Early Nutritional Support Research Articles

Nutrition Interventions Associated With Favorable Growth in Infants With Congenital Diaphragmatic Hernia.

Nutrition complications are common in survivors of congenital diaphragmatic hernia (CDH). Infants diagnosed with CDH may demonstrate poor growth despite receiving enteral tube feedings and gastroesophageal reflux treatment. This literature review was conducted to determine nutrition interventions resulting in favorable growth, which may improve outcomes in these infants. Results indicate that early nutrition support, including supplemental parenteral nutrition with provisions of ≥125 kcal/kg/d and ≥2.3 g/kg/d protein (which are higher than dietary reference intakes for infants), may have a positive impact on growth, potentially impacting neurological development.

The Role of Dietitian in Improving Energy and Protein Intake in Traumatic Brain Injury Patients Admitted to the Neurosurgical Intensive Care Unit

Introduction:Early and sufficient nutritional support is vital to improve outcomes in patients with traumatic brain injury. This study aims to determine the effects of dietitian involvementin the nutritional and clinical outcomes inpatients with traumatic brain injuries admitted tothe neurosurgical ICU. Materials &Methods: Forty-eight male patients with traumatic brain injuries admitted to Poursina Hospital neurosurgical ICU were studied, retrospectively. Patients were divided to either receive dietitian intervention or without any nutritional recommendation(control). Demographic information, Glasgow Coma Scale and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, the timing of initial enteral feeding, the amount of energy and protein intakeon day 4, the duration of mechanical ventilation and ICU length of stay were recorded. Results:Patients under the dietitian recommendation had significantly lower timing of initial enteral nutrition compared to the other cases (P=0.02). The average energy or protein intake and the percentage of target energy or protein intake on day4 appeared to be significantly lower in the subjects in the control group than in those with nutritional intervention(P≤0.001). There was no statistically significant difference in the duration of mechanical ventilation and ICU length of staybetween different groups of patients. Conclusions:Instead of occasional consultations for exclusive cases, the daily attendance of dietitians during multidisciplinary rounds of ICU is required to assess the nutritional needs of patients.

Evaluation of a novel non-surgical post-pyloric feeding technique in dogs with severe acute kidney injury.

To evaluate the placement and the performance of a new post-pyloric feeding (PPF) system, and compare it to esophageal (E) feeding in dogs with severe acute kidney injury (AKI). Prospective study. University teaching hospital. Twenty client-owned dogs with severe AKI treated with hemodialysis. Dogs were randomly assigned to 2 feeding techniques, PPF or E feeding; for PPF, an 8-Fr jejunal (J) tube was introduced through a standard 18-Fr E-tube and advanced endoscopically through the pylorus. A commercial liquid diet was administered at a continuous rate for at least 5 days. After the removal of the internal J-tube, feeding was continued through the E-tube. Control dogs were fed blended food 5 times daily through an E-tube. Placement technique, nutritional efficiency, and metabolic response to nutritional support were compared between the groups. Feeding tubes were placed a medium of 1 day (interquartile range, 0.8 d) after presentation. Median procedure-time in the group PPF was 26.5min (11.5min), including 8.5min (2.7min) for the E-tube and 17.5min (5.0min) for the J-tube. J-tubes were used for 5 days (1.5 d) with oral displacement observed in 3/10 dogs. The goal to administer 130% resting energy requirement within 3 days was reached in 13/20 dogs (8/10 PPF, 5/10 E). Despite nutritional support, dogs lost 1.2% body weight per day (1.1%), with no difference between the groups. The metabolic improvement was comparable between the groups, despite marked differences in the diet composition. This new feeding technique can be recommended as an efficient method for early nutritional support in dogs with severe AKI. The protein-energy wasting observed despite active nutritional support suggests, however, the necessity for increased feeding targets or qualitative changes in diet composition for dogs with AKI.

