Abstract Background: Patients in pancreatic surgery have a high incidence of malnutrition, and pancreaticoduodenectomy is a highly traumatic procedure that further impairs nutritional status. Chinese expert consensus on whole-course perioperative nutrition management in pancreatic surgery was published based on a national survey in 2020. This study aimed to evaluate the possible changes associated with the consensus over the past 5 years by conducting a nationwide cross-sectional survey among pancreatic surgeons in 2025. Methods: An online questionnaire survey was conducted among Chinese pancreatic surgeons. The questionnaire was divided into five sections: preoperative nutritional management, the placement of nutrition tube during operation, postoperative nutritional management, nutritional management for severe complications, and management of pancreatic exocrine and endocrine functions. Results: A total of 130 valid questionnaires were collected from 40 cities across 31 provinces and regions. Compared with the 2020 survey, the routine implementation rate of preoperative nutritional assessment increased from 62.5% (60/96) to 82.3% (107/130) ( P =0.002), the routine screening rate using Nutritional Risk Screening 2002 increased from 41.7% (40/96) to 65.4% (85/130) ( P <0.001), the participation rate of dietitians increased from 49.0% (47/96) to 70.0% (91/130) ( P =0.001), the intraoperative nasogastric tube placement rate decreased from 78.1% (75/96) to 56.9% (74/130) ( P <0.001). However, the rate of total parenteral nutrition application on the first postoperative day remained as high as 52.3% (68/130), while the proportion of early oral feeding was only 16.2% (21/130). Conclusions: Over the past 5 years, perioperative nutritional management in pancreatic surgery in China has made significant progress in standardization. However, certain differences still exist between clinical practice and consensus recommendations, requiring further promotion.

Objective: The aim of this study is to elucidate the correlation between phase angle and malnutrition, and to determine the malnutrition cutoff points based on phase angle in patients undergoing major pancreatic and biliary surgery.Methods: This is a cross-sectional study analyzing the prospective database of the Department of Hepatopancreatobiliary Surgery at Beijing Hospital, China, from December 2020 to September 2023. Basal data, diet surveys, anthropometry, and body composition were recorded. Phase angle was measured with the InBody 720. The Global Leadership Initiative on Malnutrition (GLIM) criteria were used to diagnose malnutrition. Subgroup analyses were conducted by stratifying age and pancreatic cancer.Results: A total of 185 consecutive cases were included, with a mean age of 63.66 ± 11.96 years. 63.8% (118/185) of the participants were aged 60 years or older, and 43.8% (81/185) were diagnosed with pancreatic cancer. The prevalence of malnutrition was 62.2% among all subjects, 67.8% among the elderly, and 69.1% among pancreatic cancer patients. Phase angle was significantly lower in the malnourished group than in the normal group. Positive correlations were found between phase angle and body mass index (BMI), appendicular skeletal muscle mass index (ASMI), fat-free mass index (FFMI), fat-free mass, total energy intake, grip strength, calf circumference, 6-m timed walk speed, total protein, albumin, and prealbumin. Among all the subjects, participants with a lower phase angle were significantly more likely to suffer from malnutrition than their control group, with a 1.611 times higher risk (95% confidence interval [CI]: 1.013–2.562,P = .044). The cutoff points of the phase angle for determining malnutrition were 4.82 in men (sensitivity 0.744, specificity 0.571, area under the curve 0.667, 95% CI: 0.567–0.766,P = .003), and 4.54 in women (sensitivity 0.750, specificity 0.711, area under the curve 0.757, 95% CI: 0.644–0.869,P < .001). In the subgroup analyses of elderly and pancreatic cancer patients, we obtained consistent results with statistical significance and identified corresponding cutoff points.Conclusion: The present study suggests that the phase angle could be a valid, useful, and simple indicator of malnutrition in patients undergoing major pancreatic and biliary surgery.

