Background Allogeneic hematopoietic stem cell transplantation(allo-HSCT)is an effective treatment for hematopoietic malignancies.Malnutrition is a common complication and negatively affects prognosis.Muscle mass has been shown to reflect the nutritional status of patients earlier than blood biochemical parameters such as albumin.However,the influence of pre-transplantation skeletal muscle mass(SMM)on the complications associated with early transplantation remains unclear.Objective To investigate the effect of pre-transplant SMM on the early outcomes of allo-HSCT,provide a clinical basis for nutritional interventions and prognosis improvement.Methods A study was conducted with 77 leukemia patients who underwent allo-HSCT at the Medical Center of Hematology,Xinqiao Hospital of Army Medical University from January to October 2022.Bioelectrical impedance analysis was used to assess skeletal muscle mass.The patients were divided into the normal SMM group of 36 cases and low SMM group of 41 cases according to their SMM.Baseline data,including personal and clinical details,were collected.Early post-transplant complications(within 30 days post-transplant)such as oral mucositis,gastrointestinal symptoms,infection and hematopoietic reconstitution time between the two groups were compared using SPSS 23.0 software.Results There was no statistically significant difference in the incidence of diarrhea,nausea,vomiting,and abdominal pain/gastritis incidence between the normal and low SMM groups(P>0.05).The incidence of oral mucositis,hypoalbuminemia,overt gastrointestinal bleeding,and infection was lower in the normal SMM group than in the low SMM group(P<0.05).The severity of oral mucositis in patients in the normal SMM group was lower than that in the low SMM group(P<0.001).Neutrophil implantation time and platelet implantation time were longer in patients in the low SMM group than in the normal SMM group(P<0.01).Conclusion The pre-transplant patients had a high incidence of low SMM.The low SMM before transplantation correlates with the occurrence of oral mucositis,hypoalbuminemia,overt gastrointestinal bleeding,and infections,as well as extended neutrophil and platelet engraftment time in the early transplantation period,and patients should be screened as early as possible prior to transplantation to boost SMM and improve early post-transplant outcomes.

Background Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only potentially curative treatment for acute leukemia. However, disease cure is not guaranteed post-transplantation, as numerous complications post-transplant can affect patient survival outcomes and warrant attention. Research indicates that post-HSCT, patients are prone to infections, pneumonia, liver and kidney dysfunctions, and neurological injuries. These complications not only directly impact the efficacy of the transplantation but also significantly decrease the patient's quality of life and may even threaten their life. This study aims to analyze the factors influencing survival in patients with hematological diseases undergoing HSCT and to develop a risk prediction model to provide reference for clinical treatment. Objective To analyze the risk factors affecting the survival of acute leukemia patients undergoing hematopoietic stem cell transplantation (HSCT) and to construct a survival prediction risk model to provide reference for clinical diagnosis and treatment. Methods From January 2018 to December 2020, acute leukemia patients who underwent HSCT at the Hematology Center of a tertiary hospital in Chongqing were selected. Multivariate regression analysis was used to identify factors influencing survival post-HSCT. A prediction model was constructed using R software, and the accuracy of the model was evaluated using the area under the ROC curve (AUC) and calibration curves. Results A total of 650 patients with malignant leukemia were included, with a follow-up period of 3 years. Among them, 115 patients died, resulting in a mortality rate of 18.54%. Multivariate Cox regression analysis showed that patient age (OR=1.02, P=0.035), diagnosis of ALL (OR=1.64, P=0.021), Risk (OR=1.8, P=0.01), HGB (OR=0.98, P=0.002), PLT (OR=0.97, P=0.006), GVHD (OR=0.35, P<0.001), GIB (OR=2.65, P=0.002), donor age (OR=0.98, P=0.025), PA (OR=0.99, P<0.001), NLR (OR=0.97, P<0.001), and SII/per100 (OR=0.98, P=0.002) were independent risk factors affecting survival post-HSCT in acute leukemia patients. By combining stepwise regression and clinical significance, the final model included Risk, Cells.CD34+, Donor.age, GVHD, Age, Diagnosis, HGB, Tumor.history, NLR, SII, and PA. The results showed that the AUC of the OS curve was 0.799 (95% CI 0.759 to 0.838) for 1-year post-transplant, 0.831 (95% CI 0.796 to 0.866) for 2-year post-transplant, and 0.778 (95% CI 0.739 to 0.817) for 3-year post-transplant. The consistency index (C-index) was 0.701, with a corrected C-index of 0.672 validated by bootstrap sampling. The K-fold cross-validation yielded AUC=0.8243 and Brier=0.1567, indicating good consistency between our prediction model and actual survival outcomes post-transplant. Conclusion Disease type, risk stratification, patient age, pre-transplant serum albumin, CD34+ cell count, donor age, patient age, GVHD, tumor history, and PA are high-risk factors affecting the survival of acute leukemia patients post-HSCT. Clinicians should focus on these high-risk patients and provide appropriate interventions to improve post-HSCT survival outcomes.