VALIDATION OF A NEW PROGNOSTIC BODY COMPOSITION PARAMETER IN CANCER PATIENTS

We evaluated the prognostic value of a new body composition parameter (creatinine height index [CHI]) obtained from bioimpedance vectorial analysis-derived body cell mass and its association with nutritional and functional status. Data of Italian and German cancer patients observed prospectively until death were used (N=1084). Multivariable models (adjusted for age, gender, hydration status, performance status, disease's stage) were built in both cohorts to assess the association between body composition outcome parameters (low fat-free mass, <15 [females] and <17 [males] kg/m2; low standardized phase angle, <-1.65; low CHI, <510 [females] and <660 [males] mg/24h/m) and 1-year all-cause mortality, low body mass index (<20 [<70 years] and <22 [>70 years] kg/m2), clinically significant weight loss (>10% in 6 months) and low handgrip strength (<20 [females] and <30 [males] kg). Low CHI was independently associated with mortality in both Italian (HR=1.84 [95%CI, 1.18-2.86]; P=0.007) and German cohorts (HR=1.52 [95%CI, 1.17-2.07]; P=0.008). Low FFMI and low SPA did not predict survival in the German cohort. In patients with low CHI, worse nutritional and functional status were observed in both study populations. Performance of models addressing the study endpoints showed substantial consistency with both cohorts, particularly of those including low CHI. We validated a new prognostic body composition parameter, which is easier to interpret than standard nutritional parameters and may be useful for identifying cancer patients at nutritional risk, requiring early nutritional support. Its prognostic value should be confirmed in other patient populations and its sensitivity in detecting changes in protein-calorie intake is still to be investigated.

Nutritional Considerations in Frail Older Patients with COVID-19.

The COVID-19 pandemic is posing an unprecedented challenge to healthcare systems worldwide. Older adults, which frequently present multiple chronic comorbidities, are more susceptible to COVID-19 and experience more likely negative outcomes, in terms of disease severity and mortality. However, chronological age per se may not entirely explain the dramatic scenario described among the frailest and oldest persons. Comorbidities and functional status may indeed play a relevant role. Patients at high risk of adverse clinical outcomes in COVID-19 infection are the same at risk of malnutrition, namely older adults and multimorbid individuals. In fact, COVID-19 can negatively impact on nutritional status, both in patients admitted to the hospital with the most severe manifestations of the infection, as well as in those who experience milder/asymptomatic forms of the disease. Despite being quite difficult in these emergency circumstances, nutritional status needs to be assessed in all COVID-19 patients upon admission and during hospital stay. Early nutritional support should be guaranteed in order to improve several malnutrition-related adverse outcomes. The evaluation of the nutritional status is today even more crucial than in normal times given the delicate status of older patients with COVID-19.

Comparison of Feeding Efficacy and Hospital Mortality Between Small Bowel and Nasogastric Tube Enteral Nutrition in Critical Illness at High Nutritional Risk

Abstract Objectives The current guidelines recommend that early enteral nutrition (EN) support by nasogastric tube enteral nutrition (NGEN) should be initiated within 48 h in the critically ill patients at high nutritional risk. Small bowel EN (SBEN) was suggested for those who are NGEN intolerance. Our previous study showed adjuvant feeding with SBEN at 7th ICU day may improve feeding efficacy and have survival benefit for those energy achievement rate more than 65% at the 3rd day after SBEN. However, the comparison of feeding efficacy and hospital mortality between SBEN and NGEN remains unclear. Methods A retrospective cohort study enrolled 113 critically ill patients at high nutrition risk (modified NUTRIC score≧5) and at inadequate feeding volume (&amp;lt; 750 ml/day) in the first week of ICU stay. Patients were classified into SBEN (N = 48) and NGEN (N = 65) group at 8th ICU day (enrolled day). Daily actual energy intake was recorded after enrolled day in each group and feeding efficiency was compared between two groups. Cox regression analysis was used to assess factors associated with hospital mortality. Results The feeding volume, energy and protein intake, and achievement rate (%) of energy and protein intake increased significantly in the SBEN group at the 3rd following day (P &amp;lt; 0.001). Hospital mortality in this cohort was 43.3%. By univariate analysis, SBEN group (HR: 0.56, 95% CI: 0.31–1.00, P = 0.049), SOFA score at day 7 (HR:1.12, 95% CI: 1.03–1.22, P = 0.009) and energy intake achievement rate &amp;lt; 65% at the 3rd followed-up day (HR: 2.53, 95% CI: 1.25–5.11, P = 0.010) were associated with hospital mortality. By multivariate analysis, the only factor associated hospital mortality in this cohort was energy intake achievement rate &amp;lt; 65% at the 3rd followed-up day (HR: 2.29, 95% CI: 1.12–4.69, P = 0.023). Conclusions SBEN improves energy delivery and might be reduced in hospital mortality in critically ill patients at high nutritional risk after 1 week of stomach enteral nutrition in ICU. Funding Sources None.

