Nutrition support for critical patients with intraabdominal infections / 中国实用外科杂志

Nutrition support is an important part of the therapy for critical patients with intra-abdominal infections.How to perform optimal nutrition support is crucial to improve the success rate of treatment for critical patients with intraabdominal infection.In general,proper energy and nutrient substrates and right timing and approach should be providedto maximize the benefits of nutrition support for critical patients with intra-abdominal infection according to the metabolic characteristics,gastrointestinal function and nutritional status.

Application of immune nutrition in patients with gastrointestinal tumors / 中华胃肠外科杂志

Immune nutrition refers to adding some special nutrients to the standard formula of nutrition in order to treat and regulate metabolism and immune function by its pharmacological effect. In recent years, immune nutrition, including glutamine, arginine, ω-3 PUFA, nucleotide etc, has been widely used in patients with gastrointestinal cancer. These nutrients show their different supporting functions through different mechanisms, and improve the clinical outcome of patients. Therefore, clinical nutrition has been expanded and upgraded from the traditional "nutrition" to "nutritional therapy".

Application of specific nutrients for patients after surgery / 中华胃肠外科杂志

Special nutritional support containing glutamine, arginine, and omega-3 fatty acids has therapeutic and immunomodulatory effects, and can significantly reduce the incidence of postoperative infectious complications and length of hospital stay in surgical patients. This review provides a clinical update regarding the concept and the use of pharmaconutrition and immunonutrition in patients undergoing gastrointestinal surgery.

Use of fish oil lipid emulsion in patients undergoing major surgery and those with systemic inflammatory response syndrome: a cost-effectiveness analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the cost-effectiveness of fish oil in patients undergoing major surgery and those with systemic inflammatory response syndrome(SIRS).</p><p><b>METHODS</b>A retrospective study was conducted in patients undergoing major surgery and those with SIRS on admission in the Zhongshan Hospital from January 2008 to December 2011. Fish oil group was enrolled and matched to control group by 1:2 for gender, age, diagnosis, and surgical procedure. There were 220 pairs of patients who were not admitted to ICU, 102 pairs of patients admitted to ICU, and 66 pairs of patients with SIRS. The clinical outcomes and costs were measured and cost-effectiveness analyses were conducted.</p><p><b>RESULTS</b>The clinical outcomes and costs showed no significant difference between the fish oil group and the control group in those patients who were not admitted to ICU(P>0.05). Fish oil fat emulsion supplementation significantly reduced the length of total hospital stay, postoperative hospital stay, ICU stay, re-operation rate, infection rates, perioperative mortality in patients admitted to ICU and those with SIRS(P<0.05). The cost-effectiveness ratio of non-reoperation rate, non-infection rate, and survival rate were lower in those patients receiving fish oil fat emulsion as compared with those without fish oil administration. Fish oil fat emulsion supplementation could reduce cost-effectiveness ratios of non-reoperation rate, non-infection rate and survival rate by 105 RMB, 160 RMB, and 89 RMB respectively in major surgical patients who admitted to ICU, and by 670 RMB, 280 RMB, and 220 RMB respectively in SIRS patients.</p><p><b>CONCLUSIONS</b>Addition of fish oil fat emulsion to clinical nutrition may have positive effects on critically ill patients. It seems that the effects of fish oil fat are strongly related to the severity of patient's underlying disease. Fish oil fat emulsion supplementation shows acceptable cost-effectiveness ratio and pharmacoeconomic value.</p>

Proteolysis induce factor in the digestive systematic cancer cachexia patients: its expression and role in cancer cachexia / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To demonstrate the expression of proteolysis induce factor(PIF) in the gastrointestinal(GI) cancer cachexia patients and evaluate its role in cancer cachexia.</p><p><b>METHODS</b>Examination of PIF was performed in urine samples from 28 GI cancer cachexia patients, 13 GI cancer patients without cachexia, and 12 weight loss patients with benign disease. PIF was added to the mice cultured C2C12 muscle cells, then the protein kinase B(Akt) phosphorylation and morphological change were measured.</p><p><b>RESULTS</b>The positive rate of PIF in urine of 28 cancer cachexia patients was 53.6%(15/28). In the other two groups, no positive result was detected. PIF could successfully induce Akt phosphorylation, cell atrophy, metamorphosis, and death. The peak of this phosphorylation could be detected after half an hour of the initiation of PIF at a concentration of 4 nmol/L.</p><p><b>CONCLUSIONS</b>PIF is specifically and highly expressed in GI cancer cachexia patients' urine. PIF can induce cancer cachexia possibly by activating Akt phosphorylation and inducing downstream proteolysis.</p>

