Background:The long-term effects of supplemental parenteral nutrition (SPN) on survival and recurrence in gastrointestinal (GI) cancer patients undergoing major abdominal surgery remain unclear. This study reports the 5-year overall survival (OS) results from the PNASIT randomized clinical trial (RCT), which compared early SPN [initiated on postoperative day (POD) 3] versus late SPN (initiated on POD 8) in patients with GI undergoing major abdominal surgery. Methods:This multicenter, open-label, RCT was conducted at 11 centers in China. From 1 April 2017 to 31 December 2018, a total of 217 eligible patients with nutritional risk (Nutritional Risk Screening 2002) score ≥3) who were undergoing elective major abdominal surgery for GI cancer were enrolled. Patients were randomized into two groups: the early SPN group (E-SPN; n = 107) and the late SPN group (L-SPN; n = 110). The primary endpoint was 5-year OS, analyzed using Kaplan-Meier methods and Cox proportional hazards models on an intention-to-treat basis. Results:Among the 217 analyzed patients [mean (SD) age, 60.4 (12.2) years; 60.4% male; all of Asian ethnicity], the 5-year OS rate was 70.1% (75/107) in the E-SPN group and 66.4% (73/110) in the L-SPN group [hazard ratio (HR), 0.857; 95% confidence interval (CI), 0.535-1.374; log-rank P = 0.520]. No significant differences were observed in 5-year disease-free survival rates, recurrence rates, or recurrence patterns between the two groups (all P > 0.05). HRQoL, as measured by the 36-Item Short Form Health Survey scale, was significantly higher in the E-SPN group compared with the L-SPN group during the first 6 postoperative months (P < 0.001). However, no significant differences were observed at 1, 3, or 5 years after surgery. Conclusion:In GI cancer patients undergoing major abdominal surgery, early SPN showed no significant difference in 5-year OS compared with late SPN. The findings do not support the use of early SPN to improve long-term survival in this patient population. Trial registration:ClinicalTrials.gov Identifier: NCT03115957.

BACKGROUND AND AIMS:Malnourished patients, who undergo gastrointestinal (GI) surgery, have a higher risk of postoperative complications, including higher rates of morbidity and mortality. Generally, a low-fiber diet is recommended after GI surgery. This study investigated the tolerance and clinical outcomes of an enteral formula supplemented with partially hydrolyzed guar gum (PHGG)-a soluble, prebiotic dietary fiber known to benefit gastrointestinal health-in Chinese patients following GI surgery, using a standard fiber-free formula as the control.. METHODS:This study enrolled 631 patients requiring enteral nutrition following GI surgery. Participants were subsequently randomized to receive either a fiber-enriched formula containing 15 g/L PHGG (experimental group, n = 313) or a standard fiber-free formula (control group, n = 318) for 5 days. Data on feeding effectiveness, tolerability, and clinical outcomes were subsequently collected. RESULTS:The incidence of diarrhea was 9.6 % (95 % confidence interval [CI]: 6.3 to 12.8) in the experimental group and 10.1 % (95 % CI: 6.8 to 13.4) in the control group, with an absolute difference of -0.5 (95 % CI: -5.1 to 4.2) confirming non-inferiority (P < 0.001). In patients who consumed ≥4500 kcal over 5 days (averaging 900 kcal/day), the experimental group showed significantly improved feeding tolerance, with a reduced prevalence of diarrhea and abdominal distension (10.4 % vs 24.7 %, P = 0.045; 19.4 % vs 38.4 %, P = 0.016). Patients with gastric cancer in the experimental group had significantly less abdominal distension (22.7 % vs 48.8 %; P = 0.014). Regarding weight preservation, the experimental group demonstrated benefits in weight preservation at discharge (%weight change: -1.39 vs -2.33, P = 0.049). Thirty days after surgery, the experimental group had better EQ-5D scores, especially in E4 pain/discomfort and E5 anxiety. CONCLUSIONS:The PHGG-enriched enteral nutrition formulation is well-tolerated and non-inferior to a fiber-free formula among patients following GI surgery. To maximize its benefits on GI tolerance and body weight preservation, a daily intake of 800-900 kcal is suggested, though this warrants further validation. The trial protocol was registered at www.chictr.org.cn (Identifier: ChiCTR2000038429).