OBJECTIVE:Whole-course nutrition management (WNM) has been proven to improve outcomes and reduce complications. We conducted this randomized controlled trial to validate its effectiveness in patients undergoing pancreatoduodenectomy (PD). METHODS:From 1 December 2020, to 30 November 2023, this single-center randomized clinical trial was conducted at the Department of Hepatobiliopancreatic Surgery in a major hospital in Beijing, China. Participants who were undergoing PD were enrolled and randomly allocated to either the WNM group or the control group. The primary outcome was the incidence of postoperative complications. Subgroup analysis in patients who were at nutritional risk was performed. Finally, a 6-month follow-up was conducted and the economic benefit was evaluated using an incremental cost-effectiveness ratio (ICER). RESULTS:A total of 84 patients were randomly assigned (1:1) into the WNM group and the control group. The incidences of total complications (47.6% vs. 69.0%, P =0.046), total infections (14.3% vs. 33.3%, P =0.040), and abdominal infection (11.9% vs. 31.0%, P =0.033) were significantly lower in the WNM group. In the subgroup analysis of patients at nutritional risk, 66 cases were included (35 cases in the WNM group and 31 cases in the control group). The rate of abdominal infection (11.4% vs. 32.3%, P =0.039) and postoperative length of stay (23.1±10.3 vs. 30.4±17.2, P =0.046) were statistically different between the two subgroups. In the 6-month follow-up, more patients reached the energy target in the WNM group (97.0% vs. 79.4%, P =0.049) and got a higher daily energy intake (1761.3±339.5 vs. 1599.6±321.5, P =0.045). The ICER suggested that WNM saved 31 511 Chinese Yuan (CNY) while reducing the rate of total infections by 1% in the intention-to-treat (ITT) population and saved 117 490 CNY in patients at nutritional risk, while WNM saved 31 511 CNY while reducing the rate of abdominal infections by 1% in the ITT population and saved 101 359 CNY in patients at nutritional risk. CONCLUSION:In this trial, whole-course nutrition management was associated with fewer total postoperative complications, total and abdominal infections, and was cost-effective, especially in patients at nutritional risk. It seems to be a favorable strategy for patients undergoing PD.

Background: Not all malignant tumors, especially in hepatocellular carcinoma (HCC) patients with cirrhosis, can be detected by preoperative imaging methods. Therefore, it is urgently necessary to improve the intraoperative detectability of HCCs. Contrast-enhanced intraoperative ultrasonography (CE-IOUS) is an effective technique for detecting and characterizing occulting HCC lesions. We aimed to evaluate the performance of CE-IOUS with the Kupffer phase in the detection and diagnosis of HCC tumors. Methods: From November 2019 to July 2022, we retrospectively enrolled 25 consecutive patients in the Department of General Surgery of Beijing Hospital who had HCC and were scheduled to undergo hepatic surgery. Preoperative magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) were performed pre-operatively. During laparoscopic or open surgery, intraoperative ultrasound (IOUS) and CEIOUS with Sonazoid were scheduled, and the Kupffer phase was used to detect lesions. Each pathological diagnosis of neoplasm was compared with image information. Results: Among the total of 25 patients included in this study, there were 72 lesions including 57 HCCs and 15 others. The receiver operating characteristic (ROC) analysis of the four imaging methods was statistically significant. Based on the pairwise comparison of ROC curves, CE-IOUS showed the highest (96.5%) sensitivity, which did not differ significantly from MRI and CEUS (CE-IOUS vs. MRI P=0.946, CE-IOU vs. CEUS P=0.649, all P>0.05). The four imaging methods showed significantly different sensitivities in detecting HCC lesions (Cochran's Q 27.826, P<0.05). Conclusions: CE-IOUS may be superior to other imaging methods in detecting potentially additional HCC lesions to be removed at the time of surgery. Thus, it can be used as an essential tool for patients with HCC to guide and modify surgical strategies.