Nutrient Restriction has Limited Short-Term Effects on Gut, Immunity, and Brain Development in Preterm Pigs

Extrauterine growth restriction (EUGR) in preterm infants is associated with higher morbidity and impaired neurodevelopment. Early nutrition support may prevent EUGR in preterm infants, but it is not known if this improves organ development and brain function in the short and long term. Using pigs as models for infants, we hypothesized that diet-induced EUGR impairs gut, immunity, and brain development in preterm neonates during the first weeks after birth. Forty-four preterm caesarean-delivered pigs (Danish Landrace×Large White×Duroc, birth weight 975±235g, male:female ratio 23:21) from 2 sows were fed increasing volumes [32-180mL/(kg·d)] of dilute bovine milk (EUGR group) or the same diet fortified with powdered bovine colostrum for 19 d (CONT group, 50-100% higher protein and energy intake than the EUGR group). The EUGR pigs showed reduced body growth (-39%, P < 0.01), lower plasma albumin, phosphate, and creatine kinase concentrations (-35 to 14%, P < 0.05), increased cortisol and free iron concentrations (+130 to 700%, P < 0.05), and reduced relative weights of the intestine, liver, and spleen (-38 to 19%, all P < 0.05). The effects of EUGR on gut structure, function, microbiota, and systemic immunity were marginal, although EUGR temporarily increased type 1 helper T cell (Th1) activity (e.g. more blood T cells and higher Th1-related cytokine concentrations on day 8) and reduced colon nutrient fermentation (lower SCFA concentration; -45%, P < 0.01). Further, EUGR pigs showed increased relative brain weights (+19%, P < 0.01), however, memory and learning, as tested in a spatial T-maze, were not affected. Most of the measured organ growth, and digestive, immune, and brain functions showed limited effects of diet-induced EUGR in preterm pigs during the first weeks after birth. Likewise, preterm infants may show remarkable physiological adaptation to deficient nutrient supply during the first weeks of life although early life malnutrition may exert negative consequences later.

Malnutrition-Related Factors Increased the Risk of Anastomotic Leak for Rectal Cancer Patients Undergoing Surgery.

Objective To study the possible risk factors and related prediction indexes of anastomotic leakage (AL) in patients with rectal cancer during the perioperative period and to provide effective indexes for predicting whether AL will occur in postoperative patients with rectal cancer and whether early nutritional support is needed. Background AL after rectal cancer surgery is a common and serious complication. Many of the risk factors for AL have been confirmed. Nevertheless, the evidence of the effect of perioperative malnutrition on AL is still insufficient. This article will make a further study on this point. Methods We collected perioperative clinical data from 382 patients with rectal cancer who underwent surgery from September 2015 to May 2017. After 1 month of follow-up, relevant risk factor data were collected and analyzed. Results Data analysis showed that the incidence of AL was 14.65%. In single factor analysis, patients with high score of NRS-2002, high score of PG-SGA, diabetes, perioperative blood transfusion, postoperative diarrhea, later tumor stage, high score of ASA, low postoperative albumin, and rectal cancer patients with tumor close to the anus may led to AL. Multivariate analysis revealed that low postoperative albumin (p = 0.044), tumor close to the anus (p = 0.004), diabetes (p = 0.003), perioperative blood transfusion (p < 0.001), diarrhea (p = 0.005), later tumor stage, and high score of PG-SGA (p < 0.001) were the independent risk factors for postoperative AL. Conclusions AL in rectal cancer operation is a common postoperative complication. Patients with diabetes or high PG-SGA score or low perioperative albumin will have increased risk factors of AL, which should be paid enough attention in the perioperative period and nutritional support should be provided as soon as possible. Patients who have incomplete intestinal obstruction but can make effective intestinal preparation or who receive neoadjuvant chemotherapy have no increased risk of AL.