Background Allogeneic hematopoietic stem cell transplantation is an effective method for the treatment of hematologic malignancies. Malnutrition is a common complication and has a negative impact on poor prognosis. It has been proved that blood biochemical indexes such as muscle mass ratio albumin etc. can reflect earlier the nutritional status of patients, but the influence of muscle mass pre-transplantation on the early transplantation related complications remains unclear. Objective To investigate the effect of pre-transplantation skeletal muscle mass (SMM) on the early outcome of allogeneic hematopoietic stem cell transplantation, and to provide clinical evidence for nutritional intervention and prognosis improvement. Method A cohort study was conducted in 77 patients with leukemia who received allogeneic hematopoietic stem cell transplantation in the Hematology Medical Center of Chongqing Xinqiao Hospital from January to October 2022 were selected. The skeletal muscle quality was evaluated by bioelectrical impedance method. According to the skeletal muscle mass, the patients were divided into normal skeletal muscle mass group(36) and low skeletal muscle mass group(41). The baseline data of the patients were collected, including personal information and clinical data. SPSS23.0 software was used to compare the differences in oral mucositis, digestive tract symptoms, infection and hematopoietic reconstitution time between the two groups. Result Before transplantation, the SMM of patients was poor, which was not up to the normal value in 53.25%.The incidence of oral mucitis in normal SMM group was 41.67%, significantly lower than that in low SMM group 92.68%( χ2=23.255, P<0.001).The severity of oral mucositis was significantly different (Z=6.461, P<0.001) between the normal SMM group and the low SMM group. The incidence of hypoalbuminemia in normal SMM group was 16.67%, significantly lower than that in low SMM group 46.34%( χ2=7.699， P<0.001).The incidence of overt gastrointestinal bleeding and infection in normal SMM group were significantly lower than those in low SMM group ( c２=4.208， P=0.040； c２=4.727， P=0.030). the neutrophils and platelets grafting time in the normal SMM group was significantly shorter than that in the low SMM group ( Z=2.943， P=0.003； Z=2.756， P=0.006). There was no significant difference in the incidence of diarrhea, nausea and vomiting, stomachache/ abdominal pain between the two groups. Conclusion The incidence of low skeletal muscle mass is high in patients before transplantation, and low skeletal muscle mass is associated with the onset of oral mucositis, the severity of oral mucositis, hypoalbuminemia,gastrointestinal bleeding ,infectionand the delay of neutrophil and platelet implantation time in patients at the early stage of transplantation. Patients should actively improve skeletal muscle mass before transplantation to improve the early outcome of transplantation.

目的 分析支链氨基酸(BCAA)型肠内营养制剂联合益生菌对肝硬化失代偿期患者肝功能的影响.方法 选取2017年2月至2019年3月重庆某三甲医院消化内科病区收治的肝硬化失代偿期患者72例,采用随机数字表法分为研究组和对照组,每组36例.对照组仅给予肝硬化失代偿期饮食指导,研究组在相同饮食指导基础上给予BCAA型肠内营养制剂联合益生菌治疗.比较两组患者治疗前后清蛋白(ALB)、前清蛋白(PA)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)和直接胆红素(DBIL)等相关指标变化.结果 研究组患者干预后ALB水平明显高于对照组,差异有统计学意义(P＜0.05);研究组患者干预前后ALB、PA变化幅度均明显大于对照组,差异均有统计学意义(P＜0.05).两组患者干预前后ALT、AST、TBIL、DBIL水平比较,差异均无统计学意义(P＞0.05);研究组患者干预前后TBIL、DBIL变化幅度均明显大于对照组,差异均有统计学意义(P＜0.05).研究组患者干预前后肝功能相关指标均较干预前明显好转,差异均有统计学意义(P＜0.05);对照组患者干预前后ALT、AST、TBIL、DBIL水平比较,差异均无统计学意义(P＞0.05).结论 BCAA型肠内营养制剂联合益生菌用于肠内营养支持可明显改善失代偿期肝硬化患者ALB水平,同时也有助于减轻失代偿期肝硬化患者的肝功能负担.

