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Objective To explore the predictive value of preoperative alkaline phosphatase to prealbumin ratio (APR) in prognosis and postoperative complications for patients with hepatocellular carcinoma (HCC) after radical tumor resection. Methods A total of 217 HCC patients who underwent radical tumor resection in the Department of Hepatobiliary Surgery of the Affiliated Hospital of Southwest Medical University from January 2013 to August 2021 were retrospectively recruited and their clinical data were statistically analyzed. The X-tile software was used to obtain the optimal cutoff value of APR. The χ 2 test was conducted to analyze association between preoperative APR and other clinicopathological characteristics. The Kaplan-Meier curve was plotted and the Log-rank test was performed to analyze survival of patients. The univariate and multivariate Cox proportional hazards regression models were used to analysis factors affecting the prognosis of HCC patients. The univariate analysis and multivariate Logistic regression were used to identify factors related with postoperative complications. The receiver operating characteristic (ROC) curve was used to determine the predicting value of APR. Results The optimal cutoff value for APR ratio was 0.5 and these 217 patients were divided into the low- and high APR groups (111 vs 106 cases) accordingly. Compared with the low-APR group, the proportion of patients with ALT (> 50 U/L), Alb (< 40 g/L), the CNLC of the III stage, open surgery, liver cirrhosis, multiple tumor lesions, postoperative complication, and major complication were significantly increased in the high-APR patients (all P < 0.05). Moreover, the 1-, 3-, and 5-year OS were 86.0%, 74.9%, and 71.3%, respectively in the low-APR patients, while the numbers were 79.2%, 57.5%, and 47.0%, respectively, in the high-APR patients, indicating that patients in high-APR group had significantly worse OS ( P =0.002). AFP ( HR =1.774, 95% CI : 1.107-2.843, P =0.017), CNLC stage ( HR =2.708, 95% CI : 1.514-4.844, P =0.001), tumor size ( HR =1.696, 95% CI : 1.060-2.714, P =0.028), and APR ( HR =2.022, 95% CI : 1.244-3.285, P =0.004) were all independent risk predictors for OS. The 1-, 3-, and 5-year RFS were 82.3%, 69.4%, and 61.3%, respectively, in the low-APR patients, whereas the numbers were 76.2%, 54.4%, and 44.2%, respectively in the high-APR patients, suggesting that high-APR patients had significantly worse recurrence-free survival ( P =0.016). The CNLC stage ( HR =2.509, 95% CI : 1.423-4.422, P =0.001), tumor size ( HR =1.725, 95% CI : 1.119-2.660, P =0.014), and APR ( HR =1.619: 95% CI : 1.037-2.527, P =0.034) were all independent FRS predictors. Hypertension ( OR =3.09, 95% CI : 1.385-6.893, P =0.006), open surgery ( OR =4.198, 95% CI : 1.779-9.907, P =0.001), liver cirrhosis ( OR =2.376, 95% CI : 1.194-4.729, P =0.014), and APR ( OR =2.151, 95% CI : 1.160-3.986, P =0.015) were all independent risk predictors for the postoperative major complications. The AUC for APR, ALP, a nd PA in predicting the major complications was 0.625 (95% CI : 0.547-0.702), 0.613 (95% CI : 0.534-0.693), and 0.554 (0.474-0.634). Conclusion Preoperative APR could be used to predict prognosis and postoperative major complications of HCC patients after radical tumor resection.
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SUMMARY OBJECTIVE: Prealbumin has been a reliable marker to predict protein energy malnutrition and hypercatabolic state. In this analysis, we particularly aimed to investigate the potential association between serum prealbumin levels and right ventricular dysfunction in patients receiving programmed hemodialysis. METHODS: A total of 57 subjects were included in the analysis. The subjects were then categorized into two groups: right ventricular dysfunction (n=18) and non-right ventricular dysfunction (n=39) groups. In all patients, detailed transthoracic echocardiography (following hemodialysis) were performed along with the evaluation of complete blood count, routine biochemistry parameters, and, in particular, serum prealbumin levels. RESULTS: Mortality rate at 3 years was found to be significantly higher in the right ventricular dysfunction group (p=0.042). Serum prealbumin levels were also significantly lower in the right ventricular dysfunction group compared with the non-right ventricular dysfunction group (23.83±8.50 mg/dL versus 31.38±6.81 mg/dL, p=0.001). In the receiver operating characteristics curve analysis, a prealbumin cutoff value of <28.5 mg/dL was found to predict right ventricular dysfunction, with a sensitivity of 67% and a specificity of 62% (area under the curve: 0.744). In the correlation analysis, a moderate yet significant positive correlation was demonstrated between serum prealbumin and tricuspid annular plane systolic excursion (r=0.365, p=0.005). CONCLUSION: This study suggests that low serum prealbumin might serve as a potential predictor of right ventricular dysfunction (and its clinical consequences) in patients receiving programmed hemodialysis.
