Objective:This study aimed to analyze differential metabolites in patients using a dual metabolic platform and to orientate early nutritional intervention in patients with cirrhosis.Methods:The skeletal muscle index (SMI) was calculated based on computed tomography (CT) measurements of skeletal muscle cross-sectional area at the third lumbar vertebra level. Pre-sarcopenia was diagnosed for males with SMI < 46.96 and for females with SMI < 32.46. Fifteen HBV-related liver cirrhosis patients with pre-sarcopenia were included as Group S while fourteen liver cirrhosis without pre-sarcopenia were Group NS. Liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectrometry (GC-MS) analyses were used to detect differential metabolites and disturbed pathways in the two groups.Results:Five pathways and twenty-eight pathways were defined as disturbed pathways in the plasma of liver cirrhosis patients with pre-sarcopenia by LC-MS and GC-MS, respectively. Most of these pathways are related to amino acid metabolism. Forty-two differential metabolites were imported into the disturbed pathways. Moreover, 3-hydroxypropanal, hydrocinnamic acid, betaine aldehyde, phosphohydroxypyruvic acid, (r)-3-hydroxybutyric acid, and creatinine were identified as potential biomarkers for pre-sarcopenia in HBV-related liver cirrhosis.Conclusions:The study identified a total of 33 pathways and related differential metabolites that were disturbed in HBV-related liver cirrhosis with pre-sarcopenia. The amino acid metabolism, urea cycle, and glyoxylate and dicarboxylate metabolism pathways may be associated with pre-sarcopenia in patients with HBV-related liver cirrhosis. These results provide a direction for nutritional supplementation in liver cirrhosis.
Objective:To study the correlation between nutritional status and length of hospital stay in patients with digestive disorders.Methods:The data were collected from the database of a multi-center investigation on the dynamic changes of nutritional status of hospitalized patients in China, a project led by the Geriatric Nutrition Support Group, Society of Parenteral and Enteral Nutrition, Chinese Medical Association. The enrolled patients were screened for malnutrition and possible sarcopenia using Global Leadership Initiative on Malnutrition criteria, and the dynamic changes of serum biochemical indexes during hospital stay and the effects of malnutrition and possible sarcopenia on the length and cost of hospital stay were analyzed.Results:A total of 1 180 patients were enrolled, with an average age of (56.3±16.1) years, the average height of (164.65±8.29) cm, and the average weight of (62.12±12.12) kg. There were significant differences in body weight, body mass index, calf circumference, lymphocyte count, triglyceride, hemoglobin, albumin and total protein between at discharge and at admission ( P<0.001). There might be a correlation between post-admission malnutrition and sarcopenia. There was neither significant difference in the proportion of patients with malnutrition at admission among different age groups ( P=0.438), nor in that at discharge among different age groups ( P=0.439). The proportion of patients with malnutrition showed no significant difference between subgroups with patients<65 years old and ≥ 65 years old, at admission and discharge ( P>0.05). However, comparison of the proportion of patients with sarcopenia between subgroups with patients<65 years old and ≥65 years old displayed significant differences at admission and discharge ( P<0.001), but not the comparison of the proportion of patients with possible sarcopenia ( P>0.05). The length of hospital stay in patients with malnutrition was significantly longer than that in patients without malnutrition [(13.22±6.24) days vs. (12.08±5.25) days, P<0.001]. The length of hospital stay of patients with and without sarcopenia was also significantly different [(12.87±5.93) days vs. (12.02±5.22) days, P<0.001). Patients with concurrent malnutrition and sarcopenia had longer hospital stay [(14.57±7.15) days vs. (12.07±5.22) days, P<0.001], and higher medical cost [(2.78±2.19) ten thousand Chinese Yuan vs. (2.24±2.33) ten thousand Chinese Yuan, P<0.05)] compared with those without concurrent malnutrition and sarcopenia. Conclusions:A large proportion of patients with digestive disorders were diagnosed with malnutrition and/or possible sarcopenia during hospitalization. There is possible correlation between malnutrition and possible sarcopenia, and both can lead to a longer hospital stay and higher medical cost.