11526 Background: Ripretinib has emerged as a promising second-line therapy for patients with unresectable or metastatic gastrointestinal stromal tumors (GISTs), demonstrating comparable efficacy to sunitinib and a superior safety profile. However, the optimal second-line therapy tailored to individual patient characteristics remains underexplored. This prospective, multicenter, observational study (NCT05440357) aims to evaluate real-world patterns and outcomes for GISTs patients. Methods: The choice of second-line regimen was determined by the investigators. The primary endpoint was progression-free survival (PFS). Secondary endpoints included safety, objective response rate (ORR), and overall survival (OS). Results: From October 2022, 99 patients were enrolled (ripretinib, n = 49; sunitinib, n = 47; regorafenib, n = 3), with a median follow-up of 8.0 months. Among ripretinib-treated patients, 69% (34/49) had primary KIT exon 11 mutations, while 47% (22/47) of sunitinib-treated patients had primary KIT exon 9 mutations. The objective response rates were 20% (10/49) for ripretinib, 9% (4/47) for sunitinib, and 0% for regorafenib. Median PFS (mPFS) for ripretinib, sunitinib and regorafenib was 11.4, 12.4 and 2.8 months, respectively (p = 0.296). Ripretinib demonstrated better mPFS in patients with primary KIT exon 11 mutations compared to sunitinib group (11.4 vs 7.0 months, p = 0.048). In patients with KIT exon 9 mutations, mPFS was 15.0 months for sunitinib. Ripretinib was associated with fewer grade 3/4 treatment-emergent adverse events (TEAEs) compared to sunitinib (10%vs 26%, p = 0.044). OS data are currently immature. Additionally, 27% (13/49) of patients treated with ripretinib and 17% (8/47) with sunitinib underwent surgery. Among patients who underwent surgery following ripretinib treatment, 84.6% (11/13) achieved R0/R1 resection. 100% (8/8) patients achieved R0/R1 resection in sunitinib group. Median postoperative PFS for ripretinib and sunitinib was 15.5 months and 10.2 months, respectively (p = 0.350). Conclusions: This study is the first prospective, multicenter, real-world study to compare different second-line targeted drugs for advanced GISTs. Our preliminary results suggest that ripretinib may offer superior clinical benefits for patients with primary KIT exon 11 mutations after failure of imatinib first line treatment. Its favorable safety profile and improved tumor response rate facilitated a higher rate of surgical intervention compared to sunitinib. The benefit of surgery remains to be observed. Clinical trial information: NCT05440357 .

Purpose The infiltration of immune cells and their roles of the infiltrating-immune cells in gastrointestinal stromal tumor (GIST) is still unclear. We aimed to discover the infiltration cell types and the relationship between the infiltrating-immune cells and the progression of GIST.Experimental design Single-cell RNA sequencing were performed to discover types of the infiltrating-immune cells and to analyze CellChat between cells. Immunohistochemistry of 80 GIST samples were used to clarify the relation between macrophages and recurrence risk. In vitro, flow cytometry and Real-time PCR were performed to uncover a potential mechanism of tumor cell regulation of macrophages.Results Tumor cells, macrophages, and T-cells were the predominant cell types. The MIF/CXCR4 axis was the most common ligand-receptor interaction between macrophages and tumor cells. As the risk increased, expression levels of CD68, CD206, MIF, and CXCR4 gradually increased. In vitro, we found that GIST882 was able to secrete MIF and GIST882 cell supernatant upregulated M2 polarization. Real-time PCR showed that expression levels of IL-10 mRNA and Arginase-1 mRNA were also the highest in the GIST882 cell supernatant group.Conclusions These findings identify that macrophages are the most abundant infiltrating cells in GIST. The MIF/CXCR4 axis is the most common ligand-receptor interaction between macrophages and tumor cells. GIST cells can regulate macrophage M2 polarization through the MIF/CXCR4 axis.