Diagnostic methods for initial evaluation of primary gastrointestinal stromal tumors

To describe the imaging features of gastrointestinal stromal tumors [GISTs] at initial presentation with clinical, surgical, and pathologic correlation, and to evaluate values of various techniques in GISTs. This retrospective study recruited 70 patients with histologically proved GISTs between December 2004, and May 2009 in the Department of General Surgery, Zhongshan Hospital, Fudan Univeristy, Shanghai, China. Each patient underwent CT scanning, 39 patients underwent simultaneous endoscopy, 12 patients underwent endoscopic ultrasound [EUS], and 36 patients underwent transabdominal ultrasonography [TAUS] simultaneously. Features of GISTs were assessed. Computerized tomography findings showed an eccentric mass in 44 patients, an intraluminal component in 24, and a transmural distribution in 2. Forty-two tumors were dumbbell-shaped, 2 were round, while 26 were irregular. Forty-three tumors presented with well-defined masses, while 27 with unclear borders. The arterial phase attenuation showed the continuous enhancement. The portal-venous phase attenuation was heterogeneous in 26 and homogeneous in the other 44. There was a significant correlation between certain CT features and tumor risk stratification. Gastrointestinal stromal tumors were characterized by a smooth shape and normal overlying mucosa in endoscopy, hypoechoic, and solid in TAUS. Imaging examinations are pivotal in the management of GISTs. The CT scan is valuable in the diagnosis, staging, and treatment planning of GISTs. Endoscopy and EUS contribute to the detection of mucosal lesions. Other methods including TAUS, fluorodeoxyglucose positron emission tomography, CT gastrography, and MRI help in specific cases

Experimental study on protective effect of small interfering RNA-induced Atrogin-1 gene silencing on muscle cell malnutrition / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the protective effect of Atrogin-1 gene silencing via RNA interference technique on a model of muscle cell malnutrition.</p><p><b>METHODS</b>Sequences of five target Atrogin-1 siRNA and the control were selected and synthesized and cloned to vector pBS-hU6-I and then to vector FG12. The length and rightness of the sequences were confirmed. The recombinant FG12 vectors were cotransfected along with pRSVREV, pMDLg/pRRE and pHCMV-G into 293T cells to package lentivirus particles, with which C2C12 cells were infected. The infected C2C12 cells were cultured and differentiated to form myotubes before TNF-alpha was added to induce malnutrition. Expressed products of Atrogin-1 of myotubes were identified by real time PCR and Western blot methods. Myotubes were observed and photographed directly in culture plate without fixation.</p><p><b>RESULTS</b>The length and sequences of inserted DNA were right. Compared with the RNA interferencing group, significant atrophy and upregulated expression of Atrogin-1 of myotubes treated by TNF-alpha was found in the control group.</p><p><b>CONCLUSION</b>Atrogin-1 gene silencing could be used to inhibit malnutrition of muscle cells caused by TNF-alpha. Atrogin-1 could be an ideal target in the treatment of cancer cachexia.</p>

