Abstract Background Multimodality (physical, dietary, psychological) prehabilitation is associated with a disease‐free survival advantage after colorectal cancer surgery; however, the underlying mechanism is unknown. We measured the effects of a western‐style diet on gut dysbiosis, antitumor immunity, and cancer progression in a surgical mouse model of metastatic colorectal cancer and attempted to mitigate its effects with isolated dietary prehabilitation. Methods Before surgery and tumor induction, mice were given either a western‐style diet for 6 weeks, chow for 6 weeks, or 4 weeks of a western‐style diet followed by 2 weeks of chow. Expelled stool was collected for analysis of the fecal microbiome. Four weeks after surgery, tumors were quantified and collected for analysis with an immunofluorescence panel. Results The western‐style diet was obesogenic. Fecal microbiome analysis illustrated that the western diet induced a severe and lasting dysbiosis as measured by alpha diversity metrics, pathogenic overgrowth and Firmicutes to Bacteroidetes ratio, which was partially rescued by prehabilitation. Mice fed the western diet demonstrated increased tumor bulk and decreased intratumoral immune cell infiltrate compared with chow‐fed mice. prehabilitation rescued the intratumoral immune effects, but not tumor bulk. Conclusion An obesogenic, no fiber western‐style diet increased gut dysbiosis and tumor bulk while decreasing antitumor immunity in our mouse model, which was partially rescued by prehabilitation. Microbiome‐targeted prehabilitation for colorectal cancer surgery is a promising paradigm and further translational research is warranted.
Abstract Central venous catheters (CVCs) are essential in pediatric care for long‐term venous access. While tunneled CVCs have traditionally been placed using open surgical venotomy or cut‐down (OS), ultrasound‐guided (USG) percutaneous insertion is widely used. However, no systematic review has yet evaluated pediatric evidence directly comparing both approaches. We conducted a systematic review of randomized controlled trials (RCTs) comparing USG and OS placement of CVCs in patients younger than 18 years. PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched until September 2025. The primary outcome was successful catheter placement; secondary outcomes included infection, thrombosis, venous diameter after catheter removal, and procedure duration. Five RCTs with 587 children were included. Placement success was comparable between techniques (97.5% USG vs. 95.7% OS; RR 1.00, 95% CI 0.96–1.05; moderate‐certainty evidence). Infection rates did not differ significantly. USG was associated with a significantly lower risk of thrombosis (RR 0.34, 95% CI 0.14–0.82), consistently shorter procedure times, and better preservation of venous diameter, although the certainty of evidence for these outcomes was very low. USG placement achieves comparable success to OS but may offer procedural and vessel‐preservation benefits.
Abstract Background Critically ill patients experience muscle wasting, impacting recovery. The associations between augmented enteral protein and muscle mass, strength, physical function, and quality of life are uncertain. Methods We performed a sub‐study in adult TARGET Protein participants from two sites between 23/11/2022‐23/05/2023. Our exposure of interest was enteral formula with augmented protein (100 g protein/L) and comparator usual protein formula (63 g protein/L), which were isocaloric. Our primary outcome was the change in quadriceps muscle layer thickness from Days 1 to 7, determined by ultrasonography and compared between groups. Our secondary outcomes were group differences in handgrip strength, change in physical function, and quality of life. Data are numbers (%), mean (standard deviation), and differences with 95% confidence intervals (CI). Results Seventy‐two patients were included (augmented protein n = 46, 61 (16)y, 65% male; usual protein n = 26, 56 (16)y, 46% male), 56 had primary outcome data (augmented protein n = 35; usual protein n = 21). Delivered protein was higher with augmented protein (1.2 (0.4) vs 0.8 (0.3) g/kg/day). Quadriceps muscle layer thickness decreased in both groups, with change from Days 1 to 7 similar (0.01 cm; 95% CI, −0.27, 0.28; P = 0.970). Left handgrip strength at ICU discharge and quality of life at Day 90 were similar. Augmented protein was associated with greater right handgrip strength at ICU discharge (6.23; 95% CI, 0.67, 11.79) and was associated with greater decline in physical function at ICU discharge (−15.00; 95% CI, −19.75, −10.25), but not at Day 90. Conclusion No clear difference was detected in quadriceps muscle layer attenuation over 7 days between augmented enteral protein and usual protein. Trial Registration Australian New Zealand Clinical Trials Registry identifier: ACTRN12622001465741.