BACKGROUND:This study aims to explore the effect of mobile phone-based telemedicine management of glycemic control of type 2 diabetes mellitus (T2DM).METHODS:Patients with T2DM were followed up in Chongqing Jiulongpo District Yuzhoulu Community Health Center, and randomly divided into the telemedicine group (n=47) and the control group (n=50). The control group received regularly routine intervention. The telemedicine management group used the mobile phone to manage their health condition remotely.RESULTS:Both groups had similar baseline characteristics. After a follow-up period of 12 months intervention, the weight, body mass index, waist circumference, systolic blood pressure, body fat percentage, body fat mass, body water and muscle mass, fasting blood glucose, glycosylated hemoglobin, total costs of diabetes treatment for 1 month and the quality-of-life score were significantly improved in the telemedicine group (P<0.05). And compared with the control group, body fat composition, fasting blood glucose, glycosylated hemoglobin and the cost of change shows a significant improvement (P<0.05). Positive correlation was detected between fasting blood glucose and body composition parameters, such as body fat percentage, lean body mass and body fat mass in the telemedicine group (r=0.56, P<0.05; r=0.37, P<0.05; r=0.56, P<0.05).CONCLUSIONS:Compared with conventional intervention, the mobile phone-based telemedicine management can help patients with T2DM to improve glycemic level and quality of life.

Strict and appropriate glycaemic control has a positive impact on long-term clinical outcomes in patients with type 2 diabetes mellitus (T2DM) by delaying and slowing the progression of complications related to diabetes (UK Prospective Diabetes Study (UKPDS) Group, 1998; Klaus-Dieter et al., 2011). Specific treatment such as oral hypoglycaemic agents or insulin is given to patients with T2DM according to their condition. Importantly, the adjustment of suboptimal dietary and lifestyle habits has become the primary therapy for T2DM and an important adjunctive treatment in insulin-dependent T2DM (Tuomilehto et al., 2011). However, there are an increasing number of patients who have never received systematic or scientific management and guidance on their daily diet, leading to a poor glycaemic control or malnutrition. Reducing hyperglycaemia to an appropriate range without significant hypoglycaemia is the primary goal; however, over nutrition and malnutrition in diabetic patients can cause serious concern (Franz et al., 2017).

目的 探讨围术期肠内外序贯营养治疗对膀胱全切回肠代膀胱术患者临床预后的影响及临床效果观察.方法 57例行膀胱全切回肠代膀胱术的膀胱癌患者根据围术期营养支持方式不同分为2组.观察组27例,接受优化的围术期序贯营养治疗;对照组30例,采用本院常规围术期营养治疗.比较两组患者术后的一般情况、肝脏功能、营养状况、临床并发症、住院总费用及日均营养费用.结果 除观察组碱性磷酸酶水平,两组患者手术前后肝脏功能指标变化差异无统计学意义(P＞0.05).观察组术后维生素A结合蛋白[(31.26±10.16)mg/L vs.(24.83士8.48)mg/L,P=0.012]、清蛋白[(39.53±4.11)g/L vs.(38.55±5.62)g/L,P=0.035]及前清蛋白[(158.44±41.67)g/L vs.(130.40±44.04)g/L,P=0.017]均高于对照组,差异有统计学意义.观察组并发症发生率明显低于对照组(x 2=4.041,P=0.044).观察组日均营养费用高于对照组(220.05±77.08)元 vs.(171.93±88.73)元,P=0.034],而住院总费用[(9.20±1.66)万元 vs.(10.19±1.97)万元,P=0.046]及住院时间[(18.22±2.99)d vs.(20.67±5.58)d,P=0.047]较对照组降低,差异有统计学意义.结论 膀胱全切回肠代膀胱术患者围术期的优化肠内外序贯营养治疗是安全、合理、有效的营养治疗方式,在改善患者临床预后、降低并发症发生率方面优于常规围术期营养支持.

目的:研究家庭肠内营养(EN)对老年髋部骨折病人术后人体成分的影响,为推进家庭EN提供科学依据.方法:选取2019年6月～2020年5月在新桥医院骨科诊断为髋部骨折,行全髋或半髋关节置换的老年病人156例,按照随机数字表分为两组.对照组采用常规院外饮食宣教,实验组采用EN联合个体化食谱定制.两组病人均在出院当天、出院后1个月时行人体成分分析,Harris髋关节功能评分,并记录两组病人血浆蛋白水平及伤口愈合情况.结果:出院后1个月,实验组病人体质量、骨骼肌、体脂肪、蛋白质、血浆蛋白水平、Harris评分均明显优于对照组(P＜0.05),伤口愈合不良发生率也明显低于对照组(1.4％vs 8.5％,P＜0.05).结论:合理的家庭EN能显著改善老年髋部骨折病人的营养状况,增加机体瘦体组织,促进伤口愈合及康复.