Research of the relationship between insulin signal transduction and glucose transportation in rats after trauma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the relationship between insulin post-receptor signal transduction and the change of glucose transportation by skeleton muscle after surgical trauma in rats.</p><p><b>METHODS</b>Small intestine bowel resection was performed to establish the surgical trauma model in rats. The content and the phosphorylation state of two key proteins in the insulin signaling pathway: insulin receptor substrate-1 (IRS-1) and protein kinase B (PKB/Akt) in skeletal muscle were measured respectively. The 3H labeled glucose uptake experiment was carried out to evaluate the glucose transportation function in both groups. Finally, the expression and the distribution of glucose transporter 4 (GLUT4) in skeletal muscle were detected respectively.</p><p><b>RESULTS</b>The total content of IRS-1 and PKB/Akt in skeletal muscle in both groups had no difference. The phosphorylation of tyrosine (Tyr) residue of IRS-1 in the operation group was attenuated by 31% (P = 0.018), whereas the phosphorylation of serine (Ser) residue of IRS-1 was significantly enhanced by 63% compared with the control group (P = 0.000). Accordingly, the phosphorylation state of PKB/Akt (activated) was attenuated by 48% in the operation group (P = 0.000). The rate of 2-Deoxy-D-[1-3H] glucose transported by skeletal muscle in the operation group was significantly lower than that in the control group. Both the expressions of GLUT-4 mRNA and the total content of GLUT-4 protein in two groups had no significant difference. But the expression of GLUT4 in the plasma membrane was decreased in the operation group than that in the control group.</p><p><b>CONCLUSIONS</b>Insulin resistance was associated with enhanced Ser phosphorylation of IRS-1, which impaired its interaction with its downstream target PKB/Akt. Such impaired interactions abolished the ability of IRS-1 to undergo insulin-induced Tyr phosphorylation and further propagate the insulin receptor signal. Uncoupling of signal transduction led to decrease in glucose uptake which associated with a defect in insulin-stimulated glucose transport and GLUT-4 translocation.</p>

Assessment of energy expenditure and body composition in cancer patients / 中华外科杂志

<p><b>OBJECTIVE</b>To demonstrate the changes of resting energy expenditure (REE), substrate metabolism and body composition in cancer patients.</p><p><b>METHODS</b>From September 2004 to March 2008, REE, carbohydrate oxidation (CO) and fat oxidation (FO) in 936 cancer patients and 840 control subjects were measured by indirect calorimetry. Bioelectrical impedance appliance was applied to assess intracellular fluid, extracellular fluid, fat mass (FM) and fat free mass (FFM) in the two groups.</p><p><b>RESULTS</b>No difference in REE was found between the cancer patients and non-cancer patients [(1452.2 +/- 196.4) kcal/d vs. (1429.5 +/- 182.6) kcal/d, P = 0.136]. But REE/FFM and REE/pREE were elevated in cancer patients than in controls (all P < 0.05). Of the cancer patients, 48.6% were hypermetabolic, 42.9% normal and 8.5% hypometabolic, while those were 22.5%, 58.5% and 19.0% in controls. Cancer patients had higher FO [(77.8 +/- 11.3) g/min vs. (67.1 +/- 12.1) g/min, P = 0.000], lower CO and npRQ [(68.7 +/- 10.5) g/min vs. (88.8 +/- 12.1) g/min, P = 0.000; 0.782 +/- 0.012 vs. 0.810 +/- 0.014, P = 0.000]. Cancer patients exhibited lower FM and FFM [(14.9 +/- 4.5) kg vs. (18.4 +/- 5.2) kg, P = 0.000; (44.4 +/- 7.2) kg vs. (46.1 +/- 8.1) kg, P = 0.008].</p><p><b>CONCLUSIONS</b>Elevated REE is common in cancer patients. Substrate metabolism of the cancer patients features in increased FO, decreased CO and npRQ, which is correlated with the elevated REE. FM and FFM loses in proportion in cancer patients.</p>

Effect of high amounts of medium chain triglyceride and protein enteral nutrition on nutritional status in patients after major abdominal operation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Nutrition MCT and Nutrition MF enteral nutrition on nutritional status of patients after major abdominal operation.</p><p><b>METHODS</b>In a double- blinded and randomized cross- cover study, Nutrition MCT and Nutrition MF enteral nutrition were fed in patients when the gut function restored after operation. The total calorie was 104.6 kJ(25 kcal) x kg(-1) x d(-1) and the period of full dose of enteral nutrition was 5 days. The blood samples were collected before operation,before enteral nutrition and the sixth day after full dose of enteral nutrition for the measurement of pre- albumin, total protein,albumin, transferrin and triglyceride. The urine, stool and drainage fluid were collected to analyze nitrogen balance.</p><p><b>RESULTS</b>The plasma protein and fat were obviously dropped in patients after abdominal operation and improved after the enteral nutrition support in two groups. However, the pre- albumin level increased more in patients of Nutrition MCT than Nutrition MF.</p><p><b>CONCLUSION</b>Nutrition MCT can obviously improve the nutritional status of patients after major abdominal operation.</p>

