Experiences and requirements in nutritional management of patients with esophageal cancer: a systematic review and qualitative meta-synthesis.

PURPOSE: Nutritional management of patients with esophageal cancer is a significant issue. This systematic review aimed to comprehensively synthesize qualitative research evidence on the experiences and requirements in nutritional management from the perspective of patients with esophageal cancer. METHODS: A systematic review and meta-synthesis of qualitative studies were conducted. Studies written in Chinese or English were retrieved from nine databases, namely, PubMed, Web of Science, Cochrane Library, CINAHL, Embase, CNKI, WanFang, VIP, and SinoMed, from inception to December 23, 2022. After screening the titles, abstracts, and full texts, 19 articles were finally included for quality assessment and meta-synthesis. RESULTS: Three comprehensive themes were derived. These were dietary experiences (perception of symptoms and dietary behaviors), emotional experiences (negative and positive emotions), and social support (inappropriate social support and inadequate nutritional management). CONCLUSIONS: The experiences and requirements of esophageal cancer patients in terms of nutritional management during treatment and rehabilitation were reviewed and factors influencing nutritional management were discussed. The findings suggested that medical institutions should expedite the development of comprehensive nutritional management systems, create conducive nutritional environmental facilities, and establish interdisciplinary teams to implement personalized comprehensive interventional models for the management of patient nutrition. These steps would maximize the effectiveness of nutritional therapy, promote early patient recovery, and bridge the gap between healthcare professionals and patients in the understanding of nutritional management.

Immune biomarkers are associated with poststroke fatigue at six months in patients with ischemic stroke.

Poststroke fatigue (PSF) is detrimental to rehabilitation and the pathogenesis is still indefinite. The neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI) are immune indicators reflecting the status of inflammation and nutrition and have been widely applied as prognostic biomarkers. We pointed to examine the connections between PSF and NLR, PNI in acute ischemic stroke patients. Between October 2020 and September 2021, 333 participants radiologically confirmed with first-ever ischemic stroke were enrolled from patients consecutively admitted to the Department of Neurology. Fatigue severity was evaluated by Fatigue Severity Scale (FSS) at 6 months after stroke. A total of 130 (39.0%) stroke survivors had PSF at 6 months after stroke. Patients in the PSF group had higher NLR and lower PNI on admission. The correlations between PSF and NLR (r = 0.750), and PNI (r = -0.685) were significant. In multivariate analyses, NLR (odds ratio [OR] = 11.132, 95% confidence internal [CI]:4.640-26.704, P < 0.001), PNI (OR = 0.420, 95%CI:0.292-0.603, P < 0.001), and self-rating depression scale score (OR = 1.125, 95%CI:1.028-1.232, P < 0.001) stayed as independent predictors for PSF at 6 months after adjusting potential confounders. With the Receiver Operating Characteristic curve, the areas under the curve were 0.898 (95%CI:0.862-0.934, P < 0.001), and 0.862 (95%CI:0.819-0.904, P < 0.001), respectively; and the optimal cut-off values of NLR and PNI that best identified PSF were 4.05 (sensitivity:70.8%, specificity:96.1%), and 48.4 (sensitivity:71.5%, specificity:90.1%), respectively. In conclusion, NLR and PNI on admission were independently associated with PSF at 6 months in ischemic stroke persons. NLR and PNI can be used to early screen individuals at high risk for PSF.

Correlation Between Plasma Levels of RIP3 and Acute Ischemic Stroke with Large-Artery Atherosclerosis.

