BACKGROUND:Malnutrition is common in cancer patients. The NUTRISCORE is a newly developed cancer-specific nutritional screening tool and was validated by comparison with the Patient-Generated Subjective Global Assessment (PG-SGA) and Malnutrition Screening Tool (MST) in Spain. We aimed to evaluate the performance of the NUTRISCORE, MST, and PG-SGA in estimating the risk of malnutrition in Chinese cancer patients.METHODS:Data from an open parallel and multicenter cross-sectional study in 29 clinical teaching hospitals in 14 Chinese cities were used. Cancer patients were assessed for malnutrition using the PG-SGA, NUTRISCORE, and MST. The sensitivity, specificity, and areas under the receiver operating characteristic curve were estimated for the NUTRISCORE and MST using the PG-SGA as a reference.RESULTS:A total of 1000 cancer patients were included. The mean age was 55.9 (19 to 92 years), and 47.5% were male. Of these patients, 450 (45.0%) had PG-SGA B and C, 29 (2.9%) had a NUTRISCORE ≥5, and 367 (36.7%) had an MST ≥ 2. Using the PG-SGA as a reference, the sensitivity, specificity, and area under the curve values of the NUTRISCORE were found to be 6.2, 99.8%, and 0.53, respectively. The sensitivity, specificity, and area under the curve values of the MST were 50.9, 74.9%, and 0.63, respectively. The kappa index between the NUTRISCORE and PG-SGA was 0.066, and that between the MST and PG-SGA was 0.262 (P < 0.05).CONCLUSIONS:The NUTRISCORE had an extremely low sensitivity in cancer patients in China compared with the MST when the PG-SGA was used as a reference.

Background: The Michigan Risk Score (MRS) was the only predicted score for peripherally inserted central venous catheters (PICC) associated upper extremity venous thrombosis (UEVT). Age-adjusted D-dimer increased the efficiency for UEVT. There were no external validations in an independent cohort. Method: A retrospective study of adult patients with PICC insertion was performed. The primary objective was to evaluate the performance of the MRS and age-adjusted D-dimer in estimating risk of PICC-related symptomatic UEVT. The sensitivity, specificity and areas under the receiver operating characteristics (ROC) of MRS and age-adjusted D-dimer were calculated. Results: Two thousand one hundred sixty-three patients were included for a total of 206,132 catheter days. Fifty-six (2.6%) developed PICC-UEVT. The incidences of PICC-UEVT were 4.9% for class I, 7.5% for class II, 2.2% for class III, 0% for class IV of MRS (p = 0.011). The incidences of PICC-UEVT were 4.5% for D-dimer above the age-adjusted threshold and 1.5% for below the threshold (p = 0.001). The areas under ROC of MRS and age-adjusted D-dimer were 0.405 (95% confidence interval (CI) 0.303-0.508) and 0.639 (95% CI 0.547-0.731). The sensitivity and specificity of MRS were 0.82 (95% CI, 0.69-0.91), 0.09 (95% CI, 0.08-0.11), respectively. The sensitivity and specificity of age-adjusted D-dimer were 0.64 (95% CI, 0.46-0.79) and 0.64 (95% CI, 0.61-0.66), respectively. Conclusions: MRS and age-adjusted D-dimer have low accuracy to predict PICC-UEVT. Further studies are needed.

We read with great interest the recently published guideline by Pironi L et al. [ [1] Pironi L. Boeykens K. Bozzetti F. Joly F. Klek S. Lal S. et al. ESPEN guideline on home parenteral nutrition. Clin Nutr. 2020; 39: 1645-1666 Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar ], entitled, ‘ESPEN Guideline on Home Parenteral Nutrition’. In the recommendation 13, right-sided central venous access devices were recommended for lower risk of thrombosis compared with left-sided approaches. This issue described in this article warrant further discussion. Reply to the comment by CHEN W et al. on the ESPEN HPN guidelinesClinical NutritionVol. 40Issue 2PreviewWe thank Dr. Chen et al. very much for their comments [1] on recommendation #13 of the ESPEN guidelines on home parenteral nutrition (HPN) [2], which suggest a preference for right-sided central venous access devices (CVAD) since these are associated with a lower risk of CVAD-related vein thrombosis (CVAD-VT). Full-Text PDF

