ABSTRACT
Objective To evaluate the clinical application of enteral nutrition by nasojejunal tube insertion and by percutaneous endoscopic gastrostomy (PEG) in elderly patients.Methods A total of 65 elderly patients with dysphagia recruited at our department from January 2010 to November 2014 were divided into the nasojejunal tube feeding group (35 cases) and the PEG feeding group (30 cases).Differences between these two groups in nutritional indexes,immunological indexes,complications and mortality were analyzed retrospectively.Results Serum total protein,albumin and prealbumin and upper arm circumferences all increased after treatment with nasojejunal tube feeding or percutaneous endoscopic gastrostomy (P＞0.05).There was overall improvement in nutritional status,as assessed by Nutritional Risk Screening 2002 (NRS2002).Specifically,the before/one month-after-treatment ratio of scores was 3.72±0.91/1.90±0.61 (t=7.24,P＜0.01) for the nasojejunal tube feeding group and 3.52±1.23/2.02±0.53 (t=4.17,P＜0.01) for the PEG feeding group.Compared with NRS2002 scores at one month post-operation,further improvement was achieved at 3 months postoperation both for the nasojejunal tube feeding group (1.89±0.65,t=5.21,P＜0.01) and for the PEG feeding group (1.91±0.62,t=4.40,P＜0.01).There was no difference in the indexes of nutrition,immune status or mortality between the two groups (P＞0.05).Although improvement in CD3+,CD4+,CD8+,CD4+/CD8+,IgA,IgG,and IgM was seen in both groups after operation,the differences did not reach statistical significance (P＞0.05).The incidence of aspiration pneumonia was notably lower (P＜0.05) while the incidence of diarrhea was much higher (P＜0.05) in the nasojejunal tube feeding group than in the PEG feeding group at one month and three months.The two groups had similar causes of death and mortality rates.Conclusion Both nasojejunal tube and PEG feeding can improve the nutritional status of elderly patients with dysphagia.However,the choice for the route of nutrition should be individualized.
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Objective To investigate the value of detecting methylated SEPT9 gene (mSEPT9) in serum and stool in screening colorectal cancer in elderly people.Methods Subjects were divided into three groups, the colorectal cancer group (n=82), the colorectal polyps group (n=80) and the healthy control group (n=100).Real-time quantitative polymerase chain reaction (PCR) was used to detect mSEPT9 in peripheral blood and feces.The relationship between mSEPT9 and clinical and pathological characteristics of colorectal cancer was analyzed.The agreement between serum and stool results was analyzed.Results The positive rate of serum mSEPT9 was 73.2％ in the colorectal cancer group, 6.3％ in the colorectal polyps group and 4.0％ in the healthy control group, with statistical significance between the colorectal cancer group and the other two groups (P＜0.01).The sensitivity and specificity for plasma mSEPT9 detection in screening colorectal cancer were 73.2 ％ and 95.6％, respectively.The positive rate was higher in patients with tumor maximum diameter over 3.0 cm, invasion of the entire serosa layer, lower differentiation or advanced clinical staging (P＜0.05).The detection results of plasma mSEPT9 were in complete agreement with those of stool mSEPT9 from the same patients.Conclusions The expression of mSEPT9 is high in elderly patients with colorectal cancer and has a high sensitivity and specificity for PCR detection.Complete agreement can be seen in results from plasma and feces.Detecting mSEPT9 can be a valuable approach to screening colorectal cancer in the elderly.
ABSTRACT
BacKground:The deveIopment of acute pancreatitis( AP ) is often accompanied by pancreatic microcircuIation disturbance and aIterations in bIood coaguIation and fibrinoIytic systems, which resuIts in abnormaIities of pIateIet parameters. Aims:To investigate the changes of pIateIet parameters in eIderIy AP patients and the effect of uIinastatin ( UTI)on pIateIet parameters and disease status. Methods:Two hundred and seventeen eIderIy AP patients(≥60 years) were enroIIed retrospectiveIy from Aug. 2009 to Dec. 2013 at the First AffiIiated HospitaI of Nanjing MedicaI University. According to the severity of the disease,patients were divided into three groups:miId AP( MAP),moderateIy severe AP ( MSAP),and severe AP( SAP). The pIateIet parameters,incIuding PLT,MPV and PDW before and after treatment,as weII as the differences in pIateIet parameters and cIinicaI efficacy between conventionaI therapy and UTI therapy were compared and anaIyzed. Results:In MSAP and SAP groups,PLT at admission was significantIy Iower(P<0. 01),whiIe MPV and PDW were significantIy higher(P<0. 05)than those in MAP group. After 1-week treatment,PLT increased significantIy(P<0. 01)and MPV and PDW decreased significantIy(P<0. 05)in MSAP and SAP groups. UTI therapy was superior to conventionaI therapy in increasing PLT( P <0. 01 ),decreasing MPV and PDW( P <0. 01 ),and improving the overaII efficacy in MSAP and SAP groups( MSAP:92. 3% vs. 81. 2%,P <0. 01;SAP:90. 0% vs. 80. 8%,P<0. 01). Conclusions:Changes of pIateIet parameters in eIderIy MSAP and SAP patients are different from those in MAP patients,which might refIect the disease severity. UTI is effective in reducing the activity of pIateIet and can be used in the treatment and prevention of disease progression in eIderIy AP patients.