A randomized controlled trial of postoperative artificial nutrition in malnourished patients with gastrointestinal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the potential benefits of postoperative nutrition in malnourished patients with gastrointestinal cancer.</p><p><b>METHODS</b>A total of 646 malnourished patients with gastrointestinal cancer defined by the subjective global assessment (SGA) were randomly divided into parenteral nutrition group (n=215), enteral nutrition group (n=215) and conventional group (n=216). Two nutritional regimens were designed to be isocaloric 125.5 kJ(30 kcal).kg(-1).d(-1) and isonitrogenous 0.25 g.kg(-1).d(-1) for 7 postoperative days. Conventional group did not receive artificial nutrition before and after surgery. Postoperative complications, mortality and postoperative length of hospital stay were compared.</p><p><b>RESULTS</b>All baseline and surgical characteristics were comparable among 3 groups. Overall postoperative mortality was 1.5%, and no difference was observed among 3 groups. Postoperative complications occurred in 61(28.4%) patients in enteral nutrition group, 72(33.5%) in parenteral nutrition group, and 97 (44.9%) in conventional group (P=0.000 vs enteral nutrition group; P=0.001 vs parenteral nutrition group). Postoperative length of hospital stay was (9.8+/-3.4) d in enteral nutrition group, (11.2+/-5.0) d in parenteral nutrition group, and (14.5+/-7.1) d in conventional group (P=0.001 vs enteral nutrition group; P=0.003 vs parenteral nutrition group).</p><p><b>CONCLUSIONS</b>Postoperative artificial nutrition support is beneficial to the malnourished patients with gastrointestinal cancer, which improves postoperative outcome. Early enteral nutrition significantly reduces the infectious complication rate and length of postoperative hospital stay as compared with parenteral nutrition.</p>

Effect of glucagon-like peptide 2 on the intestinal mucosal immunity and correlative cytokines in mice with gut ischemia/reperfusion injury / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of glucagon- like peptide 2 on intestinal mucosa immunity after ischemia/reperfusion injury and explore the possible mechanisms.</p><p><b>METHODS</b>A total of 70 ICR mice were randomly divided into three groups including normal control group(N), I/R group(C) and GLP-2 treatment group(T) (treated with GLP-2,200 microg/kg). The mice were sacrificed on the 1st, 3rd and 5th day after I/R injury. Liver,spleen and mesenteric lymph nodes samples were collected for bacterial culture. The endotoxin levels in plasma were also measured. Small intestine washing were obtained for IgA and the intestine homogenized were analyzed for Th1/Th2 cytokines.</p><p><b>RESULTS</b>The rate of bacterial translocation and the level of endotoxin in group C were significant higher than those in group T and group N. The IgA level in the lavage of the intestine was significantly decreased on the 1st day after I/R in group C and T compared with that in group N, while there was no difference between group C and T. The IgA level increased on the 3rd day and returned to normal on the 5th day after I/R in group T, while that in group C was still lower than normal. In group C, the levels of Th1-type (IL-2 and IFN-gamma) cytokines increased, the levels of Th2-type (IL-4 and IL-10) decreased significantly on the 1st day and then increased gradually. The change pattern of cytokines levels in group T resembled that in group C, but the levels of IL-4 and IL-10 in group T returned to normal on the 5th day after I/R.</p><p><b>CONCLUSIONS</b>GLP-2 supplementation can partly protect the intestinal mucosal immunity. The mechanism may probably be related to the restitution of the balance of Th1/Th2 cytokines in the intestinal mucosa in mice.</p>

