Objective To systematically review the effects of enteral immunonutrition (EIN) on postoperative infection and the length of hospital stay in patients with gastrointestinal cancer after surgery, in order to provide high quality evidence for the rational perioperation nutrition plan for patients with malignant gastrointestinal tumor. Methods Randomized controlled trials (RCTs) published in English about application of EIN vs. general treatment for gastrointestinal surgery published from Jan. 1st, 1997 to Oct. 31st 2012 were retrieved in the following databases: PubMed, Ovid, and EMbase. References of the included studies were also retrieved. According to the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated the methodological quality. Then, meta-analysis was conducted using RevMan 5.2 software. Results 19 RCTs involving 2 298 patients were included. The results of meta-analysis showed that: there was no significant difference between the postoperative EIN group and the control group in reducing the risk of postoperative infection (OR=0.91, 95%CI 0.56 to 1.47, P=0.70); But postoperative and perioperative EIN had reduced the risk of postoperative infection with a significant difference (OR=0.57, 95%CI 0.39 to 0.82, P=0.002; OR=0.52, 95%CI 0.35 to 0.76, P=0.000 9). Additionally, the results of sensitivity analysis revealed that: no matter when EIN was used (during preoperative, postoperative, or perioperative periods), it reduced the length of postoperative hospital stay with significant differences, compared to the standard nutrition group (OR= −2.39, 95%CI −3.28 to −1.49, Plt;0.000 01; OR= −2.42, 95%CI −4.07 to −0.78, P=0.004; OR= −2.76, 95%CI −3.46 to −2.06, Plt;0.000 01). Conclusion Current evidence shows that perioperative EIN can decrease postoperative infection and reduce the length of hospital stay of patients with malignant gastrointestinal tumor. Due to the limited quantity and quality of the included studies, high quality RCTs are needed to verify the above conclusion.
Objective To summarize the important role of sirtuin type 1 (SIRT1) in the development of gastrointestinal tumors. Methods Domestic and international publications related to biological functions of SIRT1 and its role in gastrointestinal tumors in recent years were collected and reviewed. Results SIRT1 had a significant high expression in esophageal cancer, gastric cancer, colorectal cancer, liver cancer, and pancreatic cancer tissues, by associating with long noncoding RNA (LncRNA), microRNA, and autophagy. It affected the occurrence and development of gastrointestinal tumors. Conclusions Abnormal expression of SIRT1 is closely related to the occurrence and development of gastrointestinal tumors.
ObjectiveTo summarize the application status of artificial intelligence (AI) in the diagnosis and treatment of gastrointestinal tumors using image deep learning, as well as its application prospect. MethodLiteratures on AI in the field of gastrointestinal tumors in recent years were reviewed and summarized.ResultsAI had developed rapidly in the medical field. The gastrointestinal endoscopy, imaging examination, and pathological diagnosis assisted by AI technology could assist doctors to make more accurate diagnosis opinions, and make the diagnosis and treatment of gastrointestinal tumors develop towards a more accurate and efficient direction. However, the application of AI in the medical field had just begun, and it still needed to be popularized for a long time.ConclusionThe gastrointestinal endoscopy system, imaging examination system, and pathological diagnosis assisted by AI technology all show high specificity and sensitivity, which obviously reflects its high efficiency and accuracy.
ObjectiveTo compare the predictive value of six thrombotic risk assessment scales, including Autar, Wells, Padua, Caprini, Khorana, and COMPASS-CAT, for the deep venous thrombosis (DVT) of lower extremity in patients with gastrointestinal tumors. MethodsThe patients with gastrointestinal tumors who received surgical treatment in the General Surgery Department of Lanzhou University Second Hospital from March 2023 to October 2023 were collected. The risk of DVT on day 3 after surgery for the patient with gastrointestinal tumors was prospectively evaluated using the Autar, Wells, Padua, Caprini, Khorana, and COMPASS-CAT assessment scales. And the DVT was detected by ultrasound examination. The pionts of six thrombotic risk assessment scales were compared between the patient with DVT and without DVT based on the ultrasound examination results. The predictive value of the six thrombotic risk assessment scales for the lower extremity DVT in the patients with gastrointestinal tumors was evaluated by the area under receiver operating characteristic curve (AUC). ResultsA total of 108 patients who met the criteria, including 71 males and 37 females, were enrolled, age ranged from 18 to 85 years old, (58.3±11.2) years old. Fourty-two cases (38.9%) of DVT occurred. The age of patients with DVT was older than that of patients without DVT (P<0.05), but there were no statistical differences in the gender, body mass index, tumor location, comorbidities, and so on (P>0.05). The points of Autar, Padua, and Caprini in the patients with DVT were higher than those in the patients without DVT (P<0.05), while there were no statistical differences in the points of Wells, Khorana, and COMPASS-CAT between the two (P>0.05). The AUC for differentiating the occurrence of DVT in the patients with gastrointestinal tumors using the Autar, Wells, Padua, Caprini, Khorana, and COMPASS-CAT assessment scales were 0.907, 0.548, 0.636, 0.627, 0.589, and 0.535, respectively; The sensitivities were 97.6%, 14.3%, 52.4%, 83.3%, 47.6%, and 21.4%; The specificities were 2.4%, 85.7%, 47.6%, 16.7%, 52.4%, and 78.6%, respectively. ConclusionAccording to the abilities of Autar, Wells, Padua, Caprini, Khorana, and COMPASS-CAT to distinguish the occurrence of DVT in patients with gastrointestinal tumors after surgery, only the Autar evaluation scale is found to be more effective, while the other five evaluation scales are generally able to distinguish the occurrence of DVT.
ObjectiveTo conduct an analysis and identify potential risk factors associated with postoperative complications in patients diagnosed with malignant gastrointestinal tumors who underwent laparoscopic surgery. MethodsFrom January 2023 to October 2023, 500 patients with malignant gastrointestinal tumors who underwent laparoscopic surgery at the Department of General Surgery, the First Medical Center of PLA General Hospital were prospectively selected as the research objects. The incidence of postoperative complications (Clavien-Dindo gradeⅡ and higher) was observed, and then 500 patients were divided into a complication group and a non-complication group. The preoperative physical conditions, operative time and bleeding volume related to the operation were compared and analyzed between the two groups. According to the analysis results and clinical experience, appropriate variables were selected to be included in the multivariate binary logistic regression model for analysis, in order to determine the risk factors for postoperative complications in patients with malignant gastrointestinal tumors. ResultsOf the 500 patients, 453 had no postoperative complications (non-complication group), and 47 had postoperative complications (complication group), with an incidence of 9.4%. Univariate analysis showed that there were significant differences between the complication group and the non-complications group in gender, abdominal girth, preoperative hypoalbuminemia, drinking history, protein diet habits, primary diseases, operative time and intraoperative blood loss (P<0.05), while there were no significant differences between the two groups in age, body mass index, preoperative grip strength, 6 m walking test time, preoperative anemia, hypertension, diabetes, cardiovascular and cerebrovascular diseases, smoking history, education level, exercise habits and preoperative NRS 2002 nutritional score (P>0.05). Multivariate binary logistic regression analysis showed that gender, daily protein diet and exercise frequency, operation time >200 min and intraoperative blood loss >150 mL could be used as independent predictors of postoperative complications in patients with malignant gastrointestinal tumors (P<0.05). ConclusionFor female malignant gastrointestinal tumor patients with low daily protein intake, inadequate physical activity, prolonged operation duration, and massive intraoperative bleeding, perioperative management should be taken in advance and the occurrence of postoperative complications should be vigilant.