Nutritional support therapy during treatment of chronic critical illness / 中华胃肠外科杂志

Chronic critical illness (CCI) refers to a group of critically ill patients who survive the acute phase of intensive care, but with persistent organ dysfunction, thus entering a chronic period of continuous dependence on life support system, and still need to stay in intensive care unit (ICU) for a long time. Persistent inflammatory response-immunosuppression-catabolic syndrome (PICS) is the main pathophysiological feature of CCI. Three factors interact to form a vicious circle, leading to poor prognosis. Nutritional support therapy is a key link in the comprehensive treatment of CCI. Enteral nutrition (EN) should be started as soon as possible if conditions permit. If EN can not be implemented, temporary or transitional parenteral nutrition (PN) should be used, and EN should be added gradually in time. At the same time, the amount of PN should be gradually reduced. When EN meets more than 60% of patients’ energy and protein requirements, PN can be considered to be discontinued. The main strategies and functions of CCI nutritional support therapy are as follows: strengthening high protein supply to correct negative nitrogen balance and inhibit catabolism, selecting branched chain amino acids (BCAA) to promote anabolism, using immunomodulators (arginine, ω3 polyunsaturated fatty acids) to improve immune suppression and inflammatory response, supplementing micronutrients (vitamins and trace elements) to counteract the decrease in intake and the increase in consumption, and adding probiotics to maintain the intestinal microecological balance, and so on. Reasonable nutritional support therapy not only improve malnutrition of CCI patients, but also help to reduce complications, thus speeding up rehabilitation, improving prognosis, shortening ICU hospitalization time, and even reducing mortality.

Predictors of local recurrence and survival in primary retroperitoneal leiomyosarcoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the predictors of local recurrence and survival in primary retroperitoneal leiomyosarcoma (PRLS).</p><p><b>METHODS</b>A retrospective analysis was conducted on 46 cases of PRLS between August 2006 and April 2012. There were 9 male and 37 female patients, and they were 30-79 year old (median 49 year old). Kaplan-Meier estimations and Cox regression analyses were performed.</p><p><b>RESULTS</b>The tumor size were 5-36 cm, and 29 cases (63.1%) of this group was more than 10 cm. Local 3- and 5-year control rates after complete resection were 47% and 30%. FNCLCC (Fédération Nationale des Centres de Lutte Contre le Cancer) grading (RR = 3.10, 95%CI: 1.59-6.04), gender (RR = 5.30, 95%CI: 1.64-17.13) and blood loss (RR = 3.12, 95%CI: 1.28-7.60) were independent prognostic factor of local recurrence in multivariable analysis (P < 0.05). The 5-year disease-free survival rates after complete resection of PRLS was 26%; and the 5-year disease-specific survival (DSS) rates after complete resection was 48%. The median DSS was 60 months in negative margin of resection and 50 months in positive margin. However, by multivariate analysis, only FNCLCC grading was significant independent predictors of DSS (RR = 2.01, 95%CI: 1.16-3.49, P = 0.013).</p><p><b>CONCLUSIONS</b>Gender, FNCLCC grading and blood loss were independent prognostic factor of local recurrence. The disease-specific survival in PRLS varied significantly according to FNCLCC grading.</p>

Predictive value of lymph node ratio for postoperative distant metastasis of stage III colorectal cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the predictive value of metastatic lymph node ratio for postoperative distant metastasis in patients with colorectal cancer.</p><p><b>METHODS</b>The clinicopathological data were collected from 180 patients with colorectal cancer who underwent surgical resection in General Hospital of PLA between from January, 2007 to January, 2012. The patients were divided into 2 groups according to the presence of distant organ metastasis and the clinicopathological factors were analyzed with Chi-square test and logistic regression.</p><p><b>RESULTS</b>Of the 118 surgical patients enrolled, 118 were free of distant metastasis and 62 had distant metastasis involving the liver (39 cases), lungs (12 cases), and multiple organs (11 cases). The gross types, differentiation, ELN and LNR of the tumors differed significantly between the two groups. Logistic regression analysis showed that LNR was an independent factor correlating to distant metastasis of colorectal cancer.</p><p><b>CONCLUSION</b>LNR is independently correlated with distant organ metastasis of colorectal cancer and serves as an important predicative factor for estimating the prognosis of colorectal cancer.</p>

Preoperative platelet-lymphocyte ratio is an independent prognostic factor for resectable colorectal cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the impact of preoperative platelet-lymphocyte ratio (PLR) on the prognosis in patients with operable colorectal cancer.</p><p><b>METHODS</b>The clinical data of 140 patients with operable colorectal cancer were analyzed retrospectively. According to preoperative PLR, the patients were divided into low PLR group (PLR<250) and high PLR group (PLR≥250). The overall 5-year survival rates and the clinicopathological factors in the two groups were analyzed using univariate analysis and COX regression model.</p><p><b>RESULTS</b>The patients with a high PLR had a significantly lower overall 5-year survival rate than those with a low PLR (71.4% vs 51.5%, P=0.045). Univariate analyses identified tumor location, the depth of tumor invasion, lymph nodes metastasis, TMN stage, and PLR as significant risk factors for reduced overall 5-year survival. In COX regression model, a high PLR was identified as an independent risk factor for poorer prognosis in patients with resectable colorectal cancer (RR: 2.213; 95%CI: 1.007-4.863, P=0.0048).</p><p><b>CONCLUSION</b>Preoperative PLR can be a clinically significant factor for assessment of prognosis of resectable colorectal cancer.</p>