Objective:To investigate the effect of high concentration electrolyte on fat emulsion stability in multi-chambered bag parenteral nutrition, and to protect clinical drug safety.Methods:Multi-chambered bag parenteral nutrition with the same composition containing high concentration electrolyte were used, except for that water-soluble vitamins, fat-soluble vitamins, sodium glycerophosphate and trace elements were supplemented in the experimental group only. The appearance, pH, osmolality and average particle size were examined at 0, 12, 24, 36, 48, 60, 72, and 168 hours after preparation under room temperature.Results:There was no flocculation or oil-water separation in both groups. The pH value was 5.73 to 5.83 for the experimental group, while that was 5.52 to 5.57 for the control group ( P<0.001). For both groups, the comparison between 0 and 168 hours showed significant differences ( P<0.001). The osmolality was significantly different between the experimental group (1 076-1 117 mOsmol/kg) and the control group (1 072-1 104 mOsmol/kg, P=0.012), but showed no statistical significant difference across examined time points within each group ( P>0.05). The average particle size was 296.1 to 310.9 nm for the experimental group, and 296.6 to 334.9 nm for the control group, showing no statistical significant difference ( P=0.096). The particle size showed no profound changes over time in both groups ( P>0.05). Conclusions:The average particle size of fat emulsion in multi-chambered bag parenteral nutrition were basically stable over 168 hours after preparation under room temperature. The addition of water-soluble vitamins, fat-soluble vitamins, sodium glycerophosphate and trace elements had no significant impact on the stability of fat emulsion.
Objective:To explore the necessity and feasibility of clinical nutrition pharmacist-involved consultation, and evaluate the impact on clinical outcome.Methods:Patients who received the nutritional consultation involving pharmacists at Shanxi Bethune Hospital between 2019 and 2021 were retrospectively enrolled. Patient clinical characteristics, distribution, consultation purpose and nutrition management regimen, and clinical outcomes were collected and analyzed.Results:There was increasing utilization of nutrition pharmacist-involved consultations and referrals to pharmacy clinic over the three years. An average of 95.3% of consultation advices were accepted. Over 90% of patients who were scored 3-6 points with Nutritional Risk Screening 2002 benefited from such consultations. Patients with tumors, elderly patients, and patients with digestive system disorders showed the most benefit from nutritional consultations. The purpose of consultation was focused on the development of individualized nutritional management plans, which brought about improvement in patient's nutritional indicators.Conclusion:There is a strong demand for nutritional pharmacy consultation in large-scale comprehensive hospitals, and the standardized consultation workflow paves the way for comprehensive and individualized nutrition therapy.
Objective:To establish a mouse model representing the cardinal features of pancreatic ductal adenocarcinoma-induced cachexia, and to investigate the changes in phenotype, metabolism and cachexia-related biomarkers.Methods:BALB/c nude mice were randomly divided into control group ( n=6) and tumor group ( n=6). The cachexia model of pancreatic cancer was established in BALB/c nude mice by intraperitoneal injection of Panc01 cell line. The changes in body weight, food intake, grip strength and body composition were recorded over the course of tumor development. The animals were euthanized after 2 weeks and were examined for intraperitoneal metastasis. Quantitative real-time polymerase chain reaction was used to detect the expression of cachexia related genes in muscle and adipose tissue and the expression of related inflammatory factors in peripheral blood. Results:The animals in tumor group showed an obvious cachexia phenotype, which was manifested by decreased food intake, lean body weight, and grip strength, and enhanced muscle catabolism. The wasting syndrome in this model was accompanied by hypothalamic inflammation and upregulated expression of uncoupling protein 1 (Ucp1) in white adipose tissue. Haematological abnormalities included leukocytosis and anemia.Conclusions:Intraperitoneal injection of human pancreatic cancer cell Panc01 into nude mice is a reliable model for the study of cachexia, which recapitulates the key features of the pancreatic cancer progress and induces a wide array of cachexia manifestations. Therefore, this model is suitable for preclinical researches exploring the mechanism of cachexia related to pancreatic cancer and identifying novel therapies.
