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OBJECTIVE@#To explore the clinical characteristics and genetic etiology of a child with multiple pterygium syndrome (MPS).@*METHODS@#A child with MPS who was treated at the Orthopedics Department of Guangzhou Women and Children's Medical Center Affiliated to Guangzhou Medical University on August 19, 2020 was selected as the study subject. Clinical data of the child was collected. Peripheral blood samples of the child and her parents were also collected. Whole exome sequencing (WES) was carried out for the child. Candidate variant was validated by Sanger sequencing of her parents and bioinformatic analysis.@*RESULTS@#The child, an 11-year-old female, had a complain of "scoliosis found 8 years before and aggravated with unequal shoulder height for 1 year". WES results revealed that she has carried a homozygous c.55+1G>C splice variant of the CHRNG gene, for which both of her parents were heterozygous carriers. By bioinformatic analysis, the c.55+1G>C variant has not been recorded by the CNKI, Wanfang data knowledge service platform and HGMG databases. Analysis with Multain online software suggested that the amino acid encoded by this site is highly conserved among various species. As predicted with the CRYP-SKIP online software, the probability of activation and skipping of the potential splice site in exon 1 caused by this variant is 0.30 and 0.70, respectively. The child was diagnosed with MPS.@*CONCLUSION@#The CHRNG gene c.55+1G>C variant probably underlay the MPS in this patient.
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Humans , Child , Female , Abnormalities, Multiple/genetics , Malignant Hyperthermia/genetics , Skin Abnormalities/genetics , Heterozygote , Mutation , Receptors, Nicotinic/geneticsABSTRACT
Objective:To investigate the prevalence of malnutrition in elderly patients with neurological diseases and the of nutrition, and to explore their association with clinical outcomes.Methods:A retrospective study was conducted to analyze 566 elderly patients with neurological diseases in the database of the "National Multicenter Survey on the Dynamic Changes of Nutritional Status of Hospitalized Patients" by using the Global leadership Initiative on Malnutrition(GLIM)criteria and subjective global assessment(SGA). The two diagnostic tools for malnutrition were compared to explore the correlation between malnutrition and clinical outcomes.Results:Based on the GLIM criteria, 83 cases were diagnosed with malnutrition and the incidence of malnutrition was 14.66%(83/566), with 14.72%(48/326)in men and 14.58%(35/240)in women.Patients with moderate malnutrition accounted for 8.30%(47/566)and patients with severe malnutrition accounted for 6.36%(36/566). According to the SGA, the incidence of moderate malnutrition(SGA Grade B)was 15.55%(88/566), the incidence of severe malnutrition(SGA Grade C)was 1.94%(11/566), and all cases of malnutrition(SGA Grade B+ C)accounted for 17.49% of the participants(99/566). The total length of hospital stay was(15.46±6.49)days in the malnutrition group and(13.55±5.09)days in the non-malnutrition group, with a statistical difference between the two groups( t=-3.02, P<0.01). The body weight of the malnutrition group was significantly lower than non-malnutrition group[(52.0±8.5)kg vs.(65.2±9.6)kg, t=12.92, P<0.01]. There were also statistically significant differences in BMI(19.1±2.7 kg/m 2vs.23.9±2.6 kg/m 2, t=15.48, P<0.01), upper arm circumference[(22.3±2.5)cm vs.(28.3±3.9)cm, t=7.01, P<0.01], and lower leg circumference[(28.9±3.4)cm vs.(32.5±3.3)cm, t=6.81, P<0.01]between the two groups.Laboratory tests showed that there were significant differences in lymphocytes[(5.0±8.5)×10 9/L vs.(9.4±11.8)×10 9/L, t=3.61, P<0.01]and albumin[(38.5±4.4)g/L vs.(40.7±5.1)g/L, t=3.18, P<0.01]between the malnutrition group and the non-malnutrition group.The correlation between GLIM and SGA was good, and the consistency was reasonable(AUC=0.711). Conclusions:The incidence of malnutrition in elderly patients with neurological diseases is relatively high; The GLIM criteria are suitable for the diagnosis of malnutrition in elderly patients with neurological diseases, and the diagnostic results have a good correlation with those of SGA.Malnutrition is associated with anthropometric measurements, laboratory indicators, and clinical outcomes.