Background: The effect of early isoenergetic feeding routes [early enteral nutrition (E -EN) or early supplemental parenteral nutrition (E-SPN)] on the outcome of patients undergoing major abdominal surgery is controversial. Objectives: The aim of this study was to investigate the impact of early isoenergetic EN compared with early isoenergetic SPN on nosocomial infections in patients undergoing major abdominal surgery. Methods: This study is a secondary, post hoc analysis of data from 2 open -label randomized clinical trials. Participants were recruited from the general surgery department of 11 academic hospitals in China undergoing major abdominal surgery and with Nutritional Risk Screening 2002 score >= 3. All eligible patients were categorized into 2 groups based on their achievement of the 100% energy target on postoperative day (POD) 3: the E -EN group ( n = 199) and the E-SPN group ( n = 115). The primary outcome was the incidence of nosocomial infections between POD 3 and hospital discharge. Results: In total, 314 patients [mean (SD) age, 59.2 (11.4) y; 113 (36.0%) females] were included. Patients in the E -EN group showed no signi fi cant difference in nosocomial infections compared with those in the E-SPN group {17/199 [8.5%] compared with 10/115 [8.7%], risk difference, 0.2% [95% con fi dence interval (CI): - 6.3, 6.6]}. The hematological nutritional status of the E -EN group showed a signi fi cant improvement at discharge compared with the E-SPN group (albumin: 38.0 +/- 6.0 g/L compared with 35.5 +/- 7.6 g/L; mean difference, - 2.5 g/L; 95% CI: - 4.0, - 1.0 g/L; prealbumin: 200.0 +/- 8.0 mg/L compared with 158.4 +/- 38.1 mg/L; mean difference, - 41.6 mg/L; 95% CI: - 41.7, - 36.1 mg/L). Other indicators were comparable between groups. Conclusion: E -EN compared with isoenergetic SPN may not be associated with a reduced rate of nosocomial infection in patients undergoing major abdominal surgery, but may be associated with improved hematological nutritional status.

The density of CD169+ macrophages has been reported to positively correlate with the number of CD8+ T cells, although this remains controversial. To better understand this topic, we conducted a meta-analysis. We searched the PubMed, Medline, and Web of Science databases for studies that were published before May 2022 and performed a meta-analysis of the incidence of low and high CD169 expression in groups based on CD8 expression using the random-effects model. A total of 10 studies were included in the meta-analysis. The incidence of high CD169 expression in lymph nodes was significantly lower than that of low CD169 expression in the low CD8 expression group (odds ratio (OR): 0.76, 95% confidence interval (CI): 0.6, 0.96); however, the incidence of high CD169 expression in lymph nodes was higher than that of low CD169 expression in the high CD8 expression group (OR: 1.50, 95% CI: 1.08, 2.07). We also found that the expression of CD169 in tumors was lower than that in nontumor tissues (standardized mean difference: −5.29, 95% CI: −7.47, −3.11). The overall survival and hazard ratio of patients with high and low CD169 expression was 0.45 (95% CI: 0.37, 0.55). This analysis showed that high CD169 expression was associated with a high CD8 expression, and low CD169 expression was associated with low CD8 expression. The risk of death was 55% lower for patients with high CD169 expression, and high CD169 expression may be associated with favorable survival outcomes in cancer patients. However, the number and heterogeneity of the studies should be taken into consideration when evaluating the analysis. High-quality randomized controlled trials on the association between CD169 and CD8 expression are needed to verify these effects.