Effects of glucagon-like peptide 2 on the adaptation of residual small bowel in a rat model of short bowel syndrome / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of glucagon-like peptide 2 (GLP-2) on the morphology and functional adaptation of the residual small bowel in rat model of short bowel syndrome.</p><p><b>METHODS</b>Twenty rats with 75% of the midjejunoileum removed were randomly divided into two groups, and received intra-peritoneal injection of GLP-2(250 micro*gd*kg-1*d-1) or subcutaneous injection saline(0.5 ml, twice one day) after operation. On postoperative day 6, the morphological changes of the residual jejunum and ileum, the expression of proliferating cell nuclear antigen(PCNA), and the mRNA expressions of Na-D-glucose cotransporters (SGLT1) and peptide cotransporters (PEPT1) were determined. The intestinal glucose absorption data per unit length as well as per unit weight of ileum were measured by in vivo circulatory perfusion experiment.</p><p><b>RESULTS</b>The morphological parameters of the residual gut such as the thickness of mucosa, height of villus, depth of crypt, and PCNA positive index were significantly higher, while the apoptosis rate per unit of mucosal square was significantly lower in GLP-2 treatment group than those in the control group. The expressions of mRNA SGTLl and PEPT1 in the residual ileum were significantly higher than those in the control group. There was no significant difference in glucose absorption rate per gram of mucosal wet weight between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>GLP-2 could improve morphological and functional adaptation of the residual small bowel by stimulating enterocyte proliferation and decreasing enterocyte apoptosis in short bowel syndrome.</p>

Clinical report of 81 cases of multiple primary cancers in laryngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the clinical characteristics and the survival status of the patients with laryngeal squamous cell carcinoma in the multiple primary cancers (MPC).</p><p><b>METHODS</b>Follow-up and clinical data were analyzed retrospectively in 81 laryngeal squamous cell cancer patients with MPC among 1101 patients with laryngeal carcinoma. Survival analysis and every influencing factor on survival rate were performed by Kaplan-Meier method.</p><p><b>RESULTS</b>The occurrence rate of MPC in the patients with laryngeal squamous cell cancer was 7.4% (81/1101) in this report. Oral cavity carcinoma and nasopharyngeal carcinoma were the most common MPC in 29 cases (35.8%) in head and neck regions. MPC in head and neck regions were more often seen among patients who had treated with radiotherapy (chi2 = 5.7, P = 0.017). Lung carcinoma (25.9%, 21/81) and esophageal carcinoma (22.2%, 18/81) were the most common MPC in remote organs in 52 cases (64.2%). Thirty seven MPC cases (45.7%) were occurred in aerodigestive tract and 32 cases(39.5%) in respiratory tract in this series. Fourteen cases (17.3%) were synchronous MPC, the median time interval was 2 months. Other 67 cases (82.7%) were metachronous MPC, the median time interval was 28 months. The squamous cell carcinoma (66.7%) was the most common pathologic type among all MPC in 81 cases, which was more often seen among patients who had smoked and drunk (P = 0.007). The MPC of esophageal carcinoma and oropharyngeal carcinoma were more often seen among patients of supraglottic index cancer presentation (P = 0.04). The MPC of oral cavity cancers and nasopharyngeal carcinoma and lung carcinoma were more often seen among patients of glottic index cancer presentation (P = 0.006). The total three-and five-year survival rates were 45.2% and 29.7% respectively of all MPC patients, the five-year survival rate for patients (53 cases) who received actively different therapies for their MPC was 45.5%, obviously higher than that of untreated patients (28 cases) whose three-year survival rate was zero (P = 0.000).</p><p><b>CONCLUSIONS</b>Lung carcinoma and esophageal carcinoma were the most common multiple primary cancers among MPC of the laryngeal cancer. MPC of the laryngeal cancer in head and neck regions were more often seen among patients who had treated with radiotherapy. The pathologic type of squamous carcinomas of MPC was more often seen among patients who had smoked and drunk. MPC affected the prognosis of patients in laryngeal cancer largely. Treating effectively and in time could help to improve the survival rate of patients with MPC in laryngeal squamous cell carcinomas.</p>

Pathological character and treatment of epithelial-myoepithelial carcinoma of salivary gland / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To review and evaluate pathologic features and treatment of epithelial-myoepithelial.</p><p><b>METHODS</b>Retrospectively reviewed 14 cases' pathological and clinical materials of epithelial-myoepithelial carcinoma of salivary gland. Eight cases origine from parotid gland, 2 cases from hard palate, 3 cases from submandibular gland and 1 case from nasal cavity. Three cases were performed induction chemotherapy preoperation. One case had palliative radiotherapy. Thirteen cases were performed radical surgery and 6 cases had radiotherapy postoperation.</p><p><b>RESULTS</b>Tumor arisen mostly from parotid gland and neck lymph node metastasis rate was 14.28% (2/14). The survival rate was calculated with Kaplan-Meier method. The overall 3-, 5- and 10-year survival rate were 67.20%, 45.49% and 17.06%. Its histological characteristics were inner layer composed by adenoid cells and outer layer composed by myoepithelial cells. Immunohistochemical exam show cytokeratin, S-100 and actin reaction positive.</p><p><b>CONCLUSIONS</b>Epithelial-myoepithelial carcinoma easily develops recurrence. It is sensitivity to radiotherapy and chemotherapy to some extent. It is suitable to adopt surgical treatment as primary modality combined with other therapies.</p>