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Objective:To investigate the efficacy of infliximab in the treatment of small intestinal Crohn's disease and its effects on simple endoscopic score for Crohn's disease (SES-CD), routine blood test and nutritional indexes.Methods:Eighty-four patients with small intestinal Crohn's disease who received treatment in Zhejiang Xin'an International Hospital between November 2019 and March 2021 were included in this study. They were randomly divided into control and observation groups with 42 patients each. The control group was treated with azathioprine. The observation group was treated with azathioprine and infliximab. Clinical efficacy, SES-CD score, hemoglobin (Hb) level, white blood cell (WBC) count, platelet (PLT), albumin (ALB), pre-albumin (PA) and total protein (TP) levels pre- and post-treatment were compared between the two groups.Results:Response rate in the observation group was significantly higher than that in the control group [92.8% (39/42) vs. 73.8% (31/42), χ2 = 5.48, P < 0.05]. There was no significant difference in SES-CD score pre-treatment between the control and observation groups [(7.24 ± 1.30) points vs. (7.33 ± 1.27) points, t = -0.34, P > 0.05]. After treatment, SES-CD scores in the control and observation groups were (5.12 ± 1.17) points and (4.22 ± 0.98) points, respectively, which were significantly decreased compared with those before treatment ( t = 11.01, 14.66, both P < 0.001). After treatment, SES-CD score in the observation group was significantly lower than that in the control group ( t = 4.19, P < 0.001). Before treatment, there were no significant differences in Hb level [(110.23 ± 16.19) g/L vs. (112.27 ± 15.98) g/L], WBC count [(7.61 ± 2.54) × 10 9 g/L vs. (7.47 ± 2.61) × 10 9 g/L] and PLT level [(420.14 ± 130.27) × 10 9 g/L vs. (419.23 ± 131.15) × 10 9 g/L] between the control and observation groups ( t = -0.58, 0.25, 0.03, all P > 0.05). After treatment, Hb level [(120.25 ± 14.36) g/L and (130.17 ± 12.24) g/L ], WBC count [(6.01 ± 1.88)× 10 9 g/L, (5.13 ± 1.96) × 10 9 g/L) and PLT level [(321.79 ± 110.21) × 10 9 g/L, (267.25 ± 100.23) × 10 9 g/L] in the control and observation groups were significantly decreased compared with those before treatment ( tcontrol group = -4.70, 6.60, 8.02, tobservaton group = -7.91, 3.50, 4.99, all P < 0.05). Hb level post-treatment in the observation group was significantly higher than that in control group ( t = -3.41, P < 0.05) . WBC count and PLT level in the observation group were significantly lower than those in the control group ( t = 2.10, 2.37, both P < 0.05). Before treatment, there were no significant differences in ALB level [(33.14 ± 5.66) g/L vs. (32.98 ± 5.73) g/L], PA level [(220.17 ± 71.14) mg/L vs. (219.89 ± 70.26) mg/L], TP level [(61.23 ± 8.21) g/L vs. (60.95 ± 8.17) g/L] between control and observation groups ( t = 0.12, 0.01, 0.15, all P > 0.05). After treatment, ALB level [(38.29 ± 6.13) g/L, (44.23 ± 6.07) g/L], PA level [(281.14 ± 85.23) mg/L, (320.27 ± 82.01) mg/L], TP level [(67.23 ± 7.22) g/L, (73.28 ± 6.97) g/L] in the control and observation groups were significantly increased compared with those before treatment ( tcontrol group = -7.90, -4.30, -5.08, tobservation group = -13.76, -7.52, -11.45, all P < 0.05). After treatment, ALB, PA and TP levels in the observation group were significantly higher than those in the control group ( t = -4.46, -2.14, -3.89, all P < 0.05). Conclusion:Infliximab is highly effective on small intestinal Crohn's disease. It can effectively decrease SES-CD score, improve routine blood parameters and nutritional indexes, alleviate azathioprine-induced myelosuppression, and reduce gastrointestinal reactions.
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Resumo Fundamento Amiloidose sistêmica é uma doença com manifestações clínicas diversas. O diagnóstico envolve suspeita clínica, aliada a métodos complementares. Objetivo Descrever o perfil clínico, laboratorial, eletrocardiográfico e de imagem no acometimento cardíaco da amiloidose sistêmica. Métodos Estudo de uma amostra de conveniência, analisando dados clínicos, laboratoriais, eletrocardiográficos, ecocardiográficos, medicina nuclear e ressonância magnética. Considerou-se significância estatística quando p < 0,05. Resultados Avaliaram-se 105 pacientes (com mediana de idade de 66 anos), sendo 62 homens, dos quais 83 indivíduos apresentavam amiloidose por transtirretina (ATTR) e 22 amiloidose por cadeia leve (AL). Na ATTR, 68,7% eram de caráter hereditário (ATTRh) e 31,3% do tipo selvagem (ATTRw). As mutações mais prevalentes foram Val142Ile (45,6%) e Val50Met (40,3%). O tempo de início dos sintomas ao diagnóstico foi 0,54 e 2,15 anos nas formas AL e ATTR (p < 0,001), respectivamente. O acometimento cardíaco foi observado em 77,9% dos ATTR e 90,9% dos AL. Observaram-se alterações de condução atrioventricular em 20% e intraventricular em 27,6% dos pacientes, sendo 33,7 % na ATTR e 4,5% das AL (p = 0,006). A forma ATTRw apresentou mais arritmias atriais que os ATTRh (61,5% x 22,8%; p = 0,001). Ao ecocardiograma a mediana da espessura do septo na ATTRw x ATTRh x AL foi de 15 mm x 12 mm x 11 mm (p = 0,193). Observou-se BNP elevado em 89,5% dos indivíduos (mediana 249 ng/mL, IQR 597,7) e elevação da troponina em 43,2%. Conclusão Foi possível caracterizar, em nosso meio, o acometimento cardíaco na amiloidose sistêmica, em seus diferentes subtipos, através da história clínica e dos métodos diagnósticos descritos.
Abstract Background Systemic amyloidosis is a disease with heterogeneous clinical manifestations. Diagnosis depends on clinical suspicion combined with specific complementary methods. Objective To describe the clinical, laboratory, electrocardiographic, and imaging profile in patients with systemic amyloidosis with cardiac involvement. Methods This study was conducted with a convenience sample, analyzing clinical, laboratory, electrocardiographic, echocardiographic, nuclear medicine, and magnetic resonance data. Statistical significance was set at p < 0.05. Results A total of 105 patients were evaluated (median age of 66 years), 62 of whom were male. Of all patients, 83 had transthyretin (ATTR) amyloidosis, and 22 had light chain (AL) amyloidosis. With respect to ATTR cases, 68.7% were the hereditary form (ATTRh), and 31.3% were wild type (ATTRw). The most prevalent mutations were Val142Ile (45.6%) and Val50Met (40.3%). Time from onset of symptoms to diagnosis was 0.54 and 2.15 years, in the AL and ATTR forms, respectively (p < 0.001). Cardiac involvement was observed in 77.9% of patients with ATTR and in 90.9% of those with AL. Alterations were observed in atrioventricular and intraventricular conduction in 20% and 27.6% of patients, respectively, with 33.7% in ATTR and 4.5% in AL (p = 0.006). In the ATTRw form, there were more atrial arrhythmias than in ATTRh (61.5% versus 22.8%; p = 0.001). On echocardiogram, median septum thickness in ATTRw, ATTRh, and AL was 15 mm, 12 mm, and 11 mm, respectively (p = 0.193). Elevated BNP was observed in 89.5% of patients (median 249, ICR 597.7), and elevated troponin was observed in 43.2%. Conclusion In this setting, it was possible to characterize cardiac involvement in systemic amyloidosis in its different subtypes by means of clinical history and the diagnostic methods described.