Aim To validate the role of the albumin-derived neutrophil-to-lymphocyte (ALB-dNLR) score in diagnosing malnutrition in medical inpatients over 70 years old. Methods This is a retrospective cross-sectional study involving 7 departments from 14 Chinese hospitals. The ALB-dNLR score was calculated, and outcomes between groups with positive and negative ALB-dNLR scores were compared after propensity score matching (PSM). Afterwards, the outcomes were compared between the groups receiving nutrition support and those not receiving support among malnourished patients diagnosed using the Global Leadership Initiative Malnutrition (GLIM) criteria after PSM. Results Out of 10,184 cases, 6165 were eligible. 2200 cases were in the positive ALB-dNLR score group. After PSM, 1458 pairs were analyzed, showing lower in-hospital mortality (0.8 % vs. 2.1 %, p = 0.005) and a lower nosocomial infection rate (5.9 % vs. 11.0 %, p < 0.001) in the negative ALB-dNLR score group. In malnourished patients, 259 pairs were analyzed after PSM. It showed better outcomes in mortality (0.8 % vs. 3.5 %, p = 0.033), nosocomial infection rate (5.4 % vs. 15.4 %, p < 0.001), length of stay (LOS) (13.8 ± 10.3 vs. 18.4 ± 14.1, p < 0.001), and total hospital cost (3315.3 ± 2946.4 vs. 4795.3 ± 4198.2, p < 0.001) in the support group. In malnourished patients with ALB-dNLR score as the sole etiological criterion, 94 pairs were calculated. It showed better outcomes in mortality (0.0 % vs. 6.4 %, p = 0.029), nosocomial infection rate (7.4 % vs. 18.1 %, p = 0.029), LOS (13.7 ± 8.3 vs. 19.8 ± 15.2, p = 0.001), and total hospital cost (3379.3 ± 2955.6 vs. 4471.2 ± 4782.4, p = 0.029) in the support group. Conclusions The ALB-dNLR score was validated to predict in-hospital mortality in medical inpatients over 70 years old. Malnutrition patients diagnosed by the GLIM criteria and using the ALB-dNLR score might benefit from nutrition support.

Aim: We aim to evaluate the safety and efficiency of lesion location-guided lymph node dissection and standardized lymph node sampling in treating resectable pancreatic head cancer, in order to provide evidence to standard surgical treatment of pancreatic ductal adenocarcinoma (PDAC).Methods: Consecutive sixty pancreatic head cancer patients were recruited prospectively and received total mesopancreatic resection (TMpE) and lesion location-guided lymphadenectomy from 2018 to 2021. The surgeons harvested and grouped the lymph nodes from the fresh specimen. Forty-five consecutive patients from 2016 to 2018 who received traditional procedure are included as the control group. Perioperative and outcome parameters were compared between two groups and subgroup analysis were also done between uncinate process and non uncinate process groups.Results: The perioperative mortality and the incidence of major complications were comparable without statistical significance between two groups (all Ps > 0.05). The postoperative length of hospital stay did not prolonged and the total hospitalization cost does not increased in the study group (P > 0.05). The secondary operation rate of study group decreased significantly [0.0%(0/60) vs. 8.9%(4/45), P=0.031]. The standardized lymph node sampling might increase the amount of detected nodes (23.27±8.87 vs. 15.07±3.99, P=0.001) and changed the TNM staging in some cases. Lesion location-guided lymphadenectomy might increase overall survival (OS) [21.0 months, 95%CI(17.4, 24.5) vs. 15.3 mouths, 95%CI(10.9,19.6), P=0.039] especially in non-uncinate process subgroup [22.9 months, 95%CI(19.0, 26.8) vs. 15.0 mouths, 95%CI(8.5,21.4), P=0.034].Conclusion: Lesion location-guided lymphadenectomy and standardized lymph node sampling are safe and efficient operation strategies in treating resectable PDAC, which may lead to precision therapy and prolong OS.Funding: This work was supported by the Capital Characteristic Clinical Project of Beijing Municipal Science & Technology Commission (No. Z181100001718216) and Beijing Hospital Nova Project (No.BJ-2020-082). Declaration of Interest: None to declare. Ethical Approval: This study was approved by the Ethics Committee of the Beijing Hospital (Approval letter No.2018BJYYEC-196-02).