Routine feasibility of postoperative chemoradiotherapy in head and neck squamous cell carcinoma at high risk of recurrence

ObjectiveTo assess the feasibility in routine practice of postoperative chemoradiotherapy in head and neck squamous cell carcinoma (HNSCC) at high risk of recurrence. MethodA single-center retrospective study recruited all patients receiving postoperative cisplatin chemoradiotherapy for HNSCC at high risk of recurrence. The main endpoints were the rate of complete postoperative chemoradiotherapy and the impact of various clinical factors. Secondary endpoints comprised the impact of completion of therapy on survival and on acute and late toxicity. ResultsOne hundred and six patients were included. 24.5% showed severe comorbidity. Chemoradiotherapy was complete in 61 patients (57.5%). Radiation therapy was interrupted for >3 days in 16 patients (15.1%). The 3rd concomitant cisplatin course could not be implemented in 34 patients (32.1%). Low pre-treatment glomerular filtration rate was significantly associated (p=0.003) with treatment interruption; >5% weight-loss during treatment showed suggestive association (p=0.026). Completion of treatment was not associated with any significant difference in overall survival (p=0.441) or progression-free survival (p=0.81). 14.9% of patients showed post-treatment kidney failure; there were 10 cases of osteoradionecrosis (9.4%). ConclusionThe rate of complete postoperative chemoradiotherapy was comparable to that reported in clinical trials, despite frequent comorbidity and poor nutritional status. Early nutritional support is a key factor for treatment under optimal conditions.

Association of Baseline Inflammation With Effectiveness of Nutritional Support Among Patients With Disease-Related Malnutrition

Inflammation is a key driver of malnutrition during illness and is often accompanied by metabolic effects, including insulin resistance and reduction of appetite. However, it still remains unclear if inflammation influences the response to nutritional support among patients with disease-related malnutrition. To examine whether patients' baseline inflammatory status is associated with the effect of nutritional support on 30-day mortality. This is a secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a randomized clinical trial conducted in 8 Swiss hospitals from April 2014 to February 2018. A total of 1950 participants who had C-reactive protein measurements at the time of admission were included in this secondary analysis. Data analysis was conducted between June and July 2019. Hospitalized patients at risk for malnutrition were randomly assigned to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or standard hospital food (control group). The primary end point was 30-day mortality. Based on C-reactive protein levels at admission, patients were stratified into groups with low, moderate, or high inflammation (<10 mg/L, 10-100 mg/L, and >100 mg/L, respectively). A total of 1950 patients (median [interquartile range] age, 75 [65-83] years; 1025 [52.6%] men) were included; 533 (27.3%) had low levels of inflammation, 894 (45.9%) had moderate levels of inflammation, and 523 (26.8%) had high levels of inflammation. Compared with the control group, patients receiving nutritional support showed a significant reduction in 30-day mortality, regardless of C-reactive protein level (adjusted odds ratio, 0.61; 95% CI, 0.43-0.86; P = .005). In the subgroup of patients with high inflammation, there was no beneficial effect of nutritional support (adjusted odds ratio, 1.32; 95% CI, 0.70-2.50; P = .39), providing evidence that inflammation has a significant modifying association (P for interaction = .005). Based on this secondary analysis of a multicenter randomized trial, a patient's admission inflammatory status was associated with their response to nutritional support. If validated in future clinical trials, nutritional support may need to be individualized based on a patient's initial presentation and markers of inflammation. These results may also help to explain some of the heterogeneity in treatment effects of nutrition seen in previous critical care trials. ClinicalTrials.gov Identifier: NCT02517476.

Extremely Preterm Infants Have a Higher Fat Mass Percentage in Comparison to Very Preterm Infants at Term-Equivalent Age.

Background: Early nutritional support of preterm infants is important because it influences long-term health and development. Body composition has an influence on cardiovascular disease, metabolic syndrome, and neurocognitive outcome in the long term.Objective: To assess body composition in preterm infants <32 weeks of gestation at term-equivalent age and to analyze the influence of an optimized nutritional approach.Methods: This is a prespecified secondary outcome analysis of a prospective observational study comparing the body composition in regard to gestational age. The preterm infants were classified according to gestational age as extremely preterm infants (<28 weeks gestation at birth) and very preterm infants (≥28 weeks gestation at birth) and according to weight percentile as appropriate for gestational age and small for gestational age. Body composition was determined by air displacement plethysmography using the PEA POD. The preterm infants obtained nutrition according to the ESPGHAN 2010 Guidelines.Results: Seventy-four preterm infants were analyzed. The mean (SD) gestational age was 28.7 (2.4) weeks, and birth weight was 1,162 (372) g. Fat mass percentage was significantly higher in extremely preterm infants in comparison to very preterm infants [17.0, 95% confidence interval (CI) 15.9–18.1 vs. 15.5, 95% CI 14.7–16.2]. There was no significant difference of fat mass percentage according to weight percentiles.Conclusions: Extremely preterm infants had a significantly higher fat mass percentage compared to very preterm infants at term-equivalent age. There was no significant difference of fat mass percentage according to weight percentiles.