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Objective:To study the association of frailty status with nutritional risk and the effect on clinical outcomes among elderly surgical inpatients.Methods:Elderly inpatients from the surgery department of Beijing Hospital were enrolled from January to June 2021. Frail scale and nutritional risk screening 2002 (NRS 2002) were used for frailty evaluation and nutrition risk screening. The influence of frailty and associated nutrition risk in elderly surgical inpatients was analyzed.Results:487 elderly surgical patients were included, of whom 131 cases were in the non-frailty group, 279 cases were in the pre-frailty group and 77 cases were in the frailty group, according to the Frail scale score. 146 cases were at nutritional risk, of whom 8 (6.1% of 131) were in the non-frailty group, 87 (31.2% of 279) in the pre-frailty group and 51 (66.2% of 77) were in the frailty group. According to univariate/multivariate logistic regression analysis of frailty in elderly surgical patients, a higher NRS 2002 score, older age, and the presence of multiple concurrent diseases (≥ 5) were significantly associated with frailty ( P < 0.001). The Frail scale score was positively correlated with NRS 2002 score ( r = 0.448, P < 0.01). Multiple comparisons showed that frailty had statistically significant effects on hospital stay and medical costs in elderly surgical patients ( P < 0.05). Conclusions:The prevalence of frailty is higher in elderly surgical patients, and the prevalence of nutritional risk increases with the progression of frailty. Frailty can lead to prolonged hospital stays and increased hospital costs in elderly surgical patients.
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Sarcopenia is an age-related syndrome with progressive, generalized loss of muscle mass, strength, and physiological function. Low muscle mass is an important diagnostic criterion for sarcopenia. Ultrasound is safe, convenient and cost-effective, with extensive availability. It's a promising diagnostic tool for muscle mass assessment and sarcopenia screening in the elderly population. This review focuses on the specific methods and latest research progress on ultrasound assessment of sarcopenia.
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Most hospitalized patients infected with coronavirus disease 2019 (COVID-19) are in severe or critical condition, and malnutrition is a key factor contributing to adverse outcomes. The basic principles of medical nutrition therapy have been determined in the recently released tenth edition of the National Diagnosis and Treatment Protocol. The principles have promoted nutritional risk assessment, emphasized the preferred method of enteral nutrition, and recommended the daily intake of calories at 25 to 30 kcal/kg and protein at > 1.2g/kg. Parenteral nutrition should be also added when necessary. Based on the above principles, Beijing Hospital has refined the medical nutrition therapy measures to facilitate the implementation in clinical practice, in order to improve healthcare quality and decrease the mortality in COVID-19 patients.
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Objective:To retrospectively investigate the incidence of malnutrition in patients with gastric cancer in China, and to explore the applicability of Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria.Methods:Data were extracted from National Multi-center Investigation and Study on Dynamic Changes of Nutritional Status of Inpatients database led by Geriatric Nutrition Support Group of the Chinese Society of Parenteral and Enteral Nutrition. A retrospective analysis in patients with gastric cancer was conducted. Involuntary weight loss, low body mass index (BMI) and muscle mass loss were adopted as phenotypic indicators in GLIM criteria for malnutrition diagnosis and the application of GLIM criteria for malnutrition diagnosis in patients with gastric cancer was evaluated.Results:In a total of 563 gastric cancer patients, 203 cases were diagnosed with malnutrition per GLIM criteria and 193 cases without malnutrition were identified as control using 1:1 propensity score matching. There were significant differences in body weight, BMI, right calf circumference, right hand grip strength, total cholesterol, hemoglobin, albumin and total protein between malnutrition group and non-malnutrition group ( P < 0.05). After muscle mass loss was removed from the phenotype indicators in GLIM criteria, the hospitalization duration in patients with malnutrition was (16.15±7.04) days compared with (14.28±6.70) days in patients without malnutrition, demonstrating statistically significant difference ( χ2= 0.442, P = 0.007). Conclusions:Gastric cancer patients showed high incidence of malnutrition. The cut-off value of calf circumference reported in foreign populations may be unsuitable to apply in Chinese population. Further clinical researches are needed to determine the optimal cut-off calf circumference value for Chinese individuals.