Background:Both low skeletal muscle mass and delirium are prevalent in older hospitalized patients, while their associations are unclear. This systematic review and meta-analysis aim to investigate the associations between low skeletal muscle mass and the incidence of delirium in hospitalized patients. Methods:The PubMed, Web of Science, and Embase were searched for relevant studies published before May 2022, and we conducted this systematic review and meta-analysis according to the PRISMA and MOOSE guidelines. The summary odds ratios (OR) and 95% confidence intervals (CI) were estimated, and subgroup analyses were also conducted according to the age and major surgeries. Results:Finally, nine studies with 3 828 patients were included. The pooled result showed no significant association between low skeletal muscle mass and the incidence of delirium (OR 1.69, 95% CI 0.85 to 2.52). However, sensitivity analysis suggested that one study caused a significant alteration of the summary result, and the meta-analysis of the remaining 8 studies showed that low skeletal muscle mass was significantly associated with an 88% increased incidence of delirium (OR 1.88, 95% CI 1.43 to 2.33). Furthermore, subgroup analyses indicated that low skeletal muscle mass was associated with a higher incidence of delirium in patients ≥75 years old or undergoing major surgeries instead of those <75 years old or without surgeries, respectively. Conclusions:Hospitalized patients with low skeletal muscle mass might have higher incidence of delirium, particularly in those of older age and undergoing major surgeries. Therefore, great attention should be paid to these patients.

Background: The effect of early achievement of energy targets (EAETs) using different nutritional support strategies in patients undergoing major abdominal surgery is unclear. This study determined the impact of EAETs on the incidence of nosocomial infections in patients undergoing major abdominal surgery. Methods: This was a secondary analysis of two open-label randomized clinical trials. Patients from the general surgery department of 11 academic hospitals in China undergoing major abdominal surgery and at nutritional risk (Nutritional risk screening 2002 >= 3) were divided into two groups based on whether they met the 70% energy targets, the EAET (521 EAET and non-achievement of energy target (114 NAET) groups. The primary outcome was the incidence of nosocomial infections between postoperative day 3 and discharge, and the secondary outcomes were actual energy and protein intake, postoperative noninfectious complications, intensive care unit admission, mechanical ventilation, and hospital stay. Results: Overall, 635 patients [mean (SD) age, 59.5 (11.3) years] were included. The EAET group received more mean energy between days 3 and 7 than the NAET group (22.75.0 vs. 15.1 +/- 4.8 kcal/kg/d; P<0.001). The EAET group had significantly fewer nosocomial infections than the NAET group [46/521(8.8%) vs. 21/114(18.4%); risk difference, 9.6%; 95% CI, 2.1-17.1%; P=0.004]. A significant difference was found in the mean (SD) number of noninfectious complications between the EAET and NAET groups [121/521(23.2%) vs. 38/114(33.3%); risk difference, 10.1%; 95% CI, 0.7-19.5%; P=0.024]. The nutritional status of the EAET group was significantly improved at discharge compared with the NAET group (P<0.001), and other indicators were comparable between groups. Conclusion: EAETs was associated with fewer nosocomial infections and improved clinical outcomes, regardless of the nutritional support strategy (early enteral nutrition alone or combined with early supplemental parenteral nutrition).