Objective:To investigate the clinical application of multi-oil fat emulsion (SMOF) in preterm infants with necrotizing enterocolitis (NEC).Methods:Preterm infants with NEC admitted to the Neonatal Intensive Care Unit in our hospital between January 2017 and December 2022 were retrospectively included. According to the type of fat emulsion used, they were divided into SMOF group and medium and long chain triglycerides (MCT/LCT) group. The data of two groups were compared and analyzed.Results:A total of 69 preterm infants were included, 34 in the SMOF group and 35 in the MCT/LCT group. There were no significant differences between the two groups in the levels of total bilirubin, indirect bilirubin, direct bilirubin, bile acid and γ-glutamyl transferase ( P>0.05). There were no significant differences between the two groups in triglyceride, low density lipoprotein and total cholesterol ( P>0.05). There were no significant differences between the two groups in the C reactive protein level, procalcitonin level, and the time to normal C reactive protein ( P>0.05). There were no significant differences in incidence of complications between the two groups, including parenteral nutrition-related cholestasis, bronchopulmonary dysplasia, retinopathy of prematurity, and brain injury ( P>0.05). Conclusions:Compared with MCT/LCT, the application of SMOF did not show significant effect on liver function, inflammation, or incidence of complications (parenteral nutrition-related cholestasis, bronchopulmonary dysplasia and retinopathy of prematurity) in preterm infants with NEC. Multi-center studies with larger sample size are needed for further investigation.
Objective:To evaluate the effects of foods for special medical purposes (FSMP) on physical performance, body composition, nutritional metabolic indicator levels, and inflammatory factor levels in patients at nutritional risk.Methods:A single-center, double-blind, randomized, controlled clinical study was conducted. Patients at nutritional risk were randomized to two groups. Both groups received the nutritional management for 8 weeks, including 30 gram of nutritional preparations thrice a day, standard meals, and nutritional education. The intervention group was given full nutritional FSMP while the control group was given isocaloric placebo. The primary outcomes were the changes in timed up and go (TUG) test score, grip strength and muscle mass measured by bioelectrical impedance analysis after the intervention. The secondary outcomes were the walking speed as measured by 4-meter walk test, calf circumference, blood 25 hydroxyvitamin D 3 (25-OH-VD 3), and high-sensitivity C-reactive protein. Other indicators examined included serum albumin and prealbumin and inflammatory factors, and T cell and B cell subsets. Results:Forty-five patients were enrolled and 25 completed the intervention and follow-up period. There were no significant differences between groups in sex, age, height, and weight. Muscle mass ( P=0.042), upper limb muscle mass ( P=0.035), and grip strength ( P=0.032) were significantly increased in the intervention group compared to the control group, while TUG score was significantly reduced ( P=0.047). Four-meter walk test time, calf circumference, inflammatory indicators, and serum indicators did not change significantly after the intervention( P>0.05). TUG score was positively correlated with 4-meter walk time, interleukin-8, while negatively correlated with grip strength, 25-OH-VD 3 and serum albumin. Conclusions:The full nutritional FSMP was safe and effective for long term use in patients at nutritional risk, improving physical performance and muscle mass. However, no significant effect of full nutritional FSMP were observed on serum nutritional indicators and inflammatory factors.
Objective:To evaluate the simulation effect of the placebo in a clinical trial of whole nutrition formula, and to inform the preparation of placebo in the clinical trial of foods for special medical purposes.Methods:Evaluators assessed the appearance, color, smell, and taste, and made the distinction between the placebo and the experimental product independently. The similarity and consistency between the placebo and experimental product were also assessed using a manual scoring method.Results:In the group assessing experimental product, 40% evaluators made the correct judgment while 50% did not. In the group assessing placebo, 10% evaluators made the correct judgment while 70% did not. Compared with the reference product, the experimental product and placebo were scored 9.75±0.79 vs. 6.63±3.73 for appearance, 9.75±0.79 vs. 7.25±3.99 for color, 8.75±3.17 vs. 8.50±3.16 for smell, and 9.00±1.29 vs. 7.75±2.99 for taste. The intra-evaluator consistency rate for the appearance, color, smell and taste of different products was 80%, 80%, 90%, and 90%, respectively. Conclusions:The blinding effect of placebo was relatively satisfactory in the trial we assessed. The placebo was comparable with the experimental product in terms of color, smell, and taste, but not appearance. The approaches for preparing and evaluating placebo in this clinical trial could give some clues for similar trials involving foods for special medical purposes.