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Intestinal barrier function impairment can lead to bacterial and toxin translocation in critically ill patients and is an important factor in gut-derived infections and even multiple organ failure. Early enteral nutrition (EEN) can nourish the intestine, prevent bacterial translocation, effectively maintain intestinal barrier function and immune function and provide metabolic substrates for the body, bringing clinical benefits. For critically ill patients such as those with severe acute pancreatitis, severe burns and severe traumatic brain injury and those after major abdominal surgery, there is evidence-based proof supporting EEN while in patients with uncontrolled shock and severe hypoxemia and acidosis, the initiation of EEN should be delayed. EEN in critically ill patients can be applied orally or through nasogastric tube. Dietary fiber-free intact protein preparations are recommended at initiation and administration via continuous pumping can improve EEN gastrointestinal tolerability.
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Objective:To analyze the relationship between nutritional status and frailty among elderly inpatients from cardiology department.Methods:A cross-sectional study was conducted in a total of 519 patients aged 65-92 years old who were admitted to cardiology department between September 2018 and February 2019. Mini nutritional assessment short form (MNA-SF) was used to assess the nutritional status. Fried phenotype was used to assess frailty status. The nutritional status and frailty in patients with different diseases, age and body mass index were analyzed, as well as the nutritional status of patients in different frailty strata.Results:The mean age was 75.12 years (range: 65-92 years). The prevalence of malnutrition risk was 28.9% (150/519), malnutrition 3.3% (17/519) and frailty 23.5% (122/519). When stratified by disease, the subgroup with chronic heart failure showed the highest prevalence of malnutrition and frailty (63.6% and 50.0%, respectively). The prevalence of malnutrition risk (22.8%, 35.5%), malnutrition (3.0%, 3.6%) and frailty (15.3%, 32.3%) were higher in patients ≥ 75 years compared with those aged 65 years - 75 years. MNA-SF score was negatively correlated with age( r = -0.134, P = 0.002). Fried phenotype score was positively correlated with age ( r = 0.319, P < 0.01). As for stratification based on BMI, the majority (62.6%) patients were overweight or obese (BMI ≥ 24.0 kg/m 2) and the prevalence of malnutrition risk in this subgroup was 21.2% (69/325). The prevalence of malnutrition risk in patients with normal BMI was 38.7% (70/181). The subgroup with BMI<18.5 were either at malnutrition risk or with malnutrition. MNA-SF score was positively correlated with BMI ( r = 0.353, P < 0.01). There was no significant difference in the prevalence of pre-frailty and frailty among different BMI groups. The prevalence of malnutrition was the highest in the frailty group (8.2%), followed by the pre-frailty group (2.0%). Fried phenotype score was negatively correlated with MNA-SF score( r = -0.291, P < 0.01). Logistic regression analysis showed that frailty was an independent risk factor for malnutrition, and the risk of malnutrition in frailty patients was 4.818 (95% CI:1.701～13.644) times higher than that in non-frailty patients. Conclusions:The prevalence of malnutrition risk and frailty was high in the elderly inpatients from cardiology department. Frailty patients had a higher incidence of malnutrition and required more attention.
