nutritional risk was as high as 93.5%.The PYMS score of nutritional risk in PICU was(2.61±1.42).The results of multiple linear regression analysis showed that weight,fever time before admission,white blood cells,body mass index,primary diagnosis,father's education,and diet before illness were the main influencing factors of nutritional risk of children in PICU(P<0.05).Conclusion:Children in PICU are in a state of high nutritional risk.It is suggested that children in PICU should carry out nutritional screening in a standardized manner,identify children with high nutritional risk and its influencing factors early.To actively conduct nutritional assessment and nutritional intervention could improve the clinical outcome of children in PICU.

Objective:To explore the application effect of early enteral nutrition combined with optimized blood glucose management in patients with stress hyperglycemia after cardiac surgery.Methods:A study was conducted to construct an early enteral nutrition and blood glucose optimization management plan for patients with stress hyperglycemia after cardiac surgery.A prospective analysis was conducted from May 2022 to May 2023 in the Cardiothoracic Surgery Intensive Care Unit(CICU)of a tertiary hospital in Shanghai.200 patients with stress hyperglycemia after cardiac surgery were divided into control group(n=100)and observation group(n=100)by random number table method.The control group received routine enteral nutrition and blood glucose management plan,while the observation group received early enteral nutrition combined with blood glucose optimization management plan.Nutrition related outcome indicators,blood glucose management quality indicators,and patient prognosis indicators were compared between two groups of patients.Results:After implementing the early enteral nutrition combined with optimized blood glucose management plan,the nutritional indicators(serum prealbumin,hemoglobin,and 7-day calorie compliance rate)of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05);The maximum blood glucose fluctuation amplitude,insulin use time,and incidence of hypoglycemia in the observation group were significantly lower than those in the control group(P<0.05),and the time within the glucose target range was significantly higher than that in the control group,with statistical significance(P<0.05);The mechanical ventilation time,ICU stay time,and total hospital stay in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusions:Early enteral nutrition combined with optimized blood glucose management can effectively improve the nutritional status of patients with stress hyperglycemia after cardiac surgery,reduce blood glucose fluctuations,improve blood glucose management quality,and promote patient outcomes and prognosis.

Objective:Postoperative inflammatory ileus(PII)is characterized by prolonged re-obstruction following temporary defecation after surgery.Small intestinal fistula resection(SIFE)in patients with severe abdominal adhesions may increase the risk of PII,particularly in those with oligomyosis.The ratio of visceral fat area(VFA)to total abdominal muscle area index(TAMAI)is thought to be associated with chronic inflammation and may negatively impact the recovery of intestinal motility after abdominal surgery.This study aims to evaluate the predictive value of VFA/TAMAI for postoperative PII in patients undergoing SIFE.Methods:Sarcopenic patients who underwent SIFE at Jinling Hospital between January 2016 and October 2022 were enrolled.Preoperative and intraoperative characteristics were analyzed.VFA/TAMAI was assessed as a potential risk factor for PII using regression analysis.Results:A total of 132 eligible patients(79 males[59.8%])with a median age of 52 years(interquartile range[IQR]:39～61 years)were included.Of these,18.2%(n=24)developed PII.Temporary defecation occurred 4 days after SIFE(IQR:2～5 days)and lasted for 2 days(IQR:1～2 days).Re-obstruction persisted for a median duration of 21 days(IQR:19～27 days)after temporary defecation.VFA/TAMAI was significantly associated with PII(OR=3.89,95%CI:1.88～7.92,P<0.001)and recovery of digestive tract function(HR=0.81,95%CI:0.65～0.99,P=0.04).Conclusion:VFA/TAMAI is associated with postoperative PII in sarcopenic patients with severe abdominal adhesions following SIFE.