Background: Inflammatory bowel disease (IBD) is a complex and multifactorial inflammatory condition, comprising Crohn's disease (CD) and ulcerative colitis (UC). While numerous studies have explored the immune response in IBD through transcriptional profiling of the enteric mucosa, the subtle distinctions in the pathogenesis of Crohn's disease and ulcerative colitis remain insufficiently understood. Methods: The intact bowel wall specimens from IBD surgical patients were divided based on their inflammatory status into inflamed Crohn's disease (iCD), inflamed ulcerative colitis (iUC) and non-inflamed (niBD) groups for RNA sequencing. Differential mRNA GO (Gene Ontology), and KEGG (Kyoto Encyclopedia of Genes and Genomes), and GSEA (Gene Set Enrichment Analysis) bioinformatic analyses were performed with a focus on the enteric autonomic nervous system (ANS) and smooth muscle cell (SMC). The transcriptome results were validated by quantitative polymerase chain reaction (qPCR) and immunohistochemistry (IHC). Results: A total of 2099 differentially expressed genes were identified from the comparison between iCD and iUC. Regulation of SMC apoptosis and proliferation were significantly enriched in iCD, but not in iUC. The involved gene PDE1A in iCD was 4-fold and 1.5-fold upregulated at qPCR and IHC compared to that in iUC. Moreover, only iCD was significantly associated with the gene sets of ANS abnormality. The involved gene SEMA3D in iCD was upregulated 8- and 5-fold at qPCR and IHC levels compared to iUC. Conclusion: These findings suggest that PDE1A and SEMA3D may serve as potential markers implicated in enteric smooth muscle apoptosis, proliferative disorders, and dysautonomia specifically in Crohn's disease.

Yi Huang, Xiaoting Wu, Si Chen, Wei Hu, Qing Zhu, Junlan Feng, Chao Deng, Zhijian Ou, Jiangjiang Zhao. Proceedings of the Towards Semi-Supervised and Reinforced Task-Oriented Dialog Systems (SereTOD). 2022.

Objective This study aimed to assess the prognostic value of the Nutritional Risk Score 2002 (NRS2002) and patient-generated subjective global assessment (PG-SGA) for post-operative infections in patients with gastric cancer (GC) and colorectal cancer (CRC) who underwent curative surgery. Methods This prospective study included 1,493 GC patients and 879 CRC patients who underwent curative surgery at 18 hospitals in China between April 2017 and March 2020. The NRS2002 and PG-SGA were performed on the day of admission. The relationship between the nutritional status of patients before surgery and post-surgical incidence of infection was analyzed using univariate and multiple logistic regression analyses. Results According to NRS2002, the prevalence of nutritional risk was 51.1% in GC patients and 63.9% in CRC patients. According to the PG-SGA, 38.9% of GC patients and 54.2% of CRC patients had malnutrition. Approximately 4.4% of the GC patients and 9.9% of the CRC patients developed infectious complications after surgery. The univariate and multiple logistic regression analyses showed that the risk of infections was significantly higher in GC patients with a high nutritional risk score (NRS2002 ≥5) than in those with a low score (NRS2002 <3), and the PG-SGA score was identified as a predictor of post-operative infection complications of CRC. Conclusion The pre-operative nutritional status of patients with GC or CRC has an impact on post-operative infection occurrence. NRS2002 ≥5 was a risk factor for post-operative infection in patients with GC, and the PG-SGA B/C was a predictor of infections in patients with CRC.

AbstractIntroductionThe main emphasis of the research about adjuvant imatinib for high‐risk gastrointestinal stromal tumors (GISTs) is prolonging the treatment duration and ignores the heterogeneous that 10‐year recurrence rates ranged from about 20%–100%. Thus, this study evaluated the effect of different durations of adjuvant imatinib on outcomes in high‐risk GISTs to explore the feasibility of individual treatment.MethodsWe analyzed 855 high‐risk GIST patients from three centers who underwent macroscopically complete resection between December 2007 and September 2020. The patients were divided into training (n =564) and two validation cohorts (n = 238 and53) based on their source. Recurrence‐free survival (RFS) was the primary point. Cox multivariate analysis was used to develop the nomogram. C‐index, time‐dependent area under the curves, and calibration plots were used to assess the performance of the nomogram.ResultsUnivariate analysis showed that longer adjuvant imatinib was significantly associated with better 5‐year RFS (p < 0.0001). Further investigation identified that the same high‐risk patients with lower tumor‐associated recurrence risk benefitted little from prolonged treatment and that the recommended adjuvant imatinib duration was insufficient for those with higher recurrence risk. A nomogram for predicting 2‐, 3‐, and 5‐year RFS based on different treatment durations and four major risk factors, namely, tumor site, size, mitotic count, and rupture status, was built and validated, with a C‐index of 0.82, 0.74, and 0.70 in training and two external validation cohorts, respectively. An online dynamic nomogram was further developed for clinical applications (https://ruolinliu666.shinyapps.io/GIST/), offering predictive recurrence rates based on different treatment durations and tumor features.ConclusionsWe developed a nomogram to predict the recurrence risk for high‐risk patients according to tumor features and treatment durations of imatinib to help physicians on decision‐making for individualized treatment duration.