Objective To analyze the correlation between preoperative nutritional status, frailty, sarcopenia, body composition, and anthropometry in geriatric inpatients undergoing major pancreatic and biliary surgery. Methods This is a cross-sectional study of the database from December 2020 to September 2022 in the department of hepatopancreatobiliary surgery, Beijing Hospital. Basal data, anthropometry, and body composition were recorded. NRS 2002, GLIM, FFP 2001, and AWGS 2019 criteria were performed. The incidence, overlap, and correlation of malnutrition, frailty, sarcopenia, and other nutrition-related variables were investigated. Group comparisons were implemented by stratification of age and malignancy. The present study adhered to the STROBE guidelines for cross-sectional study. Results A total of 140 consecutive cases were included. The prevalence of nutritional risk, malnutrition, frailty, and sarcopenia was 70.0, 67.1, 20.7, and 36.4%, respectively. The overlaps of malnutrition with sarcopenia, malnutrition with frailty, and sarcopenia with frailty were 36.4, 19.3, and 15.0%. There is a positive correlation between every two of the four diagnostic tools, and all six p -values were below 0.002. Albumin, prealbumin, CC, GS, 6MTW, ASMI, and FFMI showed a significantly negative correlation with the diagnoses of the four tools. Participants with frailty or sarcopenia were significantly more likely to suffer from malnutrition than their control groups with a 5.037 and 3.267 times higher risk, respectively (for frailty, 95% CI: 1.715–14.794, p = 0.003 and for sarcopenia, 95% CI: 2.151–4.963, p <0.001). Summarizing from stratification analysis, most body composition and function variables were worsen in the ≥70 years group than in the younger group, and malignant patients tended to experience more intake reduction and weight loss than the benign group, which affected the nutrition diagnosis. Conclusion Elderly inpatients undergoing major pancreatic and biliary surgery possessed high prevalence and overlap rates of malnutrition, frailty, and sarcopenia. Body composition and function deteriorated obviously with aging.

Sarcopenia is an age-related syndrome with progressive, generalized loss of muscle mass, strength, and physiological function. Low muscle mass is an important diagnostic criterion for sarcopenia. Ultrasound is safe, convenient and cost-effective, with extensive availability. It's a promising diagnostic tool for muscle mass assessment and sarcopenia screening in the elderly population. This review focuses on the specific methods and latest research progress on ultrasound assessment of sarcopenia.

Background Older patients are at an increased risk of malnutrition due to many factors related to poor clinical outcomes. Objective This study aims to develop an assisted diagnosis model using machine learning (ML) for identifying older patients with malnutrition and providing the focus of individualized treatment. Methods We reanalyzed a multicenter, observational cohort study including 2660 older patients. Baseline malnutrition was defined using the global leadership initiative on malnutrition (GLIM) criteria, and the study population was randomly divided into a derivation group (2128/2660, 80%) and a validation group (532/2660, 20%). We applied 5 ML algorithms and further explored the relationship between features and the risk of malnutrition by using the Shapley additive explanations visualization method. Results The proposed ML models were capable to identify older patients with malnutrition. In the external validation cohort, the top 3 models by the area under the receiver operating characteristic curve were light gradient boosting machine (92.1%), extreme gradient boosting (91.9%), and the random forest model (91.5%). Additionally, the analysis of the importance of features revealed that BMI, weight loss, and calf circumference were the strongest predictors to affect GLIM. A BMI of below 21 kg/m2 was associated with a higher risk of GLIM in older people. Conclusions We developed ML models for assisting diagnosis of malnutrition based on the GLIM criteria. The cutoff values of laboratory tests generated by Shapley additive explanations could provide references for the identification of malnutrition. Trial Registration Chinese Clinical Trial Registry ChiCTR-EPC-14005253; https://www.chictr.org.cn/showproj.aspx?proj=9542

Most hospitalized patients infected with coronavirus disease 2019 (COVID-19) are in severe or critical condition, and malnutrition is a key factor contributing to adverse outcomes. The basic principles of medical nutrition therapy have been determined in the recently released tenth edition of the National Diagnosis and Treatment Protocol. The principles have promoted nutritional risk assessment, emphasized the preferred method of enteral nutrition, and recommended the daily intake of calories at 25 to 30 kcal/kg and protein at > 1.2g/kg. Parenteral nutrition should be also added when necessary. Based on the above principles, Beijing Hospital has refined the medical nutrition therapy measures to facilitate the implementation in clinical practice, in order to improve healthcare quality and decrease the mortality in COVID-19 patients.

In clinical practice, pancreatic neuroendocrine neoplasms (pNENs) with a diameter smaller than 2 cm are commonly referred to as small pNENs. Due to their generally favorable biological characteristics, the diagnosis and treatment of small pNENs differ from other pNENs and are somewhat controversial. In response to this, the Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association have developed a consensus on the diagnosis and treatment of small pNENs, which is based on evidence-based medicine and expert opinions. This consensus covers various topics, including concepts, disease assessment, treatment selection, follow-up, and other relevant aspects.