Value of elective neck dissection in patients with clinically stage I squamous cell carcinoma of the tongue / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To determine the value of elective neck dissection in patients with clinically stage I (cT1N0M0) squamous cell carcinoma of the tongue.</p><p><b>METHODS</b>This was a retrospective study of patients with surgical treatment between November 1984 and November 1999. A total of 130 patients were included in the study, all of whom received operation of the primary site, meanwhile, 99 of whom underwent elective neck dissection simultaneously including level I -III or level I -IV neck dissection in 20 patients and level I - V neck dissection in 79 patients. Results Among all these patients, the rate of occult metastasis to the neck were 12. 0%. Local failure rate in patients with only local treatment, level I II, II, III/IV neck dissection and level I - V neck dissection were 25. 8%, 15. 0% and 7. 6% respectively. There were significant difference in regional failure between patients with only local treatment and patients with elective neck dissection (P < 0.05). Also, no significant differences were noted in the survival rate between patients with only local treatment, elective neck dissection (level I -III or level I -IV) and level I -V neck dissection (P > 0.05).</p><p><b>CONCLUSIONS</b>Elective neck dissection significantly reduced regional control failure but was not able to reduce distant metastasis or increase the overall survival. A prospective randomized study is worthwhile to further evaluate the benefit of elective neck dissection in the treatment of clinically stage I squamous cell carcinoma of the tongue.</p>

Effect of glutamine and growth hormone on adaptation in short bowel syndrome / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the effects of parenteral glutamine and growth hormone supplementation on gut adaptation for patients with short bowel syndrome.</p><p><b>METHODS</b>Twenty-six patients [male 15, female 11, aged (39 +/- 23) years] with short bowel syndrome received parenteral nutrition (PN) 3-52 months after surgical resection. The median length of remnant small intestine was 42.5(0-100)cm. All patients received growth hormone (0.10+/- 0.06) mg.kg(-1).d(-1) plus glutamine (0.30 +/- 0.17) mg.kg(-1).d(-1) for two or three weeks.</p><p><b>RESULTS</b>Among the 26 patients, PN was not required soon after treatment in 34.6% (n=9) of the patients, the frequency and volume of PN decreased from (6.0 +/- 1.0) d to (4.2 +/- 1.0) d, from (13.6 +/- 5.2) L per week to (8.2 +/- 3.3) L per week respectively in 30.8% (n=8) of the patients,while 34.6% (n=9) still required PN after treatment.</p><p><b>CONCLUSION</b>The combined administration of glutamine and growth hormone can promote remnant intestinal adaptation in short bowel patients.</p>