Objective:To investigate the stability of fat emulsions after the preparation of parenteral nutrient solution under different storage conditions.Methods:Standardized parenteral nutrient solution was used to prepare a total of 24 bags of nutrient solution with the same formula, except for that Group A (12 bags) contains 20% of medium and long chain fat emulsion (C6-24) while Group B contains 20% of C8-24. The preparations were stored under 2-8℃, 23-25℃, and 35-37℃ and were examined at 24h, 48h and 72h after preparation. The appearance, average size of fat particles, pH value of nutrient solution, and lipid peroxidation were investigated.Results:After storage at 4℃, 25℃ and 36℃ for 24h, 48h and 72h respectively, both groups of preparations showed no obvious change in appearance. There was no significant difference in pH ( P>0.05) nor lipid peroxidation ( P>0.05). Conclusion:Both kinds of fat emulsion are stable in terms of pH value, fat particle size and lipid peroxidation, and can be used for patients receiving intravenous nutrition support.
Objective:To investigate the effect of obesity on vascular anatomy and post-operative outcomes in patients undergoing carotid artery stenting (CAS), and to inform the choice of treatment options for obese patients.Methods:Patients who underwent CAS in the Stroke Center of First Hospital of Shanxi Medical University between January 1st, 2020 and December 31st, 2022 were collected, and their medical records and digital subtraction angiography images were collected. All patients were divided into obese group and non-obese group based on the body mass index at admission. Vascular anatomy and the incidence of peri-operative adverse outcomes were compared between the two groups. The three-step regression method was used to further explore the role of vascular anatomy in the correlation between obesity and peri-operative adverse outcomes in CAS.Results:A total of 298 patients were included. The Buffalo Risk Assessment Scale index was higher for the obese group, and high-risk vascular anatomy was more common in the obese group( P<0.05). The incidence of peri-operative stroke in the obese group was higher than that in the non-obese group (18.5% vs. 5.2%, P=0.007). The mediation analysis suggested the full mediation effect of high-risk vascular anatomy on obesity to influence the incidence of peri-operative stroke after CAS. Conclusion:Obesity increases the risk of post-operative adverse outcomes via inducing the development of complex vascular anatomy.
The aim of this work is to delineate the odyssey of parenteral nutrition (noun number: 01.080), which is also called intravenous nutrition. Robert Elman (a surgeon) administered fibrinogen hydrolysate intravenously to dogs and observed the positive nitrogen balance in 1937. Corresponding report about this clinical research was published later on. Oscar Schuberth (a surgeon) and Arvid Wretlind (an internist) developed the soybean oil emulsion with good tolerability and infused a mixture of glucose, amino acids and fat emulsion into patients for the first time. Stanley Dudrick (a surgeon) carried out laboratory studies, such as infusion of 30% glucose through the central vein, selection of materials for silicone rubber catheter, monitoring of nitrogen balance, and so on. He validated that the growth and development of beagle could be supported with parenteral nutrition. Douglas Wilmore (a surgeon) applied parenteral nutrition to a baby girl with congenital stenosis of alimentary tract and thus initially validated the effectiveness of parenteral nutrition in human after 18 months' observation. All mentioned above are landmarks in the history of parenteral nutrition.The development of it is a rugged but interesting journey parenteral nutrition, exemplifying the general principles and methodology of scientific researches. Fifty-six years passing by since the commencement, now, it is time to march into Phase 3 translational (T3) research for parenteral nutrition. T3 clinical researches in parenteral and enteral nutrition is now in the ascendant in China. By looking back at the odyssey, we would like to highlight the necessity of incessant optimization and standardization of parenteral and enteral nutrition practice, to eventually achieve the rational use of nutrition support therapy and bring about patient benefits.