脂肪乳是肠外营养中不可或缺的组成部分,临床应用中需了解其理化特性、药理特点、适应证及与其他营养素的相互作用等.合理应用脂肪乳可提供适当的能量供给并发挥药理作用,达到改善患者临床结局的目的.为规范肠外营养脂肪乳注射液的应用,中华医学会肠外肠内营养学分会与中国医师协会外科医师分会临床营养专家工作组组织国内相关领域专家,参照最新临床指南编撰国际标准规范,通过检索国内外文献,汇总临床证据,应用德尔菲法并结合我国专家经验,形成《成人肠外营养脂肪乳注射液临床应用指南(2023版)》,旨在推动肠外营养脂肪乳注射液的合理应用.

Objective:To analyze the correlation between nutritional status and frailty and sarcopenia in geriatric inpatients (GIPs) planning to receive major hepatopancreatobiliary (HPB) surgery.Methods:From December, 2020 to September, 2022, GIPs who were planning to receive major HPB surgery were recruited. Nutritional assessment was performed using nutritional risk screening 2002 (NRS-2002) and Global Leadership Initiative on Malnutrition (GLIM) criteria. Frailty and sarcopenia assessment were performed using Fried frailty phenotype (FFP) and Asian Working Group for Sarcopenia (AWGS) 2019 consensus on sarcopenia diagnosis and treatment. The prevalence and concurrence of malnutrition, frailty and sarcopenia were investigated, and the correlation between nutritional status and frailty and sarcopenia was analyzed.Results:A total of 144 participants at the mean age of (70.10±7.44) years were included. The prevalence of nutritional risk, malnutrition, and severe malnutrition were 73.6% ( n ?=?106), 68.1% ( n ?=?98), and 34.7% ( n ?=?50) respectively. The prevalence of frailty was 20.8% ( n ?=?30) and that of sarcopenia was 35.4% ( n ?=?51). The prevalence of severe malnutrition increased significantly in older participants and the prevalence of nutritional risk, malnutrition and severe malnutrition decreased significantly with higher BMI. The prevalence was 35.4% (51/144) for concurrent sarcopenia and malnutrition, 19.4% (28/144) for frailty and malnutrition, 14.6% (21/144) for sarcopenia and weakness, and 14.6% (21/144) for sarcopenia, malnutrition, and weakness. There was a positive correlation between nutritional risk and frailty ( r = 0.603, P < 0.001). The risk of pre-frailty and frailty in the nutritional risk group was higher than that in the non-nutritional risk group ( χ 2 = 31.830, P < 0.001). The risk of pre-frailty and frailty in the malnutrition group was higher than that in the normal nutrition group ( χ 2 = 36.727, P < 0.001). Logistic regression analysis showed that the risk of frailty in patients with severe malnutrition was 12.303 times higher than that in patients with normal nutrition status (95% CI: 2.592 to 58.409, P = 0.002). The risk of sarcopenia in the nutritional risk group was higher than that in the non-nutritional risk group ( χ 2 = 13.982, P < 0.001). The risk of sarcopenia in the malnutrition group was higher than that in the normal nutrition group ( χ 2 = 37.066, P < 0.001). Conclusions:The prevalence and concurrence rate of malnutrition, frailty, and sarcopenia are high in GIPs undergoing major HPB surgery. GIPs with malnutrition are susceptible to frailty.