Subject(s)
Humans , Male , Female , Adult , Cardiology , Amyloid Neuropathies, Familial/diagnostic imaging , Amyloidosis/diagnostic imaging , Cardiomyopathies/diagnostic imaging , Referral and Consultation , Brazil , Prealbumin/genetics , EchocardiographyABSTRACT
RESUMEN Introducción: El correcto funcionamiento del eje hipotálamo-hipófisis-tiroides es indispensable para el crecimiento y desarrollo embrionario-fetal, al intervenir en la diferenciación de los tejidos, el desarrollo cerebral y somático, la maduración ósea y la regulación del metabolismo. El paso de las hormonas tiroideas maternas al feto a través de la placenta depende de transportadores transmembrana, enzimas desyodinasas (DIO2 y DIO3) y proteínas transportadoras (TTR). Objetivo: Identificar las zonas de expresión de DIO3 y TTR en la placenta de ratón Mus musculus E10.5, E12.5, E14.5. Métodos: La estructura placentaria y expresión de DIO3 y TTR fueron evaluadas con técnicas histoquímicas e inmunofluorescencia. Resultados: Desde E10.5 se encontraron las tres zonas placentarias, laberinto, zona de unión y decidua. En E12.5 se observó la conformación placentaria definitiva. DIO3 y TTR fueron detectadas en los tres estadios, con predominio en la zona del laberinto. Conclusión: DIO3 y TTR se expresan a lo largo del establecimiento y maduración de la placenta de ratón. El biomodelo murino es una herramienta útil para el estudio del transporte placentario de hormonas tiroideas desde la circulación materna a la fetal.
ABSTRACT Introduction: Correct functioning of hypothalamic-pituitary-thyroid axis is essential for embryonic-fetal growth and development, as it is involved in tissue differentiation, brain and somatic development, bone maturation and metabolic regulation. Maternal thyroid hormones passage to the fetus through the placenta depends on transmembrane transporters, deiodinase enzymes (DIO2 and DIO3) and carrier proteins (TTR). Objective: Identify DIO3 and TTR expression within placental layers of Mus musculus E10.5, E12.5 and E14.5. Methods: Placental structure, DIO3 and TTR expression were evaluated using histochemistry and immunofluorescence techniques. Results: We found that the three placental layers, labyrinth zone, junctional zone, and decidua were present since E10.5. At E12.5 placental final conformation was observed. DIO3 and TTR were detected in the three stages with a predominance in the labyrinth. Conclusion: DIO3 and TTR are expressed throughout the establishment and maturation of mouse placenta. Mice are a useful tool for studying how thyroid hormones are transported from maternal t° fetal circulation at the placenta.
RESUMO Introdução: O correto funcionamento do eixo hipotálamo-hipófise-tireoide é essencial para o crescimento e desenvolvimento embrionário-fetal, pois intervém na diferenciação dos tecidos, desenvolvimento cerebral e somático, maturação óssea e regulaçãodo metabolismo. A passagem dos hormônios tireoidianos maternos para o feto através da placenta depende de transportadores transmembranas, enzimas deiodinase (DIO2 e DIO3) e proteínas transportadoras (TTR). Objetivo: Identificar as zonas de expressão de DIO3 e TTR na placenta de rato Mus musculus E10.5, E12.5, E14.5. Métodos: A estrutura placentária e a expressão de DIO3 e TTR foram avaliadas com técnicas histoquímicas e imunofluorescência. Resultados: De E10.5 as três zonas placentárias, labirinto, zona de união e decídua foram encontradas. Em E12.5 a conformação definitiva da placenta foi observada. O DIO3 e o TTR foram detectados nas três fases, com predomínio na área do labirinto. Conclusão: DIO3 e TTR são expressos ao longo do estabelecimento e maturação da placenta de rato O biomodelo murino é uma ferramenta útil para o estudo do transporte placentário dos hormônios tireoidianos da circulação materna para a fetal.