BACKGROUND: Receptor-interacting serine-threonine protein kinase 3 (RIP3) was previously discovered to be an important medium in the occurrence and development of major atherosclerotic cerebral infarction. However, the role of RIP3 in acute ischemic stroke remains unclear. OBJECTIVE: This study aimed to explore the correlation between plasma levels of RIP3 and acute ischemic stroke with large-artery atherosclerosis (LAA). METHODS: This prospective study enrolled 116 patients with LAA, 40 healthy controls, and 30 acute ischemic stroke patients with small-artery occlusion. The patients with LAA were divided according to the quartile of plasma levels of RIP3. A logistic regression model was used for comparison. The ROC curve was performed to evaluate the predictive value. RESULTS: In patients with LAA, the RIP3 levels in patients with poor outcomes as well as neurological deterioration were significantly higher than those with good outcomes (P < 0.001) and without neurological deterioration (P = 0.014). Patients in the highest levels of plasma RIP3 quartile were more likely to have neurological deterioration (OR, 11.07; 95% CI, 1.990-61.582) and poor outcomes (OR, 35.970; 95% CI, 5.392-239.980) compared with the lowest. The optimal cut-off value for neurological deterioration was 1127.75 pg/mL (specificity, 66.7%; sensitivity, 69.2%) and that for poor prognosis was 1181.82 pg/mL (specificity, 89.7%; sensitivity, 62.1%). CONCLUSION: Elevated levels of plasma RIP3 were significantly associated with neurological deterioration and poor prognosis in patients with LAA. A significant increase in plasma RIP3 levels can predict neurological deterioration and the poor prognosis of these patients.

Prospective analysis of glycemic variability in patients with severe traumatic brain injury: modified Leuven's adjustment process versus conventional adjustment process.

Objective This study was performed to evaluate the effect of two different methods of controlling glycemic variability (GV) in patients with severe traumatic brain injury (STBI) undergoing surgery. Methods Patients with STBI were randomly grouped into a conventional adjustment process (CAP) group and modified Leuven's adjustment process (mLAP) group. Each group included 50 patients. Blood glucose levels were continuously monitored and data were recorded and analyzed. Results The mean blood glucose level was stable in both groups for 5 days postoperatively with no significant difference. The standard deviation of the blood glucose level, mean amplitude of glycemic excursions, and glycemic lability index were significantly higher in the CAP than mLAP group for the first 2 days. In the final 3 days, no significant differences were observed between the two groups. The incidence of hypoglycemia was significantly higher in the CAP than mLAP group on the first day. This value gradually declined during the following 4 days, but the difference between the two groups was not significant. Conclusion The mLAP produced more favorable results than the CAP for GV control in the early stage after surgery for STBI.

New precut sphincterotomy for endoscopic retrograde cholangiopancreatography in difficult biliary duct cannulation.

AIM: To retrospectively investigate the effect and safety of various new type precut sphincterotomy techniques (VNTPST) in endoscopic retrograde cholangiopancreato-graphy (ERCP) due to difficult biliary duct cannulation (DBC). METHODS: A plough-like pull-type sphincterotome (PLPTS) or improved short nose sphincterotome or improved needle knife was applied. VNTPST was carried out in 30 of 280 patients, whose biliary tract could not be exposed well or deep cannulation was difficult to perform during ERCP with traditional methods. Patients were followed up for short-term complications and the therapeutic effect of VNTPS was observed and compared with that of traditional endoscopic sphincterotomy (EST). RESULTS: A total 280 patients underwent ERCP, of which 3 failed in operation because of pathological features in stomch or duodenum, 247 successfully underwent traditional ERCP (89.1%, 247/277), 30 failed (10.8%, 30/277). VNTPS technique succeeded in 24 (80%, 24/30) of 30 cases. The successful rate of deep biliary duct cannulation increased 8.6% (24/277), the total cannulation successful rate following precut was 97.7%. There was a significant difference between the two groups (97.7% vs 89.1%, c2 = 17.1, P < 0.01). The incidence of complications was 9.3% (26/277) for traditional ERCP group and 13.3% (4/30) for VNTPS technique group. Guideline tip was broken in pancreatic duct (KPDGP) of one patient, and there was no pancreatitis, slight or moderate bleeding postoperatively occurred in 2 patients, 1 patient had bleeding during operation (PDWN). There were no differences between VNTPS technique group and traditional ERCP (TRERCP) group (13.3% vs 9.3%, c2 = 0.478, P > 0.05). CONCLUSION: VNTPS procedure and Deng's precut are highly effective methods to get biliary access during ERCP with DBC. With skillful techniques, it can increase the successful rate for deep cannulation of biliary duct and decrease complications. VNTPS technique, especially Deng's precut is as effective and safe as EST. This technique can be well performed in hospitals without particular equipments.