Effect of early enteral nutrition on the incidence of acute acalculous cholecystitis among trauma patients.

Acute acalculous cholecystitis (AAC) often occurs in critically ill patients, especially in those that have experienced trauma, surgery, shock, and prolonged fasting. Early enteral nutrition has been shown to significantly reduce morbidity and mortality compared to other nutritional support strategies. The purpose of this study was to evaluate the effect of early enteral nutrition on the incidence of AAC among trauma patients. Multi-strategy nutritional protocol was implemented in the intensive care unit (ICU) in 2016 for early enteral nutrition and proper nutritional support. The traumatized critically-ill patients without volitional intake who were admitted to ICU between 2015 and 2017 were included. Basic characteristics, duration of fasting, and the incidence of percutaneous cholecystostomy (PC) due to AAC were analyzed according to the year. Enteral nutrition was indicated in 552 trauma patients (28.2%). The mean duration of fasting was shortened from 6.5 days in 2015 to 5.4 days in 2017 (p=0.202). The incidence of PC was significantly decreased from 2015 to 2017 [6/171 (3.5%) vs. 6/204 (2.9%) vs. 0/177 (0%), p=0.023]. The provision of central parenteral nutrition (p=0.001) and fasting over 7 days (p=0.014) proved to be a risk factor of AAC. This study showed that the incidence of PC due to AAC was decreased significantly after the implementation of a nutritional protocol among traumatized critically ill patients. Early enteral nutrition may be effective in reducing the AAC among trauma patients who are at high risk of AAC.

Comparison of the clinical effects of early enteral and parenteral nutrition support in patients with severe stroke

Objective To compare the clinical effects of early enteral and parenteral nutrition support in patients with severe stroke. Methods From June 2017 to July 2018, 65 patients with severe stroke admitted in the First People's Hospital of Yongkang were selected in the study, and the patients were randomly divided into control group(32 cases) and observation group(33 cases) according to the digital table.The control group received early parenteral nutrition support, while the observation group received early enteral nutrition support.The nutritional index, biochemical index, NIHSS score, CPIS score of clinical pulmonary infection and the incidence of complications were compared between the two groups. Results After nutritional support, the serum levels of total protein(TP), albumin(Alb), hemoglobin(Hb) in the observation group were (57.01±2.59)g/L, (39.98±2.64)g/L, (126.86±10.75)g/L, respectively, which were significantly higher than those in the control group [(54.28±0.76)g/L, (37.31±2.35)g/L, (120.75±13.46)g/L](t=5.727, 4.302, 2.025, all P<0.05). The serum levels of glucose(GLU), creatinine (SCr), alanine aminotransferase (ALT) in the observation group were (12.35±2.38)mmol/L, (84.37±13.62)μmol/L, (47.84±4.03)U/L, respectively, which were lower than those in the control group [(14.18±2.37)mmol/L, (91.84±13.21)μmol/L, (66.28±3.76)U/L] (t=3.106, 2.244, 19.060, all P<0.05). The levels of triglyceride(TG), serum urea nitrogen(BUN) in the observation group were (1.95±0.45)mmol/L, (5.80±0.61)mmol/L, respectively, which were higher than those in the control group [(1.66±0.30)mmol/L, (5.32±0.43)mmol/L] (t=0.341, 3.656, all P<0.05). The scores of NIHSS and CPIS in the observation group were (10.31±2.10)points and (3.00±0.76)points, respectively, which were lower than those in the control group [(14.68±2.75)points, (3.79±1.45)points](t=5.279, 2.763, P=0.001, 0.008). The incidence of complications in the observation group [9.38%(3/33)] was lower than that in the control group [31.25%(10/32)], and the difference was statistically significant(χ2=4.986, P<0.05). Conclusion Compared with early parenteral nutrition support, early enteral nutrition support can improve the nutritional status of patients with severe stroke and is safe and effective. Key words: Stroke; Enteral nutrition; Parenteral nutrition; Nutritional support; Albumins; Serum albumin; Hemoglobins; Comparative effectiveness research