To evaluate the effect of medical nutritional therapy (MNT) combined with low glycaemic index (LGI) formula at breakfast for 4 weeks on the glycaemic control of patients with type 2 diabetes mellitus (T2DM). Ninety-six participants were recruited and randomly equally divided into two groups. The intervention group was offered with 40g LGI formula at breakfast adjusted according to MNT, and the control group with regular MNT. After 4 weeks, fasting blood glucose, glycated albumin (GA), insulin, C-peptide levels and metabolic index were compared between the two groups. Compared to the intervention group, the total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and the change of FBG (-0.64 +/- 1.4 vs. 0.3 +/- 2.2; p < 0.05) and 2h-PBG (-1.8 +/- 3.6 vs.0.8 +/- 3.2; p < 0.01) in the control group were significantly decreased. The LGI formulations, having a significant effect on controlling glucose and lipid metabolism, could be used as a non-pharmacological intervention for T2DM self-management.

Objective: To retrospectively investigate the comparative efficacy, safety and cost-benefits of three nutritional treatment schemes including short peptide jejunal nutrition (SPJN), whole protein jejunal nutrition (WPJN), and partial parenteral nutrition (PPN) in patients underwent esophagectomy for esophageal cancer in our hospital. This study was carried out in accordance with the conceptual framework of nutritional therapy in fast-track rehabilitation surgery. Methods: We retrospectively reviewed 305 patients who were assigned to receive esophagectomy for esophageal cancer. Eligible patients was naturally divided into SPJN group [ n = 98 (32.1%)], WPJN group [ n = 95 (31.1%)], and PPN group [ n = 112 (36.7%)] according to the type of nutritional scheme which was actually prescribed to patients by the attendingphysician in clinical practice. The differences of the serum total protein (TP), albumin (ALB), pre-albumin (PA), hemoglobin (HGB), white blood cells (WBCs), red blood cells (RBCs) and neutrophils were compared among 3 nutritional schemes groups. We also investigated the relationship of the fluid intake, urine output, gastric juice drainage volume and thoracic drainage volume among 3 nutritional groups at 3 days after surgery. Moreover, the differences of cost-benefit indexes, complications, length of hospitalization and hospital expenditure were also compared. Results: The serum TP, ALB, and PA in the SPJN group were all higher than those in the WPJN and PPN groups ( p < 0.05). The gastric juice volume of gastrointestinal decompression drainage and fluid volume of thoracic drainage in the SPJN group were all less than that in the WPJN group ( p < 0.05). The overall hospital stay and post-operative hospital stay in the SPJN group were all shorter than that in WPJN group ( p < 0.05). Moreover, the incidence of post-operative complications including anastomotic leakage, infection, and gastrointestinal reaction was remarkably lower in the SPJN group compared to the WPJN group ( p < 0.05). Interesting, hospital expenditure in the PPN group was less than that in the SPJN and the WPJN groups ( p < 0.001). Conclusion: Patients may obtain benefits in improving protein level after receiving SPJN scheme at the early stage after esophagectomy. Meanwhile, patients may obtain benefits in improving post-operative complications and hospital stay after receiving SPJN or PPN compared to WPJN protocol. However, the difference between SPJN and PPN requires further study because no difference was detected in terms of clinical outcomes including complications and the length of hospitalization although PPN may achieve a possible decrease of medical expenditure.

目的:根据快速康复外科的理念,探讨关节置换围手术期营养支持效果,为关节置换患者围手术期营养治疗提供科学依据.方法:观察2014年1月-2015年12月陆军军医大学新桥医院骨关节病区行关节置换术患者,排除自动出院、严重肝肾功能障碍及高血糖等患者,最终试验组纳入66例、对照组纳入107例.试验组根据快速康复外科理念给予围手术期整蛋白型肠内营养制剂+短肽型肠内营养+益生菌制剂精细化营养治疗方案;对照组常规自行给予营养支持;对比两组患者术前、术后第1天、术后第3天共3次的C反应蛋白、白细胞、红细胞、血红蛋白、血小板计数、血清总蛋白、白蛋白、前白蛋白及术后12月内的并发症情况(创口愈合延迟、感染等).结果:术前,试验组C反应蛋白、白细胞显著高于对照组[(19.1±40.5) mg/Lvs (7.0±8.8) mg/L,P=0.034;(6.9±2.4)×109/L vs (5.9±1.7)×109/L,P=0.002],两组患者术后第1天与术后第3天的各项实验室指标差值比较,试验组血红蛋白下降幅度显著低于对照组[(8.06±11.63) g/L vs (12.27±10.50) g/L,P=0.041];试验组术后1年内并发症发率显著低于对照组(3.0％ vs 13.1％,P=0.027).结论:关节置换围手术期精细化营养治疗可减轻患者术后的炎症反应,减少术后创口愈合延迟、感染等并发症.