Abstract Background Malnutrition and nutritional risk are common among inpatients and are associated with adverse outcomes. Although dietitian‐led individualized nutrition intervention is recommended, evidence from routine practice among non‐critically ill inpatients remains limited. We aimed to evaluate the association between early dietitian‐led nutrition intervention and deterioration‐related outcomes among adults at nutritional risk. Methods We conducted a retrospective cohort study using electronic medical records from a Chinese tertiary hospital (2016–2023). Adults aged 18–90 years with Nutritional Risk Screening 2002 scores ≥3 were included; patients directly admitted to intensive care unit were excluded. Patients receiving early dietitian‐led nutrition intervention within 72 h after hospital admission were propensity score matched 1:1 to comparators. Outcomes were unplanned intensive care unit transfer, major gastrointestinal events after admission, and predefined clinically meaningful changes in laboratory indicators. Associations were estimated using logistic regression and reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results Among 96,532 eligible patients, 16,661 (17.3%) received early dietitian‐led nutrition intervention. After matching, 16,419 pairs were analyzed. Early dietitian‐led nutrition intervention was associated with lower odds of intensive care unit transfer (3.0% vs. 3.4%; OR 0.88, 95% CI 0.77–0.99), major gastrointestinal events (4.0% vs. 4.4%; OR 0.89, 95% CI 0.80–0.99), and higher odds of clinically meaningful reduction in C‐reactive protein (12.6% vs. 10.9%; OR 1.18, 95% CI 1.11–1.27). Conclusion Early dietitian‐led nutrition intervention was associated with lower odds of deterioration‐related outcomes among hospitalized adults at nutritional risk. Limited early dietitian involvement despite routine nutritional risk screening suggests an implementation gap and warrants further prospective evaluation.
Abstract Background Intestinal failure patients receiving home parenteral nutrition are at risk of catheter‐related bloodstream infection. Metastatic infections include infective endocarditis and vertebral osteomyelitis. We aimed to investigate the incidences of catheter‐related bloodstream infection, infective endocarditis, and vertebral osteomyelitis in type 3 intestinal failure patients. Methods This was a cohort study conducted in a Danish referral intestinal failure center. All data on catheter‐related bloodstream infections, infective endocarditis, and vertebral osteomyelitis were retrieved from medical records on patients receiving home parenteral nutrition through tunneled cuffed central venous access devices or peripherally inserted central catheters from 01 January 2019 to 31 December 2023. Results A total of 323 patients (209 females) were included, totaling 913 catheters and 293,650 catheter days. The catheter‐related bloodstream infection incidence was 0.93 per 1,000 catheter days (95% CI: 0.82–1.03) over the 5‐year period, with a statistically significantly higher incidence for tunneled cuffed central venous access devices than for peripherally inserted central catheters (1.10 [95% CI: 0.95–1.26] vs. 0.66 [95% CI: 0.52–0.81] per 1,000 catheter days, respectively). Thirteen cases of infective endocarditis (0.04 per 1,000 catheter days [95% CI: 0.02–0.07]) and ten cases of vertebral osteomyelitis (0.03 per 1000 [95% CI: 0.01–0.06]) were identified. Conclusion The catheter‐related bloodstream infection incidence is within the acceptable range recommended by current guidelines. The incidence of infective endocarditis is higher, and that of vertebral osteomyelitis is similar to those in other studies. Catheter‐related bloodstream infection is a serious complication that may lead to infective endocarditis or vertebral osteomyelitis, underscoring the need for timely detection and management.