Aim To propose a modified subclassification of grade B postoperative pancreatic fistula (POPF) based on management approaches in Chinese patients. Methods Data of consecutive pancreatoduodenectomy at two hospitals in China from 2013 to 2018 were collected, and outcomes were compared across different groups of POPF. Subclassification of B-POPF was made based on intervention to B1: non-interventional subclass and B2: interventional subclass. Results A total of 142 of 522 patients had biochemical leaks (BLs) (27.2%), and POPFs developed in 106 of 522 patients (20.3%), with 81 B-POPFs (15.5%) and 25 C-POPFs (4.8%). BL did not differ from the non-fistula condition in almost all outcomes. The differences of outcomes among the non-fistula/BL, B-POPF and C-POPF groups were significant. The prevalence of subclass B1 and B2 was 56.8% (46/81) and 43.2% (35/81), respectively. Compared to the B1 group, patients in the B2 group had worse outcomes, such as post-pancreatectomy hemorrhage (15.2% vs 34.3%,P = .045), biliary fistula (13.0% vs 34.3%,P = .023), postoperative hospital stay (32 vs 39 days,P = .011), and cost ($US28 601.0 vs $US39 314.5,P < .001). Conclusion The recently reported B-POPF subclassification method was modified in Chinese patients according to the intervention, and is more practical, simpler and fits Chinese patients.

目的 观察人体胰腺胰管和胰腺小叶的分布和结构特点,探讨其临床应用价值.方法 解剖3例人体胰腺标本,2例为死亡新鲜人体标本,胰腺整体取材,UW器官保存液即刻灌注,低压冲洗胰管,选择主胰管进行ABS溶液灌注,制作胰管铸型,观察分析胰管的分支分布情况;1例为固定标本,观察其表面和内部结构,并取材石蜡切片行HE染色,观察小叶结构和叶内导管分布情况.结果 大体标本显示胰腺由大小不一的小叶结构组成,小叶间为薄层结缔组织,其内有血管和导管分布.胰腺导管铸型结构完整,可清晰显示主导管和叶间导管各级分支.胰腺叶间导管直径变化范围较大,最终以一主干汇入主导管,各主干之间分布相对独立,其远端胰管形成小叶样结构,小叶大小不一,小叶间无交通.HE染色显示胰腺小叶为结缔组织包绕,结缔组织内可见血管和导管结构;胰腺小叶内部也可观察到叶内导管结构.结论 人体胰管铸型标本可以清晰显示胰管的分支分布情况,胰管的形态学和小叶结构特点的研究对于理解临床问题具有重要的参考价值.

Background Preoperative anemia is a common clinical situation proved to be associated with severe outcomes in major surgeries, but not in pancreatic surgery. We aim to study the impact of preoperative anemia on morbidity and mortality in patients undergoing open pancreatoduodenectomy and use propensity score matching (PSM) to balance the basal data and reduce bias. Methods We analyzed the data of consecutive patients undergoing open pancreatoduodenectomy with a complete record of preoperative hemoglobin, at two pancreatic centers in China between 2015 and 2019. Anemia is defined as hemoglobin less than 12 g/dl for male and 11 g/dl for female, following Chinese criteria. We compared clinical and economic outcomes before and after PSM and used logistic regression analysis to assess the correlation between variables and anemia. Results The unmatched initial cohort consisted of 517 patients. A total of 148 cases (28.6%) were diagnosed with anemia at admission, and no case received a preoperative blood transfusion or anti-anemia therapy. After PSM, there were 126 cases in each group. The rate of severe postoperative complications was significantly higher in the anemia group than in the normal group (43.7% vs. 27.0%, p = 0.006), among which the differences in prevalence of clinically relevant postoperative pancreatic fistula (CR-POPF) (31.0% vs. 15.9%, p = 0.005) and cardiac and cerebrovascular events (4.0% vs. 0.0%, p = 0.024) were the most significant. The costs involved were more in the anemia group (26958.2 ± 21671.9 vs. 20987.7 ± 10237.9 USD, p = 0.013). Among anemic patients, receiver operating characteristic (ROC) curve analysis shows the cut-off value of hemoglobin, below which, patients are prone to suffer from major complications (104.5 g/l in male and 90.5 g/l in female). Among all patients, multivariate analysis showed that preoperative obstructive jaundice [odds ratio (OR) = 1.813, 95% confidence interval (CI) (1.206–2.725), p = 0.004] and pancreatic ductal adenocarcinoma [OR = 1.861, 95% CI (1.178–2.939), p = 0.008] were predictors of anemia. Among paired patients, preoperative anemia [OR = 2.593, 95% CI (1.481–5.541), p = 0.001] and malignant pathology [OR = 4.266, 95% CI (1.597–11.395), p = 0.004] were predictors of postoperative severe complications. Conclusion Preoperative anemia is a predictor of worse postoperative outcomes following open pancreatoduodenectomy and needs to be identified and treated.