33 Improving Mortality with An Integrated Model of Care for Cervical Spine Fracture in Patients Over 75 Years Old

Abstract Introduction Cervical spine injury is a potentially life threatening trauma. Given the increase in the number of patients presenting to the emergency department (ED) who are elderly and who have fallen and sustained trauma, it has become ever so challenging to manage this cohort of patients. In addition to diagnostic challenges in the elderly population, a robust, integrated care pathway and comprehensive geriatric assessment with involvement of a geriatrician is essential to provide effective care to these patients who require cervical collar after cervical spine injury to prevent morbidity and mortality. Intervention Data was gathered about the patient’s demographics, nature of cervical spine injury, care required from January 2013 till November 2016 (pre intervention) and from November 2016 till October 2017 (post intervention). Current practice was reviewed which showed significant variability in care provision to patients with cervical spine injury including collar care. An integrated care pathway was designed with involvement of multidisciplinary team (MDT) members to standardise the care of this cohort of patients in our hospital. This included early identification of patients with cervical spine injury, co locating all patients, developing nursing expertise for cervical collar care, sitting up early to prevent complications like aspiration, pressure area care, early nutritional support, training staff in post discharge collar care with developing interface with primary care team. Outcome measures in patients over 75 years including length of stay (LOS) inpatient mortality and at 6 and 12 months were recorded respectively. Results Total: 54 patients, average age: 86.6 years Conclusions Cervical spine injuries are common in older patients, who are at greater risk of falls and thus sustaining injuries. Early identification and management of these patients in a clinical area with multidisciplinary approach with appropriate expertise is key to reducing LOS and adverse outcome including mortality.

Efficacy of Microecopharmaceutics Combined with Early Enteral Nutrition Support in the Treatment of Severe Acute Pancreatitis.

To explore the efficacy of microecopharmaceutics combined with early enteral nutrition support to the treatment of severe acute pancreatitis (SAP). A total of 26 patients diagnosed with SAP in our hospital were retrospectively reviewed. Microecopharmaceutics, the living microbial food supplements that are beneficial to the host by improving the balance of intestinal microorganisms, were combined with early enteral nutrition group, and used as the treatment group; and delayed enteral nutrition was used as the control group. Two weeks after both treatments, variables of C-reactive protein (CRP), albumin (Alb), total serum protein (TP), urinary amylase recovery time, hemodiastase recovery time, acute physiology and chronic health evaluation (APCHE) score, and hospitalisation time in both groups were compared. Alb and TP of the treatment group were significantly higher than those in the control group (p <0.05). The APCHE score and CRP in the treatment group were significantly lower than those in the control group (p <0.05). The urinary amylase recovery time, hemodiastase amylase recovery time, and hospitalisation time in the treatment group were significantly shorter than those in the control group. The use of microecopharmaceutics combined with early enteral nutrition can effectively protect the intestinal barrier function, which is an effective treatment in patients with SAP.

Effect of Qihuang Decoction Combined with Enteral Nutrition on Postoperative Gastric Cancer of Nutrition and Immune Function.