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Objective:To investigate the clinical significance of changes in heparin binding protein(HBP), procalcitonin (PCT) and prealbumin (PA) levels in the early diagnosis of intracranial infection in patients with brain tumors after surgery.Methods:The clinical data of 160 patients with brain tumors who underwent surgical treatment in the Second Affiliated Hospital of Xuzhou Medical University from January 2015 to December 2020 were retrospectively analyzed. And 80 cases of intracranial infection after surgery were classified as the infection group. According to the severity of infection, patients were divided into 33 cases in the mild infection group, 36 cases in the moderate infection group, and 11 cases in the severe infection group; 80 cases without postoperative intracranial infection were classified as the non-infection group. All enrolled members were tested for HBP, PCT, PA at time points of 0 h before surgery, 12 h after surgery, 3 d after surgery, and 6 d after surgery. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of intracranial infection in patients with brain tumors after surgery.Results:The levels of HBP and PCT in the infected group were higher than those in the non-infected group before and after surgery at all time points (all P < 0.05). The level of PA in the infected group was lower than that in the non-infected group (all P < 0.05). The levels of HBP and PCT in both groups at various time points after surgery were higher than those before surgery (all P < 0.05), which showed a decreasing trend over time. The level of PA of both groups at all time points after surgery was lower than that before surgery (all P < 0.05), which showed a trend of first decreasing and increasing and then decreasing over time. The preoperative HBP level in the severe infection group [35.45 ng/ml (23.61 ng/ml, 59.44 ng/ml)] was higher than that in the mild infection group [12.51 ng/ml (5.11 ng/ml, 19.92 ng/ml)] and the moderate infection group [22.22 ng/ml (16.49 ng/ml, 27.55 ng/ml)], and differences were statistically significant ( Z = 41.167, 19.105, both P < 0.05). The preoperative PCT level in the severe infection group [1.50 μg/L (1.27 μg/L, 2.44 μg/L)] was higher than that in the mild infection group [0.53 μg/L (0.25 μg/L, 0.85 μg/L)] and the moderate infection group [0.90 μg/L (0.47 μg/L, 1.42 μg/L)], and differences were statistically significant ( Z = 36.167, 14.875; both P < 0.05). The preoperative PA level in the severe infection group [159.22 mg/L (141.61 mg/L, 191.79 mg/L)] was lower than that in the mild infection group [215.91 mg/L (195.21 mg/L, 239.90 mg/L)] and the moderate infection group [194.48 mg/L (178.40 mg/L, 207.60 mg/L)] ( Z = 35.955, 19.567, both P < 0.05). The levels of HBP and PCT before operation were positively correlated with the degree of infection ( r = 0.637, 0.485, both P < 0.01). The preoperative level of PA was negatively correlated with the degree of infection ( r = -0.576, P < 0.01). The preoperative single index detection showed that the maximum the area of the curve (AUC) of postoperative intracranial infection in patients with brain tumors predicted by PA was 0.808 (95% CI 0.741-0.874). The highest specificity of intracranial infection in patients with brain tumors predicted by HBP was 96.3%. The AUC of postoperative intracranial infection in patients with brain tumors predicted by the combination of the three tests was 0.892 (95% CI 0.839-0.944), which was greater than that predicted by other single indicators, and the sensitivity was the highest (86.3%). The AUC of postoperative intracranial infection in patients with brain tumors diagnosed by PCT at 12 h after surgery was maximum [0.804 (95% CI 0.734-0.874)] when predicted by other single indicators. The highest specificity of postoperative intracranial infection in patients with brain tumors diagnosed by HBP was 98.6%. The AUC of postoperative intracranial infection in patients with brain tumors diagnosed by the combination of the three tests was 0.895 (95% CI 0.840-0.950), which was greater than that diagnosed by other single indicators, and the highest sensitivity was 85.0%. Conclusion:The levels of HBP, PCT and PA can provide a reference for the early diagnosis of postoperative intracranial aseptic inflammation in patients with brain tumors. The combined diagnosis of HBP, PCT and PA can better diagnose the postoperative intracranial infection in patients with brain tumors.
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Objective:To observe the clinical characteristics of patients with familial vitreous amyloidosis (FVA) and the efficacy of vitrectomy (PPV) and the occurrence of complications.Methods:A retrospective clinical study. From June 2009 to March 2020, 32 eyes of 18 patients from 3 FVA families who were diagnosed and treated by PPV at Department of Ophthalmology of Jiaxing TCM Hospital were included in the study. Among them, there were 12 males with 22 eyes and 6 females with 10 eyes. The average age of onset was 42.28±3.25 years; the average duration of disease was 3.75±3.93 years. All the affected eyes underwent best corrected visual acuity (BCVA) and B-mode ultrasound examination. A logarithmic visual acuity chart was used in the BCVA examination, which was converted to the logarithmic minimum angle of resolution (logMAR) visual acuity when recorded. The average logMAR BCVA of the affected eye was 1.72±0.53; the intraocular pressure was less than 21 mm Hg (1 mm Hg=0.133 kPa). The vitreous body of the affected eye was obviously cloudy. All the affected eyes underwent standard three-channel PPV through the flat part of the ciliary body, and vitreous specimens were collected for pathological examination during the operation. Peripheral venous blood of probands from 3 families was collected, and the whole exome gene sequencing was performed. The follow-up time after surgery was ≥6 months. The patient's clinical characteristics, fundus lesions in PPV, changes in BCVA after surgery, and complications was observed. One-way analysis of variance or t test was performed for measurement data comparison; χ2 test was performed for count data comparison. Results:The vitreous body of the affected eye showed gray-white dense and thick flocculent changes, and the posterior capsule attached to the lens showed "foot disc-like" turbidity; later the lens was mainly cystic opacity. Pathological examination of the vitreous body showed positive staining of Congo red; under a polarized light microscope, it showed apple green dots and sheet-like birefringence. The genetic test results showed that there was a c.307G>C (p.Gly103Arg) missense mutation in the TTR gene of the proband in Family 2. Peripheral retinal hemorrhages in 4 eyes (12.5%, 4/32), retinal tears in 5 eyes (15.6%, 5/32), retinal degeneration in 4 eyes (12.5%, 4/32), retinal detachment were found in PPV 3 eyes (9.4%, 3/32). The vitreous body was filled with C 3F 8 and silicone oil respectively for 2, 1 eye. Six months after the operation, the logMAR BCVA of the affected eye was 0.39±0.32, which was significantly higher than that before the operation, and the difference was statistically significant ( t=15.131, P=0.000). After the operation, high intraocular pressure occurred in 2 eyes (6.3%, 2/32), secondary glaucoma in 1 eye (3.1%, 1/32), retinal detachment in 2 eyes (6.3%, 2/32), neovascular glaucoma (NVG) in 2 eyes (6.3%, 2/32), cataract in 10 eyes (31.3%, 10/32). Conclusion:The vitreous body of FVA eyes are gray-white dense, thick and flocculent, attached to the posterior lens capsule, showing "foot disc-like" turbidity; PPV treatment can effectively improve the BCVA of the FVA eyes; secondary glaucoma, secondary retinal detachment, NVG can occur after surgery.