Objective:To evaluate the effect of dietary adjustment guided by body composition analysis on blood glucose,,blood lipids,weight gain and pregnancy outcome in patients with gestational diabetes mellitus(GDM).Methods:A total of 122 GDM patients who had regular prenatal check-ups and gave birth at Wenzhou People's Hospital from May 2021 to October 2023 were selected as the research subjects and were randomly divided into Group A and Group B,with 61 cases in each group.Group A was given routine nutritional intervention with GDM,and Group B was adjusted their dietary structure based on body composition analysis.Another 50 normal pregnant women were selected as the control group.Three groups were compared for blood glucose,lipids,and body mass growth and pregnancy outcomes.Results:After intervention,the levels of FPG and 2hPG in the three groups were significantly decreased,while the levels of TC,TG,and LDL-C were significantly increased;The HbA1c levels in Group A and Group B were decreased significantly,while the HDL-C levels in the control group were significantly increased(P<0.05).After intervention,the levels of FPG,2hPG,HbA1c,TC,TG,and LDL-C in Group A were significantly higher than those in Group B and the control group(P<0.05).After intervention,the levels of FPG,TC,and LDL-C in group B were significantly higher than those in the control group(P<0.05).The predelivery body mass and increased body mass during pregnancy in Group A and Group B were significantly higher than those in the control group,while Group B was significantly lower than Group A(P<0.05).There was no significant difference in the compliance rate of body mass increase during pregnancy between the control group and group B(P>0.05),but both groups were significantly higher than group A(P<0.05).There was no significant difference in the cesarean section rate,pregnancy complications,and overall incidence of adverse perinatal outcomes between the control group and group B(P>0.05),but they were significantly lower than group A(P<0.05).Conclusion:Dietary structure adjustment guided body composition analysis can help to control blood glucose levels in GDM patients,maintain reasonable weight gain during pregnancy,reduce cesarean section rates,and reduce the risk of pregnancy complications and adverse perinatal outcomes.

Objective:To investigate the influencing factors of diarrhea during early enteral nutrition(EEN)therapy in severe patients with temporary ileostomy.Method:A total of 154 patients with temporary ileostomy who received EEN in the Department of General Surgery,Jinling Hospital from November 2019 to November 2023 were included in this study.All patients were divided into two groups:the diarrhea group(n=43)and the non-diarrhea group(n=111).The clinical data of the patients were retrospectively collected and analyzed,and univariate analysis was performed to compare the differences between groups.The indicators with significant differences were subjected to multivariate logistic regression analysis to determine the influencing factors of diarrhea during EEN therapy in severe patients with temporary ileostomy.Result:Among the 154 patients,43 developed diarrhea during EEN therapy,with an incidence of 27.9%.Multivariate logistic regression analysis showed that enteral nutrition(EN)infusion rate(OR=6.342,P=0.001,95%CI:2.055～19.572),antibiotics type(OR=8.342,P=0.013,95%CI:1.577～44.119),mechanical ventilation(OR=7.011,P=0.001,95%CI:2.272～21.629),EN formulation type(OR=6.497,P=0.001,95%CI:2.177～19.392),and diabetes(OR=3.321,P=0.036,95%CI:1.080～10.215)were closely associated with EN-related diarrhea in severe patients with temporary ileostomy.Conclusion:There was a high incidence of diarrhea in severe patients with temporary ileostomy who received EEN.EN infusion rate,antibiotics use,mechanical ventilation,EN formulation type and diabetes were the influencing factors for presence of EEN-related diarrhea in the patients.Our data could provide a reference for preventing EEN-related diarrhea in severe patients with temporary ileostomy after surgery.