Importance The effect of and optimal timing for initiating supplemental parenteral nutrition (SPN) remain unclear after major abdominal surgery for patients in whom energy targets cannot be met by enteral nutrition (EN) alone. Objective To examine the effect of early supplemental parenteral nutrition (E-SPN) (day 3 after surgery) or late supplemental parenteral nutrition (L-SPN) (day 8 after surgery) on the incidence of nosocomial infections in patients undergoing major abdominal surgery who are at high nutritional risk and have poor tolerance to EN. Design, Setting, and Participants A multicenter randomized clinical trial was conducted from April 1, 2017, to December 31, 2018, in the general surgery department of 11 tertiary hospitals in China. Participants were those undergoing major abdominal surgery with high nutritional risk and poor tolerance to EN (<= 30% of energy targets from EN on postoperative day 2, calculated as 25 and 30 kcal/kg of ideal body weight daily for women and men, respectively) and an expected postoperative hospital stay longer than 7 days. Data analysis was performed from February 1 to October 31, 2020. Interventions Random allocation to E-SPN (starting on day 3 after surgery) or L-SPN (starting on day 8 after surgery). Main Outcomes and Measures The primary outcome was the incidence of nosocomial infections between postoperative day 3 and hospital discharge. Results A total of 230 patients (mean [SD] age, 60.1 [11.2] years; 140 men [61.1%]; all patients were of Han race and Asian ethnicity) were randomized (115 to the E-SPN group and 115 to the L-SPN group). One patient in the L-SPN group withdrew informed consent before the intervention. The E-SPN group received more mean (SD) energy delivery between days 3 and 7 compared with the L-SPN group (26.5 [7.4] vs 15.1 [4.8] kcal/kg daily; P < .001). The E-SPN group had significantly fewer nosocomial infections compared with the L-SPN group (10/115 [8.7%] vs 21/114 [18.4%]; risk difference, 9.7%; 95% CI, 0.9%-18.5%; P = .04). No significant differences were found between the E-SPN group and the L-SPN group in the mean (SD) number of noninfectious complications (31/115 [27.0%] vs 38/114 [33.3%]; risk difference, 6.4%; 95% CI, -5.5% to 18.2%; P = .32), total adverse events (75/115 [65.2%] vs 82/114 [71.9%]; risk difference, 6.7%; 95% CI, -5.3% to 18.7%; P = .32), and rates of other secondary outcomes. A significant difference was found in the mean (SD) number of therapeutic antibiotic days between the E-SPN group and the L-SPN group (6.0 [0.8] vs 7.0 [1.1] days; mean difference, 1.0 days; 95% CI, 0.2-1.9 days; P = .01). Conclusion and Relevance In this randomized clinical trial, E-SPN was associated with reduced nosocomial infections in patients undergoing abdominal surgery and seems to be a favorable strategy for patients with high nutritional risk and poor tolerance to EN after major abdominal surgery. Question When should supplemental parenteral nutrition (SPN) after major abdominal surgery be considered for patients in whom energy targets cannot be met by enteral nutrition alone? Findings This multicenter randomized clinical trial compared the effect of early supplemental parenteral nutrition (E-SPN) and late supplemental parenteral nutrition (L-SPN) in 230 patients with high nutritional risk and poor tolerance to enteral nutrition after major abdominal surgery. Results showed that E-SPN in combination with enteral nutrition was associated with a reduced incidence of nosocomial infection compared with L-SPN. Meaning These findings provide evidence that E-SPN in combination with enteral nutrition after major abdominal surgery is preferable to L-SPN to reduce nosocomial infections. This randomized clinical trial examines the effect of early vs late supplemental parenteral nutrition on the incidence of nosocomial infections in patients undergoing major abdominal surgery