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Objective:To compare the clinical effects of two enteral nutritional emulsions, TP-HE and TPF, in elderly patients with severe pneumonia.Methods:This was a randomized study with contemporaneous controls.A total of 56 elderly patients over 65 years old who met the diagnostic criteria for severe pneumonia and were receiving insulin were enrolled.They were randomly divided into the observation group(n=28, enteral TPF-HE at a uniform rate through a nasogastric tube)and the control group(n=28 cases, enteral TPF at a uniform rate through a nasogastric tube). The total daily energy supply was calculates based on the ideal weights of patients.Prealbumin(PA), serum albumin(ALB), body mass index(BMI)and hemoglobin(Hb)were continuously measured at 1, 2, 3, 4, 5, 6 and 7 days after treatment.The effects of the enteral nutritional emulsions in elderly patients with severe pneumonia were analyzed by using repeated measures analysis of variance in a general linear model.Results:There was no significant difference in PA(244.5±55.1)mg/L vs.(237.8±40.4)mg/L, ALB(37.6±5.6)mg/L vs.(38.3±5.5)mg/L, BMI(21.9±0.2)kg/m 2vs.(22.4±0.2)kg/m 2)or Hb(104.4±26.8)mg/L vs.(103.6±25.6)mg/L between the TP-HE group and the TPF group before admission( P>0.05). The energy received from the enteral nutritional emulsions was not significantly different between the TP-HE group and the TPF group(79.8±4.8)kcal/d vs.(79.3±6.6)kcal/d( P>0.05). PA and serum ALB levels had significant differences between the TP-HE group and the TPF group at 1, 2, 3, 4, 5, 6 and 7 days after treatment( P<0.01 or 0.05). Increases in PA and serum ALB levels varied at certain time points between the TP-HE group and the TPF group.Hb levels had no significant difference at 1 and 2 days( P>0.05), but were significantly different at other time points between the two groups( P<0.01). There was no significant difference in BMI between the two groups( F=1.709, P>0.05). Conclusions:Both of the enteral nutrition emulsions can improve PA, ALB and Hb levels, with TP-HE offering more significant effects on PA, ALB and Hb levels.There is no difference in BMI at any time point whether patients receive TP-HE or TPF.
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Objective:To explore the value and advantages of perioperative nutritional support in enhanced recovery after surgery (ERAS).Methods:The clinical data of patients admitted to Jinjiang City Hospital for acute abdomen and undergoing surgery from April 2018 to January 2021 were collected. They were divided into two groups: the enhanced recovery after surgery group (ERAS group, 78 cases) and the traditional perioperative management group (CPM group, 75 cases). The nutritional risk assessment of NRS2002 was performed on admission to the two groups. The postoperative inflammatory indexes, nutrition and rehabilitation related indexes were compared between the two groups.Results:There was no significant difference in preoperative NRS 2002 score, operation method, operation time and blood loss between ERAS group and CPM group ( P>0.05). There was no significant difference in C-reactive protein (CRP), albumin (Alb) and prealbumin (PA) between ERAS group and CPM group before operation ( P>0.05). The ALb and PA of the two groups on the first day after operation were significantly lower than those before operation, and the CRP levels on the first, third, fifth and seventh day after operation were higher than those before operation( P<0.05), with significant difference. The CRP level of ERAS group was lower than that of CPM group on the third day after operation, with significant difference ( P<0.05). On the 7th day after operation, the levels of Alb and PA in ERAS group were higher than those in CPM group ( P<0.05). The recovery time of gastrointestinal function and hospitalization days in ERAS group were significantly reduced, and the total cost of hospitalization was significantly less than that in CPM group ( P<0.05). Conclusions:Perioperative effective nutritional support is helpful to accelerate the recovery of patients with acute abdomen. The application of enhanced recovery after surgery can effectively improve the nutritional status of patients with acute abdomen, reduce the incidence of complications and improve the clinical outcome of patients.
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Objective:To investigate the effects of The Nutritional Risk Screening 2002 (NRS-2002)-based nutritional therapy on nutritional status and rehabilitation process in hemorrhagic stroke patients with dysphagia.Methods:Eighty-eight hemorrhagic stroke patients with dysphagia who received treatment in Lishui Central Hospital, China between June 2018 and November 2020 were included in this study. They were randomly assigned to receive either routine treatment ( n = 44, control group) or routine treatment combined with NRS-2002-based nutritional therapy ( n = 44, observation group) for 4 successive weeks. The Kubota drinking test score, the National Institutes of Health Stroke Scale (NIHSS) score, clinical efficacy, and nutritional status were compared between the control and observation groups. Results:Compared with before treatment, the Kubota drinking test score and National Institutes of Health Stroke Scale score in each group were greatly decreased after treatment ( t = 9.393, 5.998, 25.851, 21.136, all P < 0.01). The Kubota drinking test score and NIHSS score in the observation group were significantly lower than those in the control group [(2.57 ± 0.30) points vs. (4.16 ± 0.49) points; (8.93 ± 1.01) points vs. (15.83 ± 2.03) points, t = 18.357, 20.186, both P < 0.01). Total effective rate in the observation group (93.18%) was significantly higher than that in the control group ( χ2 = 4.162, P < 0.05). Compared with before treatment, serum prealbumin, albumin, and hemoglobin levels in each group were significantly increased after treatment ( t = 2.551, 4.088, 2.600, 7.239, 7.540, 8.684, all P < 0.01). After treatment, serum prealbumin, albumin, and hemoglobin levels in the observation group were significantly higher than those in the control group ( t = 5.104, 3.439, 6.024, all P < 0.01). Conclusion:NRS-2002-based nutritional therapy can effectively improve the dysphagia, neurological function and nutritional status of patients with hemorrhagic stroke.