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Objective:To investigate the prevalence of malnutrition in hospitalized elderly patients with cancer in China using the Global Leadership Initiative on Malnutrition (GLIM) criteria.Methods:The data of 854 elderly cancer patients were extracted from the database of multi-center investigation and research on the dynamic changes of nutritional status of hospitalized patients in China led by the Geriatric Nutritional Support Group of Chinese Society of Parenteral and Enteral Nutrition. Changes in anthropometrics, nutritional risk and malnutrition prevalence from admission were collected at discharge and were compared among patients with different cancer types.Results:The prevalence of nutritional risk (NRS 2002 score ≥ 3 points) and malnutrition diagnosed per GLIM criteria were 63.23% and 42.74% at admission, and 69.44% and 42.86% at discharge. When further graded, prevalence of moderate malnutrition decreased from 24.12% at admission to 10.07% at discharge, and that of severe malnutrition increased from 18.62% to 32.79%, both with statistical significance. There were significant differences in anthropometric and laboratory parameters between malnutrition and non-malnutrition groups diagnosed per GLIM criteria.Conclusions:The GLIM criteria is applicable for the diagnosis of malnutrition in elderly cancer patients. Elderly cancer patients should be screened for nutritional risk, and GLIM criteria can be used to diagnose malnutrition. The changes of nutritional status should be dynamically monitored during hospitalization
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The purpose of value-based healthcare is to effectively control medical costs on the basis of comprehensively improved healthcare quality, which is the key focus of medical system reform in China. Improving information system framework, establishing scientific evaluation methods and transforming medical insurance payment methods are the impetus for value-based healthcare practice in China. "Screening, assessment and intervention" is the critical step in standardized medical nutrition management. In line with the connotation of value-based healthcare, nutritional risk screening aims to improve clinical outcomes. The diagnosis of malnutrition per the Global Leadership Initiative on Malnutrition (GLIM) criteria enables the inclusion into Diagnosis Related Groups (DRGs). Oral nutritional supplement is the preferred medical nutrition treatment for patients at nutritional risk or with malnutrition and insufficient food intake. Standardized application can reduce weight loss, improve clinical outcomes, save medical costs and improve the health and survival of malnourished elderly patients at a lower cost, exemplifying the value-based healthcare model.
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Objective:To investigate the correlation between phase angle and muscle mass reduction in elderly diabetic patients.Methods:This paper retrospectively collected and analyzed the data of human composition and laboratory index in elderly patients with diabetes(n=106)and non-diabetic(n=153)patients in the Nutrition Department of Beijing Hospital, compared the differences between two groups, and explored the correlation between phase angle and muscle mass reduction in elderly diabetic patients.Phase angle was detected by bioelectrical impedance which was calculated as reactance/resistance× 180/π.Results:Phase angle was lower in elderly diabetic patients(5.17±0.65)°than in non-diabetic elderly patients(5.37±0.76)°( t=-2.075. P<0.05); age and fasting blood glucose were higher in elderly diabetic patients than in non-diabetic elderly patients(all P<0.05).There was no significant difference between the two groups in body mass index, fat, body fat percentage, visceral fat area, skeletal muscle index, body cell mass, total protein, albumin, and hemoglobin(all P>0.05).Correlation analysis results showed that in elderly diabetic patients, the phase angle was negatively correlated with body mass index( r=0.288, P<0.01), age( r=-0.680, P<0.01), was positively correlated with skeletal muscle( r=0.477, P<0.01), skeletal muscle index( r=0.505, P<0.01)and hemoglobin( r=0.382, P<0.01); and in the elderly non-diabetic group, phase angle was negatively correlated with age( r=-0.666, P<0.01)and positively correlated with body mass index( r=0.296, P<0.01), skeletal muscle( r=0.504, P<0.01), fat free mass( r=0.161, P<0.05), skeletal muscle index( r=0.441, P<0.01), body cell volume( r=0.496, P<0.01), and hemoglobin( r=0.420, P<0.01).The bioelectrical impedance apectroscopy detected skeletal muscle mass index<7.0 kg/m 2 for male and<5.7 kg/m 2 for female were used as the diagnosis standard for reduced muscle mass.The detection rate of muscle mass reduction was higher in elderly diabetic patients(17 cases, 16.04%)than in elderly non-diabetic patients(12 cases, 7.84%, χ2=4.229, P<0.05).The results of multiple regression analysis showed that the decrease of muscle mass in elderly diabetic patients was related to low phase angle( OR=0.413, 95% CI: 0.280-0.973, P<0.05)and aging( OR=2.174, 95% CI: 1.574-3.003, P<0.01). Conclusions:The phase angle is lower in diabetic elderly patients than in non-diabetic elderly patients, and the incidence of muscle mass reduction is higher in diabetic elderly patients than in non-diabetic elderly people.Decreased phase angle and increased age are related to the decrease of muscle mass in elderly diabetic patients.