Differentiated thyroid carcinoma in young people / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the factors that influence survival of the patients with differentiated thyroid carcinoma in young people and evaluate the efficiency of unilateral lobectomy plus isthmectomy with therapeutic cervical lymph node dissection and postoperative TSH (thyroid stimulating hormone) suppressive therapy.</p><p><b>METHODS</b>One hundred and thirty-one patients under 30 years old with differentiated thyroid carcinoma treated in this hospital (14 cases no more than and 117 cases more than 16 years) from Jan. 1st, 1985 to Dec. 31st, 1997 were retrospectively reviewed. One hundred and twenty-eight patients were received only surgery and TSH suppressive therapy, and 3 patients received chemotherapy or radiotherapy because of the progressive metastasis in necks or mediastina. A multivariate analysis was performed in these patients by the Cox proportional hazard model.</p><p><b>RESULTS</b>The mean follow-time (x +/- s) of all patients were (140.86 +/- 43.76) months, with range from 20 to 229 months; Ninety-eight patients followed more than 10 years. Ten patients died of thyroid cancer. The overall 10-year survival rate was 97.18%. The 10-year survival rate for patients < or = 16 years of age and > 16 years were 75.97% and 96.57% respectively (P = 0. 0006). The 10-year survival rate for women and men were 94.91% and 93.69% respectively (P = 0.5261). The 10-year survival rates of patients with papillary thyroid carcinoma and follicular thyroid carcinoma were 93.77% and 96. 55% respectively (P = 0.8137). For patients with tumor size of < or = 1 cm, 1-4 cm and >4 cm the survival rate was 100.0%, 96.40%, and 80.67% respectively (P = 0. 0589). The 10-year survival rates of patients with or without lymph node metastasis were 88.37% and 100. 0% respectively (P = 0.0313). For patients of with or without distant metastasis, The survival rate was 96.64% or 60.00% (P = 0.0000). The 10-year survival rates with or without recurrence were 86. 67% and 95.48% respectively (P = 0. 5681). Using multivariate analysis, risk factors that independently influence survival were distant metastasis, tumor size and age.</p><p><b>CONCLUSIONS</b>The distant metastasis, tumor size and age at diagnosis were the independent factors influencing survival significantly. The status of lymph node metastasis may have certain effect on the prognosis. Unilateral lobectomy plus isthmectomy with a therapeutic cervical lymph node dissection followed by postoperative TSH suppressive therapy is a favourable model to children and young adults with DTC without distant metastasis, but to the patients with distant metastasis, their prognosis of this therapy model is disappointing.</p>

Prevalence of malnutrition in general surgical patients: evaluation of nutritional status and prognosis / 中华外科杂志

<p><b>OBJECTIVE</b>To estimate prevalence of malnutrition on admission to hospital and the relationship between nutritional status and prognosis.</p><p><b>METHODS</b>Four thousand and twelve patients admitted to general surgery department were evaluated by a lot of nutrition indexes within 48 h. Operative morbidity and complications were recorded to identify the difference between malnourished and well-nourished patients.</p><p><b>RESULTS</b>Malnutrition rate of all patients according to BMI, TSF, MAC, AMC, albumin, prealbumin, and lymphocyte count was 21.3%, 50.6%, 20.5%, 21.2%, 24.2%, 35.4% and 55.8%, respectively. The prevalence of malnutrition as defined by SGA and MNA were 38.8% and 20.8%. The older patients (> 60 years old) were associated with a higher prevalence of malnutrition (47.6%) compared with those younger than 60 (31.5%). Malnutrition was more frequently occurred in cancer patients than non-oncologic patients (64.5% vs 22.4%). Patients with digestive tract disease had higher rates of malnutrition than those without digestive tract disease (52.6% vs 30.0%). There were large differences in the morbidity and complications between well nourished patients and malnourished patients (4.0% vs 1.1%, P < 0.01 for morbidity; 19.8% vs 5.9% for complications).</p><p><b>CONCLUSIONS</b>The prevalence of malnutrition in hospitalized surgical patients is high. Malnutrition was associated with increased length of stay, higher operative morbidity and complications.</p>

Clinicopathological features and prognosis of postirradiation osteosarcoma in nasopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Post irradiation osteosarcoma (PIOS) in patients with nasopharyngeal carcinoma (NPC) is rare and a potential late complication of radiation. We investigate its clinicopathological features and prognosis.</p><p><b>METHODS</b>426 cases of bone sarcomas in Cancer Center of Sun Yat-sen University, China between 1964 and 2003 were reviewed retrospectively. Fifteen patients were determined to have PIOS after radiation of NPC. Its prevalence rate, onset time, site, image features, and treatment were described. Kaplan-Meier analysis was used to determine the relative prognostic factors.</p><p><b>RESULTS</b>In 12 patients undertaken radical surgery, one patient had residual tumor and six patients presented tumor recurrence five to 19 months (mean of nine months) after surgery. All patients survived seven to 41 months with a mean of 18 months. The one-year and two-year survival rates were 60% and 24% respectively. Female patients with large area of tumor bone formation in images had better survival than male patients without or few tumor bone formation. Age, radiation dosage, onset time of PIOS, tumor size, and treatment were probably not significant factors to prognosis.</p><p><b>CONCLUSIONS</b>PIOS in patients with NPC is a high malignant disease and often has poor prognosis. Surgery with pre-and post-operative chemotherapy might be a way to improve its survival.</p>