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ABSTRACT Background: Fibrinogen (Fib) to albumin (ALB) fibrinogen-to-albumin ratio as a prognostic index for esophageal cancer has been confirmed. A novel prognostic index was initially proposed with fibrinogen to prealbumin ratio (FPR) in patients with resectable esophageal squamous cell carcinoma (ESCC). Objective: The objective of the study was to study the prognostic role of the novel prognostic index (FPR) in patients with resectable ESCC without any neoadjuvant treatment. Methods: In this retrospective study, a total of 372 resectable ESCC patients without any neoadjuvant treatment were included. The best cutoff values were selected by the receiver operating characteristic curves. Two Cox regression analyses with forward stepwise (one for categorical variables and the other for continuous variables) were used to evaluate the overall survival (OS) and cancer-specific survival (CSS). Results: The best cutoff point was 0.014 for FPR. Patients with lower levels of FPR (≤0.014) had better CSS (50.7% vs. 18.0%, p < 0.001) and OS (48.0% vs. 17.6%, p < 0.001) than patients with higher levels of FPR (> 0.014). Multivariate Cox analyses (categorical and continuous) demonstrated that FPR was an independent prognostic factor in CSS (categorical: hazard ratio [HR]: 2.014, 95% confidence interval [CI]: 1.504-2.697, p < 0.001; continuous per 0.01: HR: 1.438, 95% CI: 1.154-1.793, p = 0.001) and OS (categorical: HR: 1.964, 95% CI: 1.475-2.617, p < 0.001; continuous per 0.01: HR: 1.429, 95% CI: 1.146-1.781, p = 0.002). Conclusions: Our study indicated that FPR served as an independent prognostic factor in patients with resectable ESCC.
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Humans , Male , Female , Middle Aged , Fibrinogen/metabolism , Prealbumin/metabolism , Esophageal Neoplasms/pathology , Esophageal Squamous Cell Carcinoma/pathology , Prognosis , Esophageal Neoplasms/surgery , Retrospective Studies , Follow-Up Studies , Esophageal Squamous Cell Carcinoma/surgeryABSTRACT
Objective To study the correlation between serum prealbumin level before liver resection and prognosis of patients with primary hepatocellular carcinoma (HCC).Methods The clinical data of patients with HCC who underwent liver resection at the Affiliated Tumor Hospital of Guangxi Medical University from August 2007 to October 2016 were retrospectively analyzed.The previous albumin of 200 mg/L and the pre-albumin as predicted by the maximum selection rank statistic method were used as the bounding group,and reduced groups and the correlation between pre-operative serum pre-albumin levels and clinicopathological characteristics were analyzed.The Kaplan-Meier method was used to calculate the overall survival rate of patients with the different cutoff levels.The Cox proportional regression model was used to analyze,and cirrhosis,alpha-fetoprotein levels and Barcelona Clinic Liver Cancer staging were used to adjust the relationship between serum prealbumin and prognosis of liver resection for HCC patients.Analysis of stratified variables was performed and their interactions with serum prealbumin were analyzed.Results Of the 2 022 patients included in this study,there were 1 739 males and 283 females.Their age was 49.5 ± 11.2 years.The median follow-up was 37.4 months.The optimal cutoff value of prealbumin predicted by the maximum selection rank statistic method was 166 mg/L.Regardless of the cutoff values of previous albumin 200 mg/L or prealbumin 166 mg/L,multivariate analysis showed that preoperative serum prealbumin level was an independent prognostic risk factor for patients (P ＜0.05).The prognosis of patients with ＞200 mg/L (＞ 166 mg/L) serum prealbumin before surgery was significantly better than that of patients with ≤200 mg/L (≤166 mg/L) prealbumin,the differences were significant (all P ＜ 0.05).After adjusting for confounding factors,the prealbumin level correlated with prognosis of patients with HCC [cutoff value 200 mg/L:HR (95％ CI) was 1.59 (1.35-1.86),cutoff value 166 mg/L:HR (95％ CI) was 1.69 (1.44-1.98),all P ＜ 0.05].The results of stratified analysis showed that the relationship between prealbumin levels and the prognosis of HCC patients became more robust.Conclusions Preoperative serum prealbumin was an independent risk factor for prognosis of HCC patients,and it had predictive value on prognosis of HCC patients.
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Objective@#To analyze the application of accelerated rehabilitation surgery in elderly patients with gastric cancer surgery and its influence on inflammation and nutritional indicators.@*Methods@#From October 2017 to October 2018, 80 elderly patients with gastric cancer who underwent gastrectomy in Shaoxing People's Hospital were selected.According to random number table method, they were randomly divided into traditional control group and ERAS group, with 40 cases in each group.The traditional control group was treated by traditional perioperative treatment + operation, while ERAS group was treated with ERAS perioperative treatment + operation.The recovery and complications, inflammation and nutritional changes before operation, 1 day after operation and 3 days after operation, and the improvement of quality of life after operation were compared and analyzed between the two groups.@*Results@#In the ERAS group, the first exhaust time[(2.3±0.8)d] and defecation time[(2.5±0.4)d]were shorter than those in the traditional control group[(3.5±0.5)d and (3.7±0.6)d], and the incidence rate of complications (7.5%) was lower than that in the traditional control group (35.0%), the differences were statistically significant (t=8.72, 10.52, χ2=9.04, all P<0.05). On the first day after operation, the serum levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6(IL-6) in the ERAS group were (28.3±4.9)μg/L and (23.1±5.8)μg/L, respectively, which were lower than those in the traditional control group[(39.8±6.7)μg/L and (34.5±8.1)μg/L](t=8.76, 7.24, all P<0.05). The serum TNF-α and IL-6 levels in the ERAS group on the 3rd day after operation were (18.4±6.2)μg/L and (18.3±3.2)μg/L, respectively, which were lower than those in the traditional control group[(26.2±5.1)μg/L and (26.5±4.8)μg/L](t=6.14, 8.99, all P<0.05). The serum levels of albumin (Alb) and prealbumin (PRE) in the ERAS group on the first day after operation were (31.1±0.7)g/L and (161.3±7.2) mg/L, respectively, which were lower than those in the traditional control group[(30.2±0.9)g/L and (154.3±4.8)mg/L](t=4.99, 5.12, all P<0.05). The serum levels of Alb and PRE in the ERAS group on the 3rd day after operation were (33.4±0.5)g/L and (172.1±5.0)mg/L, respectively, which were lower than those in the traditional control group[(31.9±0.8)g/L and (165.3±3.2)mg/L](t=10.06, 7.24, all P<0.05). The WHOQOL-BREF score of the ERAS group[(91.4±6.5)points]was higher than that of the traditional control group[(80.3±7.8)points](P<0.05).@*Conclusion@#Accelerated rehabilitation surgery has good effect for elderly gastric cancer surgery.It can maintain the inflammation and nutritional status of patients after operation.It is worthy of clinical reference.