Objective:To explore the effect of oral nutritional supplements (ONS) during labor on delivery outcomes in low-risk pregnant women and the risk factors of cesarean section.Methods:A retrospective analysis was conducted in a total of 206 full-term pregnant women with singleton and cephalic presentation at the delivery center in our hospital from March 15th to May 15th, 2022. Standard diet education was given to all those women by midwives. Pregnant women who received the enteral nutrient solution prepared by the Department of Clinical Nutrition during labor were in the ONS group ( n = 110), while those who did not were in the control group ( n = 96). The baseline characteristics and delivery outcomes were compared between the two groups, and the risk factors of cesarean section were also analyzed. Results:There were no significant differences in terms of maternal age, height, baseline weight, baseline body mass index (BMI), weight gain during pregnancy, prenatal BMI, gestational week, intraspinal labor analgesia, oxytocin, gastrointestinal intolerance, neonatal length, and weight between the two groups ( P > 0.05). However, the total oral energy intake during labor in the ONS group was significantly higher than that in the control group ([1 349.99± 569.51] kJ vs [249.59 ± 455.19] kJ, P < 0.01). The rate of vaginal delivery in the ONS group was significantly higher than that in the control group (93.6% vs 81.3%, P = 0.01), and the duration of the first stage of labor ([487.06 ± 232.94] min vs [416.17 ± 191.13] min, P = 0.03) was also significantly longer in the ONS group. There were no significant differences between the two groups in terms of the duration of the second and third stages of labor, perineal laceration, cervical laceration, vaginal laceration, amount of bleeding, hospital stay, and Apgar score after birth ( P > 0.05). Multivariate logistic regression analysis showed that maternal age was a risk factor for changing to cesarean section in women with low-risk pregnancies ( OR 1.20, 95% CI 1.03 to 1.40, P = 0.02), while ONS during labor ( OR 0.31, 95% CI 0.11 to 0.85, P = 0.02) and intraspinal labor analgesia ( OR 0.10, 95% CI 0.04 to 0.26, P < 0.01) were protective factors. Conclusions:ONS during labor can significantly increase the vaginal delivery rate, without increasing the incidence of gastrointestinal intolerance in low-risk pregnant women. Maternal age is a risk factor for cesarean section while ONS during labor and intraspinal labor analgesia are protective factors in women with low-risk pregnancies.
Objective:To evaluate the clinical effectiveness of the standardized peripherally inserted central catheter (PICC) implantation procedure in the management of parenteral nutrition infusion routes.Methods:Patients were enrolled from January 2018 to January 2020 and were divided into the study and control groups, receiving standard operating procedures of PICC or insertion through below elbow with or without ultrasonic guidance. The differences in the success rate of PICC insertion, catheter indwelling time, incidence rate of complications, and patient satisfaction were compared.Results:A total of 943 subjects were included. The study group and the control group were comparable in terms of baseline characteristics such as disease type, body mass index and prevalence of nutritional risk. The overall success rate was 100% in both groups. The first-attempt success rate in the study group was higher compared with the control group (92.6% vs 72.2%, χ 2 = 66.229, P < 0.001), and the catheter indwelling time was longer ([25.4 ± 2.3] d vs [21.6 ± 3.1] d, t = 21.271, P < 0.001). The incidence rate of short-term complications in the study group was significantly lower than that in the control group (3.50% vs 11.52%, χ 2 = 21.490, P <0.001), while there was no significant difference in the incidence rate of long-term complications between the two groups (6.78% vs 8.85%, χ 2 = 1.388, P = 0.239). Conclusion:Establishing and implementing the standardized operating procedure of PICC is an effective method to improve the management of parenteral nutrition infusion routes.