Background This research aimed at exploring the mechanisms of alterations of metabolites and pathways in T2D from the perspective of metabolomics and transcriptomics, as well as uncovering novel drug candidate for T2D treatment. Methods Metabolites in human plasma from 42 T2D patients and 45 non-diabetic volunteers were detected by liquid chromatography-mass spectrometer (LC-MS). Microarray dataset of the transcriptome was obtained from Gene Expression Omnibus (GEO) database. Kyoto Encyclopedia of Genes and Genomes (KEGG) database was used to conduct pathway enrichment analysis. Connectivity Map (CMap) was employed to select potential drugs for T2D therapy. In vivo assay was performed to verify above findings. The protein expression levels of ME1, ME2 and MDH1 were detected by Western blot to determine the status of NAD/NADH cofactor system. Results In our study, differentially expressed metabolites were selected out between healthy samples and T2D samples with selection criteria P value < .05, |Fold Change| > 2, including N-acetylglutamate and Malate. Genes set enrichment analysis (GSEA) revealed that 34 pathways were significantly enriched in T2D. Based on CMap analysis and animal experiments, Atractyloside was identified as a potential novel drug for T2D treatment via targeting ME1, ME2 and MDH1 and regulating the NAD/NADH cofactor system. Conclusion The present research revealed differentially expressed metabolites and genes, as well as significantly altered pathways in T2D via an integration of metabolomics, transcriptomics and CMap analysis. It was also demonstrated that comprehensive analysis based on metabolomics and transcriptomics was an effective approach for identification and verification of metabolic biomarkers and alternated pathways.

目的 探讨经外周静脉置入中心静脉导管(peripherally inserted central venous catheter,PICC)并发症多媒体教学病例库在专科护师临床教学中的应用效果.方法 选择参加北京协和医院2013年1月至2014年12月PICC培训班的244例PICC专科执业护师为研究对象,以首次接受PICC并发症多媒体教学病例库教学的执业护师为研究组(139例),选择前期接受传统方式教学的执业护师为对照组(105例),比较两组培训后的考核成绩.结果 两组在年龄和职称等方面比较,差异无显著性.研究组平均考核成绩[(73.1±6.0)分]高于对照组[(70.1±6.0)分],差异有显著性(P=0.000).结论 PICC并发症多媒体教学病例库的建立和教学应用利于提高专科护师识别和处理PICC并发症的能力.

Abstract Background: The effects of keto acid (KA) supplements on Chinese patients receiving maintenance hemodialysis (MHD) are unclear. This study aimed to evaluate the effects of KA supplementation on nutritional status, inflammatory markers, and bioelectric impedance analysis (BIA) parameters in a cohort of Chinese patients with MHD without malnutrition. Methods: This was a prospective, randomized, controlled, single-center clinical study conducted in 2011 till 2014. Twenty-nine patients with MHD were randomly assigned to a control (n = 14) or a KA (n = 15) group. The control group maintained a dietary protein intake of 0.9 g/kg/day. The KA group received additional KA supplement (0.1 g/kg/day). BIA was used to determine the lean tissue mass, adipose tissue mass, and body cell mass. The patients’ nutritional status, dialysis adequacy, and biochemical parameters were assessed at the ends of the third and sixth months with t test or Wilcoxon rank-sum test. Results: The daily total energy intake for both groups was about 28 kcal/kg/day. After 6 months, the Kt/V (where K is the dialyzer clearance of urea, t is the dialysis time, and V is the volume of the distribution of urea) was 1.33 ± 0.25 in KA group, and 1.34 ± 0.25 in the control group. The median triceps skin-fold thickness in KA group was 12.00 and 9.00 mm in the control group. In addition, the median hand-grip strength in KA group was 21.10 and 25.65 kg in the control group. There were no significant differences between the groups with respect to the anthropometry parameters, dialysis adequacy, serum calcium and phosphorus levels, inflammatory markers, and amino-acid profiles, or in relation to the parameters determined by BIA. Both groups achieved dialysis adequacy and maintained nutritional status during the study. Conclusions: In this cohort of Chinese patients with MHD, the patients in the control group whose dietary protein intake was 0.9 g/kg/day and total energy intake was 28 kcal/kg/day, maintained well nutritional status during study period. The KA supplement (0.1 g/kg/day) did not improve the essential amino acid/non-essential amino acid ratio, nor did it change the patients’ mineral metabolism, inflammatory parameters, or body compositions.

Constipation means being unable to move your bowels, having bowel movements less often than is normal for you, or having to push harder to move your bowels than you have in the past. It may be a side effect of the chemotherapy that you are on, or a result of the medications you are taking to manage nausea and pain. Constipation can also be caused by being less active and eating or drinking less. However, there are many things that can be done to help with bowel regularity.