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Objective:To use the Global Leadership Initiative on Malnutrition(GLIM)criteria to assess the incidence of malnutrition in hospitalized elderly stroke patients, and to investigate the correlation between the criteria and clinical outcomes.Methods:A cross-sectional study was conducted from March 2012 to August 2021 to evaluate malnutrition in 658 elderly stroke inpatients aged 65-92 years, the GLIM criteria were used, and the correlation between the criteria and clinical outcomes was explored.Results:Of the 658 patients, men showed higher values in height, weight, Bady mass index, upper arm circumference, calf circumference and creatinine(all P<0.05), but lower total cholesterol( P<0.05). The incidence of malnutrition diagnosed with the GLIM criteria was 9.12%(60 cases). Based on the GLIM criteria, those with malnutrition had lower weight, Bady mass index, upper arm circumference, calf circumference, albumin and total cholesterol(all P<0.05), while age, duration of hospitalization, infectious complications and mortality was higher than those without malnutrition( P<0.05). Using the mini nutritional assessment-short form(MNA-SF), 14.74%(97 cases)of the patients had malnutrition.Results from the GLIM criteria and the MNA-SF were moderately consistent(sensitivity: 59.4%, specificity: 100.0%, positive predictive value: 100.0%, negative predictive value: 93.1%, Kappa=0.712). Malnutrition diagnosed with the GLIM criteria was associated with a longer duration of hospitalization( OR=1.022, 95% CI: 1.005-1.039, P<0.01), increased infectious complications( OR=16.614, 95% CI: 8.130-33.952, P<0.01), and increased risk of death( OR=2.810, 95% CI: 1.393-3.548, P<0.05). Conclusions:The incidence of malnutrition in hospitalized elderly stroke patients based on the GLIM criteria is lower than that based on the MNA-SF, and malnutrition is associated with adverse clinical outcomes.
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Objective:To evaluate nutritional status and to analyse risk factors of acute exacerbation of chronic obstructive pulmonary disease (COPD) in the elderly.Methods:Data of elderly hospitalized patients with COPD mainly from 5 grade A, class 3 hospitals (Beijing Hospital, Shanghai Huadong Hospital, Tianjin Nankai hospital, the Second Affiliated Hospital of Medical College of Zhejiang University, Guangzhou First People′s Hospital) from January 2012 to December 2020 were retrospectively analyzed. According to the global initiative for chronic obstructive lung disease criteria (GOLD), elderly COPD patients were divided into acute exacerbation group and stable group. The differences in age, gender, medical history, anthropometry, laboratory examination, nutritional support, results of nutritional risk screening 2002 (NRS2002) and global leadership initiative on malnutrition (GLIM) were compared between the two groups after admission, and the risk factors of acute exacerbation of COPD in the elderly were analyzed by multivariate Logistic regression.Results:A total of 339 elderly patients with COPD aged 65-100 years were included in this study, including 177 cases (52.21%) in acute exacerbation stage. The detection rate of malnutrition in acute exacerbation stage was higher than that in stable stage (51.98% vs 41.98%, P<0.05). The weight, body mass index and grip strength of patients in the acute exacerbation stage were significantly lower than those in the stable period [(55.47±8.42) vs (60.63±9.30) kg, (20.52±4.25) vs (22.39±4.57) kg/m 2, (12.32±4.21) vs (16.59±2.97) kg] (all P<0.05). Spearman correlation analysis showed that the acute exacerbation of elderly patients with COPD was positively correlated with malnutrition ( r=0.443, P<0.001), and negatively correlated with body weight, body mass index and calf circumference ( r=-0.200, -0.214, -0.135, all P<0.05). Multiple Logistic regression analysis showed that acute exacerbation in elderly patients with COPD was only related to malnutrition ( OR=7.799, 95% CI: 4.466-13.622, P<0.001). Conclusions:The incidence of malnutrition in acute exacerbation stage of elderly COPD patients is high. Malnutrition is independently related to acute exacerbation of COPD.
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Objective:To investigate the prevalence of malnutrition in hospitalized patients with lung cancer in China using the global leadership initiative on malnutrition (GLIM) criteria.Methods:A retrospective analysis was performed with 623 lung cancer patients selected from the national multi-center prospective investigation database in 2014. The diagnosis of malnutrition was according to GLIM criteria with muscle mass reduction not included. The prevalence of malnutrition in patients with lung cancer was investigated and the correlation between malnutrition diagnosis per GLIM criteria and anthropometry as well as laboratory indexes was explored.Results:Among the 623 lung cancer patients, 33.5% (209) were at nutritional risk as per Nutritional Risk Screening 2002, 17.8% (111) were malnourished as per GLIM criteria. There were significant differences in age, body weight, body mass index, arm circumference, leg circumference, grip strength, hemoglobin, albumin, total protein and prealbumin between malnutrition and non-malnutrition groups as diagnosed with GLIM criteria ( P<0.05). Conclusions:The nutritional risk and malnutrition prevalence in lung cancer patients are relatively high. The nutritional risk screening of lung cancer patients should be standardized and the GLIM criteria can be used for the diagnosis of malnutrition.
