Meta-analysis of enteral nutrition versus total parenteral nutrition in patients with severe acute pancreatitis.

OBJECTIVE: To compare the safety of enteral nutrition and total parenteral nutrition in nutrition support of patients with severe acute pancreatitis. DATA SOURCES: Medline, Embase, and manual search. STUDY SELECTION: 295 articles were screened for randomized controlled studies (RCTs) that compared enteral nutrition with total parenteral nutrition in patients with severe acute pancreatitis. Finally, six RCTs were identified and included in the meta-analysis. DATA EXTRACTION: six RCTs with 224 participants were analyzed. The main outcome were infections, artificial nutrition-related complications, pancreatitis-related complications, non-pancreatitis-related complications, organ failure and mortality. The meta-analysis was performed with the fixed effects model or random effects model. RESULTS: Compared with total parenteral nutrition, enteral nutrition was associated with a significantly lower risk of infections [odds ratio (OR) 0.236; 95% confidence interval (95% CI) 0.120-0.464, p<0.001], pancreatitis-related complications (0.456; 0.234-0.888, p=0.021), organ failure (0.334; 0.167-0.670, p=0.002), multiple organ dysfunction syndrome (0.306; 0.128-0.736, p=0.008), and mortality (0.251; 0.095-0.666, p=0.005). There were no significant differences in artificial nutrition-related complications (0.642; 0.354-1.162, p=0.143), and non-pancreatitis-related complications (0.716; 0.325-1.576, p=0.406) between the two groups. CONCLUSIONS: Enteral nutrition appears safer than total parenteral nutrition in nutrition support of patients with severe acute pancreatitis.

HBV infection and extra-hepatic cancers in adolescents and 20s: A retrospective study in China.

BACKGROUND: The mean age at cancer diagnosis is younger in hepatitis B virus (HBV) infected than non-infected patients. It remains unknown whether this association reflects an increase in the incidence rates of extra-hepatic cancers in adolescents and younger. METHODS: We examined 10 common extra-hepatic cancers (lung, breast, gastric, prostate, esophageal, rectal, cervical, nasopharyngeal, lymphatic, and urinary bladder) among patients diagnosed at three Chinese hospitals during 2007-2016. We compared the percentage distribution (frequencies at each age point are shown as a percentage of the total frequency) of HBsAg+ with HBsAg- patients, and calculated the standardized incidence ratio for each age group. RESULTS: A total of 60,323 patients were identified. The mean age at cancer diagnosis was 1.5-5.5 years younger in hepatitis B surface antigen (HBsAg) positive patients compared to HBsAg- patients (p ≤ 0.001). Lymphoma patients had the highest prevalence rate of HBV infection (20.7%). Among the pooled HBsAg+ cancer patients, 14.8% (1138/7666) were aged ≤39 years; by contrast, 9.7% (5122/52657) of HBsAg- cancer patients were in the same age range, giving an odds ratio of 1.6 [95%CI1.509-1.733)]. The observations were similar when each cancer was considered individually. The odds ratio was greater in pooled male patients aged ≤39 years [1.9(95%CI1.705-2.085)] compared with females [1.6(95%CI1.382-1.83)]. The ratio of the observed to the expected number of HBsAg+ patients aged 15-19, 20-24, and 25-29 years were 3.3, 4.8 and 2.0, respectively, higher than 1.2-1.7 observed for older age-groups. CONCLUSION: HBV infection is a risk factor for diverse extra-hepatic cancers in adolescents and 20s.