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Objective@#To investigate the clinical diagnosis value of serum precalcitonin(PCT) and early predictive significance of prealbumin (PA) and retinol-binding protein (RBP) in liver and renal injury for sepsis in children.@*Methods@#One hundred and fifty sepsis children were enrolled from the ward of children in Taizhou Hospital of Zhejiang Province from January 2018 to August 2019. In the same period 150 children with common infection and 150 healthy children who underwent physical examination were included into the study. According to the test, basic data was collected, and biochemical examinations, including the concentrations of the liver function, renal function, PA and RBP were measured. Then the data in the three groups was analyzed.@*Results@#The levels of PCT in sepsis group were significantly higher than those in the common infection group and the normal group: (7.02 ± 5.26) μg/L vs. (0.37 ± 0.28), (0.03 ± 0.01) μg/L; the levels of PA and RBP in sepsis group were significantly lower than those of the other two groups: (9.31 ± 4.36) mg/dl vs. (31.05 ± 5.05), (33.56 ± 4.59) mg/dl; (9.26 ± 3.58) mg/L vs. (31.2 ± 5.89), (33.83 ± 6.31) mg/L, and there were significant statistical differences (P < 0.05). The levels of PA and RBP in the common infection group and the normal group were normal and there was no difference between the two groups (P > 0.05). There were no significant statistical differences in other indicators such as alanine aminotransferase, asparagus cochinchinensis, albumin, urea nitrogen and creatinine (P > 0.05).@*Conclusions@#Combined detection of serum PCT, PA and RBP plays an important role in the early diagnosis of children′s sepsis.
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Objective@#To investigate the relationship between enteral nutrient albumin supply and prognosis in patients with mechanical ventilation.@*Methods@#The clinical data of 418 mechanically ventilated patients receiving enteral nutrition support treatment in intensive care unit (ICU) of the First Hospital of Jiaxing from January 2016 to June 2019 were retrospectively analyzed. According to whether the daily albumin supply was up to standard, the patients were divided into the standard group (albumin supply was ≥1.2 g·kg-1·d-1) and the non-standard group (albumin supply was < 1.2 g·kg-1·d-1). Prealbumin, transferrin levels before and after treatment, 28-day mortality, mechanical ventilation time and the length of ICU stay were compared between the two groups.@*Results@#A total of 418 patients were included, including 225 in the standard group and 193 in the non-standard group. There were no significant differences in gender, age and disease composition between the two groups, and the baseline data were comparable. There was no significant difference in daily calories between the standard group and the non-standard group (kJ/d: 119.73±31.55 vs. 110.05±28.98, P > 0.05), but the daily albumin supply of the standard group was significantly higher than that of the non-qualified group (g·kg-1·d-1: 1.38±0.83 vs. 0.95±0.75, P < 0.05). There was no significant difference in the levels of prealbumin, transferrin between the two groups before treatment. The levels of prealbumin, transferrin in standard group and non-standard group were significantly higher after treatment than before [prealbumin (mg/L): 188.53±69.25 vs. 119.44±57.62, 145.18±56.92 vs. 108.81±69.50; transferrin (g/L): 2.99±0.87 vs. 1.85±0.76, 2.09±0.81 vs. 1.52±0.76, all P < 0.05]. Moreover, prealbumin and transferring in the standard group were further improved than the non-standard group [prealbumin (mg/L): 188.53±69.25 vs. 145.18±56.92, transferrin (g/L): 2.99±0.87 vs. 2.09±0.81, both P < 0.05]. In addition, mechanical ventilation time, the length of ICU stay of the standard group were significantly shorter than those of the non-standard group (hours: 147.2±7.5 vs. 216.6±8.2, 198.8±9.5 vs. 295.4±8.9, both P < 0.05), but there was no statistically significant difference in 28-day mortality [11.56% (26/225) vs. 15.03% (29/193), P > 0.05].@*Conclusion@#Under the condition of standard enteral nutritional calories, increased of the albumin supply can improve the clinical nutritional status of patients with mechanical ventilation, shorten mechanical ventilation time and hospital stay.
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Objective To investigate the relationship between enteral nutrient albumin supply and prognosis in patients with mechanical ventilation. Methods The clinical data of 418 mechanically ventilated patients receiving enteral nutrition support treatment in intensive care unit (ICU) of the First Hospital of Jiaxing from January 2016 to June 2019 were retrospectively analyzed. According to whether the daily albumin supply was up to standard, the patients were divided into the standard group (albumin supply was ≥1.2 g·kg-1·d-1) and the non-standard group (albumin supply was < 1.2 g·kg-1·d-1). Prealbumin, transferrin levels before and after treatment, 28-day mortality, mechanical ventilation time and the length of ICU stay were compared between the two groups. Results A total of 418 patients were included, including 225 in the standard group and 193 in the non-standard group. There were no significant differences in gender, age and disease composition between the two groups, and the baseline data were comparable. There was no significant difference in daily calories between the standard group and the non-standard group (kJ/d: 119.73±31.55 vs. 110.05±28.98, P > 0.05), but the daily albumin supply of the standard group was significantly higher than that of the non-qualified group (g·kg-1·d-1: 1.38±0.83 vs. 0.95±0.75, P < 0.05). There was no significant difference in the levels of prealbumin, transferrin between the two groups before treatment. The levels of prealbumin, transferrin in standard group and non-standard group were significantly higher after treatment than before [prealbumin (mg/L): 188.53±69.25 vs. 119.44±57.62, 145.18±56.92 vs. 108.81±69.50; transferrin (g/L): 2.99±0.87 vs. 1.85±0.76, 2.09±0.81 vs. 1.52±0.76, all P < 0.05]. Moreover, prealbumin and transferring in the standard group were further improved than the non-standard group [prealbumin (mg/L): 188.53±69.25 vs. 145.18±56.92, transferrin (g/L): 2.99±0.87 vs. 2.09±0.81, both P < 0.05]. In addition, mechanical ventilation time, the length of ICU stay of the standard group were significantly shorter than those of the non-standard group (hours: 147.2±7.5 vs. 216.6±8.2, 198.8±9.5 vs. 295.4±8.9, both P < 0.05), but there was no statistically significant difference in 28-day mortality [11.56％ (26/225) vs. 15.03％ (29/193), P > 0.05]. Conclusion Under the condition of standard enteral nutritional calories, increased ofthe albumin supply can improve the clinical nutritional status of patients with mechanical ventilation, shorten mechanical ventilation time and hospital stay.