Background Proximal gastrectomy with double-tract reconstruction (DTR) has been used for upper third gastric cancer as a function-preserving procedure. However, the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with DTR remain uncertain. This study compared open proximal gastrectomy (OPG) with DTR and LPG with DTR for proximal gastric cancer. Methods Sixty-four patients who had undergone OPG with DTR and forty-six patients who had undergone LPG with DTR were enrolled in this case–control study. The clinical characteristics, surgical outcomes and postoperative nutrition index were analysed retrospectively. Results The operation time was significantly longer in the LGP group than in the OPG group (258.3 min vs 205.8 min; p = 0.00). However, the time to first flatus and postoperative hospital stay were shorter in the LPG group [4.0 days vs 3.5 days ( p = 0.00) and 10.6 days vs 9.2 days ( p = 0.001), respectively]. No significant difference was found between the two groups in the number of retrieved lymph nodes, complications or reflux oesophagitis. The nutrition status was assessed using the haemoglobin, albumin, prealbumin and weight levels from pre-operation to six months after surgery. No significant difference was found between the groups. Conclusion LPG with DTR can be safely performed for proximal gastric cancer patients by experienced surgeons.

Isothiocyanates, bioactive phytochemicals of cruciferous vegetables, have chemopreventative efficacy. To clarify evidence of associations between cruciferous vegetable and isothiocyanate intake and various health outcomes, we conducted an umbrella review of meta-analyses and systematic reviews in humans. A total of 413 articles were identified, and 57 articles with 24 health outcomes were included. Consumption of cruciferous vegetables was associated with a reduced risk of all-cause mortality, cancers, and depression. Dose-response analyses revealed that a per 100 g/d increment was associated with a 10% decrease in the risk of all-cause mortality. Warfarin resistance caused by vitamin K-rich broccoli was reported. Caution was warranted for those allergies/ hypersensitivities to the Brassica genus. The intake of cruciferous vegetables is generally safe and beneficial in humans. However the quality of the majority (68%) of evidence was low.

When only the TNM classification is used to predict survival in gastric cancer (GC) patients, the impact of the degree of lymphadenectomy on the prognosis is neglected. This study aimed to establish a more effective nomogram based on the log odds of negative lymph nodes/T stage ratio (LONT) to predict survival in surgically treated GC patients. The data of resected GC patients were extracted from the Surveillance, Epidemiology, and End Results Program (SEER) database. Univariate and multivariate Cox regression analyses were used to identify the significant prognostic factors. The prognostic performance was assessed using a calibration plot, concordance index (C-index), and area under the (time-dependent receiver operating characteristic) curve (AUC) to compare the predicted survival probability based on the nomogram score groups. The results showed LONT as an independent prognostic factor for cancer-specific survival (CSS) and overall survival (OS), independent of clinicopathological factors. After removing potential redundancy, only LONT, T stage, N stage, location and age were used in the final nomogram model. The model had a higher C-index (0.736 ± 0.012) and AUC (0.798) than the TNM staging system (0.685 ± 0.012 and 0.744). The nomogram score could predict a significant survival difference between any two adjacent groups in terms of CSS and OS. High LONT is associated with improved survival of gastric cancer patients, independent of other clinicopathological factors. The prognostic nomogram model based on LONT could effectively predict CSS and OS for resectable GC patients.