Objective. Early nutritional support in patients with gastric cancer can improve their nutritional status, but the impact on immune function has not been confirmed. This study aimed to analyze the effects of Qihuang decoction combined with enteral nutrition on nutrition and the immune function of postoperative gastric cancer. Methods. 120 patients with postoperative gastric cancer in the study group and 117 in the control group were selected as the study subjects from our hospital at random. Indications of nutrition and immune and the rates of complications were compared the day before surgery and 1, 3, 7, and 14 days after surgery. Results. Indications of nutrition except hemoglobin (HB) in the study group were significantly higher than those before operation and the albumin (ALB) and prealbumin (TP) were significantly increased 7 and 14 days after surgery (P &lt; 0.001 and P &lt; 0.001 versus P &lt; 0.001 and P &lt; 0.001) and the protein (PA) 3, 7, and 14 days after surgery (P = 0.011, P = 0.002, and P = 0.022) in the study group compared to those in the control group. Cellular and humoral immunity indications in the study group are significantly higher than those before operation compared to those in the control group, and the CD3+, CD4+, and CD4+/CD8+ were significantly increased 7 and 14 days after surgery (P = 0.027 and P &lt; 0.001 versus P = 0.008 and P &lt; 0.001 versus P = 0.010 and P &lt; 0.001) and IgA, IgG, and IgM 3, 7, and 14 days after surgery in the study group (P &lt; 0.001, P &lt; 0.001, and P &lt; 0.001 versus P &lt; 0.001, P &lt; 0.002, and P &lt; 0.001 versus P &lt; 0.001, P &lt; 0.001, and P &lt; 0.001). The complications such as abdominal, lung, wound, and urinary infection were also significantly decreased (; ; ; ). Conclusions. Qihuang decoction combined with enteral nutrition can promote the absorption of enteral nutrition with improving the immune and reducing complications of infection.

Early intravenous administration of nutritional support (IVANS) in metastatic gastric cancer patients at nutritional risk, undergoing first-line chemotherapy: study protocol of a pragmatic, randomized, multicenter, clinical trial.

Background:Malnutrition is common in cancer patients, particularly in those affected by gastrointestinal malignancies, and negatively affects treatment tolerance, survival, functional status, and quality of life (QoL). Nutritional support, including supplemental parenteral nutrition (SPN), has been recommended at the earliest opportunity in malnourished cancer patients. The limited available evidence on the efficacy of SPN in gastrointestinal cancer patients is positive, particularly with regards to QoL, body composition, and energy intake, but the evidence on survival is still scanty. Furthermore, studies regarding the early administration of SPN in combination with nutritional counseling from the beginning of first-line chemotherapy (CT) are lacking. We hypothesize that early systematic SPN in combination with nutritional counseling (NC), compared with NC alone, can benefit patients with previously untreated metastatic gastric cancer at nutritional risk undergoing first-line CT.Methods:The aim of this pragmatic, multicenter, randomized (1:1), parallel-group, open-label, controlled clinical trial is to evaluate the efficacy in terms of survival, weight maintenance, body composition, QoL and feasibility of cancer therapy of early systematic SNP. This is in combination with NC, compared with NC alone, in treatment-naïve metastatic gastric cancer patients at nutritional risk undergoing first-line CT.Discussion:Malnutrition in oncology remains an overlooked problem. Although the importance of SPN in gastrointestinal cancer patients has been acknowledged, no studies have yet evaluated the efficacy of early SPN in metastatic gastric patients undergoing CT. The present study, which guarantees the early provision of nutritional assessment and support to all the enrolled patients in accordance with the recent guidelines and recommendations, could represent one of the first proofs of the clinical effectiveness of early intensive nutritional support in cancer patients undergoing CT. This study could stimulate further large randomized trials in different cancer types, potentially resulting in the improvement of supportive care quality.Trial registration:This study is registered on ClinicalTrials.gov: NCT03949907.

Prognostic factors Influencing Necrotizing Soft tissue lesions in North India

Background: Severe skin or soft tissue (SST) infections can involve fascia planes, thereby constitution necrotizing fascitis. Such infections are characterized by extensive necrosis and systemic toxicity [1,2]. Early clinical diagnosis of necrotizing fascitis and superficial SST infection (erysipelas or cellulitis),may be difficult [3,4]. Method: At the time of admission a detailed clinical history were taken, clinical examination was done, patients were admitted and stabilized in emergency ward, aggressive debridement of infected and necrotizing tissue. All necrotic skin, subcutaneous tissue, fascia and nonviable muscle were removed, the excised tissue was sent for culture and sensitivity in microbiology laboratory. All the viable skin and soft tissues were saved to aid later closure. Result: the survival rate was 86.5% in patients who underwent surgical debridement in early stage of disease as compared to 61.5% mortality in patients who presented late. Septicemic shock and multiple organ failure was less in patients who presented at early stage of disease. Early and adequate nutritional support along with prompt recognition and treatment reduces the development of multiple organ failure and improves the outcome. Conclusion: Mortality rate is decreased in those patients who are treated in early cause of disease by means of surgical and medical approach. The mortality rate is directly proportional to involved body surface area in patients of Necrotizing soft tissue lesion. Site of lesion and extent of lesion influences the mortality.