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Objective:To analyze the correlation among nutritional status, sarcopenia and frailty in elderly inpatients with chronic cardiovascular disease.Methods:A cross-sectional study was conducted in a total of 147 patients aged 65-88 years old who were hospitalized for chronic cardiovascular disease between September 2018 and February 2019. Nutritional status was assessed by mini nutritional assessment short form (MNA-SF), frailty by FRAIL scale and sarcopenia by criteria from Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. The prevalence and overlapping prevalence of nutritional status, frailty and sarcopenia were analyzed, as well as the influence of nutritional status on frailty and sarcopenia.Results:The mean age was 74.45 (range: 65-88). The prevalence was 25.9% (38/147) for risk of malnutrition, 1.4% (2/147) for malnutrition, 37.4% (55/147) for risk of sarcopenia, 6.8% (10/147) for sarcopenia, 55.8% (82/147) for pre-frailty and 10.2% (15/147) for frailty. When stratified by disease, the subgroup with chronic heart failure showed the highest prevalence of malnutrition risk, sarcopenia risk, sarcopenia and frailty (66.7%, 50%, 16.7% and 50.0%, respectively). The prevalence of sarcopenia risk and sarcopenia increased with age. Age was negatively correlated with calf circumference ( r = -0.219, P = 0.008), grip strength ( r = -0.307, P < 0.01) and walking speed ( r = -0.390, P < 0.01) and was positively correlated with the five times sit-to-stand test time ( r = 0.406, P < 0.01). The prevalence of frailty also increased with age and age was positively correlated with the FRAIL score ( r = 0.232, P = 0.005). As for stratification based on BMI, the majority (63.9%) patients were overweight or obese (BMI ≥ 24.0) and the prevalence of malnutrition risk in this subgroup was 20.2% (19/94). The prevalence of malnutrition risk in patients with normal BMI was 32.0% (16/50). The subgroup with BMI < 18.5 were either at malnutrition risk or with malnutrition. MNA-SF score was positively correlated with BMI ( r = 0.334, P < 0.01). The prevalence of sarcopenia risk and sarcopenia in patients with BMI ≥ 24.0 kg/m 2 was 23.4% (22/94) and 2.1% (2/94), that in normal BMI subgroup was 62.0% (31/50) and 14.0% (7/50), and that in BMI < 18.5 subgroup was 66.7% (2/3) and 33.3% (1/3). BMI was positively correlated with calf circumference ( r = 0.659, P < 0.01) and ASMI ( r = 0.367, P < 0.01). The overlapping prevalence of sarcopenia risk/sarcopenia and malnutrition risk/malnutrition was 13.6% (20/147), that of pre-frailty/frailty and malnutrition risk/malnutrition was 21.8% (32/147), and that of sarcopenia risk/sarcopenia and pre-frailty/frailty was 26.5% (39/147). The overlapping prevalence of sarcopenia risk/sarcopenia, malnutrition risk/malnutrition and pre-frailty/frailty was 10.9% (16/147). MNA-SF score was negatively correlated with FRAIL score ( r = -0.316, P < 0.01). The prevalence of pre-frailty/frailty in the malnutrition risk/malnutrition group was higher than that in the subgroup with normal nutritional status (80.0% vs. 60.7%, χ 2 = 4.808, P = 0.028). The prevalence of sarcopenia risk/sarcopenia in the malnutrition risk/malnutrition group tended to be higher than that in the subgroup with normal nutritional status (50.0% vs. 33.6%, χ 2 = 3.302, P = 0.069). Logistic regression analysis showed that the risk of pre-frailty/frailty was 2.585 (95% CI: 1.087 to 6.147) times higher in the malnutrition risk/malnutrition group. Conclusions:The prevalence and overlapping prevalence of malnutrition risk, pre-frailty and sarcopenia risk was high in the elderly inpatients hospitalized for chronic cardiovascular disease. Patients with malnutrition risk/malnutrition had a higher incidence of pre-frailty/frailty and required close attention.