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investigate the clinical diagnosis value of serum precalcitonin(PCT) and early predictive significance of prealbumin (PA) and retinol-binding protein (RBP) in liver and renal injury for sepsis in children. Methods One hundred and fifty sepsis children were enrolled from the ward of children in Taizhou Hospital of Zhejiang Province from January 2018 to August 2019. In the same period 150 children with common infection and 150 healthy children who underwent physical examination were included into the study. According to the test, basic data was collected, and biochemical examinations, including the concentrations of the liver function, renal function, PA and RBP were measured. Then the data in the three groups was analyzed. Results The levels of PCT in sepsis group were significantly higher than those in the common infection group and the normal group:(7.02 ± 5.26) μg/L vs. (0.37 ± 0.28), (0.03 ± 0.01) μg/L; the levels of PA and RBP in sepsis group were significantly lower than those of the other two groups: (9.31 ± 4.36) mg/dl vs. (31.05 ± 5.05), (33.56 ± 4.59) mg/dl; (9.26 ± 3.58) mg/L vs. (31.2 ± 5.89), (33.83 ± 6.31) mg/L, and there were significant statistical differences (P<0.05). The levels of PA and RBP in the common infection group and the normal group were normal and there was no difference between the two groups (P>0.05). There were no significant statistical differences in other indicators such as alanine aminotransferase, asparagus cochinchinensis, albumin, urea nitrogen and creatinine (P>0.05). Conclusions Combined detection of serum PCT, PA and RBP plays an important role in the early diagnosis of children′s sepsis.
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Objective To analyze the application of accelerated rehabilitation surgery in elderly patients with gastric cancer surgery and its influence on inflammation and nutritional indicators .Methods From October 2017 to October 2018,80 elderly patients with gastric cancer who underwent gastrectomy in Shaoxing People ＇s Hospital were selected.According to random number table method ,they were randomly divided into traditional control group and ERAS group, with 40 cases in each group.The traditional control group was treated by traditional perioperative treatment +operation,while ERAS group was treated with ERAS perioperative treatment +operation.The recovery and complications, inflammation and nutritional changes before operation , 1 day after operation and 3 days after operation,and the improvement of quality of life after operation were compared and analyzed between the two groups . Results In the ERAS group,the first exhaust time[(2.3 ±0.8)d] and defecation time[(2.5 ±0.4)d]were shorter than those in the traditional control group [(3.5 ±0.5)d and (3.7 ±0.6)d],and the incidence rate of complications (7.5%) was lower than that in the traditional control group (35.0%),the differences were statistically significant (t＝8.72,10.52,χ2 ＝9.04,all P ＜0.05).On the first day after operation ,the serum levels of tumor necrosis factor-alpha (TNF-α) and interleukin -6(IL-6) in the ERAS group were (28.3 ±4.9) μg／L and (23.1 ± 5.8)μg／L,respectively,which were lower than those in the traditional control group [(39.8 ±6.7)μg／L and (34.5 ± 8.1)μg／L](t＝8.76,7.24,all P＜0.05).The serum TNF-αand IL-6 levels in the ERAS group on the 3rd day after operation were (18.4 ±6.2) μg／L and (18.3 ±3.2) μg／L,respectively,which were lower than those in the traditional control group[(26.2 ±5.1)μg／L and (26.5 ±4.8) μg／L] ( t＝6.14,8.99,all P＜0.05).The serum levels of albumin (Alb) and prealbumin (PRE) in the ERAS group on the first day after operation were (31.1 ± 0.7)g／L and (161.3 ±7.2) mg／L,respectively,which were lower than those in the traditional control group [(30.2 ± 0.9)g／L and (154.3 ±4.8)mg／L](t＝4.99,5.12,all P＜0.05).The serum levels of Alb and PRE in the ERAS group on the 3rd day after operation were (33.4 ±0.5)g／L and (172.1 ±5.0)mg／L,respectively,which were lower than those in the traditional control group [(31.9 ±0.8) g／L and (165.3 ±3.2) mg／L] (t＝10.06,7.24,all P＜0.05).The WHOQOL-BREF score of the ERAS group[(91.4 ±6.5)points]was higher than that of the traditional control group[(80.3 ±7.8)points](P＜0.05).Conclusion Accelerated rehabilitation surgery has good effect for elderly gastric cancer surgery.It can maintain the inflammation and nutritional status of patients after operation .It is worthy of clinical reference.
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PURPOSE: Feeding children is a problem in pediatric intensive care units (PICU) and it is difficult to know the correct amount. The purpose of this study is to evaluate if prealbumin or retinol binding proteins (RBP) are effective relative to daily enteral nutrition, without being affected by severity of diseases or infections and can be used to follow up nutritional amount. METHODS: This is a prospective observational study that includes 81 patients admitted to PICU in Akdeniz University with estimated duration >72 hours, age between 1 month and 8 years. Daily calorie and protein intake were calculated and prealbumin, RBP and C-reactive protein (CRP) levels were measured on the first, third, fifth and seventh mornings. RESULTS: We find moderate correlation between daily calorie intake and prealbumin levels (r=0.432, p < 0.001), RBP levels and daily protein intake (r=0.330, p < 0.001). When we investigated the relationship between changes of prealbumin, RBP, CRP, calorie and protein intake during intensive care stay, we found that increase of Prealbumin and RBP levels are explained by decrease of CRP levels (r=−0.546 and −0.645, p < 0.001) and not with increase of nourishment. CONCLUSION: Even adjusted for PRISM3, age and CRP, prealbumin and RBP are correlated with last 24 hours' diet. However, it is not convenient to use as a follow up biomarker because increase of their levels is related with decrease of CRP levels.