Impact of early nutritional support and presence of diabetes mellitus in patients with acute stroke

Introduction: the data in the medical literature are conflicting regarding the nutritional support of patients with stroke and the most appropriate time to start it. Objective: to analyze the effect of a nutritional intervention and of nutritional parameters on the clinical evolution of patients with stroke. Material and methods: this was an observational, retrospective study in 43 patients. The following baseline data were collected: tricipital skinfold (TS), mid-upper arm circumference (MUAC), muscular arm circumference (MAC), albumin, prealbumin, total cholesterol, lymphocytes, diabetes mellitus (DM), nutritional support onset, duration and type of supplementation, nutrition care plan, neurological dysfunction according to the National Institute of Health Stroke Scale (NIHSS) both at baseline and discharge, and mortality. Mortality within the first month and neurological deficit at discharge are identified as poor prognostic factors, and are related to nutritional parameters. Results: age 67.2 ± 12.5 years; 53.5% males and 34.9% females. Presence of DM: 34.88%. Nutritional parameters: TS: 18.7 ± 7.8 mm; MUAC: 30.2 ± 3 cm; MAC: 24.4 ± 3.1 cm; serum albumin 3.39 ± 0.3 g/dl; prealbumin: 22.3 ± 6.9 mg/dl; total cholesterol: 177.1 ± 46.4 mg/dL; lymphocytes: 1742 ± 885/mm3. Enteral nutritional support was started at 4.3 ± 5.8 days after the acute event, with a duration of 17.8 ± 23.2 days. Fifty percent of patients had severe neurological deficits at discharge. As markers of worse prognosis we identified a delay in the start of nutritional support of over 7 days, and the presence of DM. Conclusions: the late start of nutritional support was related to worse clinical prognosis. DM is a marker of poor prognosis in patients with stroke.

Comparative study of early enteral feeding versus parenteral feeding in acute severe pancreatitis in JSS hospital

Background: Acute Severe acute pancreatitis is found in 20-30% of patients with pancreatitis and is associated with marked increased risk of complications, such as necrosis, abscess, formation of pancreatic pseudocyst and multiorgan failure, and also the disease manifests with a “systemic inflammatory response syndrome (SIRS) that culminates with hyper metabolism and high rate of protein catabolism; consequently, nutritional reserves are rapidly consumed and malnutrition may ensue unless a higher nutritional intake is provided, thus, early nutritional support plays a central role in the management of these patients. Parenteral nutritional support has long been the standard source of exogenous nutrients for these patients; however this is associated with many disadvantages, including dysfunction of the intestinal mucosal barrier, which, in turn, promotes sepsis of intestinal origin. Enteral nutrition, on the other hand, can maintain the integrity and function of the intestinal mucosal barrier, and thus the study intends to compare the efficacy of enteral versus parenteral feeding in influencing the outcomes in acute pancreatitis cases measured in terms of acute phase proteins, duration of ICU care, length of hospital stay.Aim: To compare the efficacy of enteral feeds versus parenteral feeding in terms of, outcomes of acute pancreatitis patients, to assess acute phase response in both types of feeding and measuring the length of hospital stay including length of ICU stay.Methods: Patients admitted with diagnosis of acute pancreatitis will be randomly grouped into group A and B by odd and even number hospital admission, Sample Size is considered as 100 with 50 in group A receiving enteral feeding and 50 in group B receiving parenteral feeding, considering the mean difference in hospital stay of 6 days and SD in each group as 12 days.Results: It was seen that patients who received early enteral nutrition had better outcomes in terms of acute phase proteins, shorter length of hospital stay (p-value:0.038, t-test:7.868) and shorter length of ICU care (p-value: 0.044, t-test:1.094) that compared with total parenteral nutrition group.Conclusion: It can be concluded that in our study, early enteral nutrition can be started safely and efficient when started “within 48 hours of admission” which had better outcomes in terms of acute phase proteins, shorter duration of ICU care and length of hospital stay and also cost effective that compared to those patients who received total parenteral nutrition where lesser patients showed better outcomes, had increased hospital stay and was costlier.