Malnutrition is associated with many adverse clinical outcomes, including increased deaths and complications in perioperative period. The immunonutrition support plays an important role in the recovery process of patients with nutritional risk. Reasonable support can efficiently improve the condition of these cases and strongly suppress the inflammatory response. The immuno-nutrients include glutamine, ω-3 polyunsaturated fatty acids, arginine, nucleotides and so on. More and more evidences show that different kinds of immuno-nutrients play a regulatory role in metabolism and inflammatory response in patients with different disease stages and courses, and affect clinical outcomes and prognosis. Nowadays, there is an urgent need to standardize immunonutrition support in clinical work. In this paper, the related literatures about immunonutrition in recent years were reviewed. Our goal is to reduce the number of irregularities in the nutrition support practice, and to help nutritional risk patients achieve better clinical outcomes.
Objective To establish a prediction model for the 1-, 3-, and 5-year survival rates in patients with gastric cancer liver metastases (GCLM) by analyzing prognostic factors based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods Clinical and pathological data from 591 patients diagnosed with GCLM between 2010 and 2015 were obtained from the SEER database. The population was randomly divided into a training cohort and an internal validation cohort at a 7 to 3 ratio. Independent predictors of GCLM were analyzed using univariate and multifactorial Cox regression. Consequently, nomograms were constructed. The model's accuracy was verified by calibration curve, ROC curve, and the C-index, and the clinical utility of the model was analyzed through decision curve analysis. Results Tumor differentiation grade, surgical status, and chemotherapy were significantly associated with the prognosis of GCLM patients, and these three factors were included in constructing the prognostic model and plotting the nomogram. The C-index was 0.706 (95%CI 0.677 to 0.735) and 0.749 (95%CI 0.710 to 0.788) for the training set and the internal validation cohort, respectively. The results of the ROC curve analysis indicated that the area under the curve (AUC) was over 0.7 at 1, 3, and 5 years for both the training and validation cohorts. Conclusion The prediction model of the GCLM is developed based on the 3 factors, i.e., tumor differentiation grade, surgery, and chemotherapy, and shows good prediction accuracy and thus may promote clinical decision making and individualized treatment of GCLM patients.
ObjectiveTo investigate the clinical significance of abnormal confluence of common bile duct (CBD) and pancreatic duct. MethodsFortyfive cases of biliary pancreatic confluence portion of cadavers were dissected and observed with microscope. ResultsThe lower end of CBD inserted normally into the medial posterior portion of descending duodenum with oblique angle (41.4±5.3)° and safeguarded by the sidelong wrinkle formed by mucous membrane of duodenum. In common, pancreatic duct ampulla inserted into CBD with oblique angle (28.5±7.9)° and jointed CBD in the medial wall of dudenum. The length ampulla of Vater was about 0.5-1.5 cm. The Vater’s ampulla was dilated obviously. ConclusionThe result indicates that pancreatic duct and CBD joint with a sharp angle. A number of abnormal anatomic factors may change the relation of oblique angle, and lead to the pancreatitis.