Pancreatic cancer (PC), as a highly malignant and aggressive solid tumor, is common in the digestive system. The acidic microenvironment is one of the critical markers of cancer. Nonetheless, there are few studies on how the acidic microenvironment affects the development of PC. This study focused on investigating the specific molecular mechanisms of the acidic microenvironment in PC. In our study, qRT-PCR was conducted for examining microRNA (miR)-451a and myocyte enhancer factor 2D (MEF2D) expressions in PANC-1 cells. Then, detailed functional effects of an acidic environment on miR-451a and MEF2D in PANC-1 cells were detected by CCK-8, colony formation, flow cytometry, wound healing, transwell, mitochondrial functionality measurement, JC-1 staining, DCFH-DA staining, and sphere formation assays. The relationship between miR-451a and MEF2D was confirmed by luciferase reporter analysis. Under acidic conditions, the increase of proliferation, migration, and invasion of PANC-1 cells was observed. Moreover, the mitochondrial oxidative respiration-related gene miR-451a was reduced in acidic conditions. In addition, we found that, in PANC-1 cells under an acidic environment, miR-451a overexpression enhanced oxygen consumption, mitochondrial membrane potential (MMP) loss, and ROS generation and inhibited proliferation, migration, invasion, and stemness via sponging MEF2D. In a word, our results revealed that the acidic microenvironment regulated PC progression by affecting the miR-451a/MEF2D axis, indicating a novel avenue for the future treatment of PC.

BACKGROUND AND OBJECTIVES Assess the different nutritional status between admission and discharged in older adult patients using the GLIM criteria. METHODS AND STUDY DESIGN A retrospective analysis was conducted on a multicenter study which initiated in 34 hospitals in China with 2734 hospitalized older patients. The dynamic changes of malnutrition according to GLIM criteria were performed between at admission and discharge, and their significance was analyzed using the chi-square test. The association between malnutrition and clinical outcomes was analyzed using the chi-square test, t-test, or rank sum test, and divided into different disease types for further analysis. RESULTS The incidence of nutritional risk in elderly patients was 51.6% at admission and 48.4% at discharge. The prevalence of malnutrition according to the GLIM criteria was 19.6% at admission and increased to 33.4% at discharge, which was significantly different. Different age and disease type were related with nutrition status. Malnutrition is significantly association with adverse clinical outcomes such as increased risk of complications and prolonged length of hospital stay. CONCLUSIONS The GLIM criteria can be used in elderly patients to assess malnutrition. The prevalence of malnutrition in elderly inpatients is high, and the prevalence of malnutrition at discharge is higher than that observed at admission. Attention should be paid to the dynamic changes of malnutrition in elderly patients during hospitalization.

Background The body weight of the Chinese population rose rapidly over the past two decades. The old 2001 body mass index (BMI) cutoff value for malnutrition may underestimate malnutrition diagnosis. We explored the BMI cutoff value for malnutrition diagnosis based on national BMI data from the past 30 years and applied it to the Global Leadership Initiative on Malnutrition (GLIM) criteria when investigating malnutrition in hospitalized older patients. Methods To explore the BMI cutoff value for malnutrition, we established a linear stepwise model to predict the annual increasing BMI trend based on data from the national BMI data set. The new cutoff value was applied to a large-scale data set from a cross-sectional study pertaining to older hospitalized patients recruited from 30 large hospitals in China. Results The BMI increased from 21.8 to 23 kg/m(2) in two decades. We calculated that the net BMI increase will be 1.49 kg/m(2) from 1999 to 2019. We subsequently proposed that the BMI cutoff value for malnutrition should rise to 20 kg/m(2). This cutoff value was applied to the validation data set, containing 8725 patients, and the GLIM-determined malnutrition rate was 24.58% (using the Nutrition Risk Screening 2002 [NRS-2002]) and 23.32% (using the Mini Nutritional Assessment-Short Form [MNA-SF]). The results significantly differed from those obtained using the 2001 Chinese BMI criteria. Conclusion The GLIM tool has good applicability in Asian populations, especially in Chinese older patients. The BMI cutoff value for malnutrition should be adjusted to 20 kg/m(2) for Chinese adults.