Objective To investigate the preoperative body composition, metabolic characteristics, and postoperative changes in patients with active acromegaly and analyze the effects of gender and age. Methods We included 36 patients with untreated acromegaly and 37 patients with nonfunctional pituitary adenomas. Adipose tissue (AT), the visceral fat index (VFI), sclerotin, protein, skeletal muscle, total body water (TBW), intracellular water (ICW), and extracellular water (ECW) were measured using bioelectrical impedance analysis (BIA). Total energy expenditure (TEE) and basal metabolism (BM) were measured with a cardiopulmonary and metabolic analyzer (CMA). Tricep skinfold thickness (TST), bicep circumference, waistline, hipline, and calf circumference were measured with a skinfold caliper and tape. These indices were measured before surgery and 3 months and 1 year after surgery. Results Overall, AT, VFI, and TST were lower, whereas sclerotin, protein, skeletal muscle, TBW, ICW, ECW, TEE, and BM were higher in acromegaly patients. Postoperatively, TST rose initially and then decreased, the waistline increased, and sclerotin, skeletal muscle, TEE, and BM decreased. Changes in these indices differed with gender and age in unique patterns. Conclusions Body composition and metabolism in acromegaly patients changed after surgery, and gender and age influenced these changes.

BACKGROUND AND OBJECTIVES:To compare the effectiveness, safety, and costs of commercial standardized multi-chamber bag and customized compounded total parenteral nutrition (TPN) among gastric cancer patients after gastrectomy.METHODS AND STUDY DESIGN:A retrospective cohort study was conducted among 64 gastric cancer patients who underwent gastrectomy from 2014 to 2016 in a tertiary teaching hospital in Beijing, China. Patients were categorized into standardized (s-TPN) and customized TPN (c-TPN) groups based on their TPN order after gastrectomy. Patients were followed up until discharge. The effectiveness measures (body mass index (BMI) and albumin) and safety measures (liver and renal functions and electrolytes) were compared before TPN started and after TPN finished within and between the two groups. The length of hospital stay and costs were compared be-tween the two groups.RESULTS:There were no significant differences between the two groups in BMI preserva-tion, metabolic complications, the length of hospital stay and costs, except that both total bilirubin (Tbil) and di-rect bilirubin (Dbil) were significantly higher in the s-TPN group than c-TPN (p<0.05).CONCLUSIONS:There were no significant differences in effectiveness and safety measures, the length of hospital stay and costs between s-TPN and c-TPN groups, except that s-TPN group was more likely to lead to parenteral nutrition-associated liver disease (PNALD). More studies are needed to confirm the findings of this study in other healthcare settings and study populations.

Introduction: This pilot exploratory study aimed to compare the health-related quality of life (HRQOL) among patients diagnosed with different types of cancer receiving peripherally inserted central catheters (PICCs).Methods: A multicenter cross-section study of cancer patients with PICCs was performed from February 1, 2013 to April 24, 2014. The primary objective of this study was to compare HRQOL in different cancer type patients with PICC. HRQOL was examined based on European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 (EORTC QLQ-C30). Multiple linear regression models were conducted for coping with potential confounding variables. We also examined PICC-related quality of daily life with a self-made questionnaire.Results: Three hundred and fifty-seven cancer patients with PICC completed the survey in nine teaching hospitals. Lung cancer patients with PICC reported the worst dyspnea. Digestive tract cancer patients reported the worst appetite loss. Patients with hematologic malignancy reported the worst emotional, social function, fatigue and financial impact. Breast cancer patients reported better HRQOL. Baseline variables were proven not significant predictors of EORTC QLQ-C30 global health status. In self-made survey, pain after PICC insertion was null or a little in 98.6% of cancer patients. Limitation of upper extremity activity was null or a little in 94.1% of patients.Conclusions: HRQOL varies in different types of cancer patients with PICC. PICC may have a low impact on cancer patients' HRQOL. Further large sample studies are needed.