Green leafy vegetables (GLVs) are a key element of healthy eating patterns and are an important source of lutein. To clarify the evidence for associations between GLVs and lutein intake and multiple health outcomes, we performed a review. A total of 24 meta-analyses with 29 health outcomes were identified by eligibility criteria. Dose-response analyses revealed that, per 100 g/d GLV intake was associated with a decreased risk (ca. 25%) of all-cause mortality, coronary heart disease and stroke. Beneficial effects of GLV intake were found for cardiovascular disease and bladder and oral cancer. Dietary lutein intake was inversely associated with age-related macular degeneration, age-related cataracts, coronary heart disease, stroke, oesophageal cancer, non-Hodgkin lymphoma, metabolic syndrome, and amyotrophic lateral sclerosis. Caution was warranted for contamination with potentially pathogenic organisms, specifically Escherichia coli. GLV consumption and lutein intake therein are generally safe and beneficial for multiple health outcomes in humans.

BACKGROUND The number of negative lymph nodes (NLNs) and tumor size are associated with prognosis in rectal cancer patients undergoing surgical resection. However, little is known about the prognostic significance of the NLN count after adjusting for tumor size. AIM To assess the prognostic impact of the log odds of NLN/tumor size (LONS) in rectal cancer patients. METHODS Data of patients with stage I-III rectal cancer were extracted from the Surveillance, Epidemiology, and End Results Program database. These patients were randomly divided into a training cohort and a validation cohort. Univariate and multivariate Cox regression analyses were used to determine the prognostic value of the LONS. The optimal cutoff values of LONS were calculated using the "X-tile" program. Stratified analysis of the effect of LONS on cancer-specific survival (CSS) and overall survival (OS) were performed. The Kaplan-Meier method with the log-rank test was used to plot the survival curve and compare the survival data among the different groups. RESULTS In all, 41080 patients who met the inclusion criteria were randomly divided into a training cohort (n = 28775, 70%) and a validation cohort (n = 12325, 30%). Univariate and multivariate analyses identified the continuous variable LONS as an independent prognostic factor for CSS [training cohort: Hazard ratio (HR) = 0.47, 95% confidence interval (CI): 0.44-0.51, P < 0.001; validation cohort: HR = 0.46, 95%CI: 0.41-0.52, P < 0.001] and OS (training cohort: HR = 0.53, 95%CI: 0.49-0.56, P < 0.001; validation cohort: HR = 0.52, 95%CI: 0.42-0.52, P < 0.001). The X-tile program indicated that the difference in CSS was the most significant for LONS of -0.8, and the cutoff value of -0.4 can further distinguish patients with a better prognosis in the high LONS group. Stratified analysis of the effect of the categorical variable LONS on CSS and OS revealed that LONS was also an independent predictor, independent of pN stage, pT stage, tumor-node-metastasis stage, site, age, sex, the number of examined lymph nodes, race, preoperative radiotherapy and carcinoembryonic antigen level. CONCLUSION LONS is associated with improved survival of rectal cancer patients independent of other clinicopathological factors.

Objective:To study the correlation between third lumbar skeletal muscle index(LSMI) and inflammatory factors and other factors in peripheral blood in gastric cancer patients.Methods:From October 2017 to December 2019, patients with gastric cancer admitted to West China Hospital Sichuan University were included. The LSMI of patients was obtained by dividing the area of skeletal muscle at the third lumbar vertebra level by the square of the height based on preoperative abdominal imaging data. The correlation between preoperative LSMI and inflammatory factors and other factors in peripheral blood were analyzed by person correlation analysis.Results:This study included 132 patients with gastric cancer. Among them, 39 were classified as stage Ⅰ, 36 were stage Ⅱ, and 57 were stage Ⅲ, respectively. Pearson correlation analysis suggested that the LSMI of gastric cancer patients was positively correlated with peripheral red blood cell count( P<0.01), hemoglobin( P<0.01), and prealbumin( P<0.01), and negatively correlated with interleukin-6(IL-6, P=0.027) and C-reactive protein(CRP, P= 0.014). Conclusion:Our study suggested that LSMI can be used as a nutritional index in gastric cancer patients and IL-6 and CRP played an important in the occurrence and development of sarcopenia in gastric cancer patients.