Objective:To reveal the research hotspos and the dynamic frontier in feeding intolerance in critically ill patients.Method:We took feeding intolerance and critical illness as the theme, the CNKI and WOS core database as the research object, and used CiteSpace software as research tool, to conduct a visual atlas analysis on the research status and hotspos evolution at home and abroad. Results:There were totally 2 426 feeding intolerance related papers published, and quantity of publications increased year by year. Australia and some European and American countries are in a leading position. The institutions in the lead regarding scientific research level were Royal Adelaide Hospital, Adelaide University, Louisville University, Repatriation General Hospital and Queens University. The researches mainly focused on the investigation of mechanism, symptom evaluation, and management of feeding intolerance .Conclusion:The feeding of critically ill patients has attracted more and more attention. In the future, we should further carry out high-quality and large-scale empirical research, explore new technologies and big data, and develop evidence-based prevention and management strategies for feeding intolerance.
Objective:To summarize the evidence from guidelines, consensus and systematic reviews and provide the optimal recommendations on the management of oral and pharyngeal symptom cluster in patients with head and neck cancer during radiotherapy.Methods:National Guidelines Clearinghouse and databases such as CNKI and PubMed were searched for publications on pain management from January 2016 to March 2023, and for publications on other symptom management from the establishment of database to March 2023. Quality of included articles was evaluated, data were extracted, and evidence were synthesized.Results:We included 28 guidelines, 19 expert consensus, and 16 systematic reviews. The evidence synthesis included 144 items covering 12 aspects, namely general principles, assessment, optimizing radiotherapy plan, oral care, swallowing function intervention, nutritional management, psychosocial intervention, physical intervention, medication, other interventions, health education, and follow-up.Conclusion:Evidence about the management of oral and pharyngeal symptom cluster was adequate. Considering the interaction between various symptoms, healthcare professionals could integrate management measures and construct multimodal management plan for the management of oral and pharyngeal symptom cluster in patients with head and neck cancer during radiotherapy.
Metabolic associated fatty liver disease (MAFLD) is a cluster of chronic, progressive diseases with an increasing prevalence rate worldwide. MAFLD has become the leading cause of chronic liver disease around the world, for which approved therapy is currently lacking. In recent years, growing evidence has demonstrated the close link between gut microbiome dysbiosis and MAFLD. The generation of pro-inflammatory bacterial components and metabolites is susceptible to the changes in the abundance, diversity, and ratio of intestinal bacteria, which could accelerate the progress of MAFLD through the gut-liver axis. As a new therapeutic strategy, fecal microbiota transplantation (FMT) is the transplantation of flora from the intestines of healthy people into the gastrointestinal tract of patients, to directly correct intestinal flora disorders and alter bacterial metabolites. FMT has been widely used in the treatment of Clostridium difficile infections and inflammatory bowel disease. The role of FMT in the treatment of MAFLD has also been explored. However, studies about FMT in MAFLD are overall scarce and the mechanism of action and the therapeutic effect of FMT on MAFLD remains ambiguous. We summarized the existing evidence on the potential molecular mechanism and effectiveness related to FMT in MAFLD.
Objective:To systematically evaluate the postoperative changes in several nutrient levels in obese patients who received laparoscopic Roux-en-Y gastric bypass (LRYGB).Methods:CNKI, Wan Fang, Pubmed, Web of Science and Cochrane library databases were systematically searched and studies were included based on inclusion and exclusion criteria. The Stata 11.0 was used for meta-analysis.Results:A total of 37 studies including 3 282 individuals with obesity were eligible for analysis. A significant decrease was observed after LRYGB in serum vitamin A ( SMD = -0.56, 95% CI: -0.82 to -0.31, P < 0.001), zinc ( SMD = -0.45, 95% CI: -0.89 to -0.01, P = 0.047) and iron ( SMD = -0.44, 95% CI: -0.81 to 0.62, P = 0.021). A significant increase in serum folic acid ( SMD = 0.81, 95% CI: 0.32 to 1.30, P = 0.001) and vitamin D ( SMD = 0.35, 95% CI: 0.11 to 0.58, P = 0.004) was found after laparoscopic RYGB. No significant changes in serum vitamin B 12 ( SMD = -0.22, 95% CI: -0.65 to 0.21, P = 0.309) and calcium ( SMD = -0.13, 95% CI: -0.47 to 0.22, P = 0.470) were observed. Conclusions:The changes in serum nutrient indicators in obese patients after LRYGB were not consistent in trend. The levels of vitamin A, serum iron and serum zinc were significantly decreased, while the levels of vitamin D and folic acid were significantly increased. Levels of calcium and vitamin B 12 showed no significant changes. Therefore, close monitoring of the nutritional indicators and appropriate use of nutrient supplements are recommended, in order to prevent postoperative nutritional deficiencies.