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As aging in our society picks up pace, the number of elderly patients undergoing surgery is increasing every year.Recovery of elderly surgical patients is affected by poor nutrition, frailty, decline of cardiopulmonary function and other health issues.A new concept of surgical nutrition, whole-course nutrition management, advocates multi-disciplinary and multi-modal intervention to improve the clinical outcome of patients and to promote postoperative rehabilitation.Here whole-course nutritional management is summarized to provide theoretical basis for effectively promoting postoperative rehabilitation of elderly patients.
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Alanyl-glutamine dipeptide is an important component in parenteral nutrition, which can be decomposed into alanine and L-glutamine in vivo. It plays multiple functions including maintaining intestinal barrier, improving immunity, promoting protein synthesis, and regulating the production and release of inflammatory mediators. Substantial clinical evidences have demonstrated its favorable effectiveness and safety. Rational application of alanyl-glutamine dipeptide can reduce postoperative complications, shorten hospital stay and save medical costs. There are still controversies at home and abroad on the applicable population and dosage of alanyl-glutamine dipeptide. Chinese Society of Parenteral and Enteral Nutrition organized China's experts of related disciplines to compile international standards in accordance with the latest guidelines and consensus, so as to achieve the goal of standardized application and patient benefits.
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Objective:To analyze the prevalence of malnutrition in stable-phase elderly patients with chronic obstructive pulmonary disease (COPD) using the Global Leadership Initiative on Malnutrition (GLIM) criteria.Methods:Using cross-sectional survey, 60 elderly patients with COPD in stable phase were investigated, with 72 elderly patients without COPD in the same age group selected as controls. Differences in basic characteristics, anthropometric indicators, hematology indicators and body composition were compared between the two groups. According to the GLIM diagnostic criteria for malnutrition, the first step is nutritional risk screening, the second step is to diagnose malnutrition, and the third step is to determine severe malnutrition. The prevalence of malnutrition and severe malnutrition were investigated.Results:The levels of total protein, albumin, creatinine, and lymphocyte percentage in the elderly stable COPD group were significantly lower than those in the control group. The nutritional risk and the prevalence of malnutrition in elderly COPD patients were significantly higher than those in the control group, and the prevalence of severe malnutrition was higher .Conclusions:Elderly stable COPD patients of different age groups have a higher nutritional risk. The onset age of malnutrition is younger than that of non-COPD patients and early intervention is required.
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Nutritional support therapy can improve to the postoperative nutritional status and quality of life of patients with digestive tract malignancies. Clinical guidelines at home and abroad recommend early preoperative nutritional support therapy based on oral nutrition supple-mentation for patients undergoing surgery for digestive tract malignancies to reduce the risk of malnutrition. Enteral nutrition powder is the main perioperative nutritional support method for patients with basically normal gastrointestinal function. At present, many Meta-analyses also point out that early postoperative nutrition can effectively enhance the body′s immunity, reduce post-operative complications and shorten the length of hospital stay. However, the analysis of short-term outcome indicators is not comprehensive, and there is no summary analysis result on Chinese patients. The authors review the relevant literatures and conduct a Meta-analysis to evaluate the effect of enteral nutrition powder on the short-term postoperative outcomes of Chinese patients with digestive tract malignancies.
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Diffuse neurofibrillary tangles with calcification(DNTC)is a rare neurodegenerative disease and belongs to the category of tauopathies.The main characteristics of DNTC include presenile dementia, symmetrical bilateral calcification in the basal ganglia and cerebral dentate nuclei, and bilateral atrophy of the temporal lobes.At present, the majority of reported cases with DNTC were from Japan, with only a few cases from other countries.Although DNTC is a pathological diagnosis based on autopsy, ante-mortem diagnosis for DNTC can be achieved based on clinical features and presentation of brain tau protein shown on positron emission computed tomography.The clinical characteristics, pathological changes and diagnosis criteria of DNTC are reviewed in this paper.