Background: Peripherally inserted central venous catheters (PICCs) are widely used in patients with cancer. Catheter usage is one of the risk factors for venous thromboembolism. We aimed to scrutinize the incidence and risk factors for PICC-related upper extremity venous thrombosis (UEVT) in patients with lung cancer receiving chemotherapy. Patients and Methods: We performed a retrospective cohort study of patients with lung cancer with PICC insertion undergoing chemotherapy. Symptomatic PICC-UEVT was diagnosed by ultrasound. The relationship between chemotherapeutic agent exposure and PICC-UEVT was evaluated. Patient-, catheter-, and insertion-related factors were analyzed in univariable and multivariable logistic regression to identify significant independent risk factors for PICC-UEVT in patients with lung cancer. Results: A total of 328 patients with lung cancer having PICC undergoing chemotherapy were included, for a total of 34 895 catheter days. Seventeen (5.2%) patients developed PICC-related UEVT, with an incidence of 0.49 per 1000 catheter days. In multivariable logistic analysis, advanced disease was shown to be a significant risk factor for PICC-UEVT (odds ratio [OR]: 4.9; 95% confidence interval [CI]: 1.4-16.7; P = .011). Patients treated with etoposide had a higher risk of PICC-related UEVT (OR: 3.6; 95% CI: 1.1-12.1; P = .042). Patients were followed up after PICC removal for a median duration of 246 days. None of the patients developed pulmonary embolism. Conclusion: Patients with lung cancer harboring an advanced disease or treating with etoposide were at higher risk of PICC-UEVT.

Purpose To evaluate incidence and risk factors of peripherally inserted central catheter (PICC)-related complications in cancer patients. Methods A prospective, multicenter, cohort study of cancer patients with PICC insertion was performed from February 1, 2013 to April 24, 2014. All patients were monitored in clinic until PICCs were removed. The primary endpoint was PICC removal due to complications. Patient-, catheter- and insertion-related factors were analyzed in univariable and multivariable logistic regression analysis to identify significant independent risk factors for PICC-related complications. Results There were 477 cancer patients included, for a total of 50,841 catheter-days. Eighty-one patients (17.0%) developed PICC-related complications, with an incidence of 1.59 per 1000 catheter days. Thirty-six (7.5%) PICCs were removed because of complications. The most common complications were skin allergy (4.6%), catheter occlusion (3.4%) and accidental withdrawal (2.3%). Nine (1.9%) patients developed symptomatic upper extremity deep venous thrombosis (UEDVT) and central line associated bloodstream infection (CLABSI) was shown in six (1.3%) PICCs with an infection rate 0.12 per 1000 catheter days. In multivariable analysis, body mass index (BMI) >25 (odds ratio, 2.09; 95% confidence interval, 1.26-3.47, p = 0.004) was shown to be a significant risk factor for PICC complications. Conclusions Cancer patients with BMI greater than 25 were more likely to have PICC complications.

Mitochondrial neurogastrointestinal encephalopathy (MNGIE) is characterized by significant gastrointestinal dysmotility. Early and long-term nutritional therapy is highly recommended. We report a case of MNGIE in a patient who was undergoing long-term nutrition therapy. The patient was diagnosed with a serious symptom of fatty liver and hyperlipidemia complications, along with homozygous mutation of the thymidine phosphorylase (TYMP) gene (c.217G > A). To our knowledge, this is the first report of such a case. Herein, we describe preventive measures for the aforementioned complications and mitochondrial disease-specific nutritional therapy.

The application of Low Protein Diet (LPD) in the treatment of CKD has been more accepted by all medical stuffs nowadays. However, the diversity and complexity of therapeutic diet as well as being difficult to obtain more detailed consultation have caused poor long-term maintenance and compliance in most patients.To investigate patient’s compliance to dietary therapy as well as the impact of Dietary Protein Exchange (DPE) on patient’s compliance in CKD patients.To investigate patient’s self understanding and prehension to educational resources on DPE in CKD patients.CKD patients are diagnosed in clinics from 6 hospitals according to the random digits table. 200 enrolled patients are randomly divided into test groups and control groups after signing the concent forms.Test groups:Face to face education of the utilization of new DPE as well as attentions in follow-up is conducted by dietitians.Control groups:Regular face to face counseling as well as attentions in follow-up is conducted by dietitians.Time arrangement for follow-up,3 times within 24 weeks (week 4, 12 and 24 respectively).180 cases completed the trail. Compared with control group, the test group patients’s compliance with DPI was better, 58.5±6.8 gvs45.6±8.9 g p<0.05).The knowledge of diet protein score was higher than the control group, 19.4±4.5 vs 11.3±3.2,P<0.01).The clinical data still had no difference.In Conclusion,the DPE is a new good tool for Chinese CKD patients.