Objective:To retrieve, evaluate, and integrate the evidence on perioperative nutritional management in patients with bladder cancer, and summarize the optimal evidence to inform clinical practice.Methods:Evidence on nutritional management, including guidelines, systematic reviews, evidence summaries, best practices, and expert consensus, was retrieved from BMJ Best Practice, UpToDate, Registered Nurses' Association of Ontario Evidence-Based Nursing Care Guidelines, Scottish Intercollegiate Guidelines Network, National Institute for Health and Care Excellence, European Society for Clinical Nutrition and Metabolism, Cochrane Library, PubMed, CINAHL, Springer Link, Elsevier Science Direct, OVID, Medlinker, China National Knowledge Infrastructure, Wanfang Data, VIP Database for Chinese Technical Periodicals, and China National Biomedical Literature Database. Records published from the establishment of the databases until December 31, 2022 were included. The methodological quality of the guidelines was assessed using the Appraisal of Guidelines for Research and Evaluation II tool, and other types of studies were evaluated using the corresponding criteria in the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports (2016 edition).Result:A total of 11 articles were included, and four themes were identified based on expert panel review, namely nutritional screening and assessment, nutritional support, intestinal management, and health education, on which a total of 24 pieces of best evidence were summarized.Conclusions:This study used an evidence-based approach to generate the best evidence on perioperative nutritional management in patients with bladder cancer, providing solid rationales for standardized nutritional care in these patients. In clinical practice, healthcare professionals should take in to account the clinical environment, patient conditions, and patient preferences, and translat the evidence to tailored management plan to improve patients' clinical outcomes and quality of life.
Gut microbiota is the microbial community that resides on the surface of human intestinal mucosa. During normal pregnancy, the composition of gut microbiota may change dynamically with the progress of pregnancy. Gestational diabetes mellitus (GDM) is a common complication of pregnancy, which can affect maternal and neonatal intestinal flora, and affect the long-term glucose metabolism of mothers and infants through exacerbating insulin resistance and promoting inflammatory response. Adjustment of dietary structure and application of probiotics may regulate intestinal microbiota and improve maternal and neonatal glucose metabolism in GDM. Here we reviewed the correlation between intestinal flora and glucose metabolism during pregnancy, and discussed the effects of diet and probiotics on gut microbiota.
Objective:To systematically evaluate the clinical efficacy of compound α-ketoacid tablets in the treatment of diabetic kidney disease (DKD).Methods:CNKI, Wanfang database, EMBASE, PubMed and Cochrane Library database were searched for eligible records published from the establishment of individual database to November 13 th, 2022. The quality of the included studies were assessed, data were extracted, and meta-analysis was conducted using RevMan5.3. Results:A total of 26 randomized controlled trials were included, with a total of 2 790 DKD patients (1 465 in the experimental group and 1 325 in the control group). Multiple parameters were significantly improved in the experimental group compared with the control group, including 24-hour urinary protein, blood creatinine, urea nitrogen, nutritional index, oxidative stress level, fasting blood glucose, glycated hemoglobin, homocysteine, HGF, VEGF, TGF-β1, and systolic blood pressure.Conclusions:Limited low-quality evidence showed that compound α-ketoacid tablets combined with low-protein diet may be related to the improved 24-hour urinary protein, renal function, and glucose metabolism in patients with DKD. Due to the lack of randomized controlled trials designed for respective stages of DKD, the inclusion criteria of our study were relatively general, possibly leading to the lack of pertinence of the results. Some indicators showed apparent heterogeneity among different groups, and more high-quality multi-center studies with large sample sizes are still needed to verify our findings.
