Objective To study the effects and mechanisms of major immune nutrients and to introduce the progresses of clinical applications about enteral immunonutrition. Methods The related literatures about the effects and clinical applications of enteral immunonutrition were reviewed. Results Infection rate can be reduced and the hospitalization can be shortened as a result of the improved nutritional status and immune competence of patients which can be enhanced by reasonable enteral immune nutrition. Most of the patients suffering from serious diseases can benefit from enteral immunonutrition, such as gastrointestinal cancers, post-transplantation complications, chronic liver disorders, acute pancreatitis and so on. However, as a new nutrition therapy, the clinical use of enteral immunonutrition in critically ill patients is still controversial. Conclusions Enteral immunonutrition plays an important role in the nutritional support of patients with serious diseases, such as gastrointestinal cancers, organ failures. However, much work remains to be done.
ObjectiveTo introduce the progresses and applications of nutritional status assessment in hospitalized patients. MethodsThe related literatures of nutritional status assessment were reviewed. ResultsThe rates of malnutrition and nutritional risk were high in hospitalized patients worldwide. Traditional nutrition assessment tools were not in common use in all hospitalized patients. All clinical health care workers should use the most suitable tool when faced with different patients. ConclusionAll hospitalized patients should be screened for nutritional risk on admission in order to improve clinical outcomes and reduce overall treatment costs.
Objective To promote the clinical application of parenteral and enteral nutrition preparations in hospitalized patients. Methods Domestic and foreign articles about parenteral and enteral nutrition support were enrolled to make a review. Results Nowadays, parenteral and enteral nutrition played an important role in the medical treatment of perioperative and critically ill patients. Rational nutrition support could improve the condition of patients with nutritional risk and result in better clinical outcomes. Different enteral nutrition formulations should be used according to the diseases. Supplementally parenteral nutrition may also be useful in combination with enteral nutrition to reach the required intake targets. We should pay attention to the application of glucose, lipid emulsion, amino acids, vitamins, and so on, when performed parenteral nutrition support. Conclusion It is necessary to standardize parenteral and enteral nutrition support in the work of clinical practice, including the application of nutrition support and selection of nutrition preparations.
The pathogenesis of Vogt-Koyanagi Harada disease (VKH) has not yet been fully defined. Current studies mainly suggest that VKH is actually an autoimmune disease, especially related to the immune response mediated by various signal transduction pathways involved in the function of T cells. In recent years, the influence of the balance imbalance of various T cell subsets in cellular immunity on the pathogenesis of VKH has been a hot research direction. Currently, T helper cell 17/T regulatory cells, balance is the focus of clinical research, meanwhile, new discoveries and potential clinical treatment schemes have been made for related cellular pathways, particularly the Janus kinase/signal transducers and activators of transcription pathway and NF-kappa B pathway. The exploration of B cells in the pathogenesis of VKH has also achieved initial results through the successful application of various targeted drugs. In the future, further screening and localization of genes or proteins that are abnormally regulated or expressed in VKH, for which early comprehensive and in-depth exploration will be helpful, thus improve the efficacy of clinical treatment programs and develop new therapeutic targets.
ObjectiveTo investigate the nutritional risk, incidence of malnutrition, and clinical application of nutrition support in hospitalized patients with gastric cancer by the nutritional risk screening (NRS) 2002 score summary table. MethodsFrom June 2009 to February 2010, nutritional risk screen and application of clinical nutritional support were carried out in the hospitalized patients with gastric cancer in this hospital. Nutritional risk was assessed case-by-case according to the severity of illness, nutritional status 〔including body mass index (BMI), recent changes in body weight and eating〕 and patients age. NRS ≥3 was accepted as nutritionally at-risk, while NRS lt;3 no nutritional risk; BMI lt;18.5 kg/m2 (or albumin lt;30 g/L) combined with clinical conditions was judged to be malnourished. Results Three hundreds and eighty-six patients were included, 329 of which completed the NRS2002 screening. One hundred and sixty-five patients (50.15%) were at nutritional risk, while another 164 (49.85%) were no nutritional risk. Malnutrition was found in 57 patients (17.33%). By gender, male malnourished patients and nutritionally at-risk patients were accounting for 16.45% (38/231) and 48.05% (111/231) respectively, while female nutritionally at-risk patients and malnourished patients were accounting for 55.1% (54/98) and 19.39% (19/98) respectively, 72.04% (237/329) of the screened patients accepted clinical nutrition support, among which, 115 patients were at nutritional risk, accounting for 69.70% in that group, and 122 patients were no nutritional risk, accounting for 74.39% in that group. ConclusionsThe incidences of malnutrition and nutritionally at-risk in hospitalized gastric cancer patients are high. And irrationality of clinical nutrition support exists. Evidence-based guidelines are required to improve the nutritional status of support.
Objective To explore the postoperative influence of intra-abdominal implantation of sustained-releasing 5fluorouracil on the hepato-renal function, immune function, nutritional state and complications in patients with gastric and colorectal cancer. Methods Sixty-five patients with gastric or colorectal cancer were included into this study from January to June 2009. The patients (35 cases of gastric cancer, 18 cases of colon cancer and 12 cases of rectal cancer) were randomly divided into experimental group (n=25) and control group (n=40). In experimental group, 400 mg sustained-releasing 5-fluorouracil was used. Blood samples were gained before operation, the second day and the seventh day after operation to examine the indexes of hepato-renal function, immune function and nutritional state. Complications， venting time and length of stay after operation were also recorded. Results There was no statistical significance for distribution of tumor stages and patients’ gender between experimental group and control group (Pgt;0.05). Preoperative indexes of hepato-renal function, immune function and nutritional state were also not reached statistical significance between two groups (Pgt;0.05). Compared with control group, the indexes of total protein and transferrin were decreased and urea nitrogen and IgM were increased in the second day after operation in experimental group (Plt;0.05). The number of lymphocyte was increased, while CD4, Alb, total protein and IgA were decreased in the seventh day after operation in experimental group, respectively. The time of passage of gas of experimental group was longer than that of control group (Plt;0.05).Conclusion Intra-abdominal implantation of sustained-releasing 5-fluorouracil is safe and feasible, which does not increase the complications and the time of length stay after operation. However, there is a little influence on immune function and gastrointestinal function after operation for intra-abdominal implantation of sustained-releasing 5-fluorouracil.
Objective To summarize the application of enteral nutrition support in hospitalized patients. Methods The related literatures about enteral nutrition support in recent years were reviewed. Results The rates of malnutrition and nutritional risk were still high in patients. Enteral nutrition support could improve the condition and result of these cases in better clinical outcome, such as shorten hospitalization time and reduced the cost of hospital expenditure. Enteral nutritional support included both oral supplementation and tube-feeding techniques. Artificial nutrition may be provided by nasal tube (nasogastric or nasojejunal tube) or surgically placed tube (gastrostomy, jejunostomy, percutaneous endoscopic gastrostomy or percutaneous endoscopic gastrostomy-jejunostomy). More attention should be paid to the issues relating to feeding intolerance, including abdominal distension, diarrhea, reflux, and aspiration, especially for postoperative patients with early enteral nutrition support. Conclusion Enteral nutrition support requires highly individually and specialized tailored management.