Objective To evaluate the parenteral nutrition formula's character of all-in-one-mixed preparation and pre-mixed preparation applied for hospitalized patients in China. Methods We collected parenteral nutrition (PN) prescriptions in hospitalized patients with various diseases at dispensing centers of 6 hospitals in different areas of China. Statistic analysis was made by nutrients application, total liquid, nonprotein calories, total nitrogen, ratio of non-protein calories and total nitrogen, and ratio of glucose and fat. A comparison was made between all-in-one-mixed and pre-mixed preparation as to all the indices. Results The nutrients supply in all-in-one-mixed PN preparation, as well as in the pre-mixed PN preparations of 3 different energy degrees can meet the basic nutrition requirements of most patients. The total nitrogen supply in all-in-one-mixed PN prescriptions meets nutrition requirements in most patients, but the ratio of non-protein calories and total nitrogen[( 180-250) : 1]and the ratio of glucose and fat (0. 56-1.26)were significantly different from what a doctor would recommend[( 100-150) : 1, 1.0]. While the ratios in the pre-mixed PN preparation on 3 different energy degrees are more consistent with recommeded values,which are at 167 and 0. 8 respectively. Conclusions All-in-one-mixed and pre-mixed PN preparation have their own individual advantages and limits, and both of them can meet the requirements of most hospitalized patients. More attention should be paid to the nutrients proportion when doctors prescribe all-in-one-mixed PN preparations.

Nutrition support includes three parts: supplementation, support, and therapy. When? and how? to use nutrition support which should be related with clinical outcome of the patients. Parenteral nutrition became widely accepted in the States since the presentation at American College of Surgeons Congress 1967 by Dudrick et al. More detail study of baby growth and development receiving all nutrients exclusively by vein from Wilmore et al 1968. In China, it was Jiang et al reported the clinical applications of parenteral nutrition at Surgical Congress of Chinese Medical Association 1978. Enteral elemental diet and parenteral nutrition for intestinal fistulae illness by Jiang et al 1979 which enrolled by Medline. Although nutrition support has become a standardized technology in China, but evidences on improving the patients' outcomes were still insufficient. After Kondrup et al estsblished Nutritional Risk Screening 2002 tool, the nutrition support could use an evidence-based approaching with outcome. One prospective cohort study based on hospitals in Baltimore and Beijing, using Nutrition Risk Screening 2002 as the tool, have evaluated the impact of nutritional support (both parenteral and enteral nutrition) on the infective complications among patients at nutritional risk and demonstrated that the overall incidence of complications was significantly lower in patients who had received nutritional support, which was achieved mainly due to the decline of the incidence of infective complications. Therefore, support with appropriate nutrients being necessary for patients at nutritional risks or already with malnutrition. However, more cohort studies and randomized controlled studies with larger samples are still required.

http://pen.sagepub.com/content/34/5/521 The online version of this article can be found at: DOI: 10.1177/0148607110362587 2010 34: 521 JPEN J Parenter Enteral Nutr Yan Wang, Zhu-Ming Jiang, Marie T. Nolan, Hua Jiang, Hae-Ra Han, Kang Yu, Hai-Long Li, Bin Jie and Xiao-Kun Liang Patients: A Meta-Analysis of Randomized Clinical Trials Supplemented Parenteral Nutrition on Outcomes of Surgical − The Impact of Glutamine Dipeptide

Objective: To evaluate the impact of glutamine dipeptide–supplemented parenteral nutrition (GLN‐PN) on clinical outcomes in surgical patients. Methods: MEDLINE, EMBASE, Web of Science, and the Cochrane Controlled Clinical Trials Register were searched to retrieve the eligible studies. The studies were included if they were randomized controlled trials that evaluated the effect of GLN‐PN and standard PN on clinical outcomes of surgical patients. Clinical outcomes of interest were postoperative morbidity of infectious complication, mortality, length of hospital stay, and cost. Statistical analysis was conducted by RevMan 4.2 software from the Cochrane Collaboration. Results: Fourteen randomized controlled trials (RCTs) (N = 587) were included in this meta‐analysis. The results showed that glutamine dipeptide significantly reduced the length of hospital stay by around 4 days in the form of alanyl‐glutamine (weighted mean difference [WMD] = −3.84; 95% confidence interval [CI] −5.40, −2.28; z = 4.82; P < .001) and about 5 days in the form of glycyl‐glutamine (WMD = −5.40; 95% CI −8.46, −2.33; z = 3.45; P < .001). The overall effect indicated a significant decrease in the infectious complication rates of surgical patients receiving GLN‐PN (risk ratio = 0.69; 95% CI 0.50, 0.95; z = 2.26; P = .02). Conclusion: GLN‐PN was beneficial to postoperative patients by shortening the length of hospital stay and reducing the morbidity of postoperative infectious complications.