Intestinal microecological changes are closely related to liver cirrhosis and cirrhosis-related sarcopenia.Studies has demonstrated that interventions targeting the intestinal microbiota could contribute to the treatment of cirrhosis and cirrhosis-related sarcopenia.Here we reviewed the research progress on the alterations in intestinal microbiota during liver cirrhosis and the underlying mechanisms by which these changes impacted the development of the disease.The potential of microbiota-targeted interventions in both preventing and treating liver cirrhosis and related sarcopenia was also discussed,which might provide valuable insights into clinical diagnosis and management of the disease.

objective:To investigate the factors influencing failure of preoperative optimisation with exclusive enteral nutrition(EEN)in patients with Crohn's disease(CD)and to construct a predictive model.Methods:Clinical data of 161 patients with Crohn's disease who underwent surgical treatment after preoperative EEN optimization at the Inflammatory Bowel Disease Center of General Surgery of the Eastern Theater General Hospital from June 2021 to November 2023 were retrospectively analyzed.Patients were divided into two groups according to the preoperative EEN optimisation effect:optimisation success and optimisation failure.Logistic regression analysis was used to determine the factors influencing optimisation failure,and a column line graphical model was constructed using R4.4.0 software.Results:After at least 4 weeks of EEN treatment,a total of 44 patients(27.33%)failed preoperative optimization.Multifactorial analysis showed that FC>500 μg/g and use of corticosteroids were independent risk factors for failure of preoperative optimization,and an increase in prealbumin after 1 week of treatment was a protective factor for successful preoperative optimization.Based on the results of the multivariate analysis,a column graph was constructed,and the C-index was 0.873(95%CI=0.783～0.964).The calibration curve shows that the probability of failure predicted by the nomogram model prior to optimization is in good agreement with the actual probability.The clinical decision curve confirms that the risk threshold is between 0.03～0.96,and the nomogram model can be used to predict the failure of preoperative EEN optimization over other treatment options.Conclusion:FC>500μg/g and history of corticosteroid use were independent risk factors for failure of preoperative optimization,and an increase in prealbumin after 1 week of treatment was a protective factor for successful preoperative optimization.The nomogram constructed on the basis of these results has a good predictive value and is clinically applicable.

Objective:This study aimed to validated the diagnostic accuracy of Global Leadership Initiative on Malnutrition(GLIM)criteria for malnutrition in pancreatic cancer patients undergoing pancreaticoduodenectomy and to evaluated its prognostic value for postoperative outcome.Methods:A retrospective analysis was conducted on 230 consecutive pancreatic cancer patients who underwent pancreaticoduodenectomy at the Department of Pancreatobiliary Surgery,Sun Yat-sen University Cancer Center,between January 2018 to January 2024.Patients were stratified into malnutrition group and non-malnutrition group using Nutritional Risk Screening 2002(NRS 2002)and GLIM criteria.Multivariable logistic regression identified independent risk factors for postoperative morbidity.Results:GLIM criteria identified malnutrition in 96 patients(41.7％).Compared with the non-malnourished group,the number of preoperative nutritional support(t=20.038,P<0.001),the number of preoperative enteral nutrition support(t=8.377,P=0.004),the number of preoperative parenteral nutrition support(t=22.302,P<0.001),the number of anemia(t=8.037,P=0.005)and preoperative parenteral nutrition use days(t=-2.898,P=0.009),the difference was statistically significant.There were statistically significant differences in C-reactive protein(t=10.944,P=0.008),NLR(t=-2.523,P=0.012)and PNI(t=-2.397,P=0.017)between the two groups before surgery.Preoperative BMI(t=-4.410,P<0.001)was significantly lower in the malnourished group.The number of postoperative parenteral nutrition days(Z=-2.283,P=0.022)and amino acid supplementation during postoperative hospitalization were significantly higher in the malnourished group(Z=-2.309,P=0.021).The incidence of malnutrition was higher in patients with Clavien-Dindo grade≥Ⅲ(P=0.030)and intra-abdominal infections(P=0.049).Multivariable analysis identified preoperative weight loss(OR=2.154,95％CI:1.158～4.005;P=0.015)and BMI reduction(OR=0.175,95％CI:0.040～0.775;P=0.022)as independent predictors of postoperative complications.Conclusions:The GLIM standard effectively characterize malnutrition status in pancreatic cancer patients after pancreaticoduodenectomy patients and demonstrate superior predictive performance for postoperative morbidity.It has good predictive performance and clinical application value.